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Endotracheal tube in position fixed to skin. Submental intubation combines the advantages of nasotracheal intubation, which allows the mobilization of the dental occlusion, and those of orotracheal intubation, which allows access to naso-orbito-ethmoidal fractures Caubi et al.
This technique was first described in by Francisco Hernandez Altemir and since its first description 10 articles have been published outlining modifications to the original technique primarily aimed at reducing complications Altemir, ; Jundt et al.
Radiologic examination confirmed the presence of Le Fort II fracture, naso-orbitoethmoid fracture, bilateral zygomaticomaxillary complex fractures and left mandible subcondylar fracture.
Reinforced endotracheal tube fixed to skin. The maxillofacial trauma can cause serious disturbances of the soft and hard tissues of the anatomical components of the upper airway and often with little external evidence of deformity Arya et al. At the end of the surgery the tube was disconnected, pulled back ijtubacion the oral cavity and reconnected.
Pasaje Ihtubacion de Honduras interior The breathing circuit is briefly disconnected as the tube is externalized and reconnected to the circuit and then secured to the patient Fig. Additional research is necessary to validate new modifications reported in the literature.
Submental intubation or its modification as retrograde submental intubation was first described in a patient with restricted mouth opening by Arya et al. The endotracheal tubes now lies on the floor of the mouth between the tongue and the mandible. In addition, the surgical anatomy of the technique is detailed described.
In addition to fewer reported minor complications infection, fistula, hypertrophic scarring, mucocelesubmental intubation requires less time than a tracheostomy, costs less and results in an aesthetically well tolerated scar Jundt et al.
intubacion retrograda tecnica pdf – PDF Files
The connector and breathing system were reattached and retrogradq cuff reinflated. Several airway management techniques have been described, including: In our case where the patient only presented midface isolated trauma with need of intraoperative intermaxillary fixation, submental intubation was the correct choice for intraoperative airway. A skin incision of 2 cm in the submental, paramedian region and with blunt dissection toward the floor of mouth until the mucosa was tented with a hemostat after which another 2 cm incision is made in the mucosa Fig.
A closed Kelly hemostatic forceps was introduced through the incision until the tip of the hemostat tented the mucosa of the floor of the mouth staying close to the lingual surface of mandible and lateral to the sublingual caruncle to avoid intubaciob to the submandibular duct and lingual nerve. The main objective of this study is intubxcion describe a modification of the original technique by performing a retrograde submental intubation assisted by direct laryngoscope video in a maxillofacial trauma patient with restricted mouth opening.
intubacion retrograda tecnica pdf
We described a modification of the original technique by performing a retrograde submental intubation assisted by direct laryngoscope video in a maxillofacial trauma patient with restricted mouth opening. Finally, the endotracheal tube is fixed to skin with sutures to prevent accidental displacement Fig. Throat pack was placed. In a literature review conducted by Jundt et al.
The tented oral mucosa was incised to make a small opening and the blades of the hemostat were opened to allow the entrance of the reinforced endotraqueal tube. Each technique has its indications with advantages and disadvantages. Perimortem intracranial orogastric tube in pediatric trauma patient with a basilar skull fracture. San Juan, Puerto Rico. Afterwards the pilot balloon was grasped with the hemostat and pulled out gently through the passage, then the hemostat was reinserted through the passage to grasp the proximal end of the endotracheal tube to be brought out with controlled rotational movements.
Submental intubation versus tracheostomy.
Guide wire insertion through cricothyroid membrane; B. Examination of the face revealed periorbital and nasal swelling, traumatic telecanthus, nasal deformity, epistaxis and bilateral subconjuntival hemorrhage. Intracranial malposition of nasopharyngeal airway.
Communication between the surgeon and anesthesiologist is extremely important for the safety of the patient and the success of the procedure. Then using Seldinger technique the malleable wire Spring-Wire Guide: Submental intubation in oral maxillofacial retfograda In addition, the surgical anatomy of the technique is described in detail.
The submental intubation is a procedure that was reported to avoid intubacioh and allow for the concomitant restoration of occlusion and reduction of facial fractures in patients with craniomaxillofacial trauma, ineligible for nasotracheal intubation due to the potential risk of creating a false passage to the cranial cavity Jundt et al.
The anesthesiologist reassures the adequate end tidal carbon dioxide curve and auscultation of the chest for correct position of the tube. There was midface mobility, malocclusion and mouth opening was restricted. Mandible border blue lineskin incision yellow linecenter region of geniohyoid and genioglossus retrogtada red area ; B. In such cases a tracheostomy is the indicated procedure. University of Puerto Rico.
The original surgical procedure consists in intubackon externalization of the endotracheal tube from the mouth through the floor of the mouth and the submental triangle. The Insertion of the wire guide through the cricothyroid membrane helps to place correctly the endotracheal tube and also counting with the assistance of the direct video laryngoscopy, where the complete mouth opening is not necessary.
Many trials have shown the submental route to be a simple, quick and safe approach to airway management Caubi et al. Many features make the submental intubation very useful in several clinical scenarios including craniomaxillofacial trauma, orthognathic surgery and pathology. The mortality rate of tracheostomy has been reported to range from 0. The appropriate reinforced endotracheal tube size was passed which connector was previously removed through with the malleable wire as guidance, when the distal end of the endotracheal tube meets the resistance at the level of the cricothyroid membrane against the wirethe wire was cut at the puncture site and the endotracheal tube passed, the remaining wire removed through the tube.
Nevertheless, we report for the first time the retrograde submental intubation technique using direct video laryngoscopy. The endotracheal tube was disconnected from the breathing circuit and the connector removed the anesthesiologist stabilized at this moment the endotracheal tube with Magill’s forceps to avoid extubation. Technical Note and Case Report. On initial evaluation the patient was in non-acute distress, alert, awake and oriented, with a Glascow coma score of It was decided to use retrograde intubation technique in the present case due to the restricted mouth opening, and the difficulty to maintain a clear airway with the submandibular incision bleeding or other invasive manipulation.
The maxillofacial trauma can cause serious disturbances of the soft and hard tissues of the anatomical components of the upper airway and often with little external evidence of deformity.