Transmylohoid/Submental Endotracheal Intubation in Pan-facial Trauma: A Paradigm Shift in Airway Management with Prospective Study of 35 Cases

The present study was planned to assess the efficacy, utility and complications of transmylohoid intubation in facial polytrauma patients, by setting and design: prospective study. This study was conducted between May 2008 and May 2011 and 35 patients of facial polytrauma were included irrespective of sex, caste and religion. All the selected 35 patients were male and the age of patients ranged between 15 to 45 years (mean age 31 years). All the patients were intubated with transmylohoid, orotracheal intubation using an armoured endotracheal tube (ETT). Average time to perform transmylohoid intubation was 15.51 + 1.85 min (mean + standarad deviation). Average time for drawing the ETT transmylohoid from the submental incision was 49.7 + 24.8 s. Mean duration for which the ETT was kept indwelling was 0.37 + 1.03 days. Accidental extubation of ETT was noted in two patients. Minor post operative complications like swelling in the submental area (2 patient), dehiscence of the submental incision (2 patient) and minor infection at the site of submental incision (3 patients) were noticed, which were found to be statistically insignificant. The transmylohoid intubation allowed simultaneous reduction and fixation of all the facial fractures and intraoperative control of dental occlusion without interference from the tube during the surgery without interfering in the maintenance of the anesthesia and air way.