전안면골 골절에서의 변형된 아래턱밑 삽관

최상문,송승한,강낙헌 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.1

Purpose: Nasotracheal or oral intubation procedure is widely used for facial bone fractures. However, during the operation intubated tube can interfere or obstruct the view of the operator. We authors used a modified submental intubation method in panfacial bone fracture patients for intact airway and the operation view. Methods: After intravenous induction of anaesthesia, traditional orotracheal tubation was done. A horizontal incision was made 2 cm from the midline, 2 cm medial to and parallel with the mandible in the submental region.1 In order to approach to the floor of the oral cavity, a haemostat was pushed through the soft tissues. A chest tube front cover was applied to the intubation tube and the tube was inserted through the submental tunnel. Orotracheal tube was disconnected and pulled back through the soft tissue and secured with a suture. Results: The procedure took about 30 minutes and there were no problems during the intubation. Intraoral manipulation and occlusal checks were free without any interference. Extubation was also easily done and complications such as lung aspiration, infection, hematoma, or fistula did not occur. Conclusion: Submental endotracheal intubation is fast, safe, easy to use and do not have to concern about the tube being pull back again. Conventional submental intubations are being held without any coverage of the tip. We authors applied the modified method to the trauma patients and the results were satisfied. From above advantages, modified submental intubation is widely available not only in fractured patients, but also in aesthetic or orthognathic surgeries.

Submental intubation: alternative short-term airway management in maxillofacial trauma

Ravi Raja Kumar,Suresh Vyloppilli,Shermil Sayd,Annamala Thangavelu,Benny Joseph,Auswaf Ahsan 대한구강악안면외과학회 2016 대한구강악안면외과학회지 Vol.42 No.3

Objectives: To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in cranio-maxillofacial trauma, along with an assessment of its morbidity and complications. Materials and Methods: Submental intubation was performed in 17 patients who had maxillofacial panfacial trauma and management was done under general anesthesia during a period of one year from 2013 to 2014 at Departments of Oral and Maxillofacial Surgery and Dentistry, the Malankara Orthodox Syrian Church Medical College, Kochi, India. Results: In all 17 cases, the technique of submental intubation was found to be simple and reliable. Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient. Conclusion: Submental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications.

Treatment of panfacial trauma patient via submental intubation: a case report

( Tae-woong Ahn ),( Kil-hwa Yoo ),( Min-seok Oh ),( Chul-min Park ),( Seong-hoe Yoon ),( Sun-woong Yoon ),( Ka-young Seol ),( Dong-keun Lee ),( Young-ju Park ),( Dong-soo Shin ) 조선대학교 구강생물학연구소 2017 Oral Biology Research (Oral Biol Res) Vol.41 No.4

Airway management in complex craniomaxillofacial trauma surgery is an important factor, and the choice of the intubation technique is often difficult and challenging. The choice of the intubation technique requires good assessment by the multidisciplinary team that includes maxillofacial surgeons and neurosurgeons as well as good communication between them. Submental intubation is a technique that is maintained extraorally after the conventional orotracheal intubation and the tube is extruded through the incision site in the submental region. It is a useful and safe airway management technique for craniomaxillofacial trauma surgery. It makes it possible to perform reduction of the nasal-orbital-ethmoidal complex fracture, and LeFort I, II, III fractures simultaneously. The aim of this study is to report a case of a craniomaxillofacial trauma patient who had an accompanying periorbital space abscess and treatment was performed by open reduction and internal fixation via submental intubation with a review of literature. After considering the method, complications and indications, we suggest this technique for safe and useful airway management of craniomaxillofacial trauma surgery.

범발성 안면골절환자의 변형 악하접근법을 이용한 구강기관내삽관술

권경환 大韓顎顔面成形再建外科學會 2003 Maxillofacial Plastic Reconstructive Surgery Vol.25 No.1

The use of nasoendotracheal intubation has become feasible in a wide variety of patients who were previously considered for tracheostomy in oral and maxillofacial surgery. But, according to the development of surgical technique, we need another method of intubation. It is possible that orthognathic surgery can be accomplished with other supplemental surgeries. However, rhinoplasty is impossible using the nasoendo-tracheal intubation. During the operation, it is uncomfortable and dangerous for intubation position to be changed. In addition, Le Fort Ⅱ and Ⅲ facial fractures, which involve the cribriform plates, pose the greatest potential for untoward effects from nasoendotracheal intubation. The purpose of this article is to present another technique of airway management, first described by Altermir in 1986. With the intention of avoiding tracheostomies and making our surgery easier in given cases, the submental approach has been developed for endotracheal intubation. In our method, the incision sites are located in different positions between skin and muscle in order to avoiding the direct connection from extraoral to intraoral sites. The advantages of this method are very simple, non-complicated, secured the good operation field and avoiding the tracheostomy.

안면부의 다발성 손상 환자에서 시행된 악하 기관삽관술 2예

임길채 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.5

Submental endotracheal intubation is a method introduced by Hernandez Altemir in 1986 for maintaining the airway. In the treatment of multiple facial fractures, the appropriate airway maintenance is a challenge for both anesthesiologists and surgeons. Oral endotracheal intubation precludes achieving adequate access to the fracture and maxillomandibular fixation for proper occlusion. Nasotracheal intubation is contraindicated in cases accompanying fractures of skull base or nasal bones. Tracheostomy is the standard method for airway management in these traumas. It does not interfere with surgical access and occlusion, and can be used for prolonging ventilation treatment. However, it has a significant risk of iatrogenic complications. On the other hand, submental endotracheal intubation is an alternative method of airway maintenance in facial traumas. It does not compromise the surgical fields but enables maxillomandibular fixation and can avoid complications of tracheostomy. In this case report, we present our experience of submental endotracheal intubation in two cases with multiple facial traumas.

Modified submental intubation techniques for maxillofacial surgery - A report of five cases -

Jeon Yeong-gwan,Lee Chunui,Hong Dongeui,Jin Younghyun,임현교 대한마취통증의학회 2022 Anesthesia and pain medicine Vol.17 No.3

Background Submental intubation has been the recommended airway management procedure for maxillofacial surgery since proposed by Altemir in 1986. We adopted various submental intubation modifications based on modified intubation protocols and report on the effectiveness and problems of each modified method.Case Among a total of 13 submental intubation cases during the last five years, five representative methods are described. The proximal end of the endotracheal tube was protected by a nelaton catheter in case 1, by a suction connector in case 2, and by a dental needle cap in case 3. In case 4, a nasal speculum was used to expand a single route, and in case 5, a laparoscopic trocar was used to secure a single route.Conclusions Use of a laparoscopic trocar might be the most effective way to obtain a single submental route. However, considering cost, use of a nasal speculum is also an effective suboptimal solution.

전안면골 외상 환자에서 턱밑 기관내 삽관에 대한 증례보고

서동준,김남균,박세현,강연희,이성진,김형준,Seo, Dong-Jun,Kim, Nam-Kyun,Park, Se-Hyun,Kang, Yeon-Hee,Lee, Sung-Jin,Kim, Hyung-Jun 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.6

턱밑 기관내 삽관술은 기본적인 수술적 술기가 필요하지만, 간단하고 안전하며 술식이 빠른 장점을 가지고 있다. 또한 술 중 악간 고정이 가능하며, 수술 시야를 확보할 수 있으며, 술 후 합병증이 적고 기관절개술로 인한 부작용을 줄일 수 있다는 장점을 가지고 있다. 따라서 기본적인 술기의 습득과 마취과와의 협조가 동반된다면 많은 분야에서 사용 될 수 있는 방법이라고 생각된다. The technique of submental intubation in patient with multiple facial fracture and skull base fracture was originally described by Altemir. Not only is intermaxillary fixation feasible when using this surgical technique but a good field of vision is acquirable, and postoperative complications due to tracheostomy can be prevented. After Altemir presented submental intubation, many modified techniques were reported, applicable not only to trauma patients but also to elective surgeries such as orthognathic surgery including Lefort II or III osteotomy. This technique is easy to use, rapid and free of complications compared to alternative intubation method especially tracheostomy for multiple facial trauma patients.

구강악안면 영역의 수술 시 악하 기관 삽관술의 유용성에 대한 임상적 고찰

김일규,장금수,최진호,오남식,류승현,김재우,정종권 大韓顎顔面成形再建外科學會 2003 Maxillofacial Plastic Reconstructive Surgery Vol.25 No.2

It is hardto make a decision of what route we will select for endotracheal intubation at open reduction of oral and maxillofacial trauma. In the patients with fractures of multiple facial bones combined with fracture of crainal basal bone, intermaxillary fixtion makes oro-endotracheal intubation impossible. And the possibility of injury to the fracture site of crainal basal bone and the impossibility of reconstruction of naso-orbito-ethmoidal(NOE) complex fractures also make the naso-endotracheal intubation difficult. But it is not easy to select the tracheostomy because of its several complications and abhorrences. For above reson, Altermir introduced submental route for endotracheal intubation as new technique in 1986 and Green etc. modified this technique in 1996. The purpose of this article is to evaluate the efficiency of submental route for endotracheal intubation after experience of 10-clinical cases for variable reasons with review of articles.

Intubating Laryngeal Mask Airway 용 강화튜브를 이용한 턱밑 기관내 삽관 : 증례 보고

박호동,김기준,김형준,하지영 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.4

Nasotracheal intubation, when performed after craniomaxillofacial trauma, may result in the passage of the tube into the cranium, causing significant brain damage. Orotracheal intubation may be preferred, but interferes with the placement of intermaxillary fixation. To avoid these problems, a tracheostomy may be an alternative but it carries significant morbidity. The submental route for endotracheal intubation has been proposed as an alternative to a tracheostomy in the surgical management of craniomaxillofacial trauma. Ideally, this maneuver is performed by using a reinforced tube. Unfortunately, however, some reinforced tracheal tubes are manufactured with nondetachable connectors. Removing them forcefully may be possible, but they will then stay dangerously loose after reconnection. We report a case in which a standard oral Ring-Adair-Elwyn (RAE) tube and reinforced tube for ILMA was used so not to be loose after the reconnection. (Korean J Anesthesiol 2002; 43: 507~510)

상악골 Le Fort I 골절 환자에서 경구 기관 내 삽관 하에서의 악간고정 및 정복: 증례보고

최은주,이석련,Choi, Eun-Joo,Lee, Seok-Ryun 대한치과마취과학회 2014 Journal of Dental Anesthesia and Pain Medicine Vol.14 No.4

In order to reduce jaw fracture accompanied by basal skull or nasal fracture, submental intubation could be generally performed. Albeit submental intubation has been widely accepted, it could develop complications such as nerve injury, glandular duct injury, and orocutaneous fistula. Here, we suggest oral intubation for overcoming complications and providing more stable surgical environment in emergency case. Under oral intubation maintaining in retromolar triangle and buccal corridor space, intermaxillary fixation was successfully underwent in 38-years-old female patient with Le Fort I fracture accompanied by pneumocephalus.