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Submental intubation or its modification as retrograde submental intubation was first described in a patient with restricted mouth opening by Arya et al.
Retrograde submental intubation by pharyngeal loop technique in a patient with faciomaxillary trauma and restricted mouth opening. The management of a difficult airway is one of the biggest challenges of perioperative anesthesia management. 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. The connector and breathing system were reattached and the cuff reinflated.
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.
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. On initial evaluation the patient was in non-acute distress, alert, awake and oriented, with a Glascow coma score of In addition, the surgical anatomy of the technique is described in detail.
The maxillofacial trauma can cause serious disturbances of the soft and hard tissues of fetrograda anatomical components of the upper airway and often with little external evidence of deformity Arya et al.
intubacion retrograda tecnica pdf
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. Submental intubation in oral maxillofacial surgery: Nevertheless, we report for the first time the retrograde submental intubation technique using direct video laryngoscopy.
The endotracheal tube was secured and adequate end tidal carbon dioxide curve was observed. The main objective of this study is to 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. 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.
San Juan, Puerto Rico. There was midface mobility, malocclusion and mouth opening was restricted. 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.
Then using Seldinger technique the malleable wire Spring-Wire Guide: 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.
University of Puerto Rico.
Since the first application of this technique, less than thirty years ago, many authors have studied the clinical use of this procedure. Endotracheal tube in position fixed to skin. Additional research is necessary to validate new modifications reported in the literature.
Several airway management techniques have been described, including: Throat pack was placed. After preoxygenation and intravenous induction of anesthesia, submental region and anterior neck is disinfected and draped as usual sterile fashion. Finally, the endotracheal tube is fixed to skin with sutures to prevent accidental displacement Fig. In conclusion, submental intubation is a safe and effective technique for establishing retorgrada secure airway in patients requiring facial reconstructive surgery where traditional oral and nasotracheal intubation are contraindicated.
Guide wire insertion through cricothyroid membrane; B.
Each technique has its indications with advantages and disadvantages. In such cases a tracheostomy is the indicated procedure. The submental intubation is a procedure that was reported to avoid tracheostomy 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 retrobrada al.
Perimortem intracranial orogastric tube in pediatric trauma patient with a basilar reyrograda fracture.
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Radiologic examination confirmed the presence of Le Fort II fracture, naso-orbitoethmoid fracture, bilateral zygomaticomaxillary complex fractures and left mandible subcondylar fracture. There have been several articles in the literature describing and modifying the technique Altemir; Jundt et al.
At the end of the surgery the tube was disconnected, pulled back into the oral cavity reteograda reconnected.
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. Reinforced endotracheal tube fixed to skin.
The mortality rate of tracheostomy has been reported to range from 0.
Intubación retrograda modificada
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 Insertion of the wire guide through retrlgrada cricothyroid membrane helps to intubadion correctly the endotracheal tube and also counting with the assistance of the direct video laryngoscopy, where the complete mouth opening is not necessary.
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. The submental route iintubacion endo-tracheal intubation. The patient had suffered trauma to the midface. 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.