Maintaining the airway while operating panfacial trauma patients is very crucial and important. Panfacial trauma may include cranial fractures, nasal fractures along with maxillomandibular fractures. The conventional oroendotracheal intubation is contraindicated since the tube will hinder the maxillomandibular fixation by wiring or while reducing and stabilising the fractured segments. Nasoendotracheal intubation is also not a choice of intubation since the nasal fractures are also present in a panfacial fracture. Even it can cause meningitis or the tube can be passed intracranially in patients with frontobasillar fractures. Only option for maintaining the airway remained complex procedures like tracheostomy or cricothyrotomy until 1986 when a Spanish maxillofacial surgeon named Francisco Hernandez Altemir invented an alternate way known as submental intubation for airway maintainance after intubation. In submental intubation at first the normal orotracheal intubation is done followed by which an incision is placed at the submental region and blunt dissection is made through which the tube is passed from iside to outside and then reconnected. Its an excellent method of intubation for panfacial trauma since it does not interfere with the treatmentor surgical proceduresand at the same time complicated procedures like tracheostomy. Several modifications are available for the submental intubation. Five cases of maxillomandibular fractures along with nasal fractures are operated successfully while using the lateral submental intubation approach for maintaining the airway.
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