Intraoperative airway management with pan-facial fractures: alternative approaches.

Nasoendotracheal intubation is contraindicated in patients with pan-facial fractures for securing the airway during reconstructive surgery. Oral intubation interferes with intermaxillary fixation during fracture reduction. In these situations, elective tracheostomy is often the airway of choice. However, with the use of rigid internal fixation, postoperative maxillomandibular fixation is unnecessary and traditional tracheostomy may be avoided, unless oral intubation is impossible or long-term airway control is necessary. This article presents Bullard laryngoscopy and submandibular intubation techniques as innovative alternative methods of airway management during surgery. These procedures are indicated in those patients with severe injuries who do not require long-term airway management postoperatively and did not require tracheostomy in the emergency room.