A Ujam1, M Perry2. 1. Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, UK. aujam@nhs.net. 2. Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
Abstract
PURPOSE: Submental intubation is widely accepted as a safe and effective alternative to nasal intubation or tracheostomy in head and neck surgery patients. Forceful or careless technique can cause significant bleeding and trauma to the soft tissues at this point, increasing the likelihood of troublesome sublingual haematoma. METHODS: We describe the use of a percutaneous tracheostomy horn (Cook Medical Blue Rhino®) to allow minimally traumatic submental intubation without the need for serial dilations. A patient with severe midfacial injuries requiring surgery was intubated via a standard oral technique. Following this, submental access was achieved using a novel dilational technique with a tracheostomy dilator. This resulted in a very secure and safe submental intubation and unrestricted access to the entire surgical field. RESULTS: The single instrument, one-pass dilation technique to achieve submental intubation was found to be easy, quick, and avoided excessive trauma to the floor of mouth. CONCLUSION: Patients will sometimes require a protected airway that allows surgeons unrestricted and simultaneous access to the dental occlusion, oral cavity, midface, and nose. In our case, this simple, easy, and quick adaptation of an established technique using a tracheostomy dilator is an excellent alternative to the traditional blunt dissection used to achieve submental intubation.
PURPOSE: Submental intubation is widely accepted as a safe and effective alternative to nasal intubation or tracheostomy in head and neck surgery patients. Forceful or careless technique can cause significant bleeding and trauma to the soft tissues at this point, increasing the likelihood of troublesome sublingual haematoma. METHODS: We describe the use of a percutaneous tracheostomy horn (Cook Medical Blue Rhino®) to allow minimally traumatic submental intubation without the need for serial dilations. A patient with severe midfacial injuries requiring surgery was intubated via a standard oral technique. Following this, submental access was achieved using a novel dilational technique with a tracheostomy dilator. This resulted in a very secure and safe submental intubation and unrestricted access to the entire surgical field. RESULTS: The single instrument, one-pass dilation technique to achieve submental intubation was found to be easy, quick, and avoided excessive trauma to the floor of mouth. CONCLUSION:Patients will sometimes require a protected airway that allows surgeons unrestricted and simultaneous access to the dental occlusion, oral cavity, midface, and nose. In our case, this simple, easy, and quick adaptation of an established technique using a tracheostomy dilator is an excellent alternative to the traditional blunt dissection used to achieve submental intubation.