Submandibular Intubation as an Airway Management Strategy in Panfacial Fractures: A Case Report

Abstract

Background: Management of the airway in patients with panfacial fractures is challenging. Submandibular intubation is useful as an alternative method to establish safe airway patency with full access to the surgical site without the need for a tracheostomy with its associated risks and complications.

Case: A 16-year-old male suffered craniofacial trauma due to a motorcycle accident with panfacial fractures. The patient’s condition required an unobstructed surgical field for occlusion evaluation, intermaxillary fixation, and complex reconstruction. It was decided to use submandibular intubation. The procedure was performed by making a small incision in the submandibular region, diverting the endotracheal tube from the oral cavity to outside the incision, and fixing it to the skin. The surgery went smoothly without intraoperative or postoperative complications.

Intervention and Management: Submandibular intubation was performed by making a small right submandibular incision, redirecting the endotracheal tube through the floor of the mouth, and securing it with sutures, ensuring a clear operative field. The patient tolerated the procedure well and recovered without complications, with smooth healing of the incision site.

Discussion: Recent literature indicates that submandibular intubation provides stable airway access, avoid tracheostomy complications, and facilitates complex reconstruction procedures. This case reinforces the evidence of the effectiveness and safety of this technique in the management of panfacial fractures.

Conclusion: Submandibular intubation is an alternative method for airway management in panfacial fractures. It is safe, effective, and viable strategic option for complex panfacial fractures.