Submental Intubation for LeFort Type III Fracture

Abstract

Introduction: This case report describes the use of submental intubation for an open reduction internal fixation (ORIF) LeFort Type III fracture encountered at Methodist Dallas Medical Center operating room (OR). Other airway management options in maxillofacial fractures include nasotracheal intubation or tracheostomy, however, these options come with complications and may be contraindicated in certain cases.

Case description: This case involved a 51-year-old male who came in from an automobile vs pedestrian type accident who underwent an open reduction internal fixation of a LeFort Type III fracture with hip graft. The patient was intubated orally first for general anesthesia and then converted to submental intubation by the oral/maxillofacial surgeon to allow for surgical access.

Discussion: Submental intubation is an alternative airway route for oral/maxillofacial surgeries when nasotracheal intubation or tracheostomies are not indicated. While submental intubations are low-risk, low-cost, simpler, and faster, it still comes with its list of complications. These complications rates are low, minimal scarring is reported, and no special equipment is needed.

Conclusions: Submental intubation is the preferred airway route with oral/maxillofacial trauma when nasotracheal intubation or tracheostomy is not indicated. If there are no contraindications to submental intubation, it allows advantageous intraoperative airway access in patients requiring surgical fixation of oral/maxillofacial fractures.