Submental Orotracheal Intubation
Pearl contributed by:
Rangraj Setlur
Associate Professor
Department of Anaesthesiology and Critical Care
Armed Forces Medical College,
Pune, India
Scenario: A pateint with CSF rhinorrhea and mandibular fractures for fixation. Neither oral nor nasal intubation preferred. Retromolar space not adequate. Tracheostomy not indicated, planned to extubate immediately after surgery.
Answer: Submental Orotracheal Intubation
Incision made anterior to facial artery (not the midline submental area which is conventionally the site of incision, on the surgeons request), blunt dissection with artery forceps till I got into the oral cavity, tube disconnected from its catheter, pilot balloon deflated and grabbed with the artery forceps and delivered through the incision. Artery forceps reintroduced, tube grabbed and delivered, pilot balloon reinflated, tube sutured in place. After surgery, sutures cut, tube deflated and delivered through the incision, which was then closed.
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