Submental endotracheal intubation in concurrent orthognathic surgery: a technical note.

INTRODUCTION: Achieving the necessary occlusion for orthognathic surgery is not possible with conventional oral intubation since the tube interferes with the occluding teeth. Sometimes nasotracheal intubation is impossible due to developmental malformations requiring repair. Also, the oral or nasotracheal tube may interfere with the operation or may be damaged during the procedure. In 1986, Hernandez Altemir described a method of submental endotracheal intubation. His intentions were to avoid tracheostomy in maxillofacial trauma cases where short-term intermaxillary fixation was required. PATIENTS: Between January 2000 and May 2003, 13 patients were operated on, using submental intubation. Eight of these (three females and five males) had surgery for orthognathic malformations. METHODS: The Hernandez Altemir technique was modified to ease the procedure: a sterile nylon guiding tube and the '222 rule' incision were introduced. Eight cases with concurrent complex orthognathic surgery, using this modified technique are reported in this paper. RESULTS: There were no operative or postoperative complications related to the procedure. CONCLUSION: The technique is easy to use, rapid and free of complications compared to 'alternative' intubation methods (tracheostomy, retromolar location of tube, etc.). Submental scarring is acceptable. It is recommended for orthognathic procedures in selected cases.