Submental Intubation: An Alternative and Cost-Effective Technique for Complex Maxillofacial Surgeries

Introduction  

Management of airway is a significant issue especially in cases of complex maxillofacial trauma like panfacial fractures or concomitant nasoethmoidal injuries, where the nasotracheal intubation is contraindicated or possess a significant problem. In these cases the only other alternative is tracheostomy. Submental intubation is an alternative to tracheostomy and it can be easily performed with little or lesser post-operative complications. This method involves lesser expenses as it does away with longer post-operative stay in the hospital as required by tracheostomy patients.     

Comparative Evaluation of Drill-Free and Self-Tapping Titanium Miniscrews for Semi-Rigid Internal Fixation in Maxillofacial Trauma

IntroductionConventional semi-rigid fixation systems in maxillofacial trauma use self-tapping titanium miniscrews (STS) that require preliminary drilling of a pilot hole. Although drill-free miniscrews (DFS) accompany these systems, they have not dominated practice despite their allure of improved screw-bone contact and holding power. The COVID-19 pandemic has brought these DFS to light as they avoid aerosol production. The present study has compared DFS to STS in patients being treated with miniplate fixation for maxillofacial trauma to understand their feasibility for maxillofacial fracture fixation. MethodologyThis prospective case–control study sampled 16 patients each with zygomaticomaxillary buttress fracture and parasymphysis fracture of the mandible and grouped alternating patients as case (DFS) and control (STS). Intraoperatively duration of fixation, incidence of screw failures and fragment stability; postoperatively occlusion, neurosensory deficits, teeth vitality and infection and removal rates were evaluated at postoperative week 1, 3, 6, 12 and 24 using Cramer''s V test. A P value < 0.05 was considered significant.ResultsIn the 32 patients evaluated, DFS reduced internal fixation time at zygomaticomaxillary buttress (P = 0.001) but not at parasymphysis (P = 0.206). No significant difference in screw failures or fragment stability was observed. Stable occlusion was maintained in all groups with vital teeth and intact neurosensory function, but the summative incidence of infection was significant at week 24 when STS was used at parasymphysis (P = 0.019).DiscussionWhile DFS may facilitate ease of insertion with a single instrument pick-and-screw-in approach, avoiding thermal osteonecrosis and aerosol production, they fail to confer any other clinical advantage.     

自攻牵引钉应用于颌面骨折颌间牵引的并发症

目的：探讨自攻牵引钉应用于颌面骨折颌间牵引的并发症及防治对策。方法：总结2007年1月～2009年12月间颌面骨折,应用自攻牵引钉行颌间牵引30例。其中上颌骨骨折5例,下颌骨骨折25例。结果：29例咬合关系恢复至正常,1例咬合关系恢复不良。在222枚螺钉中有39（18%）枚牵引钉在拆除时发现螺钉尾部被口腔黏膜覆盖,有4（2%）枚螺钉断裂。在牵引完成前有7（3%）枚螺钉松动,未发现螺钉两侧的牙根损伤。结论：虽然自攻颌间牵引钉是一种安全,省时的颌间牵引方法,但它本身存在一定的局限性和潜在并发症,临床医生应该意识到这一点,更加安全有效地使用它。