Submental Intubation Offers Effective Airway Management in Severe Facial Trauma: Case Report
A recent case report highlights submental intubation as a highly effective, minimally invasive airway solution for severe facial trauma. The smart approach safely bypasses the serious risks of traditional breathing tubes and tracheostomies, guaranteeing surgeons perfectly clear access during complex facial reconstructive surgeries.
These findings of the case report are published in Research and Innovation in Anesthesia by Suraj Bhanuse and colleagues from HBT Medical College.
Managing airways in patients with extensive facial trauma represents a profound clinical challenge because anesthesiologists and surgeons must simultaneously operate within the identical anatomical space. The specific case highlights why submental intubation matters immensely to clinical practice, as it safely circumvents the absolute contraindications of standard oral or nasal routes while simultaneously avoiding the severe invasiveness of surgical airway procedures. Ultimately, this technique ensures completely unobstructed surgical access, allowing clinicians to perform critical dental occlusion assessments without risking intracranial tube placement.
A twenty-three-year-old male presented following a vehicular collision with profound facial swelling; subsequent computed tomography (CT) revealed extensive injuries, including bilateral maxillary and mandibular fractures, leading to a definitive diagnosis of Le Fort II trauma. Clinicians initially secured his airway via standard oral intubation, subsequently rerouting the tube through a minor incision beneath the chin to facilitate unobstructed fracture fixation, which resulted in a smooth operation and completely uneventful postoperative extubation.
Mechanistically, the procedure involves establishing a secure anatomical tract through the subcutaneous tissues and the mylohyoid muscle to physically exteriorize the endotracheal tube from the anterior floor of the mouth. Rerouting the ventilation apparatus in this specific manner expertly clears the nasal and oral cavities, actively removing any physical obstruction for the surgical team while maintaining highly reliable gas exchange throughout the reconstructive procedure.
For critical care practitioners, this technique adds vital value to current medical understanding by conclusively proving that complex shared-airway scenarios do not automatically necessitate highly invasive, morbidity-inducing procedures like a standard tracheostomy. The broader implications for patient care strongly suggest that multidisciplinary medical teams should actively prioritize submental access in appropriately selected maxillofacial reconstructive procedures to drastically minimize visible scarring, reduce severe complications, and successfully drive better postoperative healing.
Reference
Bhanuse S, Madan HK, Choudhury R, et al. Definitive Airway Management through Submental Intubation in a Case of Facial Trauma (Le Fort II): A Case Report. Res and Innov Anesth 2025;10(2):58–60.
