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Surgical Pearls
May/Jun 2016

Submental Orotracheal Intubation—A Technique for Airway Management in Severe Facial Trauma

Author Affiliations
  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
JAMA Facial Plast Surg. 2016;18(3):228-229. doi:10.1001/jamafacial.2015.2198

Severe facial and anterior skull base trauma present particular challenges to the surgeon and anesthesiologist. A variety of methods have been described for airway management in cases of panfacial trauma; however, the literature is equivocal on the ideal technique. In 1986, Hernández Altemir1 described a technique that exteriorized an oral endotracheal tube through a floor-of-mouth and submental incision. Submental orotracheal intubation (SMOTI) avoids the risks, morbidity, and hindrance associated with nasotracheal intubation, orotracheal intubation, or tracheostomy. SMOTI secures the endotracheal tube and provides uninhibited access to craniofacial injuries. We present a step-by-step description with a Video of SMOTI to provide surgeons a clear and concise reference when managing the airway in patients with severe facial trauma. The intraoperative photographs and Video depicting this technique are taken from the case of a 15-year-old male who sustained left-sided LeFort III, right-sided LeFort II, naso-orbito-ethmoid, and skull base fractures with cerebrospinal fluid leak (Figure 1).

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