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Submental Intubation

Submental Intubation

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Preoperative Considerations

Consent:

  • Scar in submental region
  • Damage to FOM structures

Anesthesia/Positioning:

  • Oral intubation with armored tube (prevents kinking)
  • See technique for preparing tube prior to intubation for easy circuit disconnect 

Other:

  • Examine for gaps in dentition- may obviate need to perform submental intubation

Armamentarium:

  • Size 5 or 6 regular oral endotracheal tube
  • 6 or 7 armored endotracheal tube
  • Knife to cut tube from connector
  • #15 blade
  • Large hemostat
  • 24g wire if wiring tube to dentition
  • 3-0 chromic gut
  • 5-0 plain gut

Technique

  • Examine dentition, if there is an edentulous space that may accomodate an oral tube while patient is in maxillomandibular fixation, it may obviate the need to perform a submental intubation

  • At this stage the tube needs to be secured to prevent dislodgment. Options include dental wiring or suturing to submental skin (shown below)
  • When reversing the submental, the tube will be pulled through first followed by the cuff
  • Intra and extraoral incisions can be closed with resorbable/nonresorbable sutures per surgeon preference

Postoperative Considerations

Immediate:

  • Soft diet

Follow Up:

  • None

Operative Note

Coding

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