Intubation in maxillofacial trauma-a dilemma

Complex midfacial or panfacial injuries often require tracheostomy to ensure a free operative field. Oral intubation can interfere with assessment of occlusion and nasal tracheal intubation may lead to complications (brain damage, leakage of cerebrospinal fluid, and meningitis) when there are also fractures of the base of the skull. On the other hand, tracheostomy is associated with complications such as haemorrhage, pneumomediastinum or pneumothorax, injury to the recurrent laryngeal nerve, and tracheal stenosis and should be reserved for severely injured patients who need protracted assistance with ventilation or further operations. A useful alternative method of managing the airway intraoperatively are by submental endotracheal intubation and retromolar intubation. Submental intubation allows tracheal intubation by passing the tube through a submental skin incision into the mouth. Retromolar intubation is a non-invasive technique and avoids both submental tracheal intubation and tracheostomy in the majority of patients.In this paper two cases of maxillofacial injury, operated one using submental technique and another with retromolar intubation are reported.