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Retromolar tracheal tube positioning for patients undergoing faciomaxillary surgery

Sir Ganga Ram Hospital, New Delhi, India, E-mail: duttaamitabh{at}yahoo.co.in

To the Editor:

In patients undergoing complex faciomaxillary surgery, orotracheal [need for inter-maxillary fixation (IMF)] and nasotracheal intubations (nasal injury, skull base fracture, rhinoplasty) may be unsuitable.¹ Alternative options include: short-term tracheostomy (invasive, scar) and submental intubation (orocutaneous fistula)² but have their own limitations.

A closer observation by the author (S.S.S.) revealed that there is enough space in the retromolar region for an endotracheal tube (ETT) to be placed and allow IMF without tube compression or kinking. We successfully utilized tracheal tube positioning in the retromolar trigone³ for short-term intraoperative use in 42 adult patients undergoing a variety of maxillofacial procedures.

After routine preoperative preparation (orodental examination, informed consent, aspiration prophylaxis, IM glycopyrrolate), anesthetic induction, skeletal muscle relaxation and orotracheal intubation with a reinforced tracheal tube are carried out in a standardized manner. While instituting IMF, the ETT is moved laterally along the buccal sulcus beyond the last molar and placed in the retromolar groove to be taken out at the angle of the mouth (Figure). On completion of the scheduled procedure, the IMF is cut open

View larger version (191K): [in this window] [in a new window]   FIGURE Retromolar placement of the tracheal tube with inter-maxillary wire fixation in place. and usual orotracheal tube position is resumed. Adequacy of oxygenation, ventilation and tube paten-cy (peak airway pressure) are monitored continuously.

In conclusion, retromolar positioning of the tracheal tube is an attractive option for maintaining the airway in patients during faciomaxillary procedures.

References

1 Zmyslowski WP, Maloney PL. Nasotracheal intubation in the presence of facial fractures (Letter). JAMA 1989; 262: 1327–8.

2 Hernandez Altemir FH. Nasotracheal intubation in patients with facial fractures (Letter). Plast Reconstr Surg 1992; 89: 165–6.

3 Sharma PK, Schuller DE, Baker SR. Malignant neoplasms of the oral cavity. In: Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Schuller DE, Richardson MA (Eds). Otolarngology Head & Neck Surgery, 3rd ed. St. Louis: Mosby; 1998: 1422.

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This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dutta, A. Articles by Khazanchi, R. K. Search for Related Content PubMed PubMed Citation Articles by Dutta, A. Articles by Khazanchi, R. K.