October 30, 2013

Submental Intubation [video]

Holy moly... Never realized submental intubation was actually a procedure that really is performed. Check out this video (or watch below) showing a submental intubation being performed.

First, an incision is created right below the jawline slightly off from midline. Dissection is bluntly carried right to the floor of the mouth under the tongue. The endotracheal tube is than grasped and pulled through this opening resulting in a submental intubation.

Seems quick and elegant with minimal bleeding... but I have some big issues with this procedure. There are multiple avoidable risks associated with this approach including:

1) Permanent lip paralysis. The nerve that innervates the lower lip crosses right through this region.
2) Chronic submandibular sialadenitis. The duct that carries spit from the submandibular gland (one of the major glands that produce spit) to the mouth can potentally be injured resulting in stenosis and chronic salivary gland inflammation if not infection.
3) Permanent numbness of the bottom of the mouth. The nerve that provides sensation to the region under the tongue crosses right through this area.
4) Permanent tongue paralysis. The nerve that allows for tongue movement crosses through this area.

Rather than a submental intubation, why not perform a tracheostomy or cricothyroidotomy. With either of these alternative procedures, the risks are minimal (there is no risk of nerve damage).

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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