Das Sabyasachi, Das Tara Pada, Ghosh Pralay S
Department of Anaesthesiology, North Bengal Medical College, P.O.-Sushrutanagar, Dist- Darjeeling, West Bengal, India.
J Anaesthesiol Clin Pharmacol. 2012 Jul;28(3):291-303. doi: 10.4103/0970-9185.98320.
Airway management in patients with faciomaxillary injuries is challenging due to disruption of components of upper airway. The anesthesiologist has to share the airway with the surgeons. Oral and nasal routes for intubation are often not feasible. Most patients have associated nasal fractures, which precludes use of nasal route of intubation. Intermittent intraoperative dental occlusion is needed to check alignment of the fracture fragments, which contraindicates the use of orotracheal intubation. Tracheostomy in such situations is conventional and time-tested; however, it has life-threatening complications, it needs special postoperative care, lengthens hospital stay, and adds to expenses. Retromolar intubation may be an option, But the retromolar space may not be adequate in all adult patients. Submental intubation provides intraoperative airway control, avoids use of oral and nasal route, with minimal complications. Submental intubation allows intraoperative dental occlusion and is an acceptable option, especially when long-term postoperative ventilation is not planned. This technique has minimal complications and has better patients' and surgeons' acceptability. There have been several modifications of this technique with an expectation of an improved outcome. The limitations are longer time for preparation, inability to maintain long-term postoperative ventilation and unfamiliarity of the technique itself. The technique is an acceptable alternative to tracheostomy for the good per-operative airway access.
由于上颌面部损伤患者的上呼吸道结构遭到破坏，气道管理颇具挑战性。麻醉医生必须与外科医生共同处理气道。经口和经鼻插管途径通常不可行。大多数患者伴有鼻骨骨折，这排除了经鼻插管的可能性。术中需要间歇性牙齿咬合来检查骨折碎片的对齐情况，这使得经口气管插管无法使用。在这种情况下，气管切开术是常规且经过时间检验的方法；然而，它存在危及生命的并发症，需要特殊的术后护理，会延长住院时间并增加费用。磨牙后插管可能是一种选择，但并非所有成年患者的磨牙后间隙都足够。颏下插管可在术中控制气道，避免使用经口和经鼻途径，并发症最少。颏下插管允许术中牙齿咬合，是一种可接受的选择，尤其是在不计划进行长期术后通气的情况下。该技术并发症最少，患者和外科医生的接受度更高。为了期望获得更好的效果，对该技术进行了多种改进。其局限性在于准备时间较长、无法维持长期术后通气以及对该技术本身不熟悉。对于良好的术中气道通路而言，该技术是气管切开术的一种可接受的替代方法。
