Szantyr Aleksandra, Szuta Mariusz, Zapała Jan
Department of Cranio-Maxillofacial Oncological and Reconstructive Surgery Jagiellonian University Medical College, Ludwik Rydygier Memorial Specialized Hospital ,os. Złotej Jesieni 1, Kraków, Poland.
Folia Med Cracov. 2016;56(3):79-85.
In 1995 the first tracheosubmental intubation (TSI) in Poland was performed in the Clinic and De- partment of Cranio-Maxillofacial Surgery at Jagiellonian University Medical College in Kraków. Our 20 years of experience with using TSI in the eld of cranio-maxillofacial surgery, with 316 successfully performed intubations, resulted in one of the largest bodies of material analysed in the literature so far. The aim of this study was to evaluate the eficacy and complications of TSI in the field of cranio-maxillofacial surgery in patients where orotracheal or nasotracheal intubation is contraindicated and tracheostomy can be avoided. To fulfil this objective we present our own experience with the use of TSI in the field of cranio-maxillofacial surgery. This retrospective study included 316 patients who were operated on with general anaesthesia via TSI in the Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, Kraków, from 1995 to 2014 (20 years). Indications for TSI were as follows: multifragmentaric fractures of the bones of mid- and lower face in 262 patients (82.9%), simultaneous osteotomies of the maxilla and mandible due to mandibular prognathism with maxillary compression in 62 patients (19.6%), extensive facial cancer infiltrating both the nose and lips in 4 patients (1.2%) and posttraumatic deformities of the nose and jaws in 4 patients (1.2%). In all 316 patients TSI was successfully performed and proved to be the optimal method of airway management, providing a comfortable surgical approach with the operating field free from an intubation tube. Complications were observed in 12 patients (3.8%) and included wound infection in 7 patients (2.21%), transitory salivary fistula in 3 patients (0.95%), and hypertrophic scarring in 2 patients (0.63%). TSI is considered to be a safe and simple technique of intubation, which makes it possible to to avoid tracheotomy complications when it is difficult or impossible to perform orotracheal or nasotracheal intubation. TSI facilitates the simultaneous performance of complex procedures, including both mid-face and lower face correction, in a one-step procedure, providing complete intraoperative control of the occlusion as well as facial symmetry.
1995年，波兰首例经气管-颏下插管（TSI）在克拉科夫雅盖隆大学医学院颅颌面外科诊所及科室完成。我们在颅颌面外科领域使用TSI已有20年经验，成功进行了316次插管，这形成了迄今为止文献中分析的最大规模材料之一。本研究的目的是评估TSI在颅颌面外科领域对经口气管插管或经鼻气管插管禁忌且可避免气管切开的患者的有效性和并发症。为实现这一目标，我们介绍了自己在颅颌面外科领域使用TSI的经验。这项回顾性研究纳入了1995年至2014年（20年）在克拉科夫雅盖隆大学医学院颅颌面外科通过TSI接受全身麻醉手术的316例患者。TSI的适应证如下：262例（82.9%）中、下脸部骨骼多发骨折；62例（19.6%）因下颌前突伴上颌受压而行上颌和下颌同时截骨术；4例（1.2%）广泛面部癌侵犯鼻和唇；4例（1.2%）鼻和颌骨创伤后畸形。在所有316例患者中，TSI均成功实施，并被证明是气道管理的最佳方法，提供了舒适的手术入路，手术视野无插管。12例患者（3.8%）出现并发症，包括7例伤口感染（2.21%）、3例暂时性唾液瘘（0.95%）和2例肥厚性瘢痕（0.63%）。TSI被认为是一种安全、简单的插管技术，当难以或无法进行经口气管插管或经鼻气管插管时，可避免气管切开并发症。TSI有助于在一步手术中同时进行复杂手术，包括中面部和下面部矫正，实现术中对咬合及面部对称性的完全控制。
