Rodrigues Willian Caetano, de Melo Willian Morais, de Almeida Rafael Santiago, Pardo-Kaba Shajadi Carlos, Sonoda Celso Koogi, Shinohara Elio Hitoshi
PhD Student in Oral & Maxillofacial Surgery Program, Department of Diagnostic and Surgery, Araraquara School of Dentistry, Univ Estadual Paulista Júlio de Mesquita Filho - UNESP, Araraquara, São Paulo, Brazil.
PhD in Oral & Maxillofacial Surgery, Department of Surgery and Integrated Clinic, Araçatuba Dental School, Univ Estadual Paulista Júlio de Mesquita Filho - UNESP, Araçatuba, São Paulo, Brazil.
Anesth Prog. 2017 Fall;64(3):153-161. doi: 10.2344/anpr-64-04-07.
Surgical treatment of panfacial fractures usually requires intraoperative temporary occlusion of the teeth and simultaneous access to the nasal pyramid. In such cases, the standard method of airway management is to perform a tracheostomy, but this may be associated with a significant number of perioperative and late complications. This study aimed to determine if submental endotracheal intubation (SEI) is a viable alternative to tracheostomy, especially when short-term postoperative control of the airway is foreseen. This was an observational retrospective study, carried out between 2012 and 2014, which involved 32 consecutive patients who sustained panfacial fractures and were surgically treated during a 3-year period in a level I trauma center hospital. Only those who required SEI were included in the sample. Four cases were excluded because of incomplete registries, follow-up period less than 4 months after hospital discharge, or other unrelated complications. The medical charts of all patients involved in the sample were carefully reviewed in order to qualify and quantify perioperative and postoperative complications related to anesthetic management. We hypothesized that SEI would not interfere with the surgical procedures and would present less morbidity and reduced complication rates. Twenty-eight patients, 24 male and 4 female, met all the inclusion criteria. The mean age was 29.5 ± 9.05 years (range, 18-56 years). The mean duration time of surgery was 8.07 ± 4.0 hours (range, 4-16 hours). There were no perioperative complications. Postoperatively, only 1 patient (3.57%) experienced a cutaneous infection at the submental region, which was easily treated. Additionally, only 1 case (3.57%) of hypertrophic scar was reported. SEI appears to be a safe, simple, and effective technique of immediate perioperative airway management in selected cases of panfacial fractures.
面颅骨骨折的手术治疗通常需要在术中临时咬合牙齿并同时显露鼻骨。在这种情况下，气道管理的标准方法是进行气管切开术，但这可能会引发大量围手术期及远期并发症。本研究旨在确定颏下气管内插管（SEI）是否是气管切开术的可行替代方法，尤其是在预计术后短期内需要控制气道的情况下。这是一项回顾性观察研究，于2012年至2014年期间开展，纳入了32例连续发生面颅骨骨折并在一级创伤中心医院接受了为期3年手术治疗的患者。样本仅包括那些需要进行颏下气管内插管的患者。4例因记录不完整、出院后随访期少于4个月或其他无关并发症而被排除。仔细查阅了样本中所有患者的病历，以确定并量化与麻醉管理相关的围手术期和术后并发症。我们假设颏下气管内插管不会干扰手术操作，且发病率更低、并发症发生率更低。28例患者符合所有纳入标准，其中男性24例，女性4例。平均年龄为29.5±9.05岁（范围为18 - 56岁）。平均手术时长为8.07±4.0小时（范围为4 - 16小时）。围手术期无并发症发生。术后，仅1例患者（3.57%）颏下区域出现皮肤感染，易于处理。此外，仅报告了1例（3.57%）肥厚性瘢痕。在选定的面颅骨骨折病例中，颏下气管内插管似乎是一种安全、简单且有效的围手术期气道管理即时技术。
