Strategic Airway Management in Facial Trauma Cases

Submental Intubation: A Smart Alternative for Facial Trauma Airway Management?

Mira Elwood in Health & Wellness June 2025 • 4 min read.

"Discover how submental intubation offers a safe, effective, and less invasive airway solution for patients with severe maxillofacial injuries, ensuring better surgical outcomes and faster recovery."

In the realm of treating complex facial fractures, ensuring a stable airway is as crucial as the surgical repair itself. When accidents lead to severe damage in the maxillofacial area, both surgeons and anesthesiologists face the challenge of securing the patient's ability to breathe without hindering the necessary reconstructive procedures. Traditional methods often involve a balancing act, where securing the airway could compromise the surgical field, and vice versa.

Historically, when standard oral or nasal intubation methods were not viable, options like cricothyrotomy or tracheostomy were the go-to solutions for maintaining a patient's airway. However, these methods come with their own sets of complications, prompting a search for safer, less invasive alternatives. The need for a technique that provides unobstructed surgical access while minimizing risks to the patient led to the exploration of new approaches.

Enter submental intubation—a technique introduced in 1986 as a groundbreaking alternative for airway management in patients with cranio-maxillofacial trauma. This method involves creating a temporary airway through an incision in the submental area (under the chin), allowing surgeons the necessary access to perform complex reconstructions without airway obstruction. Submental intubation stands out as a short-term solution that avoids many of the complications associated with traditional tracheostomy, marking a significant step forward in patient care.

Why Submental Intubation is Gaining Popularity in Facial Trauma Cases?

Strategic Airway Management in Facial Trauma Cases

Submental intubation offers several key advantages, making it an attractive option for managing airways in specific cases of maxillofacial trauma. The primary benefit lies in its ability to provide a clear surgical field. Unlike traditional methods where tubes can obstruct the surgeon's view or access, submental intubation allows for unobstructed reconstruction and maxillo-mandibular fixation.

Moreover, this technique avoids many complications associated with tracheostomy. Tracheostomy, while effective, carries risks, including cardiac arrest, hemorrhage, and potential long-term issues such as tracheal stricture. Submental intubation minimizes these risks by providing a short-term airway solution tailored to the duration of the surgical procedure.

Unobstructed Surgical Access: Facilitates complex facial reconstructions without interference from airway devices.
Reduced Risk of Complications: Avoids the general, local, early, and late complications associated with tracheostomy.
Short-Term Solution: Perfectly suited for surgeries requiring temporary airway management.
Minimized Trauma: Less invasive than traditional methods, leading to quicker recovery times.

A study published in the Journal of the Korean Association of Oral and Maxillofacial Surgeons assessed submental intubation as an alternative to tracheostomy in cranio-maxillofacial trauma management. Seventeen patients with maxillofacial trauma underwent submental intubation. The results indicated that the technique was simple and reliable. Hypertrophic scars were noted in three cases, and orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient. The study concluded that submental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications.

Is Submental Intubation Right for You?

If you or a loved one is facing maxillofacial surgery, understanding all available options for airway management is essential. Submental intubation presents a promising alternative to traditional methods, offering a balance of safety, surgical accessibility, and reduced complications. Discussing this option with your medical team can help ensure the best possible outcome for your specific situation. By staying informed and proactive, you can navigate your treatment journey with confidence and peace of mind.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.5125/jkaoms.2016.42.3.151, Alternate LINK

Title: Submental Intubation: Alternative Short-Term Airway Management In Maxillofacial Trauma

Subject: Oral Surgery

Journal: Journal of the Korean Association of Oral and Maxillofacial Surgeons

Publisher: The Korean Association of Oral and Maxillofacial Surgeons

Authors: Ravi Raja Kumar, Suresh Vyloppilli, Shermil Sayd, Annamala Thangavelu, Benny Joseph, Auswaf Ahsan

Published: 2016-01-01

Everything You Need To Know

What exactly is submental intubation?

Submental intubation is a technique used to manage a patient's airway, especially in cases of severe facial trauma. It involves creating a temporary airway through an incision under the chin (the submental area). This allows surgeons to perform complex facial reconstructions without the airway tube getting in the way. It's favored for being a short-term solution that avoids many of the complications associated with a tracheostomy. Compared to oral or nasal intubation, submental intubation is used when those methods aren't suitable due to the extent of the facial injuries.

Why is submental intubation becoming a more common choice for facial trauma cases?

Submental intubation is gaining popularity because it offers unobstructed surgical access, which is crucial for complex facial reconstructions. It also reduces the risk of complications compared to a tracheostomy, such as hemorrhage and tracheal stricture, because submental intubation is designed as a short-term solution. The procedure is less invasive than traditional methods, which can lead to quicker recovery times for patients. This is a significant advantage, ensuring the surgical team can focus on the facial reconstruction without airway-related hindrances.

Are there any complications associated with submental intubation?

While submental intubation is a good technique, potential complications include hypertrophic scars, orocutaneous fistula, and mucocele. A hypertrophic scar is an elevated scar. An orocutaneous fistula is an abnormal connection between the mouth and the skin. A mucocele is a cyst filled with mucus. However, these complications are generally manageable without causing significant long-term issues for the patient. It's important to discuss these potential risks with your medical team to understand how they will be managed if they occur.

What are the alternatives to submental intubation?

Traditional methods like tracheostomy and cricothyrotomy are alternative airway management techniques. A tracheostomy involves creating an opening in the neck to place a tube into the trachea. A cricothyrotomy involves making an incision through the skin and cricothyroid membrane to establish an airway. While these methods are effective, they carry risks such as cardiac arrest, hemorrhage, and long-term issues like tracheal stricture. Submental intubation is often preferred because it aims to minimize these risks while still providing a stable airway during surgery.

How do I know if submental intubation is the right choice for me or my loved one?

If you're facing maxillofacial surgery and traditional airway methods aren't suitable, submental intubation might be an option. It's essential to discuss all available airway management options with your medical team. Consider the benefits of unobstructed surgical access and reduced complications compared to a tracheostomy. Understanding the potential risks and benefits will help you make an informed decision about the best approach for your specific situation, ensuring the best possible outcome.