Submental intubation in maxillofacial fracture surgery: single-centre experience

Abstract

Introduction: Submental intubation provides a valuable alternative in maxillofacial fracture surgery when oral and nasal routes are contraindicated. A key advantage is that it allows for dental occlusion, which is necessary for proper alignment of fractured bone fragments. Despite its benefits, this technique remains underutilised in Malaysia due to limited research, training, and exposure among anaesthesiologists. Therefore, this study explores the types of maxillofacial fractures as well as the indications and complications of submental intubation.

Methods: This was a retrospective study using the census sampling technique. A total of 11 patients who underwent submental intubation via a paramedian approach with double haemostats at Hospital Teluk Intan between January 2022 and March 2025 were reviewed. Immunocompromised patients were excluded. A descriptive analysis was performed on the types of maxillofacial fractures, indications for submental intubation and postoperative complications.

Results: Data from 11 patients were analysed. Seven patients (63.6%) sustained combined midface and mandibular fractures, 3 patients (27.3%) had midface fractures, and 1 patient (9.1%) had mandibular fracture. Additionally, 7 patients (63.6%) presented with nasal bone and/or septum fractures, 2 patients (18.2%) had skull base fracture, and 2 patients (18.2%) had combined fractures of nasal bone, septum, and skull base. One patient developed a postoperative infection and hypertrophic scar, while the remaining 10 recovered uneventfully. The observed complication rate was 9.1% (95% CI: 0.2%–40.3%).

Conclusion: Submental intubation appears to be a safe and feasible alternative with minimal complications. Larger studies are needed to validate these preliminary findings.