Retromolar Intubation - A Non-Invasive Approach of Airway Management during Maxillofacial Surgery:

Kumkum Gupta; Bhanupriya Agrawal; Prashant K Gupta; Salony Agarwal; Akshat Trivedi; Kopal Gupta

doi:10.21276/aan.2018.3.2.7

Kumkum Gupta Professor, Department of Anaesthesiology and Critical care, Subharti Medical College, Swami Vivekanand Subharti University, NH-58, By Pass Road, Meerut-UP, India.
Bhanupriya Agrawal Resident, Department of Anaesthesiology and Critical care, Subharti Medical College, Swami Vivekanand Subharti University, NH-58, By Pass Road, Meerut-UP, India.
Prashant K Gupta Director Professor, Department of Radio diagnosis and Imaging, Subharti Medical College, Swami Vivekanand Subharti University, NH-58, By Pass Road, Meerut-UP, India.
Salony Agarwal Associate Professor. Department of Anaesthesiology and Critical care, Subharti Medical College, Swami Vivekanand Subharti University, NH-58, By Pass Road, Meerut-UP, India.
Akshat Trivedi Resident, Department of Anaesthesiology and Critical care, Subharti Medical College, Swami Vivekanand Subharti University, NH-58, By Pass Road, Meerut-UP, India.
Kopal Gupta Resident, Department of Anaesthesiology and Critical care, Subharti Medical College, Swami Vivekanand Subharti University, NH-58, By Pass Road, Meerut-UP, India.

DOI: https://doi.org/10.21276/aan.2018.3.2.7

Keywords: Maxillofacial Injury, Flexometallic Tracheal Tube, Maxillomandibular fixation, Retromolar Intubation

Abstract

Background: Patients of maxillofacial injury require precise attention for securing and protecting the shared airway. Moreover, intraoperative assessment of dental occlusion and maxillomandibular fixation is often required for meticulous reduction of facial fractures, which makes the presence of oral endotracheal tube unfeasible. The aim of the study was to evaluate the retromolar placement of tracheal tube to secure the airway in patients of maxillofacial injury. Subjects and Methods: Thirty seven adult consenting patients of ASA physical status I and II of either gender aged 20 to 58 years who met the inclusion criteria, were enrolled for this prospective cohort study. After induction, orotracheal intubation was done with flexometallic tube, then the tube was grasped with gloved fingers and mobilize to retromolar apace, fixed with elastic tap at the angle of mouth and oropharyngeal packing was done. After completion of surgery, patients were extubated after proper suction of oral cavity and removal of oropharyngeal pack. There was no intraoperative or postoperative complication due to anesthetic technique. Results: Retromolar intubation was performed successfully without any difficulty in all patients. Intraoperative assessment of dental occlusion and maxillomandibular fixation could be performed without any noticeable changes in airway pressure or visible tube kinking. No anesthetic or surgical complications were encountered in any patient. Conclusion: Retromolar intubation efficiently secured the airway and provided uninterrupted operating field to the surgeon during maxillofacial surgery. Lack of any adverse events encouraged us to present the advantages of retromolar intubation on the basis of our own experience.

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