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Revista Cubana de Anestesiología y Reanimación

2014, Number 2

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Revista Cubana de Anestesiología y Reanimación 2014; 13 (2)

Submandibular bypass to secure the airway in facial trauma

Torres RLE, Villarreal TC, Morejón ÁFC, Díaz GE, Camacho DR

Language: Spanish
References: 15
Page: 182-191
PDF size: 199.11 Kb.


ABSTRACT

Introduction: Tracheostomy is one of the most effective resources in the treatment of facial trauma. This technique has been used for more than two hundred years. Few surgical interventions have saved as many lives as tracheostomy, since it makes it possible to secure a safe airway for the patient. However, as with all surgical procedures, tracheostomy may also have complications. Submandibular endotracheal bypass is a viable alternative when temporary tracheostomy is required. It consists in the passage of an endotracheal tube from the mouth outwards through an incision in the submandibular region. It is called panfacial fracture when the lesions compromise the upper, middle and lower thirds of the face, resulting in serious disturbance of the facial architecture.
Introduction: Tracheostomy is one of the most effective resources in the treatment of facial trauma. This technique has been used for more than two hundred years. Few surgical interventions have saved as many lives as tracheostomy, since it makes it possible to secure a safe airway for the patient. However, as with all surgical procedures, tracheostomy may also have complications. Submandibular endotracheal bypass is a viable alternative when temporary tracheostomy is required. It consists in the passage of an endotracheal tube from the mouth outwards through an incision in the submandibular region. It is called panfacial fracture when the lesions compromise the upper, middle and lower thirds of the face, resulting in serious disturbance of the facial architecture.
Methods: A presentation is provided of the four stages of the technique described by Altemir and detailed by Guevara Mantilla and cols. Patients were carried to the operating room for emergency and elective surgery prior coordination with the Anesthesiology and Resuscitation Service. Submandibular bypass was performed first, followed by the procedure scheduled for each patient.
Conclusions: The procedure allows appropriate control of the airway and constitutes a safe, effective alternative for patients with complex trauma of the facial middle third. No complications were found during surgery or in the postoperative period.


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