The incidence was surely less than seen in our case. In another study conducted by Nyarady et al 6 no cases out of 8 developed infection at the site.
In our study there was no reported any other potential complication as mentioned in literature like accidental extubation, tube obstruction, orocutaneous fistula, submandibular mucocele, salivary fistula, trauma to the submandibular and sublingual glands or canals, lingual nerve damage. This was in accordance with the studies conducted by Nyarady et al 6, Thomas et al 24 and Shetty et al 22. On the contrary studies conducted by Gupta et al 23 and Chandu et al 5 these complications were reported. Gupta et al 23 found in 1 case out of 15 cases that there was accidental disconnection of tube from the circuit perioperatively, which was recognized immediately and reconnected to breathing circuit whereas Chandu et al 5 found that out of 44 cases there was one case of mucocele of the floor of the mouth, which resolved spontaneously, and one case of temporary paraesthesia of the lingual nerve, which was also resolved spontaneously and there were two episodes of dislodgement of the tube from the trachea. One among that happened intraoperatively, and the other during reversal. Those were promptly recognized, and the patients were re-intubated.
Scar formation is another theoretical disadvantage in submental intubation. In our study we used Vancouver scar scale at 1 month and 3rd month for scar measurement. Vancouver scar scale uses three criteria’s for measuring scar which include vascularity, pigmentation and height. The results showed that the scar was minimal and well accepted by the patient after 3 months. No hypertrophic scar was present too. This was in accordance with the studies conducted previously. 5, 6, 22, 23, 24
In previous studies intubation never interfered with the planned orthognathic operation and in study conducted by Nyarady et al 6 intraoral manipulation was free in all patients. The interdental occlusion was also easily checked. Our study also supports this as 9 out of 10 cases showed no interference during the procedure whereas in 1 case mild interference was noted which also did not affected the planned procedure as such.
Damage to nasotracheal tubes during orthognathic surgery has occasionally been reported 25 but it may be more common than realised. Moreover due to inadvertent technique using surgical saw and pterygomaxillary disjunctions may severed or displace the nasotracheal tube in some instances.
Securing the naso-tracheal tube with septum have been reviewed, but in case correction of deviated nasal septum will be difficult and unpredictable.
The traditional method of nasal to oral tracheal tube change is sim¬ply removing the naso-endotracheal tube and replacing it with an oro-tracheal tube via direct laryngoscopy 26, 27. Unfortunately, this approach does not guarantee success of reintubation or even ventilation and poses some other potential risks like damage to the previously repaired area and aspiration of blood.
Werther et al. 28 converted a naso-endotracheal tube to an oro-endotracheal tube without extubation and reintubation in 10 cases by pushing the nasal portion of the endotracheal tube posteriorly into the nasopharynx and pulling the nasal portion of the tube into and out of the oral cavity. Muto et al. 29 im¬proved the technique using a specially designed retractor and clamp. These techniques carry a potential risk for problems with the pilot balloon assembly, which is replaced and used simulta¬neously with the same endotracheal tube.
The main advantage of the submental intubation being minimal intraoperative distortion of the nasolabial soft tissue was clearly evident in our study. In our study all patients required maxillary movement, the submental intubation technique allowed accurate measurement of the changes in the soft tissue of the nose and upper lip. This technique allows accurate placement of
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