Submental intubation: a literature review

A literature review was performed to analyse the evidence supporting submental intubation and to aid in the development of a new airway algorithm in craniofacial surgery patients. A systematic search of Pub Med, OVID, the Cochrane Database and Google Scholar between January 1984 and April 2011 was performed. Measured variables included the outcome, complications, publishing specialty journal and method of intubation including technique modifications, indications for the procedure, devices utilized and the total procedure time to complete the submental intubation. Of the 842 patient cases from 41 articles represented in the review, the success rate was 100%. Minor complications were reported in 60 patients and included superficial skin infections (N = 23), damage to the tube apparatus (N = 10), fistula formation (N = 10), right mainstem bronchus tube dislodgement/obstruction (N = 5), hypertrophic scarring (N = 3), accidental extubation in paediatric patients (N = 2), excessive bronchial flexion (N = 2), lingual nerve paresthesia (N = 1), venous bleeding (N = 2), mucocele (N = 1), and dislodgement of the throat pack sticker in the submental wound (N = 1). The average reported time to complete a submental intubation was 9.9 min. Submental intubation is a safe, effective and time efficient method for securing an airway when increased surgical exposure or restoration of occlusion is a priority.