Thirty years of submental intubation: a review

Submental intubation has been used as an alternative to conventional intubation in the field of oral and maxillofacial surgery since its introduction by Francisco Hernández Altemir in 1986. A review of submental intubation was performed using data from all case reports, case-series, and prospective and retrospective studies published between 1986 and 2016. The indications, variations in incision length, incision sites, types of endotracheal tube used, methods of exteriorization, and complications were recorded and analyzed. A total of 70 articles reporting 1021 patients were included. The main indication was maxillofacial trauma (86.9%, n = 887), followed by orthognathic surgery (5.8%, n = 59), skull base surgery (2.8%, n = 29), and rhinoplasty and rhytidectomy (1.5%, n = 15). The complication rate was relatively low: 91.0% of patients (n = 929) were complication-free. The most common complication was infection, occurring in 3.5% (n = 36) of the total number of patients, followed by scarring (1.2%, n = 12) and formation of an orocutaneous or salivary fistula (1.1%, n = 11). In summary, submental intubation is a good alternative airway with minimal complications.