Stoll's submandibular intubation: A safety alternative to Altemir's submental technique and traditional tracheostomy

ObjectiveSelection of the method of intubation during complex facial surgeries is a difficult task for the anesthetist because of airway is sharing area and oral or nasal intubation is not preferable, even though, tracheostomy is a worthy alternative; however, it has serious complications. Altemir FH introduced the ‘submental technique’ as a substitute for tracheostomy but it has demonstrated the complications of ‘lingual nerve damage’ and ‘Wharton's duct injuries’. So, the Stoll's approach is the safest option in this scenario. The purpose of the present study was to evaluate ‘Stoll's submandibular method’ as a safest choice to Altemir's technique.Materials and methodThe study was conducted prospectively in a sample of 42 patients for intra-operative airway management in complex facial surgeries during the period of six years from 2008 to 13 by considering the following objectives: duration of the procedure, and intra-operative and postoperative complications.ResultsThe average time taken for this procedure was 9 min. The complications encountered were superficial skin wound infection in a total of three patients (7%), partial extubation in one case (2%), cuff leakage in one case (2%) and dislodgement of the tube in one case (2%).ConclusionThe results of the present study have provided the evidence of Stoll's technique as a safest choice both for Altemir's and tracheostomy in justifiable circumstances because of simple, quick technique associated with negligible complications. So, anesthetist should consider this underutilized technique in complex facial surgeries and it is a valuable option in patients, who underwent tracheostomy in previous surgeries.