Pathways to Airways: Review and Considerations of Different Intubation Techniques in Oral and Maxillofacial Surgery

The aim of this work is to review and enlist the variations of intubations required in complex maxillofacial surgeries where temporary maxillomandibular fixation is essential.

Most of the major maxillofacial trauma cases are operated under general anaesthesia. In these cases, both the anaesthetist and maxillofacial surgeon compete for the same area that is oral cavity. Routinely oral intubation is used in anaesthesia, but in maxillofacial surgical cases, there is a possibility of oro-endotracheal tube interfering with the sterile field of surgery as well as it causes inconvenience while working in the oral cavity. Modifications in intubation techniques for anaesthesia are important in complex maxillofacial surgeries.

In complex maxillofacial surgeries fibreoptic, submental, transmylohyoid and retromolar intubation are available techniques where interim maxillomandibular fixation is essential for the reduction of fracture. Of all these techniques, the fibreoptic technique is preferred as it is the most reliable of all techniques. In the case of pan-facial trauma, maxillomandibular fixation is required and interference of tube cannot afford trans mylohyoid and submental can be used as a potential alternative.