Evaluation of the Safety and Complications of Submental Intubation in Maxillofacial Trauma Patients: A Five-Year Clinical and Ultrasonographic Study (2018–2023) Publisher Pubmed



Roochi MM ; Asefi H ; Heydar H ; Matloubi N
Source: Oral and Maxillofacial Surgery Published:2025

Abstract

Objective: Submental intubation offers a safe and less invasive alternative to tracheostomy in maxillofacial trauma patients when oral or nasal intubation is contraindicated. This study aimed to assess the safety, complications, and long-term outcomes of submental intubation over a five-year period (2018–2023), with a novel emphasis on salivary gland evaluation using ultrasonography. Methods: A retrospective cohort study was performed on 31 patients who underwent submental intubation between 2018 and 2023 at Sina Hospital, Tehran University of Medical Sciences. Clinical assessments included intraoperative and postoperative complications, scar outcomes, and lingual nerve function. Ultrasonographic examinations of submandibular and sublingual glands were conducted to detect volumetric and echoparenchymal changes, with comparisons made between the incision and contralateral intact sides. Statistical analysis employed paired t-tests and Wilcoxon signed-rank tests. Results: Submental intubation was successfully performed in all patients with a mean operative time of 7 ± 2 min. No major intraoperative or postoperative complications such as bleeding, hematoma, or infection were observed. Scar appearance was acceptable in all cases, with only two patients developing widened scars and none exhibiting hypertrophic scars. Ultrasonography revealed normal echoparenchyma in 90.3% of cases. Three patients showed hyperechoic parenchyma with reduced gland volume on the incision side, potentially attributable to previous trauma rather than the intubation procedure. No significant differences in gland volume were detected between the incision and intact sides (p = 0.165). Conclusion: Submental intubation is a safe, effective, and minimally invasive airway management technique for maxillofacial trauma patients, associated with minimal complications and favorable cosmetic outcomes. This five-year study provides new ultrasonographic evidence confirming the safety of salivary gland function. Further studies with extended follow-up are recommended to exclude rare late-onset complications such as mucoceles or ranulas. © 2025 Elsevier B.V., All rights reserved.