(2) Can Positioning an Oral Endotracheal Tube in the Retromolar Space Allow Maxillomandibular Fixation without Occlusal Interference?

Abstract:

Purpose: Traumatic maxillofacial injuries requiring maxillomandibular fixation (MMF) traditionally necessitate airway management via tracheostomy or submental intubation. The aim of this study is to understand whether the retromolar space can accommodate passage of a reinforced endotracheal tube (ETT) without interfering with establishing MMF, a technique previously described as retromolar intubation.

Methods: A retrospective cross-sectional study was created, including previously treated facial trauma patients by the authors' department as the study sample. From this group, 3D-reconstructed scans were created and used to estimate dimensions of the retromolar space. The averages of these dimensions were calculated and compared to the area occupied by differently sized reinforced ETTs (6.0, 6.5, 7.0, 7.5, 8.0). A 1-sample T-test was used to compare the retromolar areas to each ETT size for all patients and by gender.

Results: Forty-one patients, ages 19-69 years old, treated from July 2010 to November 2018 were included in this study. This included 24 males (21-69 years old) and 17 females (19-60 years old), with a total of 81 measurements. The retromolar areas calculated were statistically bigger than the reinforced ETT sizes 6.0 and 6.5 for both males and females, but not statistically significant for reinforced oral ETT sizes 7.0, 7.5 and 8.0.

Conclusion: The study results suggest the use of 6.0 and 6.5 reinforced ETTs can be positioned in the retromolar space, therefore allowing the establishment of MMF without occlusal interference. This technique could provide an alternative option to submental intubation or tracheostomy.