A new modification for safer submental orotracheal intubation

Hiroshi Hanamoto, Yoshinari Morimoto, Hitoshi Niwa, Seiji Iida, Tomonao Aikawa

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


In patients in whom a tracheal tube cannot be inserted through the nostrils due to multiple facial trauma or hypoplasty of the nose, submental orotracheal intubation (SOI) is performed to avoid tracheostomy. We report a new modification for SOI to minimize the risk of apnea. A 20-year-old man was scheduled for sagittal split ramus osteotomy. As the patient had severe hypoplasia of the nose, SOI was planned. Following orotracheal intubation with a spiral tube (first tube), a submental tunnel was surgically created. A second tube that had been confirmed, in advance, to snugly fit into the proximal end of the first tube was passed into the submental tunnel via a polypropylene cylinder and connected between the first tube and the breathing circuit. After careful withdrawal of the second tube through the submental tunnel, the first tube was directly connected to the breathing circuit after removal of the second tube. Although this technique requires additional time, apnea time is minimal even in patients in whom withdrawal of the tracheal tube through the submental tunnel takes time, because the second tube forms a link between the first tube and the breathing circuit, making it possible to ventilate the patient throughout the procedure.

Original languageEnglish
Pages (from-to)781-783
Number of pages3
JournalJournal of Anesthesia
Issue number5
Publication statusPublished - 2011


  • Apnea time
  • Oral and maxillofacial surgery
  • Submental orotracheal intubation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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