INTRODUCTION: Surgical repair of complex maxillofacial trauma presents a challenge to the surgeon and anesthesiologist. Where intubations via oral and nasal route cannot be performed, sub-mental route of endotracheal intubation is a very useful alternative. Here is a case report where we avoided tracheostomy in a patient with multiple maxillofacial fractures and opted for the sub-mental endotracheal intubation technique.

CASE DESCRIPTION: A 38yrs old male presented with facial trauma. Diagnosis of Lefort # was made and Patient was posted for ORIF. Pre anesthetic assessment was done. Difficult airway was anticipated and consent for surgical tracheostomy was obtained. Awakefibreoptic bronchoscope guided nasal intubation was planned. In OR, after topical anesthesia of airway, Nasal intubation withfibreoptic flexible bronchoscope was attempted. Because of bleeding, the procedure was abandoned. Bronchoscope guided Oral intubation was done and airway was secured. After induction, Oral endotracheal tube was changed submentally. After surgery, ET tube is changed back orally.

CONCLUSION: Sub-mental intubation is a reliable and safe method of alternative airway management in maxillofacial surgery. This technique is simple, quick to perform, cosmetically better, and associated with lesser complications than tracheostomy. It should be considered by both the anaesthesiologists and the maxillofacial surgeons in challenging cases.