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Background <p>Submental intubation is a useful alternative to tracheostomy in maxillofacial trauma when oral and nasal intubation compromise the surgical field. However, many existing modifications depend on additional guiding instruments, increasing complexity, cost, and operative time.</p> Methods <p>Here we introduce a novel modification of Hernández-Altemir’s technique, in which 3-0 non-absorbable sutures were pre-placed near the proximal end of a flexo-metallic endotracheal tube. After oral intubation, a 1-cm submental incision was made and blunt dissection was performed to create a tunnel. The sutures were grasped intraorally with artery forceps and gently pulled through the tunnel, guiding the tube externally without trocars, catheters, or other adjunct tools.</p> Results <p>The technique was performed in five patients with maxillofacial trauma. Passage of the tube through the submental tunnel took 2 minutes 50 seconds to 3 minutes 40 seconds. All cases were completed smoothly without air leakage, soft-tissue trauma, infection, or postoperative complications.</p> Conclusions <p>Suture-guided submental intubation is a simple, safe, and efficient modification that minimizes reliance on specialized equipment and reduces operative duration. This economical approach is particularly advantageous in resource-limited environments and expands the practicality of submental intubation in maxillofacial trauma management.</p>

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A Novel Tube Tie Technique for Submental Intubation Using Non-Absorbable Suture Guidance

  • 期刊论文

  • 发表日期：

    2026年1月19日

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  • Akshay Toshniwal,
  • Shallu Bansal

摘要

Background

Submental intubation is a useful alternative to tracheostomy in maxillofacial trauma when oral and nasal intubation compromise the surgical field. However, many existing modifications depend on additional guiding instruments, increasing complexity, cost, and operative time.

Methods

Here we introduce a novel modification of Hernández-Altemir’s technique, in which 3-0 non-absorbable sutures were pre-placed near the proximal end of a flexo-metallic endotracheal tube. After oral intubation, a 1-cm submental incision was made and blunt dissection was performed to create a tunnel. The sutures were grasped intraorally with artery forceps and gently pulled through the tunnel, guiding the tube externally without trocars, catheters, or other adjunct tools.

Results

The technique was performed in five patients with maxillofacial trauma. Passage of the tube through the submental tunnel took 2 minutes 50 seconds to 3 minutes 40 seconds. All cases were completed smoothly without air leakage, soft-tissue trauma, infection, or postoperative complications.

Conclusions

Suture-guided submental intubation is a simple, safe, and efficient modification that minimizes reliance on specialized equipment and reduces operative duration. This economical approach is particularly advantageous in resource-limited environments and expands the practicality of submental intubation in maxillofacial trauma management.