Transmylohyoid/Submental intubation: review, analysis, and refinements.

Successful outcome in any surgery is dependent on unobstructed access. Management of patients with polytrauma of the face or those undergoing multiple/complex facial osteotomies has always been a challenge, not only to maxillofacial surgeons but also to the anesthetists, as both specialists fight for the same anatomic territory. Hernandez in 1986 published the first article on the submental route for endotracheal intubation. He developed this technique to avoid tracheotomy particularly in maxillofacial trauma where short-term maxillomandibular fixation was required.Since our first report in 1992, we have successfully avoided tracheostomy in 400 patients, by using this technique of transmylohyoid intubation. Experience of 20 years is put forward with critical analysis of problems and complications along with certain suggestions and refinements.