Airway management using submental intubation in a patient with multiregional facial fractures from a blast injury: a case report.

Airway management in complex maxillofacial trauma is challenging because intraoperative occlusion assessment requires an unobstructed oral cavity, typically favoring nasotracheal intubation (NTI). However, NTI is absolutely contraindicated in patients with a confirmed or suspected basilar skull fracture and is additionally contraindicated when concurrent nasal bone reduction is required. We report the case of a 36-year-old man with multiregional facial fractures caused by a workplace fire-extinguisher blast, in whom an expansile left ethmoid sinus hematoma raised concern for cribriform plate involvement. This finding alone constituted an absolute contraindication to NTI throughout the operative period, irrespective of the planned nasal bone reduction. Tracheostomy was considered disproportionately invasive given that postoperative mechanical ventilation was not required. Submental intubation was performed via a midline submental incision after orotracheal intubation. Mandibular open reduction and internal fixation, closed maxillary and nasal bone reduction, and maxillomandibular fixation were completed without airway interference. The patient was discharged on postoperative day 17 without complications. In this patient, submental intubation served as a safe and effective primary airway strategy when NTI was contraindicated throughout the operative period, providing a less invasive alternative to tracheostomy for patients with complex maxillofacial trauma.