**5.6 Submental orotracheal tube intubation**

The technique was described to give the surgeon full access to the oral cavity and is indicated in patients with mid-face comminuted fracture, when nasal intubation is contraindicated, or in those patients who require restoration of the occlusion and their condition permits extubating patients at the end of surgery [29].

The technique is contraindicated in inpatients with comminuted mandibular fractures [29].

**Figure 4.** *Submental intubation.*

A reinforced, armored, endotracheal tube is used in this technique, in order to prevent the tube from kinking during its usage. After a regular orotracheal intubation, the tube is passed by blunt dissection through the floor of the mouth at halfway between the chin and the angel of the mandible, and then sutured to the skin to secure position (**Figure 4**).

Complications from submental endotracheal intubation include bleeding, damage to the lingual and mandibular branch of the facial nerve and damage to the submandibular gland and/or its duct [30, 31].
