In Situ Submental Tunneling Using Traumatic Tracts for Airway Management in Maxillofacial Gunshot Injury: A Two-Case Series

Submental intubation is an alternative to tracheostomy when oral and nasal intubation are contraindicated in maxillofacial surgery. We report two cases of self-inflicted facial gunshot injuries in which pre-existing traumatic tracts were used to externalize reinforced endotracheal tubes, avoiding tracheostomy and additional incisions. Multidisciplinary coordination between anesthesia and surgical teams enabled safe airway management and unobstructed surgical access. Both patients remained intubated postoperatively for airway protection without airway-related complications. These cases suggest that, in selected trauma patients, existing tracts may provide a safe and efficient alternative to traditional submental intubation.