Improved submental intubation

Tracheal intubation via the submental route can be useful for safe and effective airway management during maxillofacial surgery. This method requires use of a tracheal tube, which is flexible, kink resistant and whose connector can be quickly and easily removed and reattached. This is necessary during passage of the tube through the floor of the patient's mouth. Until recently, standard armoured tubes were the only option for this, but use was limited because the connector was bonded firmly to the tube [1]. We report that the flexible tracheal tube supplied with the intubating laryngeal mask (ILM, Intavent, Maidenhead, UK) can be used for submental intubation. The tube is flexible, kink resistant and also has the distinct advantage that its connector is purposely designed for easy removal and refitting. Additionally, the design of the tube tip is such that entry into the larynx is more efficient compared with other tubes [2]. We also mention that should an ILM tube be unavailable, a standard armoured tube can be adapted for submental intubation just before use by using a suitable dental drill to shave off the edges of the connector to a smooth edge. D. R. BallM. ClarkP. JeffersonT.