091. Role of submandibular intubation according to altemir in osteotomies to access the cranial base

Federico Biglioii, Pietro Mortini, Roberta Brusati

Research output: Contribution to journalArticlepeer-review


Aim: Transfacial access to the cranial base often implies displacement of the upper teeth arcade or part of it as in Le Fort I osteotomy or zygomatic-maxillo-cheek flap. The correct and exact reposition of the bone segment is simplified by modeling of the titanium plates prior to executing the osteotomy and by controlling the restoration of individual occlusion at the end of surgery. This is possible if the endotracheal tube does not exit through the mouth. Also, downward displacement of the maxilla in Le Fort I osteotomy is limited by the presence of the orotracheal tube. As the tube may not be rhinotracheal because it would be into the surgical field, a good solution is represented by converting the passage of the orotracheal tube from the mouth through the oral pelvis to the skin of the submental region as suggested by Altemir in 1986. The authors describe their experience with this technique. Materials: Sixteen cases of tumors of the cranial base and rhinopharynx where accessed through transfacial osteotomies with the aid of Altemir's intubation. Methods: Possibility to check that individual occlusion has been tested taking the mandibular condyles into centric occlusal position at the end of surgery. Complications and esthetic results of the intubations where registered. Results: The passage of the tube through the oral pelvis to the submandibular region did not impair mandibular movement as the occlusion has been tested easily any time. In one case the patient developed postoperative infection, treated by washing with saline solution surgically for some days. The scar was always well hidden under the chin. Conclusions: Authors recommend Altemir's intubation as it is quick and easy to be executed, allows control of individual occlusion after transfacial access and frees the surgical field from the presence of the endotracheal tube.

Original languageEnglish
Pages (from-to)34
Number of pages1
JournalSkull Base
Issue numberSUPPL. 2
Publication statusPublished - 2001

ASJC Scopus subject areas

  • Clinical Neurology


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