[The experience of submental intubation for severe maxillofacial injuries]. / Opyt submental'noi intubatsii trakhei pri tyazhelykh chelyustno-litsevykh povrezhdeniyakh.

Oral and nasal routes for intubation are often not feasible in maxillofacial fractures. The paper presents our experience of midline and paramedial approaches for submental intubation in the airway management of facial trauma patients. The prospective study included 47 patients with maxillofacial trauma in whom submental orotracheal intubation was performed in 2005-2014. When using midline approach the tube does not always accurately fit into the mandibular lingual groove creating an inconvenience for the surgeon. By paramesial approach the working conditions for the surgeon were the most comfortable. The average duration of the procedure was 5-6 minutes. At the end of the surgery the tube was reversed, the submental wound was stitched, patients were extubated (10 of them were extubated through the submental approach). Eight patients required short-term post-operative mechanical ventilation. In all patients the submental intubation allowed simultaneous reduction and fixation of fractures and intraoperative control of the dental occlusion without interference from the tube during the operation. There were no significant operative or postoperative complications. Submental intubation is a simple, secure and effective procedure for operative airway control in maxillofacial traumas. It is an attractive alternative to tracheotomy in the surgical management of selected cases of maxillofacial trauma.

[General anaesthesia with sevoflurane in dental surgery with use of LMA-Flexible and LMA-ProSeal].

To compare the laryngeal mask airways (LMA), LMA - Flexible (LMA-F) and LMA-ProSeal (PLMA) with respect to airway management in dental surgery. 35 patients, with the pathology of stomatological area (cysts of the lower jaw; diseases maxillary sinus) were investigated during the operation. Anesthesia was induced with propofol, fentanyl and atracurium besylate. Anesthesia was maintained with sevoflurane and neuromuscular blockade with mechanical ventilation. The operation lasted 30-40 min. For airway management was used LMA-F in 20 patients, in 15 patients was made PLMA. There were no statistically significant differences between LMA-F/PLMA groups for SpO(2), ET CO(2) or airway pressure during anesthesia. As for the gas exchange no difference was noticed in both groups (p<0.05). Undesirable laryngo-phryngeal reflexes were not noticed in total myoplegia. The reaction of cardiovascular system while installating LMA-F and PLMA was absent. As for the gas exchange no difference was noticed in both groups (p<0.05). A correctly placed LMA-F or PLMA during general anaesthesia with sevoflurane is effective for airway management in surgery.

[Morphofunctional changes of maxillary sinus mucosa in odontogenic fungal sinusitis].

Complex morphological research of maxillary sinus mucosa in odontogenic fungal sinusitis has revealed signs of granulomatous inflammation. In epithelium occurred metaplasia of simple cubic or columnar layer. Epithelium fiber-synthetic and plastic functions showed significant down-regulation.

[Submental tracheal intubation is an alternative to tracheostomy in oral surgery].

A prospective study was performed in 17 patients who had undergone submental tracheal intubation in facial injury, tumors of the upper jaw, and congenital and acquired deformities of the facial skeleton. The time required for intubation, and the adequacy of gas exchange and ventilation during tracheal intubation and an operation was estimated. Submental intubation was successfully carried out in all the patients. The mean time spent on tracheal intubation was 5-6 min. At surgery, there was no chance extubation or endotracheal tube damage, the parameters of ventilation and gas exchange remained to be within the normal range. A submental scar was minimal. There was inflammation and formation of a bad scar or bleeding at the site of intubation in none case. Submental orotracheal intubation is a safe and simple procedure for airway patency and it may be used as an alternative to tracheostomy in maxillofacial injury, tumors of the upper jaw, and congenital and acquired deformities of the facial skeleton.

[Estimation of tracheal intubation methods in patients with pathology of maxillofacial region].

In 42 patients with pathology of face cranium tracheal intubation was performed by different methods--intubation with artificial jet high frequency lung ventilation (I+AJHFV) and fiber optic intubation (FOI). It was established that more favourable conditions for intubation were created when I+AJHFV was used. FOI with preserved consciousness and spontaneous breathing in patients with pathology of maxillofacial region reduces the time factor significance but demands significant sedative preparation of the patient.

[Efficacy of laryngeal mask use during anesthesia in cases of short-term operations in maxillofacial area].

40 patients, with the pathology of maxillofacial area were investigated during the operation. The operation lasted 60.5+/-6.8 min. Combined intravenous anesthesia with propophol, phentanil, atracrium besylate was used for all patients. The utilization of a laryngeal mask (LM) for respiratory support was used in the first group (20 patients). An tracheal intubation (TI) was made in the second group (20 patients). In total myoplegia, the installation of LM was simple. Undesirable laryngo-pharyngeal reflexes were not noticed. The reaction of cardiovascular system while installing. LM was absent unlike TI. As for the gas exchange no difference was noticed in both groups (p>0.05). After the operation the patients of the first group recovered quicker than the patients of the second group (p<0.05). It is the result of reducing the amount of relaxants in the first group (p<0.05). Hence, anesthesia with LM may be regarded as alternative method of anesthesiological provision for a maxillofacial operations of short duration.

[Transtracheal jet pulmonary ventilation as a measure for preventing hypoxia during reconstructive maxillofacial operations]. / Transtrakheal'naia struinaia ventiliatsiia legkikh kak mera profilaktiki gipoksii pri rekonstruktivnykh cheliustno-litsevykh operatsiiakh.

Anesthesia including high- or low-frequency transtracheal jet ventilation of the lungs was used in 52 patients with maxillofacial abnormalities subjected to repair surgery. The number of respiratory cycles was 20 per min in 1 group and 120 per min in the other. Intubation of the trachea was started 20 min after ventilation was started. Transtracheal jet ventilation of the lungs prevented hypoxia during intubation of the trachea in such patients. High-frequency jet ventilation of the lungs may be a method of choice in such cases.