Securing a definitive airway in maxillofacial trauma is paramount yet challenging due to anatomical disruption, hemorrhage, and trismus. Conventional orotracheal or nasotracheal intubation can be contraindicated or hazardous. Submental intubation (SMI) has emerged as a effective and safe alternative to tracheostomy, providing unobstructed surgical access without the associated long-term morbidity. This comprehensive review critically appraises the technique, outcomes, and applications of SMI, anchored by a typical case of a 32-year-old male with Le Fort II and frontal bone fractures successfully managed with SMI.
We detail the evolution of SMI, its surgical technique, precise indications, contraindications, and comparative benefits. Its principal advantages include a reduced risk of dental injury, avoidance of tracheostomy-related complications, and facilitation of intraoperative maxillomandibular fixation. A systematic analysis of the literature reveals high success rates (~98.5%) and low complication rates (~6.2%), supporting its utility in both trauma and elective orthognathic surgery.
Despite its benefits, SMI demands precise anatomical knowledge to avoid neurovascular injury. This review underscores the role of multidisciplinary planning in complex trauma and advocates for the wider adoption of SMI, contingent on structured training and standardized protocols. Future studies should focus on long-term functional outcomes and technical refinements to solidify its place in the airway management arsenal.

Submental intubation, Maxillofacial trauma, Airway management, Le Fort fractures, Surgical access, Trauma anesthesia, Alternative intubation