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MAGILL OR MCGILL
- DR. SHASHI KIRAN, DR. KIRAN PREET KAUR (18 February 2008)
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Submandibular approach for tracheal intubation in patients with panfacial fractures.
- Wilson Thomas (10 June 2007)
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Submandibular approach for tracheal intubation in patients with panfacial fractures
- Muhammad Farooq (1 June 2007)
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DR. SHASHI KIRAN, DOCTOR PT.B.D. SHARMA PGIMS, ROHTAK-124001. INDIA, DR. KIRAN PREET KAUR
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To The editor “MAGILL OR MCGILL” We read with interest the article “Submadibular approach for tracheal intubation in patients with panfacial fractures” published in BJA 2007 ; 98(6) : 835-40 (1) .The authors had described the name of “Magill forceps” as “Mcgill forceps” in the discussion part. Since at our institute it is commonly spelled as “Magill” rather than “Mcgill” so we were confused after reading this article and searched the literature for the correct name. In the text Miller’s Anaesthesia sixth edition edited by Ronald D. Miller chapter -1, page- 37 (2), author had used both the name as synonyms i.e he had described “To and fro respiration ------- is credited to Ivan W. Mcgill (1888- 1986)”whereas in the same paragraph in line no. 8, the instrument designed by him had been written as “Magill”. On page no. 38, depicting the picture of various scientists “A” has been named as Sir Ivan Whiteside Magill. This became confusing while teaching the trainees. Can the authors further elaborate on the controversy regarding the exact spelling of the name. Thanks Dr. Shashi Kiran ( Professor) Dr. Kiran Preet ( Registrar ) Department of Anaesthesiology and Critical Care, Pt. B.D. SHARMA PGIMS, ROHTAK-124001 INDIA Conflict of Interest:None declared |
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Wilson Thomas, Anaesthetist Dudley Group of Hospitals, Dudley
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I read with interest on the alternative approach to tracheal intubation for Maxillo-facial surgery1. The submandibular approach to tracheal intubation is a drastic alternative approach to stay away from the surgical field. It is a recognised method of securing airway in patients with severe maxillo-facial injuries. In my set-up the surgeons are quite happy to work around an endo-tracheal tube without dislodging it and would rarely require this technique. In this article 8 out of the 14 patients were reintubated orally at the end of surgery. Why not an oral tube in the first place? The pictures that the author has displayed in the article do not seem to warrant this technique. The risk of the surgical approach would had have been far greater than oral intubation. Dislodgement of the airway tube during surgery in a potential difficult airway with facial trauma and having drapes and blood in the airway would only spell disaster. In the postoperative period it would be quite difficult to access the airway for suctioning and fibro-optic bronchoscopy if needed. In view of the above problems and the risk of surgical trauma to the structures in the neck I would be inclined to use this approach only if the oral route to intubation or tracheostomy was not possible. Reference: 1. Anwer HMF, Zeitoun IM, Shehata EAA. Submandibular approach for tracheal intubation in patients with panfacial fractures. Br J Anaesth 2007;98:835- 40. Conflict of Interest:None declared |
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Muhammad Farooq, dr AMNCH, DUBLIN
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Dear editor I read this article submandibular approach for tracheal intubation in patients with panfacial fractures by H.M.F.Aanwer et al [1].I agree with authors that this technique may be suitable for patients in which oral intubation is not acceptable by surgeons and nasal intubation is impossible. But I have these serious concerns about this technique and I want to ask from authors. My first concern is that reinforced tube when pulled through the dissected track will kink or distort which is source of difficulty in ventilating patient. How did they manage this issue? Pilot tube will either rupture or will be broken because you need a lot force to pull it through the track. This track is not a free tunnel for tube. Secondly, an anaesthetist is not very good in the surgical dissection and especially in these patients with multiple fractures, was this dissection done by surgeon or anaesthetist. Thirdly, Injury to marginal mandibular branch of facial nerve can occur during blunt dissection because mandibular branch runs deep to platysma below the angle of the jaw, crosses superficially to the submandibular gland in the diagastric triangle and then runs forward over the surface of the mandible to supply the muscles of the lower lip and chin [2]. Was there any case of nerve injury, because this will have a huge impact over acceptance of this technique. I do not think that this is a good option as compared to tracheostomy because tracheostomy is well recognised and proven way of airway management when this is not. I agree that tracheostomy is related to more complication but I think this technique is not free of complications. Reference 1. H.M.F.Anwer, I.M.Zeitoun and EA.A.Shehata. Submandibular approach for tracheal intubation in patients with pan facial fractures.BJA 2007 98(6):835-840. 2. H.Ellis et al. Anatomy for Anaesthetists, Eighth Edition. Conflict of Interest:None declared |
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