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Endotracheal Tube Fixation to the Maxilla in Patients with Facial Burns

Although the adult face represents only 4 to 5 percent of the total body surface area, optimization of wound care is critical for achieving the best possible aesthetic outcome in this highly visible area. Good results are one factor that will ease the patient’s reintegration into the community after a severe burn. Patients with a severe burn may be intubated for a prolonged period. A tracheostomy is not always required or desired. Traditionally, the endotracheal tube is secured with two fabric tapes tied to the tube and then tied around the lower face and behind the neck. Various forms of sticky tape fixation sometimes used during pediatric anesthesia are completely unsuitable in the setting of raw facial wounds or when prolonged intubation is required. Whatever method is used, fixation must be absolutely secure. A displaced endotracheal tube, especially during the acute edematous phase of a severe burn, may be impossible to reposition. When the burn also involves facial skin, fabric tape fixation is suboptimal, as it interferes with access to the burn wound for cleansing and dressings. It is an ongoing source of sepsis for the subjacent wound. Friction from the tape with even minor head movement will cause shearing of skin grafts or other skin substitutes. Delayed wound healing contributes to suboptimal scars and hypertrophic scar. To minimize these potential problems, our unit has evolved a technique of rigidly securing the endotracheal tube to the maxilla. Dental wires are fixed securely to the tube and are then wired to two screws placed in the alveolar process of the maxilla. PATIENTS AND METHODS