In a patient with Le-fo II, Le-fo III, & naso-ethmoid , what is the choice of intubation?

Submental Surgical repair of maxillofacial trauma requires modification of the standard anesthesia technique. Nasal endotracheal intubation is often contraindicated in the presence of fracture of base of he skull. Comminuted midfacial fractures cause physical obstruction to the passage of nasotracheal tube. Fuher, the presence of nasotracheal tube can interfere with surgical reconstruction of fractures of the naso- orbital ethmoid (NOE) complex. Surgical reconstruction often involves maxillo-mandibular fixation in the intra operative period to restore patient's dental occlusion. This precludes the use of oral endotracheal intubation in such cases. In these conditions tracheostomy may be indicated but it carries a significant morbidity. Submental endotracheal intubation has been described as an useful alternative totracheostomy