In patients who have sustained base of skull fractures, the mode of in
tubation is controversial, with many anaesthetists arguing against nas
al intubation. In several maxillofacial procedures temporary intermaxi
llary fixation (IMF) in the intraoperative period may be essential to
achieve optimal results in fixation. For patients with combined facial
and base of skull injury, tracheotomy may have to be performed. The s
ubmental approach to intubation allows IMF to be used without resort t
o nasal intubation or tracheotomy. We describe a modification of the o
riginal technique which is applicable to any reinforced tracheal tube
and which does not compromise the airway.