Submental intubation. The patient had bilateral mandibular, maxillary, and nasal bone fractures; a nasal intubation was contraindicated. After induction of anesthesia and orotracheal intubation with an armored endotracheal tube (ETT), the surgeons incised the mucosal and external submandibular area and then pulled the ETT through the floor of the mouth to the submandibular area, reattaching the connector. If the patient is to remain in mandibular–maxillary fixation (MMF), he can be extubated from this location. If MMF is released at the end of the case, the ETT is returned to the oropharynx and extubation proceeds as usual: in the operating room, the postanesthesia care unit, or the intensive care unit.