Airway Management in Facial Trauma Patients

Abstract

Airway management in craniofacial trauma patients is a challenge for an anesthetist. Treating these patients requires a close interdisciplinary communication and cooperation. Maintaining the airway and oxygenation of the patient is the initial challenge in craniofacial trauma patients. The management of the difficult airway is facilitated and patient's safety improved by following one of several published difficult airway algorithms. We describe the St. Gallen difficult airway algorithm for the management of difficult airway in general and the airway in facial trauma patients in particular. Whenever possible, the airway should be secured in a conscious and spontaneously breathing patient. It is important to be familiar with different techniques and to change the approach after two unsuccessful attempts with one technique. Once the airway is established, all available preventive measures should be used to avoid losing the airway. A tracheotomy has its place in a significant number of patients in whom an immediate postoperative or a delayed extubation appears unfeasible.

Severe craniofacial trauma after multiple pistol shots

“…Immediate airway management and bleeding control followed by coordinated multi-disciplinary treatment by the emergency physician, anesthesiologist, intensivist, radiologist, ENT surgeon, craniofacial surgeon, neurosurgeon and plastic surgeon is crucial for the successful treatment of penetrating craniofacial trauma [6,7].…”

“…Treatment plan depends on associated vascular injuries, intracranial communication of lesions, and injuries to any other adjacent vital structures. Establishing a secure airway is of paramount importance [6]. In the case presented here, rapid sequence induction was performed with moderate doses of midazolam and S-ketamine but without administration of any muscle relaxant to maintain spontaneous breathing.…”

“…Impaired airways were more frequently observed after high-velocity injuries and in cases with injuries to the tongue, floor of the mouth, and midline or bilateral facial skeletal bones [4]. Maintaining airway and oxygenation and supporting circulation are crucial in treatment of victims at the scene of crime [5], particularly when mask ventilation and supraglottic airway devices are impractical and intubation difficult [6]. Whenever ventilation fails, at least lateral positioning of the patient should be established to achieve airway patency and drainage of blood [7].…”