Facing the airway challenges in maxillofacial trauma: A retrospective review of 288 cases at a level i trauma center

Abstract

Background:Maxillofacial trauma is an apt example of a difficult airway. The anesthesiologist faces challenges in their management at every step from airway access to maintenance of anesthesia and extubation and postoperative care.Methods:A retrospective study was done of 288 patients undergoing surgery for maxillofacial trauma over a period of five years. Demographic data, detailed airway assessment and the method of airway access were noted. Trauma scores, mechanism of injury, duration of hospital stay, requirement of ventilator support were also recorded. Complications encountered during perioperative anaesthetic management were noted.Results:259 (89.93%) of the patients were male and 188 (62.85%) were in the 21-40 year range. 97.57% of the cases were operated electively. 206 (71.53%) patients were injured in motor vehicular accidents. 175 (60.76%) had other associated injuries. Mean Glasgow coma scale score (GCS), injury severity score (ISS) and revised trauma score (RTS) were 14.18, 14.8 and 12, respectively. Surgery was performed almost nine days following injury. The mean duration of hospitalization was 16 days. ICU admission was required in 22 patients with mean duration of ICU stay being two days. Majority of patients had difficult airway. 240 (83.33%) patients were intubated in the operating room and fibreoptic guided intubation was done in 159 (55.21%) patients. Submental intubation was done in 45 (14.93%) cases.Conclusions:Maxillofacial injuries present a complex challenge to the anaesthesiologist. The fibreoptic bronchoscope is the main weapon available in our arsenal. The submental technique scores over the time-honored tracheostomy. Communication between the anaesthesiologist and the surgeon must be given paramount importance.

Rapid Sequence Intubation for Head Injury Patients. A Practice

“…In the case of these fractures associated with bruise and swelling of the brain, the occurrence of intracranial hematoma, fractures in the anteriol and the middle cranial fossa, the patient's condition requires rapid airway protection and multidisciplinary treatment of: the neurosurgeon, neurotraumatologist, maxillofacial surgeon and the intensive care team. Among the fractures of the middle part of the face there are isolated fractures of the orbital fracture, zygomatic-orbital fracture, zygomatic-maxillo-orbital fracture and orbitonasal displacement [5][6][7] Unless it is accompanied by multiorgan injury, they are generally not life-threatening. Fractures of the lower part of the face in the form of mandibular fractures on both may lead to coverage for the front of the tongue and its maturity by closing the airway.…”

Safely Airway Management in Larinks and Tracheobronchial Injuries

“…Travma yönetiminin ABC'lerinin acil serviste yapılmasını sağlamak için ciddi bir fasiyal travma ile uğraşırken multidisipliner yaklaşıma gereksinim duyulmaktadır. Amaç; hava yolu güvenliğinin sağlanması, hastanın solunumunun stabilize edilmesi, kanamanın kontrol edilmesi ve servikal vertebralarda herhangi bir hasar olmadığından emin olmaktır (7) .…”

“…Gupta ve ark. (7) MFT geçirmiş hastalarda, ağız açıklığının iki parmak genişliğinden daha az ve Mallampati skorunun 3 veya 4 olduğunu belirlemişlerdir. Bu yüzden bu hastaların acil serviste mevcut zor hava yolunu yönetmek için kıdemli bir anestezi personelin mevcut olması gerektiği önerilir.…”

“…Travma yönetiminin ABC'lerinin acil serviste yapılmasını sağlamak için ciddi bir fasiyal travma ile uğraşırken multidisipliner yaklaşıma gereksinim duyulmaktadır. Amaç; hava yolu güvenliğinin sağlanması, hastanın solunumunun stabilize edilmesi, kanamanın kontrol edilmesi ve servikal vertebralarda herhangi bir hasar olmadığından emin olmaktır (7) .Supraklavikular bölgede yaralanması olan bir hastada görüntüleme ile aksi ispat edilene kadar servikal vertebra hasarı var olarak kabul edilir (8) . Bilinci yerinde olmayan veya nörolojik defisitli, anormal refleksleri Okmeydanı Tıp Dergisi 33(Ek sayı):…”

Validation of Prehospital Predictor of Macroaspiration at Trauma Site Score: Correlating with Mortality following Severe Aspiration Pneumonia

“…[10][11][12] b. Fracture of mandible causes difficulty in swallowing and internal hemorrhage. If associated with retching and vomiting, it may predispose to macroaspiration.…”