Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach

Abstract

According to the Advanced Trauma Life Support recommendations for managing patients with life-threatening injuries, securing the airway is the first task of a primary caregiver. Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient's survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient's airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult. Additionally, some of these patients may not yet have been cleared of a cervical spine injury, and all are regarded as having a full stomach and having an increased risk of regurgitation and pulmonary aspiration. The requirements of the intended maxillofacial operation may often preclude the use of an oral intubation tube, and alternative methods for securing the airway should be considered before the start of the surgery. In order to improve the clinical outcome of patients with maxillofacial trauma, cooperation between maxillofacial surgeons, anesthesiologists, and trauma specialists is needed. In this review, we discuss the complexity and difficulties of securing the airway of patients with maxillofacial trauma and present our approach for airway management of such patients.

Penetrating Neck Trauma: Challenges to Anaesthesiologist

“…Airway stabilisation with adequate pulmonary mechanics is the cornerstone of management in these patients [6]. Pre-oxygenation should be mandatory in these patients, as most of these cases are warranted difficult airway [7]. Effective pre-oxygenation of lungs gives an extra time in the management of airway by increasing oxygen content and Functional Residual Capacity which is the principal store of oxygen during apnoea.…”

“…These patients were considered to be full stomach because digestion stops when trauma occurred [7]. As these patients bleed from upper airway, blood is swallowed and accumulated in stomach, therefore risk of regurgitation and aspiration is high.…”

Failed Mask Ventilation due to Air Leakage around the Orbit in a Patient with a History of Radical Maxillofacial Surgery with Orbital Exenteration

“…There have been several reports on difficulties in the airway management of patients with maxillofacial trauma (3,4). One study found that difficult intubation occurred in 6 of 18 (33%) patients who underwent maxillofacial surgery and previous major head and neck surgeries (1).…”

Anesthesia and Analgesia In War and Terror Injuries

“…Son yıllarda savaş ve terör yaralanmalarında koruyucu ekipmanların diğer vücut bölglerini iyi korumasından kaynaklı penetran yüz ve boyun yaralanma insidansı artmıştır (4,10,11) . Bu yaralanmalardaki hava yolu yönetimine yönelik her bir teknikte avantaj ve dezavantajlar vardır.…”

“…Mutiple yaklaşımların yanı sıra önerilen rehberlerin izlenmesi önemlidir (2) . Standart monitörizasyon ile (özellikle ETCO 2 ) hasta izlenmelidir, preoksijenasyon mutlaka uygulanmalı, hava yolu optimizasyonunu için bilinçli hastanın en rahat pozisyon almasına izin vermeli, bilinci yerinde olmayan hastalarda çenelerin itilmesi (Jawthrust) manevrası ile hava yolu açıklığı sağ-lanmalıdır (4)(5)(6)(7)(8)(9)(10)(11)(12) . Penetran boyun yaralanmaları olan stabil hastalarda tomografi ilk seçenek olarak düşü-nülmeli ve yaralanmanın durumu ortaya konmalıdır.…”