Blast injury face: An exemplified review of management

Abstract

Facial injuries are extremely common due to increased incidence of vehicular and industrial trauma and warfare injuries. But isolated injury to the face due to low voltage cells exploding is rare. In blast injury, the force can cause massive soft tissue injury, along with injury to facial fractures and damage to adnexa. Facial injury is not life threatening unless associated with other injuries of the skull and airway. The major risks to airway in facial trauma are due to anatomic alteration of patient's airway through bony and soft tissue disruption and increased chances of aspiration. The past several decades have seen a rapid growth in the range of procedures available for reconstructive purposes. However, the essential preliminary management is a must and needs to be structured. The patient, a 10-year-old boy, was joining three pencil batteries in series and twisting the wire with his teeth when one battery exploded causing severe injuries to midface and mandibular region. After stabilization, the patient was taken up for surgery. A cap splint with zygomatic suspension was done for the maxilla, and wiring of residual mandibular segments with lining and skin cover provided by a deltopectoral flap was done. Reconstructive surgeries for reconstruction of the upper lip and maintenance of oral continence were planned for the future. The present case stresses the importance of educating the masses about unsafe handling of low voltage devices, management of airway, massive soft tissue injury, along with facial fractures and damage to adnexa.

Transmylohyoid Orotracheal Intubation: An Expedient Method of Airway Management in Multiple Facial Fractures

“…Fiberoptic-guided nasotracheal intubation requires advanced expensive equipment and technical expertise, thus limiting its use at primary health care center. 4 In these conditions, tracheostomy may be indicated, but is known to be associated with hemorrhage, surgical emphysema, wound site infection, recurrent laryngeal nerve injury, tracheal stenosis, poor scar esthetics, fistula, and death. 5 Transmylohyoid intubation is indicated in cases of panfacial fractures, NOE complex fractures, skull base fractures, transmaxillary skull base tumors, pathologies of maxillofacial region, congenital deformities, elective facial osteotomy, and requirement of short-term airway maintenance (>7 days).…”

“…1 Anesthesiologists may be reluctant to use nasotracheal intubation in cases of naso-orbito-ethmoid (NOE) and skull base fractures. If performed, it may interfere CASE REPORT [1][2][3][4] Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University Dental College and Hospital Pune, Maharashtra, India requires surgical expertise, diligent postoperative care, and is known to cause nonesthetic visible scarring. The transmylohyoid orotracheal intubation is an excellent alternative to maintain the airway during maxillofacial surgeries, with access to all fracture sites, intraoperative assessment of occlusion, and use of MMF.…”

Extraordinary bleeding control technique for massive bleeding in maxillofacial injury due to improvised explosive device

“…yabancı cisimleri temizlemek, havayolunu sağlamak ve defektleri onarmak öncelikli ve hayat kurtarıcıdır. [1,4] Kompleks makillofasiyal yaralanmalar cerrah için hem maksillofasiyal bütünlüğün sağlanabilmesi nedeniyle hem de acil kanama kontrolü ve havayolu güvenliği sağlanması sorumluluğu nedeniyle zorluk yaratmaktadır. [5] Acil cerrahi sırasında en azından kanama kontrolünün sağlanması hayat kurtarıcı olmakta ve bu cerrahinin temel amacını oluşturmaktadır.…”

Safely Airway Management in Larinks and Tracheobronchial Injuries

“…Günümüzde, fasiyal travmalar, trafik kazaları, endüstriyel kazalar, silah ve bıçak saldırıları, terör eylemleri ve savaş yaralanmaları nedeniyle oldukça yaygındır (4,5) . Fasiyal yaralanmalar, kafa travması ve hava yolu bütünlüğünde bozulma ile birlikte değilse genellikle yaşamı tehdit etmez.…”

“…Hastaneye varmış politravma hastalarının morbidite ve mortalitesi genellikle hava yolu yönetimindeki hatalar sonucu ortaya çıkar. Gruen ve ark.(3) hastaneye ulaştırıl-mış 2594 politravma hastasında mortaliteye katkıda bulunan hata modellerini saptamaya çalışmışlar, hava yolu güvenliğinin sağlanamaması veya korunamamasının mortaliteye ilişkin en yaygın faktör olduğunu bulmuşlardır.Günümüzde, fasiyal travmalar, trafik kazaları, endüstriyel kazalar, silah ve bıçak saldırıları, terör eylemleri ve savaş yaralanmaları nedeniyle oldukça yaygındır (4,5) . Fasiyal yaralanmalar, kafa travması ve hava yolu bütünlüğünde bozulma ile birlikte değilse genellikle yaşamı tehdit etmez.…”