Clinical and critical care concerns of cranio-facial trauma: A retrospective study in a tertiary care institute

Abstract

Background and Objectives:Maxillofacial trauma is commonly associated with other injuries, predominantly head injuries. The predictors of outcome in such concomitant injuries have been studied the least. The present study aims at the evaluation of types of injury, management and outcome of patients sustaining maxillofacial trauma and concomitant cranial injuries.Materials and Methods:A retrospective study was carried out in the department of anesthesiology and intensive care. A case series of 129 patients was evaluated who were admitted in ICU (Intensive Care Unit) with maxillofacial trauma and head injuries. The data was then compiled systematically and analyzed using SPSS windows and value of P < 0.05 was considered significant and P < 0.001 as highly significant.Results:Among the 129 patients, majority of them had roadside accidents (RSA > 90%) and male gender predominance with male to female ratio of 5: 1. Fracture maxilla and nasal bones were the most commonly encountered injuries (51.93%) followed by mandibular fractures (39.53%) and fracture of zygomatic bones (28.68%). Eighty five patients (65.90%) required mechanical ventilation, tracheostomy was needed in 29 (22.48%) patients and 81 (62.8%) patients were operated for head injuries as well. Majority of the victims were aged between 15 and 40 years.Conclusions:Maxillofacial trauma and cranial injuries are common among young males and so is the nature of injuries, that is, RSA. Besides facial injuries, head injuries are important determinant of outcome in such patients. Timely resuscitation and surgical interventions at specialized centers are of prime importance as far as a better prognosis is concerned in such injuries.

Craniofacial and maxillary anomalies: Anesthetic implications and management

“…[8] The principles of airway management remain same as with the other craniofacial reconstructive procedures. An important concern is use of nasotracheal intubation desired by the operating surgeon to avoid interference in the surgical fi eld.…”

“…[8,18] The maxillofacial trauma is considered more dangerous due to close proximity of the cranium and involvement of airway leading to breathing abnormalities. [8,18] These maxillofacial fractures can be classifi ed according to their anatomical position and displacement as:…”

“…[24] The most common causes of deterioration in these patients post-operatively are hypoxia, hypercapnia, cerebral edema, intracranial bleeding, electrolyte imbalance and hypoglycemia. [8,18] The extubation of patients of maxillofacial trauma should be done keeping in mind all the general principles of extubation as described above. In addition, use of IMF may cause airway obstruction so tools to release IMF should be readily available at the time of extubation and nasopharyngeal airway should be used to maintain airway patency in post-extubation period.…”

“…[8,18] These patients are slowly weaned and the extubation is performed a er assessment of level of consciousness, airway edema, recovery of protective airway refl exes, normothermia, hemodynamic stability and adequacy of blood loss replacement and circulatory volume. The post-operative complications commonly seen are infection, meningitis and loss of bone segments.…”

Importância epidemiológica de acidentes com motocicletas e bicicletas no contexto atual do trauma bucomaxilofacial no sul do Brasil

“…Studies show that traffic collisions are among the leading causes of maxillofacial trauma [5,[7][8][9][10][11][12][13][14]17,18,20]. Notable subtypes of this type of trauma are incidents involving bicycles or motorcycles, which are represented at a significant percentage as etiological agents.…”