Upper Airway Obstruction in a Panfacial Fracture

Colombo, Luara Teixeira; Mulinari‐Santos, Gabriel; Souza, Francisley Ávila

doi:10.1097/scs.0000000000004736

Cited by 3 publications

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“…Hallmark injury profiles in facial fracture patients requiring primary endotracheal intubation include posterior displacement of the fractured maxilla or flail mandibles, which are complicated by intractable fracture site haemorrhage [ 5 , 6 ]. Critical airway obstruction typically occurs in panfacial fractures, however, isolated mandibular fractures with inward displacement of the genial tubercle and floor of the mouth may also contribute to this [ 7 , 8 ].…”

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confidence: 99%

“A” stands for airway – Which factors guide the need for on-scene airway management in facial fracture patients?

et al. 2022

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Background Numerous guidelines highlight the need for early airway management in facial trauma patients since specific fracture patterns may induce airway obstruction. However, the incidence of these hallmark injuries, including flail mandibles and posterior displacement of the maxilla, is contentious. We aim to evaluate specific trauma-related variables in facial fracture patients, which affect the need for on-scene versus in-hospital airway management. Methods This retrospective cohort study included all patients with any type of facial fracture, who required early airway management on-scene or in-hospital. The primary outcome variable was the site of airway management (on-scene versus hospital) and the main predictor variable was the presence of a traumatic brain injury (TBI). The association of fracture type, mechanism, and method for early airway management are also reported. Altogether 171 patients fulfilled the inclusion criteria. Results Of the 171 patients included in the analysis, 100 (58.5) had combined midfacial fractures or combination fractures of facial thirds. Altogether 118 patients (69.0%) required airway management on-scene and for the remaining 53 patients (31.0%) airway was secured in-hospital. A total of 168 (98.2%) underwent endotracheal intubation, whereas three patients (1.8%) received surgical airway management. TBIs occurred in 138 patients (80.7%), but presence of TBI did not affect the site of airway management. Younger age, Glasgow Coma Scale-score of eight or less, and oro-naso-pharyngeal haemorrhage predicted airway management on-scene, whereas patients who had fallen at ground level and in patients with facial fractures but no associated injuries, the airway was significantly more often managed in-hospital. Conclusions Proper preparedness for airway management in facial fracture patients is crucial both on-scene and in-hospital. Facial fracture patients need proper evaluation of airway management even when TBI is not present.

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Section: Introductionmentioning

confidence: 99%

“A” stands for airway – Which factors guide the need for on-scene airway management in facial fracture patients?

et al. 2022

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“…In trauma patients, airway management is challenging beyond the placement of an endotracheal tube, and the outcomes depend upon the provider's ability to anticipate difficulty [2]. Among the types of facial trauma, panfacial fractures are caused by high-energy trauma and potential-ly result in upper airway obstruction, which needs a rapid diagnosis to save the patient's life [3].…”

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Adam's apple and airway obstruction

Hwang¹

2022

J Trauma Inj

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I enjoy action movies like the James Bond (007) series because many famous landmarks are filmed in them. The title of the 14th film in the 007 series was "A View to a Kill" (1985, starring Roger Moore). While watching this movie, I enjoyed the depiction of several places in France, especially the Château de Chantilly. This castle has a very beautiful garden and the Musée Condé.Among the many collections of the museum, a drawing in a book intrigued me. A naked man is holding his neck with both hands. He seems to be suffering from asphyxia. A naked woman with an apple in her right hand is looking at him. Between the man and woman, a snake is slithering up a tree. The name of the book is Abstract of the Bible, Revelation (Chantilly, Condé Museum, 0028, printed in 1378) (Fig. 1).This drawing was made very early, in 1378, well before the publication of Milton's Paradise Lost in 1667, which reads:"Of man's first disobedience, and the fruit Of that forbidden tree, whose mortal taste Brought death into the world, and all our woe, With loss of Eden, till one greater man Restore us, and regain the blissful seat, Sing Heav'nly Muse…" Among the many paintings of Adam and Eve, this one is unique because it expresses the suffering face of Adam as he experiences asphyxia caused by eating an apple. This leads to an intriguing question: why do people believe that the fruit was an apple and use the term "Adam's apple" for the thyroid cartilage? In Genesis 3:5, Vulgate, Satan says, "You will be like God, knowing good and evil (Eritis sicut Deus, scientes bonum et malum)". The Latin word "malum" has several meanings: evil, disaster, and apple. It seems that in this context, "malum" was understood as an apple.As trauma surgeons, we frequently encounter patients who suffer from airway obstructions, like Adam in the above-described picture, especially in cases of facial injuries.Airway obstruction due to a foreign body often can be easily treated; if the foreign body is removed, the patency of the airway can be restored. Airway obstruction caused

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Anatomist’s View of Artistic Works

Hwang

2024

Good Physician, Good Plastic Surgeon

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Upper Airway Obstruction in a Panfacial Fracture

Cited by 3 publications

References 4 publications

“A” stands for airway – Which factors guide the need for on-scene airway management in facial fracture patients?

“A” stands for airway – Which factors guide the need for on-scene airway management in facial fracture patients?

Adam's apple and airway obstruction

Anatomist’s View of Artistic Works

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