Pattern of airway management in craniomaxillofacial injury patients with fracture mandible: A retrospective analysis (original) (raw)
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Nigerian journal of surgery : official publication of the Nigerian Surgical Research Society
Despite advancements in airway management, treatment of fractures in the maxillofacial region under general anesthesia remains a unique anesthetic challenge. We reviewed the pattern of airway management in patients with maxillofacial fractures and assessed those challenges associated with the different airway management techniques employed. The anesthetic chart, theatre and maxillofacial operations records of patients who had reduction and immobilization of various maxillofacial fractures over a 2-year period were reviewed. Information obtained included the patient demographics, mechanisms of injury, types of fractures and details about airway management. Statistical Package for Social Sciences, SPSS version 17.0 was utilized for all data analysis. Fifty-one patients were recruited during the 2-year study period. Mask ventilation was easy in 80-90% of the patients, 80% had Mallampati three or four, while 4 (7.8%) had laryngoscopy grading of 4. There was no statistically significant ...
Journal of Health & Biological Sciences, 2021
Introduction : Jaw fractures are one of the most common sites of maxillofacial injuries. The location of the jaw makes it very vulnerable to direct impacts. The purpose of treatment is to restore aesthetic function. Case Report : The purpose of this report is to present a case of comminuted mandible fracture in a young male patient, treated urgently due to the need for maintenance of the airways, where fracture osteosynthesis surgery was submitted. Conclusion: The initial assessment of these trauma patients should follow the Trauma Life Support protocol, and structural damage should be investigated. Introduction: Jaw fractures are one of the most common sites of maxillofacial injuries. The location of the jaw makes it very vulnerable to direct impacts. The purpose of treatment is to restore aesthetic function. Case Report: The purpose of this report is to present a case of comminuted mandible fracture in a young male patient, treated urgently due to the need for maintenance of the a...
Airway management in maxillofacial trauma: do we really need tracheostomy/submental intubation
Journal of clinical and diagnostic research : JCDR, 2014
There are various techniques available for airway management in patients with maxillofacial trauma. Patients with panfacial injuries may need surgical airway access like submental intubation or tracheostomy, which have their associated problems. We have been managing these types of cases by a novel technique, i.e, intraoperative change of nasotracheal to orotracheal intubation. To review our experience about various techniques for the airway management in patient with maxillofacial trauma. To analyse the possibility of using nasotracheal intubation and intraoperative change of nasotracheal to orotracheal intubation in panfacial fractures. In a tertiary care centre four hundred eighty seven patients of maxillofacial injuries, operated over a period of 2 years were reviewed in relation to age, sex, mode of injury, type of facial fractures, methods of airway management and their associated complications. Young patients with male predominance is the most common affected population. Panf...
Implications of Facial Fracture in Airway Management of the Adult Population
Annals of Plastic Surgery, 2019
Purpose: Facial fractures are a harbinger when it comes to airway management. Facial fractures can cause airway obstruction or preclude the use of intubation. We aim to examine the etiologies, types of facial fractures, and the risk factors that may lead to requirement of an advance airway. Methods: A retrospective chart review was performed of all facial fractures in the adult population in a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and course of hospital stay. Results: During the period examined, 2626 patients were identified as 18 years or older and with facial fracture. Among these patients, 443 received airway management. Mean age was 34.21 years (range, 18-95 years), with a male predominance of 91.9%. One hundred nineteen patients were intubated on, or before, arrival to the trauma bay. One hundred three patients required surgical airways on arrival to the trauma bay, and 91 of these patients were also reported to have been intubated before arrival. There were a total of 741 fractures identified on radiologic imaging. The most common fractures observed were orbital fractures, frontal sinus fractures, and nasal fractures. Mean Glasgow Coma Scale score on arrival was 9.45 (range, 3-15). Gunshot wound was also the most common etiology among those who were intubated and those who received a surgical airway. The most common concomitant injuries were traumatic brain injury, intracranial hemorrhage, and skull fracture. Forty-one patients died, most of which were intubated during their hospital course. Conclusions: There is a dearth of literature detailing standardization of airway management for patients who present with facial fractures. The difference between intubation and surgical airway is often a subjective judgment call, but the authors believe that a more streamlined process can be elucidated after analyzing previous trends as well as variabilities in patient survival and prognosis.
Airway management in maxillofacial trauma
Journal of Anaesthesiology Clinical Pharmacology
Airway management of patients with maxillofacial trauma remains a challenging task for an anesthesiologist in the emergency and perioperative settings due to anatomical distortion. Detailed knowledge of maxillofacial and airway anatomy is desired for the correct diagnosis of extent and severity of the injury. Basic principles of advanced trauma life support protocols should be followed while managing such patients. Establishing unobstructed airway remains the top priority while maintaining C-spine immobilization and preventing aspiration. Although multiple options exist for securing the airway, a universal technique of airway management may not be applicable to all the patients. Hence, a high index of suspicion along with timely and skillful management is warranted. In this brief review, issues affecting the airway management in cases of maxillofacial trauma are addressed with the possible uses of a wide range of airway management devices available in emergency and elective scenarios.
2018
Background: a review of airway management in maxillofacial trauma, according to the etiology and the affected anatomical location of the injuries has been performed. Methods: an electronic search was conducted in the meDline on published data from January 1996 to December 2016 with the use of relevant keywords and hand-searching. initial search yielded 569 potential articles; 67 were studies or case series with titles relevant to the subject and had abstracts. these articles were evaluated to identify those with epidemiological data on the airway management of individuals with maxillofacial trauma. only 18 publications were derived from retrospective studies. The under review populations were evaluated according to the etiology and anatomical characteristics of the injuries, the airway management conditions (e.g. emergent or elective) and the specific airway management techniques applied. Results: the cumulative frequencies of specialized airway management techniques applied in gene...
Flail Mandible and Immediate Airway Management
Journal of Craniofacial Surgery, 2017
Isolated mandibular fractures usually represent themselves as non-life-threatening injuries and are not treated in emergency setting. However, some rare patterns of them may result in airway obstruction as a result of displacement of bony fragments. The authors report a patient of an open comminuted fracture of mandibular symphysis which exhibited an uncommon split pattern with retrogression of lingual cortical plate, and thereby induced glossoptosis, painful deglutition, and obstruction of the upper airway within a few hours. The patient underwent immediate intubation for establishing a definitive airway, followed by open reduction and internal fixation of fracture. Surgical airway management was not needed. Anatomic reduction of the fracture was achieved, by reestablishing the patency of upper airway and resolving the painful deglutition. Patient's occlusion and mouth opening returned to the preinjury status. Timely osteosynthesis surgery offered early relief of patient's signs and symptoms, prevented airway complications and development of traumatic mandibular osteomyelitis, as well as obviated the potential need for surgical airway management. The appropriate management of mandibular fractures placing the airway at risk requires immediate diagnosis based on knowledge of specific clinical and radiographic findings. This case emphasizes that emergency clinicians should be able to distinguish those patients who will need airway securing techniques in emergent or prophylactic context, due to an uncommon fracture pattern of facial skeleton. Moreover, emergency clinicians should be conversant with wiring techniques to achieve stabilization of the mandibular framework and to control the pain, hemorrhage, and airway patency.
Blunt laryngeal trauma in patients with mandible fracture: Report of 3 cases
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 2012
Three cases of mandibular injury with blunt laryngeal trauma in 2 different age groups are presented. In the common presenting sign of hoarseness of voice and its implication in the recognition of blunt laryngeal trauma, the role of direct laryngoscopy in the diagnosis is discussed. Arytenoid cartilage dislocation associated with maxillofacial injury is rare and infrequently diagnosed cause of vocal cord immobility. One case in our series had arytenoid involvement and both the cases had restricted vocal cord mobility, confirmed by direct laryngoscopy. ORIF of the mandibular fractures and conservative management of the laryngeal injury were carried out. Prompt history, careful examination, initial medical line of treatment followed by voice rest and voice therapy led to gradual decrease in the hoarseness.
Management of Palatal Fracture and Airway Challenge in A Child — A Red Flag
Malaysian Journal of Paediatrics and Child Health, 2019
Airway managements in maxillofacial fracture patients are complex and crucial. Trauma to the maxillofacial region may cause hemorrhage, swelling which may lead to pulmonary aspiration and airway obstruction. Airway managements in maxillofacial fracture patients are complex and crucial. Besides being uncooperative, presence of fractures and soft tissue injuries posed challenges in managing pediatric patient who already have smaller airway opening. This condition is an important red flag which required extra caution from the treating clinicians. A 6-year-old boy was involved in a road traffic accident and presented with profuse bleeding from the oral cavity and nostrils. Physical examination showed oozing of blood with step deformity of the midpalate. Multiple attempts in intubation resulted in failure before succeeding with the aid of suction devices. After intubation was done, intraoral bleeding was successfully managed with transpalatal wiring and nasal packing. The patient was ven...
Anesthetic Challenges and Management of Maxillofacial Trauma
Journal of Anesthesia and Surgery, 2017
Management of Maxillofacial trauma is a challenging task for an anaesthesiologist. It requires a prompt and skillful response from the anaesthesia team. Bilateral parasymphsial fracture, condylar fracture, fracture of zygoma, flattening of face, moderate bleeding and derranged occlusion are the main cautionary pointers of difficult airway. Emergency airway management should be done by a team led by an anaesthesiologist. A difficult airway cart along with resuscitation trolley should be ready. Plan A should be direct laryngoscopy and manual in line stabilization. Video laryngoscope if available should be preferred. Plan B must include fiberoptic, optical and lighted stylets and airway rescue supraglottic devices. Surgical access should be used as backup plan C. Elective management for definitive surgery should be based on specific maxillofacial trauma, surgical approach, associated inflammation and need of prolonged mechanical ventilation in postoperative period.