Airway management in Maxillofacial Trauma
Six specific problems which may affect the airway
A fractured maxilla
May be displaced postero-inferiorally along the inclined plane of the base of the skull, blocking the nasal airway.
MANAGEMENT – disimpact by pulling the maxilla forward in the mouth
The tongue
May lose its anterior insertion in patients with a bilateral anterior mandibular or symphyseal fracture. It may then drop back in a supine patient, blocking the oropharynx.
MANAGEMENT – Pull the tongue forwards e.g. by inserting a suture (0 black silk) transversely through the dorsum of the tongue and tape it onto the side of the face.
Teeth, dentures, bone fragments, vomitus, haematoma and other foreign bodies
May block the airway at any site from the oral cavity through the oropharynx, larynx and trachea down to the bronchi (especially the right main bronchus).
MANAGEMENT – Clear the oral cavity by sweeping finger, a laryngoscope and sucker may also be required
Haemorrhage
May be from several causes including distinct vessels in open wounds and the nose.
MANAGEMENT – insert ribbon gauze to achieve pressure, request cross match if severe bleeding and arrange for definitive treatment
Soft tissue swelling and oedema
Trauma of the oral cavity causes swelling around the upper airway. This rarely presents as an immediate problem, but the swelling may worsen over a few hours and cause later airway problems
Maxillofacial trauma
May occasionally be associated with trauma to the larynx and trachea, which may cause obstruction of the airway by swelling or displacement of structures such as the epiglottis, arytenoid cartilages and vocal cords. Note any neck swelling, dyspnoea, voice alteration, frothy haemorrhage