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Major Maxillofacial trauma —Airway
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Six specific problems associated with maxillofacial trauma 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
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