Maxillofacial trauma patient: coping with the difficult airway

The first priority in assessing and managing the trauma patient is airway maintenance with cervical spine control. This is based on the Advanced Trauma Life Support (ATLS) concept for managing patients who sustained life-threatening injuries [1]. According to that concept, loss of an airway kills more quickly than does the loss of the ability to breathe or circulatory problems. Thus, life saving intervention should begin with airway management, when required [1,2]. Indeed, problems in airway management could lead to grave morbidity and mortality in the general surgical population [3,4] as well as in trauma patients [5].Airway management problems are not confined to the early stages of 'triage' or to the resuscitation of the patient. Morbidity and mortality of in-hospital trauma patients often result from critical care errors. The most common critical care errors are related to airway and respiratory management [5,6]. Gruen et al studied 2594 trauma mortality patients in order to identify patterns of errors contributing to inpatient deaths [6]. They found that failure to intubate, secure or protect the airway was the most common factor related to patient mortality, responsible for 16% of inpatient deaths.Immediate management of maxillofacial injuries is required mainly when impending or existing upper airway compromise and/or profuse hemorrhage occurs. Hutchinson et al [7] addressed six specific situations associated with maxillofacial trauma, which may adversely affect the airway:1. Posteroinferior displacement of a fractured maxilla parallel to the inclined plane of the skull base may block the nasopharyngeal airway.2. A bilateral fracture of the anterior mandible may cause the fractured symphysis to slide posteriorly along with the tongue attached to it via its anterior insertion. In the supine patient, the base of the tongue may drop back, thus blocking the oropharynx.3. Fractured or exfoliated teeth, bone fragments, vomitus and blood as well as foreign bodies –