Approach to the Maxillofacial Trauma Patient’s Airway Management Airway Evaluation and Preparation Airway evaluation should be as thorough and as quick as possible,
due to the fact that the patient’s airway is compromised. Nevertheless, defining the exact difficulty involved could direct the physician to the best approach to managing that airway. The questions that should be answered are: Is the patient conscious? If so, the use of sedation or analgesics should be done cautiously since the airway can be lost following injudicious use of such drugs [25]. Is he/she breathing spontaneously? If so, there is time to arrive at the hospital, preferably to the operating room, and manage the airway under the best conditions and by Trichostatin A mw the most experienced personnel. Failed attempts at endotracheal intubation by non-qualified caretakers could cause rapid deterioration. Indeed, according to the American Society of Anesthesiologists (ASA) Practice Guidelines for management of the difficult airway, spontaneous breathing should be preserved in patients with anticipated difficult endotracheal intubation [26]. What is the extent, the selleck chemical composition and the anatomy of the injury? Figure 1 shows patient with very extensive injury to the face, where mask ventilation was not possible and tracheal intubation was very difficult (Figure 1). Figure 1 A woman who sustained a single gunshot injury. She arrived at
the hospital conscious and breathing spontaneously. Impossible mask ventilation and diffucult intubation were anticipated. Direct laryngoscopy Interleukin-2 receptor was performed and oro-tracheal intubation was successful. How extensive is the damage to the bony structures of the face? In cases of massive injuries, mask ventilation may be impossible, while injury limited to the soft tissues may enable mask ventilation. Figure 2 shows 3 dimensions CT of a patient with comminuted fracture of the right orbit, zygoma and
right mandible. Figure 2 A patient with high velocity long distance injury, with severe soft tissue damage of the right chick. 3 dimensions CT shows comminuted fracture of the right orbit, zygoma and right mandible. Is there a limitation in mouth opening? Is that limitation the result of pain and after sedation the mouth could be opened wider? The answer for this question depends, among other things, on the clinical and radiological evidence of a temporo-mandibular joint (TMJ) injury. If the limitation in mouth opening is caused by a TMJ injury, sedation will not GDC-0941 mw improve mouth opening, will not help in managing the airway, and may worsen the scenario. Is there soft tissue oedema and pressure on the airway? Figure 3 shows lateral radiography of a patient who sustained low velocity missile injury to the left chick. The radiograph demonstrates the bullet location and the patent airway. Figure 4 is the lateral x-ray of a patient with comminuted fracture of the mandible with huge soft tissue swelling of the neck and narrowing of the airway.