Maxillofacial Trauma

Maxillofacial trauma • Lower 1/3 → mandible (30% in the body of the mandible) • Middle 1/3 → maxilla, zygomatic, orbital, nasal → LeForte I, II, III • Upper 1/3→ frontal and cranium ( CNS) Airway • 100% O2, and clear the A/W from foreign bodies, blood, # teeth (count), if there is bleeding apply pressure, nasal packing, and consider a close reduction for a # • In case of tongue injury → laceration→ edema/swelling → difficult intubation • In case of mid and upper facial injury avoid nasal intubation → Bleeding, and possible basal skull # Laryngeal injury • S/S hoarseness, stridor, sub-Q emphysema with crepitus → void blind technique • After intubation with direct vision bypass the injury and make sure that the cuff is beyond the injury Trismus→ after facial injury → due to muscle spasm → relived by GA

pneumocephalus→ with LeForte II and III → Avoid N2O Management: • According to ATLS • ABC, look for the cause of the obstruction: foreign bodoy, vomit, blood bone, teeth, laryngospasm, bimandibular #, edema, laryngeal #, tracheal diviation, loss of structural support • A/W → early management if late→ edema → more difficult, have a surgeon to perform a trach, and have all A/W equipment ready • The goals of A/W are o Protect from full stomach o Avoid a situation where retreat is impossible ( give reversible drugs) o Have a backup plan o SO → premed ( glyco, zantac) if possible, consider doing an awake look, FOI Vs RSI with cricoid pressure