title: Difficult endotracheal intubation as a result of penetrating cranio-facial injury by an arrow.
abstract: Penetrating injury of the face and airway may make endotracheal intubation difficult or impossible. We report the case of a patient who attempted to commit suicide with a crossbow. Surgery under general anesthesia was required to remove the arrow. The oral intubation route was impossible, and a fiberoptic nasal intubation under local anesthesia was performed.
  
  
  CONCLUSIONS
  We report a case of a 42-yr-old patient who underwent surgery for a penetrating craniofacial injury caused by an arrow. Because of the median vertical trajectory of the arrow (from the chin to the frontal skull), only the right nasal approach was accessible for endotracheal intubation. Fiberoptic nasal intubation and securing the airway under local anesthesia are described.
authors.affiliation: Département d'Anesthésie-Réanimation, Centre Hospitalier Sainte Anne, 75674 Paris Cedex 14, France. joly@chsa.broca.inserm.fr
authors.forename: Luc-Marie
authors.initials: LM
authors.lastname: Joly
authors.forename: A M
authors.initials: AM
authors.lastname: Oswald
authors.forename: M
authors.initials: M
authors.lastname: Disdet
authors.forename: J L
authors.initials: JL
authors.lastname: Raggueneau
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D000772:Anesthesia, Local; D003392:Cranial Sinuses / Q000293:injuries / Q000601:surgery; D005547:Foreign Bodies / Q000601:surgery*; D020197:Head Injuries, Penetrating / Q000601:surgery*; D006801:Humans; D007440:Intubation / Q000379:methods*; D007442:Intubation, Intratracheal; D008297:Male; D009666:Nose