Airway status in civilian maxillofacial gunshot injuries in Johannesburg, South Africa.
BACKGROUND
Airway management of the maxillofacial gunshot injury constitutes a critical decision and an area that requires review in the context of civilian injuries. Most of our knowledge is extrapolated from military experience, which constitutes a different trauma patient group. This paper reports a retrospective survey of airway status in relation to maxillofacial gunshot injuries. The objective is to correlate clinical findings with treatment decisions.


METHODS
A survey was done of 11,622 archived maxillofacial surgery records (1987-1992) in the three academic hospitals in Johannesburg.


RESULTS
There were 211 maxillofacial gunshot injuries, for which 92 patient records had sufficient detail for inclusion in the analysis. The typical patient was a black male aged 20-29 years, shot with a low-velocity bullet of 0.38 calibre, admitted to hospital the day of the injury, operated on within 4 days, and discharged 4 days later. The airway was threatened in 20/92 cases at admission; 12/20 cases were treated with oro-or nasotracheal intubation, and 9/12 later had elective tracheostomies; 8/20 needed immediate surgical airways, 5 tracheostomies and 3 cricothyroldotomies (all later converted to tracheostomies). Three of thirty-seven patients with normal airways on admission later required emergency tracheostomy.


CONCLUSIONS
An abnormal airway was significantly more likely after a high-velocity injury, and when the tongue, floor of mouth, midline or bilateral facial skeletal bones were involved.
Tsakiris
P
P
Division of Maxillofacial and Oral Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
Cleaton-Jones
P E
PE
Lownie
M A
MA
D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008446:Maxillofacial Injuries / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D014139:Tracheostomy; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*