title: Management of maxillofacial injuries with severe oronasal hemorrhage: a multicenter perspective.
abstract: BACKGROUND
  Airway establishment and hemorrhage control may be difficult to achieve in patients with massive oronasal bleeding from maxillofacial injuries. This study was formulated to develop effective algorithms for managing these challenging injuries.
  
  
  METHODS
  Trauma registries from nine trauma centers were queried over a 7-year period for injuries with abbreviated injury scale face >/= 3 and transfusion of >/=3 units of blood within 24 hours. Patients in whom no significant bleeding was attributed to maxillofacial trauma were excluded. Patient demographics, injury severity measures, airway management, hemostatic procedures, and outcome were analyzed.
  
  
  RESULTS
  Ninety patients were identified. Median injury severity scores for 60 blunt trauma patients was 34 versus 17 for 30 patients with penetrating wounds (p < 0.05). Initial airway management was by endotracheal intubation in 72 (80%) patients. Emergent cricothyrotomy and tracheostomy were necessary in 7 (8%) and 5 (6%) patients, respectively. Seventeen (57%) patients with penetrating wounds were taken directly to the operating room for airway control and initial efforts at hemostasis versus 12 (20%) patients with blunt trauma (p < 0.05). Anterior or posterior or both packing alone controlled bleeding in only 29% of patients in whom it was used. Transarterial embolization (TAE) was used in 12 (40%) patients with penetrating injuries and 20 (33%) patients with blunt trauma. TAE was successful for definitive control of hemorrhage in 87.5% of patients. Overall mortality rate was 24.4%, with 6 (7%) deaths directly attributable to maxillofacial injuries.
  
  
  CONCLUSIONS
  Initial airway control was achieved by endotracheal intubation in most patients. Patients with penetrating wounds were more frequently taken directly to the operating room for airway management and initial efforts at hemostasis. Patients with blunt trauma were much more likely to have associated injuries which affected treatment priorities. TAE was highly successful in controlling hemorrhage.
authors.affiliation: Department of Surgery, Gundersen Lutheran Medical Center, LaCrosse, Wisconsin, USA. THCogbil@gundluth.org
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Cogbill
authors.forename: Clay C
authors.initials: CC
authors.lastname: Cothren
authors.forename: Meghan K
authors.initials: MK
authors.lastname: Ahearn
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cullinane
authors.forename: Krista L
authors.initials: KL
authors.lastname: Kaups
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
authors.forename: Lindsay
authors.initials: L
authors.lastname: Maggio
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Brasel
authors.forename: Paul B
authors.initials: PB
authors.lastname: Harrison
authors.forename: Nirav Y
authors.initials: NY
authors.lastname: Patel
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: Steven E
authors.initials: SE
authors.lastname: Ross
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004844:Epistaxis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008446:Maxillofacial Injuries / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000209:etiology / Q000628:therapy*; D012042:Registries; D055815:Young Adult