title: Airway Management in Severe Combat Maxillofacial Trauma.
abstract: OBJECTIVE
  Airway stabilization is critical in combat maxillofacial injury as normal anatomical landmarks can be obscured. The study objective was to characterize the epidemiology of airway management in maxillofacial trauma.
  
  
  METHODS
  Retrospective database analysis.
  
  
  METHODS
  Military treatment facilities in Iraq and Afghanistan and stateside tertiary care centers.
  
  
  METHODS
  In total, 1345 military personnel with combat-related maxillofacial injuries sustained March 2004 to August 2010 were identified from the Expeditionary Medical Encounter Database using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes.
  
  
  METHODS
  Descriptive statistics, including basic demographics, injury severity, associated injuries, and airway interventions, were collected. A logistic regression was performed to determine factors associated with the need for tracheostomy.
  
  
  RESULTS
  A total of 239 severe maxillofacial injuries were identified. The most common mechanism of injury was improvised explosive devices (66%), followed by gunshot wounds (8%), mortars (5%), and landmines (4%). Of the subjects, 51.4% required intubation on their initial presentation. Of tracheostomies, 30.4% were performed on initial presentation. Of those who underwent bronchoscopy, 65.2% had airway inhalation injury. There was a significant relationship between the presence of head and neck burn and association with airway inhalation injury (P < .0001). There was also a significant relationship between the severity of facial injury and the need for intubation (P = .002), as well as the presence of maxillofacial fracture and the need for tracheostomy (P = .0001).
  
  
  CONCLUSIONS
  There is a high incidence of airway injury in combat maxillofacial trauma, which may be underestimated. Airway management in this population requires a high degree of suspicion and low threshold for airway stabilization.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA Matthew.keller@med.navy.mil.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Keller
authors.affiliation: Naval Health Research Center, San Diego, California, USA.
authors.forename: Peggy P
authors.initials: PP
authors.lastname: Han
authors.affiliation: Naval Health Research Center, San Diego, California, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Galarneau
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Brigger
mesh_terms: D055826:Afghan Campaign 2001-; D058109:Airway Management / Q000706:statistics & numerical data*; D001753:Blast Injuries / Q000453:epidemiology; D001999:Bronchoscopy / Q000706:statistics & numerical data; D002056:Burns / Q000150:complications; D002059:Burns, Inhalation / Q000453:epidemiology; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D054542:Iraq War, 2003-2011; D008297:Male; D008446:Maxillofacial Injuries / Q000628:therapy*; D008887:Military Medicine / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014139:Tracheostomy / Q000706:statistics & numerical data; D014948:Wounds, Gunshot / Q000453:epidemiology; D055815:Young Adult
keywords: airway trauma; facial trauma; inhalation injury; intubation; tracheostomy