title: Facing the airway challenges in maxillofacial trauma: A retrospective review of 288 cases at a level i trauma center.
abstract: BACKGROUND
  Maxillofacial trauma is an apt example of a difficult airway. The anesthesiologist faces challenges in their management at every step from airway access to maintenance of anesthesia and extubation and postoperative care.
  
  
  METHODS
  A retrospective study was done of 288 patients undergoing surgery for maxillofacial trauma over a period of five years. Demographic data, detailed airway assessment and the method of airway access were noted. Trauma scores, mechanism of injury, duration of hospital stay, requirement of ventilator support were also recorded. Complications encountered during perioperative anaesthetic management were noted.
  
  
  RESULTS
  259 (89.93%) of the patients were male and 188 (62.85%) were in the 21-40 year range. 97.57% of the cases were operated electively. 206 (71.53%) patients were injured in motor vehicular accidents. 175 (60.76%) had other associated injuries. Mean Glasgow coma scale score (GCS), injury severity score (ISS) and revised trauma score (RTS) were 14.18, 14.8 and 12, respectively. Surgery was performed almost nine days following injury. The mean duration of hospitalization was 16 days. ICU admission was required in 22 patients with mean duration of ICU stay being two days. Majority of patients had difficult airway. 240 (83.33%) patients were intubated in the operating room and fibreoptic guided intubation was done in 159 (55.21%) patients. Submental intubation was done in 45 (14.93%) cases.
  
  
  CONCLUSIONS
  Maxillofacial injuries present a complex challenge to the anaesthesiologist. The fibreoptic bronchoscope is the main weapon available in our arsenal. The submental technique scores over the time-honored tracheostomy. Communication between the anaesthesiologist and the surgeon must be given paramount importance.
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Babita
authors.initials: B
authors.lastname: Gupta
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Arunima
authors.initials: A
authors.lastname: Prasad
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sarita
authors.initials: S
authors.lastname: Ramchandani
authors.affiliation: Department of Surgery, JPNATC, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Maneesh
authors.initials: M
authors.lastname: Singhal
authors.affiliation: Department of Microbiology, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Purva
authors.initials: P
authors.lastname: Mathur
keywords: Difficult airway; fibreoptic intubation; maxillofacial injury; submental intubation; tracheostomy; videolaryngoscopy