title: Maxillofacial Injury-Not Always a Difficult Airway.
abstract: The optimal method for securing the airway in injured patients is controversial. Maxillofacial injury has been shown to be a marker for difficult airway management; however, a delay in intubation may result in deterioration of intubating conditions due to further airway bleeding and swelling. Decisions on the timing and method of airway management depend on multiple factors, including patient characteristics, the skill set of the clinicians, and logistical considerations. This report describes the case of a multi-agency response to a motor-vehicle collision in a rural area in Ireland. One young male patient had sustained significant maxillofacial injuries, multiple limb injuries, and had a decreased level of consciousness. Further airway compromise occurred following extrication. Difficult intubation was predicted; however, abnormal jaw mobility from bilateral mandibular fractures enabled easy laryngoscopy and intubation. Although preparation must be made for difficult airway management in the setting of maxillofacial injury, appropriately trained and experienced practitioners should not be deterred from performing early intubation when indicated.
authors.affiliation: 1Emergency Department,Cork University Hospital,Cork,Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Glasheen
authors.affiliation: 2Clinical Development,National Ambulance Service,Limerick,Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Hennelly
authors.affiliation: 1Emergency Department,Cork University Hospital,Cork,Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Cusack
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D058109:Airway Management; D004632:Emergency Medical Services; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008446:Maxillofacial Injuries / Q000628:therapy*
keywords: CT computerized tomography; EMS Emergency Medical Services; RSI rapid sequence intubation; maxillofacial; prehospital care; trauma