title: An Algorithm for the Management of Concomitant Maxillofacial, Laryngeal, and Cervical Spine Trauma.
abstract: Concomitant maxillofacial, laryngeal and cervical spine injuries may occur after high-energy accidents. Although this presentation is uncommon, the multiple injuries may compromise airway, breathing, circulation, and neurologic function. We identified 8 adult trauma patients admitted to the National University Hospital with the concomitant injuries. We reviewed the patient data and existing literature to identify the important factors that must be considered for management. Seven resulted from high velocity accidents, whereas 1 was assaulted. An algorithm that prioritizes in-tandem diagnosis and acute management of the adult trauma patient with maxillofacial, laryngeal, and cervical spine trauma was developed. The first priority is to assess airway, breathing, and circulation with cervical spine immobilization. Early diagnosis of patients with severe laryngeal injury, confirmation by video endoscopy, and establishing a surgical airway prevents airway obstruction or even a laryngotracheal dissociation. Urgent computed tomography scans of the head and neck are essential for definitive diagnosis and surgical planning for the 3 injuries. Prudent sequencing of surgery is important to avoid complications and to achieve better functional outcomes.
authors.affiliation: From the *Yong Loo Lin School of Medicine, †Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore; ‡Division of Plastic, Reconstructive and Aesthetic Surgery, National University Health System; and §Department of Otolaryngology-Head & Neck Surgery, National University Hospital, Singapore.
authors.forename: Joshua Yuan Wang
authors.initials: JY
authors.lastname: Tan
authors.forename: Wan Xin
authors.initials: WX
authors.lastname: Khoo
authors.forename: Eileen Chor Hoong
authors.initials: EC
authors.lastname: Hing
authors.forename: Yan Lin
authors.initials: YL
authors.lastname: Yap
authors.forename: Hanjing
authors.initials: H
authors.lastname: Lee
authors.forename: Vigneswaran
authors.initials: V
authors.lastname: Nallathamby
authors.forename: Mark Kim Thye
authors.initials: MK
authors.lastname: Thong
authors.forename: Wei Chen
authors.initials: WC
authors.lastname: Ong
authors.forename: Jane
authors.initials: J
authors.lastname: Lim
authors.forename: Thiam Chye
authors.initials: TC
authors.lastname: Lim
mesh_terms: D000465:Algorithms; D002574:Cervical Vertebrae / Q000293:injuries*; D000066491:Clinical Decision-Making / Q000379:methods*; D003661:Decision Support Techniques; D042241:Early Diagnosis; D006801:Humans; D007830:Larynx / Q000293:injuries*; D008297:Male; D008446:Maxillofacial Injuries / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000628:therapy*; D013124:Spinal Injuries / Q000175:diagnosis / Q000628:therapy*