Tsakiris P, Cleaton-Jones P E, Lownie M A
Division of Maxillofacial and Oral Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
S Afr Med J. 2002 Oct;92(10):803-6.
Airway management of the maxillofacial gunshot injury constitutes a critical decision and an area that requires review in the context of civilian injuries. Most of our knowledge is extrapolated from military experience, which constitutes a different trauma patient group. This paper reports a retrospective survey of airway status in relation to maxillofacial gunshot injuries. The objective is to correlate clinical findings with treatment decisions.
A survey was done of 11,622 archived maxillofacial surgery records (1987-1992) in the three academic hospitals in Johannesburg.
There were 211 maxillofacial gunshot injuries, for which 92 patient records had sufficient detail for inclusion in the analysis. The typical patient was a black male aged 20-29 years, shot with a low-velocity bullet of 0.38 calibre, admitted to hospital the day of the injury, operated on within 4 days, and discharged 4 days later. The airway was threatened in 20/92 cases at admission; 12/20 cases were treated with oro-or nasotracheal intubation, and 9/12 later had elective tracheostomies; 8/20 needed immediate surgical airways, 5 tracheostomies and 3 cricothyroldotomies (all later converted to tracheostomies). Three of thirty-seven patients with normal airways on admission later required emergency tracheostomy.
An abnormal airway was significantly more likely after a high-velocity injury, and when the tongue, floor of mouth, midline or bilateral facial skeletal bones were involved.
颌面枪伤的气道管理是一项关键决策，也是 civilian injuries 背景下需要审视的领域。我们的大部分知识是从军事经验推断而来，而军事经验涉及的是不同的创伤患者群体。本文报告了一项关于与颌面枪伤相关的气道状况的回顾性调查。目的是将临床发现与治疗决策相关联。
对约翰内斯堡三家学术医院存档的11,622份颌面外科手术记录（1987 - 1992年）进行了调查。
有211例颌面枪伤，其中92份患者记录有足够详细信息可纳入分析。典型患者为20 - 29岁的黑人男性，被0.38口径低速子弹击中，受伤当天入院，4天内接受手术，4天后出院。入院时9 / 2例患者气道受到威胁；20 / 12例患者接受了口 - 或鼻气管插管治疗，但其中9 / 12例后来进行了择期气管切开术；20 / 8例患者需要立即建立手术气道，5例进行了气管切开术，3例进行了环甲膜切开术（所有后来均改为气管切开术）。37例入院时气道正常的患者中有3例后来需要紧急气管切开术。
高速损伤后，以及当舌、口底、中线或双侧面部骨骼受累时，气道异常的可能性显著增加。
