Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 1: dilemmas in the management of the multiply injured patient with coexisting facial injuries.

Maxillofacial trauma is without doubt still a very challenging area, especially in the early stages of care when other injuries may be present. Craniofacial trauma, with or without life and/or sight-threatening complications, may be associated with significant injuries elsewhere. Both general trauma and facial trauma management have evolved considerably over the last 20 years and on occasion clinical priorities may seemingly conflict, suddenly change or be hidden. In these circumstances a number of clinical dilemmas may arise, which this and three further reviews will discuss. These are based on review of the current literature, supplemented where appropriate by the collective experiences of the co-authors. Facial injuries can be broadly placed into one of four groups, which can aid determination of the urgency for treatment. Advanced Trauma Life Support is generally regarded as the gold standard and is founded on a number of well known principles, but strict adherence to protocols may have its drawbacks when facial trauma co-exists. These can arise in the presence of either major or minor facial injuries, and oral and maxillofacial surgeons need to be aware of the potential problems.