Raval Chetan B, Rashiduddin Mohd
Department of Anesthesia, Al-Nahdha Hospital, Muscat, Oman.
Saudi J Anaesth. 2011 Jan;5(1):9-14. doi: 10.4103/1658-354X.76476.
Airway management in maxillofacial injuries presents with a unique set of problems. Compromised airway is still a challenge to the anesthesiologist in spite of all modalities available. Maxillofacial injuries are the result of high-velocity trauma arising from road traffic accidents, sport injuries, falls and gunshot wounds. Any flaw in airway management may lead to grave morbidity and mortality in prehospital or hospital settings and as well as for reconstruction of fractures subsequently.
One hundred and seventy-seven patients of maxillofacial injuries, operated over a period of one and half years during July 2008 to December 2009 in Al-Nahdha hospital were reviewed. All patients were reviewed in depth with age related type of injury, etiology and techniques of difficult airway management.
The major etiology of injuries were road traffic accidents (67%) followed by sport (15%) and fall (15%). Majority of patients were young in the age group of 11-30 years (71 %). Fracture mandible (53%) was the most common injury, followed by fracture maxilla (21%), fracture zygoma (19%) and pan-facial fractures (6%). Maxillofacial injuries compromise mask ventilation and difficult airway due to facial fractures, tissue edema and deranged anatomy. Shared airway with the surgeon needs special attention due to restrictions imposed during surgery. Several methods available for securing the airway, both decision-making and performance, are important in such circumstances. Airway secured by nasal intubation with direct visualization of vocal cords was the most common (57%), followed by oral intubation (17%). Other methods like tracheostomy and blind nasal intubation was avoided by fiberoptic bronchoscopic nasal intubation in 26% of patients.
The results of this study indicated that surgically securing the airway by tracheostomy should be revised compared to other available methods. In the era of rigid fixation of fractures and the possibility of leaving the patient without wiring an open mouth and alternative techniques like fiberoptic bronchoscopic intubation, it is unnecessary to carry out tracheostomy for securing the airway as frequently as in the past.
颌面损伤的气道管理存在一系列独特的问题。尽管有各种可用的方法，但气道受损对麻醉医生来说仍然是一个挑战。颌面损伤是由道路交通事故、运动损伤、跌倒和枪伤等高速创伤导致的。气道管理中的任何缺陷都可能在院前或医院环境中导致严重的发病率和死亡率，以及随后骨折重建过程中的问题。
回顾了2008年7月至2009年12月在纳赫达医院接受手术的177例颌面损伤患者。对所有患者进行了深入评估，包括与年龄相关的损伤类型、病因以及困难气道管理技术。
损伤的主要病因是道路交通事故（67%），其次是运动损伤（15%）和跌倒（15%）。大多数患者年龄在11 - 30岁之间（71%）。下颌骨骨折（53%）是最常见的损伤，其次是上颌骨骨折（21%）、颧骨骨折（19%）和全面部骨折（6%）。颌面损伤由于面部骨折、组织水肿和解剖结构紊乱，会影响面罩通气并导致困难气道。由于手术过程中的限制，与外科医生共享气道需要特别注意。在这种情况下，有几种可用的气道固定方法，无论是决策还是操作，都很重要。通过直接观察声带进行经鼻插管固定气道是最常见的方法（57%），其次是经口插管（17%）。26%的患者通过纤维支气管镜经鼻插管避免了气管切开术和盲目经鼻插管等其他方法。
本研究结果表明，与其他可用方法相比，通过气管切开术手术固定气道的做法应重新审视。在骨折坚固内固定的时代，以及患者可能无需颌间结扎就能开口的情况下，还有纤维支气管镜插管等替代技术，没有必要像过去那样频繁地进行气管切开术来固定气道。
