Le Thuy-My T, Oleck Nicholas C, Khan Wajiha, Halsey Jordan N, Liu Farrah C, Hoppe Ian C, Lee Edward S, Granick Mark S
Division of Craniofacial and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, MS.
Ann Plast Surg. 2019 Apr;82(4S Suppl 3):S179-S184. doi: 10.1097/SAP.0000000000001883.
Facial fractures are a harbinger when it comes to airway management. Facial fractures can cause airway obstruction or preclude the use of intubation. We aim to examine the etiologies, types of facial fractures, and the risk factors that may lead to requirement of an advance airway.
A retrospective chart review was performed of all facial fractures in the adult population in a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and course of hospital stay.
During the period examined, 2626 patients were identified as 18 years or older and with facial fracture. Among these patients, 443 received airway management. Mean age was 34.21 years (range, 18-95 years), with a male predominance of 91.9%. One hundred nineteen patients were intubated on, or before, arrival to the trauma bay. One hundred three patients required surgical airways on arrival to the trauma bay, and 91 of these patients were also reported to have been intubated before arrival. There were a total of 741 fractures identified on radiologic imaging. The most common fractures observed were orbital fractures, frontal sinus fractures, and nasal fractures. Mean Glasgow Coma Scale score on arrival was 9.45 (range, 3-15). Gunshot wound was also the most common etiology among those who were intubated and those who received a surgical airway. The most common concomitant injuries were traumatic brain injury, intracranial hemorrhage, and skull fracture. Forty-one patients died, most of which were intubated during their hospital course.
There is a dearth of literature detailing standardization of airway management for patients who present with facial fractures. The difference between intubation and surgical airway is often a subjective judgment call, but the authors believe that a more streamlined process can be elucidated after analyzing previous trends as well as variabilities in patient survival and prognosis.
在气道管理方面，面部骨折是一个先兆。面部骨折可导致气道阻塞或妨碍插管操作。我们旨在研究面部骨折的病因、类型以及可能导致需要高级气道的危险因素。
对城市环境中一家一级创伤中心（新泽西州纽瓦克大学医院）成年人群中的所有面部骨折患者进行回顾性病历审查。收集患者的人口统计学数据、骨折部位、伴随损伤以及住院病程。
在所研究的时间段内，确定了2626名18岁及以上且有面部骨折的患者。在这些患者中，443人接受了气道管理。平均年龄为34.21岁（范围为18 - 95岁），男性占比91.9%。119名患者在到达创伤病房时或之前已插管。103名患者在到达创伤病房时需要手术气道，其中91名患者据报告在到达之前也已插管。影像学检查共发现741处骨折。观察到的最常见骨折为眼眶骨折、额窦骨折和鼻骨骨折。到达时的平均格拉斯哥昏迷量表评分为9.45（范围为3 - 15）。枪伤也是插管患者和接受手术气道患者中最常见的病因。最常见的伴随损伤为创伤性脑损伤、颅内出血和颅骨骨折。41名患者死亡，其中大多数在住院期间接受了插管。
缺乏详细阐述面部骨折患者气道管理标准化的文献。插管和手术气道之间的差异往往是主观判断，但作者认为在分析既往趋势以及患者生存和预后的变异性后，可以阐明一个更简化的流程。
