Daniels John Spencer, Albakry Ibrahim, Braimah Ramat Oyebunmi, Samara Mohammed Ismail, Albalasi Rabea Arafa, Begum Farzana, Al-Kalib Mana Ali-Mohamed
Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia.
Department of Oral and Maxillofacial Surgery, Specialty Regional Dental Center, Najran, Kingdom of Saudi Arabia.
Ann Maxillofac Surg. 2020 Jul-Dec;10(2):402-408. doi: 10.4103/ams.ams_202_19. Epub 2020 Dec 23.
Special cooperation is required among surgeons and anesthetists in airway management during repair of panfacial fractures, due to problems of shared airway and occlusion. Several methods have been proposed for airway management and sequencing of repair of panfacial fractures. The main objective of the current study was to share our experience in the airway management and sequencing of repair of panfacial fractures.
This was a retrospective study of panfacial fractures in the Kingdom of Saudi Arabia from January 2008 to December 2018. Data collected included demographics, type of airway management, sequence of repair (as primary variables), and outcome of surgery (secondary variable), while surgeon and anesthetic expertise are confounders. Data were analyzed using IBM SPSS Statistics for Windows Version 25 (Armonk, NY, USA: IBM Corp). Results were presented as simple frequencies and descriptive statistics. Pearson Chi-square was used to compare categorical variables such as airway management and sequencing of repair with the panfacial fractures. Statistical significance was set at ≤ 0.05.
Overall, 1057 patients sustained different categories of maxillofacial bone fractures with 23 females and 1034 males (M:F of 46:1). A total of 43 male patients out of 1057 patients had panfacial fractures during the study period, giving a prevalence rate of 4.1%. Only the 43 male patients with panfacial fractures were analyzed. All cases were as a result of motor vehicular accident. Six (13.9%) patients had tracheostomy while 37 (86.1%) patients had submental intubation. "Bottom-up" and "outside-in" approach was used in 33 (76.7%) patients, while "top-bottom" and "inside-out" approach was used in 10 (23.3%) patients.
Submental intubation was the major airway management of panfacial fracture, and "bottom-up" and "outside-in" approach was the main sequence of repair in our series. These approaches have been mentioned in the literature.
From our study, victims of pan-facial fractures were found to be exclusively male with MVA as the sole etiological factor. Barring severe head injuries, which may necessitate the use of tracheostomy to sustain breathing over a longer period, submental intubation is extremely reliable as a mode of airway management during surgical treatment of panfacial fractures. The sequencing of repair of panfacial fractures can only be determined according to the case presentation rather than a predetermined one.
由于存在气道共享和咬合问题，在修复面中份骨折时，外科医生和麻醉医生之间需要进行特殊协作。目前已经提出了几种面中份骨折修复的气道管理和手术顺序的方法。本研究的主要目的是分享我们在面中份骨折修复的气道管理和手术顺序方面的经验。
这是一项对2008年1月至2018年12月沙特阿拉伯王国面中份骨折的回顾性研究。收集的数据包括人口统计学资料、气道管理类型、修复顺序（作为主要变量）和手术结果（次要变量），而外科医生和麻醉专业知识为混杂因素。使用IBM SPSS Statistics for Windows Version 25（美国纽约州阿蒙克市：IBM公司）对数据进行分析。结果以简单频率和描述性统计呈现。采用Pearson卡方检验比较气道管理和修复顺序等分类变量与面中份骨折的关系。设定统计学显著性水平为≤0.05。
总体而言，1057例患者发生了不同类型的颌面骨骨折，其中女性23例，男性1034例（男:女为46:1）。在研究期间，1057例患者中有43例男性患者发生了面中份骨折，患病率为4.1%。仅对这43例男性面中份骨折患者进行了分析。所有病例均因机动车事故所致。6例（13.9%）患者行气管切开术，37例（86.1%）患者行颏下插管。33例（76.7%）患者采用“由下向上”和“由外向内”的方法，10例（23.3%）患者采用“由上向下”和“由内向外”的方法。
颏下插管是面中份骨折的主要气道管理方式，“由下向上”和“由外向内”的方法是我们系列研究中的主要修复顺序。这些方法在文献中已有提及。
从我们的研究来看，面中份骨折的受害者均为男性，机动车事故是唯一的病因。除了可能需要行气管切开术以维持较长时间呼吸的严重头部损伤外，颏下插管作为面中份骨折手术治疗期间的气道管理方式非常可靠。面中份骨折的修复顺序只能根据具体病例情况来确定，而不是预先确定的。
