Merola Raffaele, Troise Stefania, Palumbo Daniela, D'Auria David, Dell'Aversana Orabona Giovanni, Vargas Maria
Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy.
Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy.
J Stomatol Oral Maxillofac Surg. 2025 Mar;126(2):102044. doi: 10.1016/j.jormas.2024.102044. Epub 2024 Sep 5.
Airway management in maxillofacial surgery is a critical aspect of anesthesia and perioperative care, demanding a broad array of techniques to ensure effective ventilation and oxygenation. The anatomical and physiological complexities of maxillofacial procedures necessitate a deep understanding of airway management strategies. Patients undergoing maxillofacial surgery often face heightened risks of airway compromise due to trauma, congenital abnormalities, or the surgical interventions themselves, requiring clinicians to be proficient in both routine and advanced techniques. This narrative review synthesizes current evidence and clinical practices in airway management for maxillofacial surgery. It examines the anatomical and physiological considerations, preoperative assessment protocols, intraoperative management, and postoperative care strategies. Preoperative assessments are crucial for identifying potential airway management difficulties, utilizing risk assessments, physical examinations, and imaging. Intraoperative strategies include endotracheal intubation while surgical techniques such as tracheostomy, cricothyroidotomy, submental, and retromolar intubation offer alternatives for securing the airway. Postoperative care focuses on meticulous planning and coordination to prevent complications such as airway obstruction and hypoxemia. Extubation is identified as a particularly high-risk phase, necessitating advanced techniques and multidisciplinary collaboration to ensure patient safety. The review underscores the importance of a comprehensive, multidisciplinary approach to airway management in maxillofacial surgery, highlighting the need for ongoing advancements in techniques and technologies to enhance patient outcomes.
颌面外科手术中的气道管理是麻醉和围手术期护理的关键环节,需要运用一系列广泛的技术来确保有效的通气和氧合。颌面手术的解剖和生理复杂性要求对气道管理策略有深入的了解。由于创伤、先天性异常或手术干预本身,接受颌面外科手术的患者往往面临气道受损的更高风险,这就要求临床医生精通常规技术和先进技术。本叙述性综述综合了颌面外科手术气道管理的当前证据和临床实践。它探讨了解剖和生理方面的考虑因素、术前评估方案、术中管理及术后护理策略。术前评估对于识别潜在的气道管理困难至关重要,可利用风险评估、体格检查和影像学检查。术中策略包括气管插管,而气管切开术、环甲膜切开术、颏下插管和磨牙后插管等手术技术为确保气道安全提供了替代方法。术后护理重点在于精心规划和协调,以预防气道梗阻和低氧血症等并发症。拔管被认为是一个特别高风险的阶段,需要先进技术和多学科协作以确保患者安全。该综述强调了颌面外科手术气道管理采用全面、多学科方法的重要性,突出了技术和技术持续进步以改善患者预后的必要性。