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颌面创伤中的气道挑战:100例回顾性研究

Airway Challenges in Maxillofacial Trauma: A Retrospective Study of 100 Cases.

作者信息

Amjad Afnan, Shaheen Nusrat

机构信息

Anesthesia and Critical Care, Lady Reading Hospital Medical Teaching Institution, Peshawar, PAK.

Anesthesia and Intensive Care, National Maternity Hospital, Dublin, IRL.

出版信息

Cureus. 2025 Mar 30;17(3):e81470. doi: 10.7759/cureus.81470. eCollection 2025 Mar.

Abstract

INTRODUCTION

Maxillofacial trauma creates uniquely challenging airways. Anesthesiologists often struggle with initial access, maintaining the airway during surgery, safe extubation, and postoperative monitoring. These cases require experience and careful planning.

METHODS

This retrospective analysis included 100 patients who were presented with maxillofacial trauma. Patients were assessed for airway patency based on preoperative criteria, including Mallampati classification, thyromental distance, mentohyoid distance, and neck movement. The intubation technique was selected based on fracture type and the anticipated difficulty in securing the airway. Techniques used included direct laryngoscopy, videolaryngoscopy, and blind nasal intubation.

RESULTS

Direct laryngoscopy was the most commonly used technique in 53% of patients with minimal facial trauma. However, videolaryngoscopy was used in 23% of cases where a difficult airway was anticipated, while blind nasal intubation was performed in 24% of patients. The most common fractures were mandibular (29%), followed by nasal (24%) and maxillary (24%).

CONCLUSION

Airway management in maxillofacial trauma patients requires a tailored approach, with videolaryngoscopy being a valuable tool for difficult intubations. Proper preoperative evaluation and the collaboration between anesthesiologists and surgeons are essential for optimizing patient outcomes.

摘要

引言

颌面创伤会造成极具挑战性的气道问题。麻醉医生在初始气道建立、手术过程中维持气道、安全拔管及术后监测方面常常面临困难。这些病例需要经验和精心规划。

方法

这项回顾性分析纳入了100例颌面创伤患者。根据术前标准评估患者气道通畅情况,包括马兰帕蒂分级、甲状软骨-颏下距离、颏舌骨距离及颈部活动度。根据骨折类型和预计的气道建立难度选择插管技术。使用的技术包括直接喉镜检查、视频喉镜检查和盲鼻插管。

结果

在面部创伤最小的53%患者中,直接喉镜检查是最常用的技术。然而,在预计气道困难的23%病例中使用了视频喉镜检查,24%的患者进行了盲鼻插管。最常见的骨折是下颌骨骨折(29%),其次是鼻骨骨折(24%)和上颌骨骨折(24%)。

结论

颌面创伤患者的气道管理需要采用个性化方法,视频喉镜检查是困难插管的重要工具。术前进行适当评估以及麻醉医生与外科医生之间的协作对于优化患者预后至关重要。

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本文引用的文献

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Airway management in patients undergoing maxillofacial surgery: State of art review.颌面外科手术患者的气道管理:现状综述
J Stomatol Oral Maxillofac Surg. 2025 Mar;126(2):102044. doi: 10.1016/j.jormas.2024.102044. Epub 2024 Sep 5.
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Airway management in maxillofacial trauma.颌面创伤中的气道管理。
J Anaesthesiol Clin Pharmacol. 2021 Jul-Sep;37(3):319-327. doi: 10.4103/joacp.JOACP_315_19. Epub 2021 Oct 12.

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