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    Anaesthetic Challenges in Complex Maxillofacial Trauma - A

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    Praveen Ramasamy

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    Anaesthetic Challenges in Complex Maxillofacial Trauma - A

    Uploaded by

    Praveen Ramasamy
    48 views18 pages

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    Anaesthetic challenges in complex maxillofacial trauma – A

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    48 views18 pages

    Anaesthetic Challenges in Complex Maxillofacial Trauma - A

    Uploaded by

    Praveen Ramasamy

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 18

    Anaesthetic challenges in complex

    maxillofacial trauma – A review of


    cases

    Dr. Adari Chandrasekhar (PG)


    Dr. Rathna Paramaswamy,MD,Professor
    Department of Anaesthesia.
    Saveetha Medical College & Hospital.
    INTRODUCTION
    • Causes-RTA,
    assault, sports
    injury,industrial
    accidents
    • Accompanied with
    other injuries
    • Multidisciplinary
    approach
    • Difficult airway-
    edema &
    haemorrhage
    ANAESTHETIC CHALLENGES
    • Distorted anatomy – difficult mask ventilation,
    difficult airway
    • Full stomach
    • Cervical spine injury
    • Haemorrhage
    • Failure to intubate(lack of experience)-
    hypoxia, and cardiac arrest (20%)
    Conventional laryngoscopy
    Fibreoptic
    Video laryngoscopy
    Optical light stylet

    Modes of
    airway control
    Backup surgical airway –
    cricothyroidotmy and
    tracheostomy
    Anaesthetic Technique
    Anaesthesia is based on difficulty of airway

    1. Conventional induction
    No anticipated difficult airway
    No cervical spine injury
    VLS is preferable
    2. Awake Fiberoptic Technique

    Nasal or oro tracheal route

    Spray as you go with LA/airway blocks

    Safest when no active bleeding


    3.Submental intubation

    Indications
    • Complex craniofacial trauma
    • Base of skull fractures
    • CSF rhinorrhea
    • Occlusion
    • Oral tube hinders surgical access

    Alternative to Tracheostomy
    Case 1 & 2
    1) 29yr/m
    H/o RTA, #Maxilla and
    #mandible
    - Nasotracheal intubation-
    conventional
    -RAE tube

    2)33yr /m
    h/o RTA,maxilla,mandible#

    -Blind nasal intubation


    Case 3

    Submental intubation
    (31 cases – 3years)
    -48 yr/f
    - h/o RTA
    - panfacial injury
    - basal of skull #,
    -CSF leak
    -FOB
    Case no 4
    28yr male,
    CT Brain & Facial bones – multiple
    # in facial bones, sphenoid bone,
    right nasal, displlaced # of maxillary
    sinus, medial and lateral pterygoid
    plates
    -Conventional laryngoscopy
    Case 5

    -32yr/male
    -Le fort 2
    -Conventional
    laryngoscopy
    Case no 6 -
    18 yr male h/o blunt trauma of rt
    mandible & neck
    -CT- #atlas
    -MRI- vertebral artery thrombosis
    -FOB
    -post op neck collar & anti
    coagulants
    Summary
    • Airway is primary concern
    • Sharing airway
    • High chances of aspiration
    • Intracranial and cervical injuries
    References
    • 1. Saraswat, V. Airway Management in Maxillofacial Trauma: A Retrospective Review of
    127 Cases. (2008) Indian J Anaesth 52: 311-316.
    Pubmed |
    • 2. American College of Surgeons Committee on Trauma, et al. Advanced trauma life
    support (ATLS®): the ninth edition. (2013) J Trauma Acute Care Surg 74(5): 1363-1366.
    Pubmed
    • 3. Telfer, M.R., Jones, G.M., Shepherd, J.P. Trends in the aetiology of maxillofacial
    fractures in the United Kingdom (1977-1987). (1991) Br J Oral Maxillofac Surg 29(4):
    250-255.
    Pubmed 
    • 4. Rosen, P., Barkin, R., Rosen, P., et al. Emergency Medicine Concepts and Clinical
    Practice. 5th ed. St. Louis. (2002) Mo: Mosby-Year Book 315-329.
    Pubmed
    • 5. Tintinalli, J.E., Kelen, G.D., Stapczynski, J.S. Maxillofacial trauma, Emergency Medicine:
    A Comprehensive Study Guide. 6th edition (2004) New York, NY McGraw-Hill 1583-
    1589.
    THANK YOU

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