Securing the Airway in Maxillofacial Trauma Patients: A Systematic Review of Techniques

Abstract

Study design: The present study is a systematic review of the literature.

Objective: The goal of this study is to review our experience and the current literature on airway management techniques in maxillofacial trauma.

Methods: Independent searches of the PubMed and MEDLINE databases were performed from January 1, 2019 to February 1, 2019. Articles from the period of 2008 to 2018 were collected. All studies which described both airway management and maxillofacial trauma using the Boolean method and relevant search term combinations, including "maxillofacial," "trauma," and "airway," were considered.

Results: A total of 452 relevant articles in total were identified. Articles meeting inclusion criteria by abstract review included 68 total articles, of which 16 articles were focused on airway management techniques for maxillofacial trauma in the general population and were deemed appropriate for inclusion in the literature review.

Conclusions: Establishing an effective and stable airway in patients with maxillofacial trauma is of paramount concern. In both the acute setting and during delayed reconstruction, special considerations must be taken when securing a reliable airway in this patient population. The present article provides techniques for securing the airway and algorithms for utilization of these techniques, including both during the initial evaluation and the definitive operative management.

Keywords: difficult airway; intubation; maxillofacial trauma; submental intubation; tracheostomy.

Figure 1.

PRISMA flow diagram depicting the process of selecting studies for the literature review.

Figure 2.

Factors contributing to a difficult airway in craniomaxillofacial trauma.

Figure 3.

Retraction of tongue using a towel clamp to decrease soft tissue obstruction of the oropharynx in maxillofacial trauma. Alternatively, a penetrating towel clamp can be used.

Figure 4.

The proposed algorithm for approaching acute airway management.

Figure 5.

Demonstration of retromolar intubation. (Image reprinted with permission from Jaisani MR, Pradhan L, Bhattarai B, Sagtani A. Intubation Techniques: Preferences of Maxillofacial Trauma Surgeons. J Maxillofac Oral Surg. 2015;14(2):501-505).

Figure 6.

Demonstration of an anchored endotracheal tube by (A) suturing the tube to the lip and (B and C) fixing the tube circumdentally.

Figure 7.

Demonstration of an anchored nasotracheal tube by (A) securing the tube to the septum with 3-0 silk suture with a Merocel pack in place and (B) taping the tube to the forehead with a Merocel pack in place.

Figure 8.

Demonstration of submental intubation with endotracheal tube secured to the skin at the exterior incision site with a 3-0 silk purse-string suture.

Figure 9.

Proposed algorithm for securing the difficult airway intraoperatively.