Implications of Facial Fracture in Airway Management of Adult Population: What is the Most Effective Management Strategy?
Farrah C. Liu, BS, Thuy-My T. Le, MSE, Nicholas C. Oleck, BA, Jordan N. Halsey, MD, Edward S. Lee, MD, Mark S. Granick, MD.
Rutgers New Jersey Medical School, Newark, NJ, USA.
PURPOSE: Facial fractures are a harbinger when it comes to airway management. Facial fractures can cause airway obstruction or preclude the use of intubation. We aim to examine the etiologies, types of facial fractures, and the risk factors that may lead to requirement of an advance airway.
METHODS: A retrospective chart review was performed of all facial fractures in the adult population in a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and course of hospital stay.
RESULTS: During the period examined, 2834 patients were identified as greater or equal to 18 years of age with a facial fracture. Amongst them 458 were identified as requiring surgical airway or intubation. This cohort had a mean age of 33.81 (range 19 – 95) years, with a male predominance of 92.3%. 126 (27.51%) patients were intubated on, or prior to, arrival to the trauma bay. Thirteen (2.84%) required surgical airways while 94 (20.52%) patients required both intubation and surgical airways. There was a total of 1346 fractures identified on radiologic imaging. The most common fractures were orbital fractures (22.51%), frontal sinus fractures (17.23%), and zygoma fractures (11.37%). Mandible fractures were the most common fractures among those requiring surgical airway (61.54%%) while orbital fractures were the most common associated with intubation (73.01%). Mean Glasgow Coma Scale on arrival was 12.01 (range 3 – 15). The majority of those who required a surgical airway were sustained facial fractures due to gunshot wound (76.92%). Gunshot wound was also the most common etiology among those who were intubated (34.92%). Those who were required both surgical airways and intubation required the greatest average OR time (252.03 mins). The mean OR time for patients who did not require any airway management was 213.18 mins. The most common concomitant injuries were TBI, intracranial hemorrhage, and skull fracture. The most common concomitant injury associated with intubation and surgical airway was TBI. Fifty patients expired, most of which were intubated during their hospital course.
CONCLUSION: There is a dearth of literature detailing standardization of airway management for patients who present with facial fractures. The difference between intubation and surgical airway is often a subjective judgement call, but the authors believe that a more streamlined process can be elucidated after analyzing previous trends as well as variabilities in patient survival and prognosis.
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