AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 11

Maxillofacial Trauma

Basic Tenets of Trauma Management When you are treating maxillofacial trauma, the basic (ABC) tenets of trauma management hold: • You must secure an A irway. • You must make sure the patient is B reathing and ventilating adequately. • You must ensure adequate C irculation by stopping bleeding and providing fluid replacement. • You must ensure that no C -spine (cervical spine) fracture is present. Always consider the airway first. Healthcare professionals always wonder whether a patient should have a cricothyrotomy or intubation. This is sometimes a judgment call. One way to think about this decision is to review a checklist of ways to secure the airway. Do not forget that the most common cause of airway obstruction in a patient with an altered level of consciousness is the tongue falling back into the throat. This can be treated by a jaw lift maneuver , placement of an oral airway , or a long nasal airway (also known as a nasopharyngeal airway or a nasal trumpet) . Because we must assume that a cervical spine injury will be associated with maxillofacial trauma, the head tilt/chin lift should NEVER be performed in these patients until the C-spine is cleared both by radiologic studies and by clinical exam following ATLS (advanced trauma life support) protocols. Also consider the possibility of a foreign body obstructing the airway (dentures in adults; balloons, small toys, food, etc., in children). If the cause of airway obstruction is not so simple, however, the quickest and easiest method of securing the airway is endotracheal intubation through the mouth. This requires placing a laryngoscope down through the mouth to the larynx (direct laryngoscopy) and lifting up. The vocal

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