Maxillofacial injuries are a frequent cause of presentations in an emergency department. Varying from simple, common nasal fractures to gross communication of the face, management of such injuries can be extremely challenging.
Injuries of this highly vascular zone are complicated by the presence of upper airway and proximity with the cranial and cervical structures that may be concomitantly involved. While, with non maxillofacial injuries, a protocol for management of airway, breathing, and circulation is relatively well established, injuries to this region have often been a subject for discussion.
We present an overview of the initial management of such patients in terms of airway, cervical spine, and circulation.
A compromised airway usually complicates the first and foremost maxillofacial injuries. On account of its location in the “crumple zone” of the face, even minor injuries can result in significant casualty to the airway. The situation may be aggravated by diminished consciousness, alcohol, and/or drug intoxication, as well as altered laryngeal and pharyngeal reflexes, making the patient vulnerable to the risk of aspiration. Furthermore, this scenario is complicated by the presence of broken teeth, dentures, foreign bodies, avulsed tissues, multiple mandibular fractures, and massive edema of the glottis, which can cause a direct threat to the airway.
Cervical Spine and Maxillofacial Trauma:
In a complex maxillofacial trauma scenario, cervical spine fracture should always be considered unless proven otherwise. The incidence is very less and ranges from 1% to 10% in all maxillofacial trauma. Because of the proximity of the cervical spine any force of such magnitude that causes facial fractures can potentially traumatize the c-spine and its ligamentous attachments.
Circulation and Hemorrhage Control:
After the acquisition of airway and addressing breathing problems, attention must be given to circulation. Maxillofacial injuries are very prone to massive hemorrhages, and life-threatening hemorrhage can vary from 1.4% to 11%. One out of every ten complicated facial fractures bleeds significantly. The main vessels involved are an ethmoid artery, ophthalmic, vidian branch of internal