Maxillofacial fractures occur in a significant proportion worldwide and can occur as an
isolated injury or in combination with other severe injuries including cranial, spinal,
and upper and lower body injuries requiring prompt diagnosis with possible emergency
interventions. The epidemiology of facial fractures varies with regard to injury type,
severity, and cause and depends on the population studied.
Traumatic maxillofacial fractures are known to have difficulty in airway management due
to anatomical and functional reasons. In many situations, treatment of facial fractures
requires tracheal intubation. For fractures that involve occlusion, such as mandibular
and Lefort fractures, oral intubation inhibits appropriate resolution of the occlusion.
In these situations, nasotracheal intubation is indicated.
Direct laryngoscopic (DL) nasal intubations may be challenging if there is altered airway
anatomy, difficulty in advancing the endotracheal tube through the glottis or in
providers who are in training or those with less experience, even for patients with
normal airway anatomy. The presence of cervical spine injury limit neck extension and
makes airway manipulation more difficult. The use of Magill forceps is not always
successful and is associated with endotracheal tube cuff damage and postoperative
pharyngitis.
Video laryngoscopy (VL) is an adjunctive technique in anesthesia that utilizes a camera
at the tip of the laryngoscope blade, which provides an indirect view of the glottis and
surrounding structures during intubation displayed on a monitor. Use of video
laryngoscopes has been shown to result in higher first intubation success, better
laryngoscopic views, less mucosal trauma.
A bougie that is a long, stiff plastic wand is required to direct the tube to the glottis
through manipulation through nasal route. bougie overcame the limitations of endotracheal
tube direction and provided an advantage of rail-roading the tube over the bougie under
vision leaving no possibility of trauma caused by direct or magill forceps tube
manipulation.
Epistaxis is the most common complication encountered during nasotracheal (NT) intubation
and may have serious consequences, such as lifethreatening bleeding and airway
obstruction by aspirated blood. In addition, it may occur even when mucosal
vasoconstriction, a lubricated tracheal tube and careful manipulation of the tube during
insertion are employed.