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Anaesthesia for maxillofacial trauma 

Anaesthesia for maxillofacial trauma
Anaesthesia for maxillofacial trauma

Joy Curran

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date: 01 December 2020

Maxillofacial trauma is a vitally important area of trauma management. Four of five of our vital senses are contained within the facesight, hearing, smell, and taste. Also, scarring and disfigurement to the face deeply affects our sense of self and our front to the world.

The aetiology of facial trauma has shifted in the more developed world towards assault being the most common cause (at around 3641%), closely followed by road traffic accidents (RTAs)(2532%). Other causes listed in order of frequency are falls (mainly in the extremes of age), sport, occupational injuries, and gunshot wounds.

As a group, 5570% of patients with significant facial trauma will have other serious injuries. Looking at it the other way around, 30% of severely injured trauma patients also had maxillofacial trauma4. The most common isolated fracture reported is the nose which serves as the ‘crumple zone’ for the face when hit from the front. Those patients with injuries resulting from gunshots and RTAs had higher injury severity scores (ISS).

One study from an American level 1 trauma centre looked at those patients with maxillofacial injuries and an ISS of over 12. They found that 43.7% of patients also had cerebral haematoma, with subdural being the most common. The second most commonly associated injury was pulmonary trauma, in particular contusions. Forty-two per cent of patients required intubation and 14% required a tracheostomy at some point. With regard to cervical spine injuries, 5% also had a cervical fracture and a quarter of these had neurological deficit. Looking at significant trauma injuries in Canada between 1992 and 1997, 17% of patients with an ISS score of over 12 had maxillofacial injuries. The entire group had some kind of head injury with altered conscious level and 11% had a cervical spine injury.

Ophthalmic injury has been strongly linked to not wearing a seatbelt, increasing the risk from 2% up to 20% in one review. Blindness is associated with 0.5 3% of midfacial fractures. Upper and midfacial fractures are associated particularly with smell or taste disturbances. In one Italian series, about one-third of those who had treatment for upper third and mid third fractures suffered long-term disturbances of smell or taste.

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