Maxillofacial injuries may be dramatic in appearance but are rarely life-threatening, unless airway, breathing, or circulation are compromised as a result of the injury.
- Secure the airway: An emergency surgical airway may be necessary if orotracheal intubation is not possible. (Note: A cricothyroidotomy takes significantly less time than a tracheostomy and should be the surgical airway of choice if respiratory failure is imminent.) Nasotracheal intubation is contraindicated. If trained personnel are available and a cricothyroidotomy is not feasible, retromolar intubation or submental intubation may be considered.
- Maintain cervical spine stabilization during airway management, with inline immobilization and minimal extension.
- Establish large-bore peripheral intravenous access and begin fluid resuscitation.
- Ask the surgical team to obtain local control of hemorrhage.
- Assess the patient for concomitant injury.
- Management of associated life-threatening injuries is undertaken first.
- Early tracheostomy should be considered in selected patients as follows:
- Pan-facial fractures
- Profuse nasal bleeding
- Severe soft tissue edema in the proximity of the airway
- Patients with altered mental status
- Severe facial burns
- High spinal cord injuries
- Difficult airway characteristics
- Need for prolonged intubation
- Assume that the cervical spine is unstable. A cervical collar should remain in place until definitive clearance by a combination of physical examination and radiographic examination.
- Definitive management of facial injuries, particularly facial fractures, is usually delayed until life-threatening injuries are managed and the patient is stable.
Maxillofacial injuries themselves are seldom life-threatening. Associated injuries, however, are serious and must be managed first in order to prevent loss of life.