Facial Trauma : Immediate Management

By | October 4, 2017


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.

Immediate Management

  • 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.

Subsequent Management

  • Management of associated life-threatening injuries is undertaken first.
  • Early tracheostomy should be considered in selected patients as follows:
  1. Pan-facial fractures
  2. Profuse nasal bleeding
  3. Severe soft tissue edema in the proximity of the airway
  4. Patients with altered mental status
  5. Severe facial burns
  6. High spinal cord injuries
  7. Difficult airway characteristics
  8. Need for prolonged intubation
  9. 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.
  10. 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.

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