Simplified Airway Management in Craniomaxillofacial Surgery and Facial Trauma

ABSTRACT

Safe airway management is essential in pediatric craniofacial surgery. In the presence of deciduous teeth, securing the airway for midface surgery can be difficult. We have successfully used oral intubation with an armored tube secured by circummandibular wires to safely manage the airway in over 1200 craniofacial patients without any airway complications. With this technique, the airway is reliably secured and the possibility of intraoperative tube transection is lessened. Positioning the tube behind the maxillary tuberosity allows the application of intermaxillary fixation without the need for an intraoperative conversion to a nasotracheal tube. Circummandibular wiring of an armored oral endotracheal tube is a safe and effective method of managing the airway in children undergoing midface surgery.

KEYWORDS

Craniofacial surgery - anesthesia - intubation - airway

REFERENCES

• 1 Crysdale W S, Kohli-Dang N, Mullins G C. Airway management in craniofacial surgery: experience in 542 patients.  J Otolaryngol . 1987;  16 207
• 2 Munro I R. Craniofacial surgery: airway problems and management.  J Anesthesiol Clin . 1988;  26 72
• 3 Handler S D, Beaugard M E, Whitaker I A, Potsic W P. Airway management in the repair of craniofacial defects.  Cleft Palate J . 1978;  16 16
• 4 Whitaker L A, Munro I R, Salyer K E. Combined report of problems and complications in 793 craniofacial operations.  Plast Reconstr Surg . 1979;  64 198
• 5 Wolfe S A. Patient care and airway control during maxillofacial surgery.  Clin Plast Surg . 1982;  9 443
• 6 Nargozian C. Anesthetic management.  Clin Plast Surg . 1991;  18 227
• 7 Litchmore L, Sachs S A. Technique to minimize cutting the nasoendotracheal tubing during maxillary osteotomy.  J Oral Maxillofac Surg . 1984;  42 268
• 8 Schwartz L B, Sordill W C, Liebers R M, Schway W. Difficulty in removal of accidentally cut endotracheal tube.  J Oral Maxillofac Surg . 1982;  40 518
• 9 Posnick J C, Nakano P, Taylor M. A modified occlusal splint to avoid tracheotomy for total midfaceosteotomies.  Ann Plast Surg . 1992;  29 223
• 10 Altermir F H. Nasotracheal intubation in patients with facial fractures.  Plast Reconstr Surg . 1992;  89 165
• 11 Schendel S A, Delaire J. Functional musculo-skeletal correction of secondary unilateral cleft lip deformities: combined lip-nose correction and LeFort I osteotomy.  J Max Fac Surg . 1981;  9 108
• 12 Gaudet P T, Peerless A, Sasaki C T, Kirchner J A. Pediatric tracheostomy and associated complications.  Laryngoscope . 1978;  88 1633
• 13 David D J, Cooter R D. Craniofacial infection in 10 years of transcranial surgery.  Plast Reconstr Surg . 1987;  80 213
• 14 Horellou M F, Mathe D, Feiss P. A hazard of naso-tracheal intubation.  Anesthesia . 1978;  33 73
• 15 Gruss J S. Naso-ethmoid-orbital fractures: classification and role of primary bone grafting.  Plast Reconst Surg . 1985;  75 303