Airway Management in Severe Combat-Related Maxillofacial Trauma

Abstract

Objectives:

Airway stabilization is critical in combat-related maxillofacial injury as normal anatomical landmarks can be obscured by blood and debris. The objective of this study was to characterize the epidemiology of airway management in maxillofacial trauma.

Methods:

A total of 1345 military personnel with combat-related maxillofacial injuries were retrospectively identified from the Expeditionary Medical Encounter Database using ICD-9-CM diagnostic codes. Maxillofacial injury severity was quantified with the Abbreviated Injury Scale (AIS). Service members with maxillofacial injury and severe combat trauma were included in the analysis (n = 239). Study variables included the frequency and timing of intubation, presence and severity of burn injury, frequency of tracheostomy, and presence of inhalational injury.

Results:

A total of 239 severe maxillofacial injuries were identified. The most common mechanism of injury was Improvised Explosive Device (IED) (66%), followed by gunshot wounds (8%), mortar (5%), and landmines (4%). A total of 51.0% of the subjects required intubation on their initial presentation to triage facilities. Field surgical airways were rare, but demonstrated a 75% success rate. Of the patients who underwent bronchoscopy, 65.2% were found to have airway inhalational injury. There was a significant relationship between the severity of facial injury and the need for intubation on initial presentation (P = .0027). Of the subjects, 19.7% had tracheostomy performed. Furthermore, 12.3% of the study subjects required surgical neck explorations.

Conclusions:

There is a high incidence of airway injury in combat-related maxillofacial trauma, which may be underestimated. Airway management in this population requires a high degree of suspicion and low threshold for airway stabilization.