Management of Maxillofacial Trauma (Part 1: Initial assessments) The document outlines the initial steps in managing maxillofacial trauma: 1) Assessing the airway is the top priority, checking for obstruction from mandibular or midface fractures. Techniques to secure the airway like chin lifts, oropharyngeal airways, and needle cricothyroidotomy are described. 2) Evaluating the patient's consciousness using the Glasgow Coma Scale to determine if they are in a coma. 3) Preventing aspiration by removing any dental fragments or prosthetics and suctioning blood or saliva. 4) Controlling any active bleeding in the maxillo

1. Management of Maxillofacial
Trauma (Part 1: Initial assessments)
Reza Tabrizi DMD
Associate Professor of Oral and Maxillofacial Surgery
Shahid Beheshti University of Medical Science
Email: tabmed@gmx.at

2. First Step in management of maxillofacial
trauma
 In Emergency situations: C (circulation) , A (airway), B (breathing) , P (position)

3. Risk of airway obstruction in mandibular
fractures
“Bucket handle” or comminuted
fractures of the mandible
place the airway at risk. The tongue is
attached to the central mobile
fragment(s) ( a ). If the patient is supine,
any displacement can allow the
tongue to fall back and obstruct the
upper airway ( b ). Snoring is a sign
of impending obstruction

4. Risk of airway obstruction in the midface
fractures
Collapse of the soft
palate together with
swelling can result in
airway obstruction

5. Chin lift and jaw trust

6. Oropharyngeal airway

7. Nasopharyngeal tubes

8. Surgical cricothyroidotomy.
Surgical cricothyroidotomy. ( a ) The
cricothyroid (C-T) membrane passes
between the thyroid cartilage (Adam’s
apple) and cricoid ring.
It is usually covered by a relatively thin
layer of skin and subcutaneous tissues,
making access to it relatively simple. ( b
)

10. Needle cricothyroidotomy.
The aim of needle
cricothyroidotomy
is to place a cannula into the
upper airway through the C-T
membrane.
Although this facilitates
oxygenation, the patient cannot be
ventilated. C O 2 will therefore
quickly rise

11. The second step in management of
maxillofacial trauma
 The evaluation of patients’ conscious
 Generally it is described by Glasgow coma scale
 The minimum scale is 3/15 and the maximum is
15/15
If GCS is under 8/15, the condition is considered
Coma.

12. Step 3: Prevention of Aspiration
 Any removal device such as removable prosthesis , fracture tooth fragments
should be removed and blood or saliva is suctioned to prevent aspiration.

13. Foreign bodies in the upper airway

14. Step 4
 If a traumatic patient has an active bleeding source in the maxillofacial area, it
should be managed in this step.

15. Resolving sublingual haematoma 1
week following mandibular
fracture. Patient was on warfarin
(International Normalized
Ratio [INR] 6 on presentation) with
partial airway obstruction.
Management included urgent
fiberoptic intubation, correction of INR,
incision and drainage of haematoma
and repair of fracture

16. Step 5: Occlusion
 Occlusion is a key factor in the assessment of post-traumatic jaw injuries

17. Step 6: Tooth mobility or change of tooth
position

18. Light Palpation of facial bone borders to
detect any steps

19. Bozcaada.Turkey