Airway and Breathing

Maxillofacial trauma places the airway at risk [21]. Bleeding, oedema or foreign bodies such as loose teeth may further obstruct the airway. Alcohol intoxication is frequently a factor, with a resultant reduction in consciousness and increased likelihood of vomiting.

Allowing a conscious patient to sit up may help maintain airway patency and reduce the risk of aspiration (only if no spinal injuries are present). A left lateral position may be required if a patient also has suspected spinal injuries and feels like vomiting prior to intubation.

Jaw thrusting or anterior traction on a floating segment of mandible may help open the airway, at the price of possibly increasing haemorrhage.

Endotracheal intubation in this setting is likely to be very difficult, requiring senior input and availability of a difficult airway trolley.

See this RCEM blog for more information:

Circulation:

While maxillofacial haemorrhage can be dramatic, it is only rarely responsible for profound hypotension. Clinicians must look for other causes of blood loss/shock in hypotensive patients [21].

Prompt haemostasis of external bleeding may involve direct pressure, sutures or staples. Internal haemorrhage control may require packing, balloon tamponade, temporary reduction of fractures, or either embolization or surgical ligation of bleeding vessels.

Following haemostasis, most maxillofacial injuries do not require immediate surgical repair.