Anaesthesia for facial trauma

Abstract 

This article considers the causes of facial trauma and the differing patterns of injury seen. The relative strengths of the facial bones and Le Fort fractures lines are described. The important airway and other management issues for the initial acute phase and the later second-stage management for surgical treatment of facial fractures are discussed. The concern regarding actual and potential cerebrospinal fluid leak from Le Fort 2- and 3-level fractures is reviewed, and different strategies for airway management put forward. Specific difficulties with endotracheal intubation of patients with facial trauma are examined. The maintenance of anaesthesia and extubation problems are then discussed.

Keywords: cerebrospinal fluid, haemorrhage, facial fracture, Le Fort fractures, remifentanil