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Anesthetic Assessment and Treatment of Facial and Ocular Trauma

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Anesthesia for Trauma

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Abstract

The anesthetic management of facial trauma can be challenging, with airway management as a particular concern. Difficulties can exist with (1) spontaneous ventilation, due to depressed consciousness and concomitant brain injury; (2) mask ventilation, due to the potential for altered facial soft tissue and bony structures; and (3) intubation, due to the extent of trauma present. Innovative intubation techniques must sometimes be utilized. Patients with previous facial trauma present airway complications, sometimes in the form of significant scarring and limited mouth opening. In patients with ocular trauma, open globe injuries are of special concern. Intraocular and extraocular pressures must be limited by avoiding anesthetic agents that cause myoclonus and eliminating compression of the globe.

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References

  1. Zandi M, Seyed Hoseini SR. The relationship between head injury and facial trauma: a case-control study. Oral Maxillofac Surg. 2013;17(3):201–7.

    Article  PubMed  Google Scholar 

  2. Tung TC, Tseng WS, Chen CT, Lai JP, Chen YR. Acute life-threatening injuries in facial fracture patients: a review of 1,025 patients. J Trauma. 2000;49(3):420–4.

    Article  CAS  PubMed  Google Scholar 

  3. Kostakis G, Stathopoulos P, Dais P, Gkinis G, Igoumenakis D, Mezitis M, et al. An epidemiologic analysis of 1,142 maxillofacial fractures and concomitant injuries. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(5 Suppl):S69–73.

    Article  PubMed  Google Scholar 

  4. Gassner R, Tuli T, Hachl O, Moreira R, Ulmer H. Craniomaxillofacial trauma in children: a review of 3,385 cases with 6,060 injuries in 10 years. J Oral Maxillofac Surg. 2004;62(4):399–407.

    Article  PubMed  Google Scholar 

  5. Gassner R, Tuli T, Hachl O, Rudisch A, Ulmer H. Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg. 2003;31(1):51–61.

    Article  PubMed  Google Scholar 

  6. Asensio JA, Trunkey DD, ScienceDirect (Online service). Current therapy of trauma and surgical critical care. Philadelphia: Mosby/Elsevier; 2008. Available from: http://www.sciencedirect.com/science/book/9780323044189.

  7. Shanmugasundararaj S, Zhou X, Neunzig J, Bernhardt R, Cotten JF, Ge R, et al. Carboetomidate: an analog of etomidate that interacts weakly with 11beta-hydroxylase. Anesth Analg. 2013;116(6):1249–56.

    Article  CAS  PubMed  Google Scholar 

  8. Smith CE, Fallon WF. Sevoflurane mask anesthesia for urgent tracheostomy in an uncooperative trauma patient with a difficult airway. Can J Anaesth. 2000;47(3):242–5.

    Article  CAS  PubMed  Google Scholar 

  9. Heath KJ. The effect of laryngoscopy of different cervical spine immobilisation techniques. Anaesthesia. 1994;49(10):843–5.

    Article  CAS  PubMed  Google Scholar 

  10. Aoi Y, Inagawa G, Hashimoto K, Tashima H, Tsuboi S, Takahata T, et al. Airway scope laryngoscopy under manual inline stabilization and cervical collar immobilization: a crossover in vivo cinefluoroscopic study. J Trauma. 2011;71(1):32–6.

    Article  PubMed  Google Scholar 

  11. Thoren H, Schaller B, Suominen AL, Lindqvist C. Occurrence and severity of concomitant injuries in other areas than the face in children with mandibular and midfacial fractures. J Oral Maxillofac Surg. 2012;70(1):92–6.

    Article  PubMed  Google Scholar 

  12. Barash PG. Clinical anesthesia. Philadelphia: Wolters Kluwer; 2009. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=booktext&D=books&AN=01429405.

  13. Afrooz PN, Grunwaldt LJ, Zanoun RR, Grubbs RK, Saladino RA, Losee JE, et al. Pediatric facial fractures: occurrence of concussion and relation to fracture patterns. J Craniofac Surg. 2012;23(5):1270–3.

    Article  PubMed  Google Scholar 

  14. Pappachan B, Alexander M. Correlating facial fractures and cranial injuries. J Oral Maxillofac Surg. 2006;64(7):1023–9.

    Article  PubMed  Google Scholar 

  15. Anderson V, Catroppa C, Morse S, Haritou F, Rosenfeld J. Functional plasticity or vulnerability after early brain injury? Pediatrics. 2005;116(6):1374–82.

    Article  PubMed  Google Scholar 

  16. Puljula J, Cygnel H, Makinen E, Tuomivaara V, Karttunen V, Karttunen A, et al. Mild traumatic brain injury diagnosis frequently remains unrecorded in subjects with craniofacial fractures. Injury. 2012;43(12):2100–4.

    Article  PubMed  Google Scholar 

  17. Zhou HH, Ongodia D, Liu Q, Yang RT, Li ZB. Dental trauma in patients with maxillofacial fractures. Dent Traumatol. 2013;29(4):285–90.

    Article  PubMed  Google Scholar 

  18. Iso-Kungas P, Törnwall J, Suominen AL, Lindqvist C, Thorén H. Dental injuries in pediatric patients with facial fractures are frequent and severe. J Oral Maxillofac Surg. 2012;70(2):396–400.

    Article  PubMed  Google Scholar 

  19. Roccia F, Boffano P, Bianchi FA, Ramieri G. An 11-year review of dental injuries associated with maxillofacial fractures in Turin. Italy Oral Maxillofac Surg. 2013;17(4):269–74.

    Article  Google Scholar 

  20. Yang WG, Tsai TR, Hung CC, Tung TC. Life-threatening bleeding in a facial fracture. Ann Plast Surg. 2001;46(2):159–62.

    Article  CAS  PubMed  Google Scholar 

  21. Khanna S, Dagum AB. A critical review of the literature and an evidence-based approach for life-threatening hemorrhage in maxillofacial surgery. Ann Plast Surg. 2012;69(4):474–8.

    Article  CAS  PubMed  Google Scholar 

  22. Grassetto A, Saggioro D, Caputo P, Penzo D, Bossi A, Tedesco M, et al. Rotational thromboelastometry analysis and management of life-threatening haemorrhage in isolated craniofacial injury. Blood Coagul Fibrinolysis. 2012;23(6):551–5.

    PubMed  Google Scholar 

  23. Salvatori M, Kodikara S, Pollanen M. Fatal subarachnoid hemorrhage following traumatic rupture of the internal carotid artery. Leg Med (Tokyo). 2012;14(6):328–30.

    Article  Google Scholar 

  24. Badjate SJ, Shenoi SR, Budhraja NJ, Ingole P. Transmylohyoid orotracheal intubation: case series and review. J Clin Anesth. 2012;24(6):460–4.

    Article  PubMed  Google Scholar 

  25. Shetty PM, Yadav SK, Upadya M. Submental intubation in patients with panfacial fractures: a prospective study. Indian J Anaesth. 2011;55(3):299–304.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Caron G, Paquin R, Lessard MR, Trépanier CA, Landry PE. Submental endotracheal intubation: an alternative to tracheotomy in patients with midfacial and panfacial fractures. J Trauma. 2000;48(2):235–40.

    Article  CAS  PubMed  Google Scholar 

  27. Caubi AF, Vasconcelos BC, Vasconcellos RJ, de Morais HH, Rocha NS. Submental intubation in oral maxillofacial surgery: review of the literature and analysis of 13 cases. Med Oral Patol Oral Cir Bucal. 2008;13(3):E197–200.

    PubMed  Google Scholar 

  28. Davis C. Submental intubation in complex craniomaxillofacial trauma. ANZ J Surg. 2004;74(5):379–81.

    Article  PubMed  Google Scholar 

  29. Lee SS, Huang SH, Wu SH, Sun IF, Chu KS, Lai CS, et al. A review of intraoperative airway management for midface facial bone fracture patients. Ann Plast Surg. 2009;63(2):162–6.

    Article  CAS  PubMed  Google Scholar 

  30. Truong A, Truong DT. Retromolar tracheal intubation in a pediatric patient with a difficult airway and bilateral nasal stenoses. Can J Anaesth. 2012;59(8):809–10.

    Article  PubMed  Google Scholar 

  31. Habib A, Zanaty OM. Use of retromolar intubation in paediatric maxillofacial trauma. Br J Anaesth. 2012;109:650–1.

    Article  CAS  PubMed  Google Scholar 

  32. Apfelbaum JL, Caplan RA, Barker SJ, Connis RT, Cowles C, Ehrenwerth J, et al. Practice advisory for the prevention and management of operating room fires: an updated report by the American Society of Anesthesiologists Task Force on Operating Room Fires. Anesthesiology. 2013;118(2):271–90.

    Article  PubMed  Google Scholar 

  33. Rinder CS. Fire safety in the operating room. Curr Opin Anaesthesiol. 2008;21(6):790–5.

    Article  PubMed  Google Scholar 

  34. Chee WK, Benumof JL. Airway fire during tracheostomy: extubation may be contraindicated. Anesthesiology. 1998;89(6):1576–8.

    Article  CAS  PubMed  Google Scholar 

  35. Ng JM, Hartigan PM. Airway fire during tracheostomy: should we extubate? Anesthesiology. 2003;98(5):1303.

    Article  PubMed  Google Scholar 

  36. Rosenblatt W, Ianus AI, Sukhupragarn W, Fickenscher A, Sasaki C. Preoperative endoscopic airway examination (PEAE) provides superior airway information and may reduce the use of unnecessary awake intubation. Anesth Analg. 2011;112(3):602–7.

    Article  PubMed  Google Scholar 

  37. Benaglia MB, Gaetti-Jardim EC, Oliveira JG, Mendonca JC. Bilateral temporomandibular joint ankylosis as sequel of bilateral fracture of the mandibular condyle and symphysis. Oral Maxillofac Surg. 2014;18(1):39–42.

    Article  PubMed  Google Scholar 

  38. K M, Rupa LM, Krishna Murthy SG, P G G, U B. Anaesthesia for TMJ Ankylosis with the Use of TIVA, Followed by Endotracheal Intubation. J Clin Diagn Res. 2012;6(10):1765–7.

    PubMed Central  PubMed  Google Scholar 

  39. Morimoto Y, Sugimura M, Hirose Y, Taki K, Niwa H. Nasotracheal intubation under curve-tipped suction catheter guidance reduces epistaxis. Can J Anaesth. 2006;53(3):295–8.

    Article  PubMed  Google Scholar 

  40. Watanabe S, Yaguchi Y, Suga A, Asakura N. A “bubble-tip” (Airguide) tracheal tube system: its effects on incidence of epistaxis and ease of tube advancement in the subglottic region during nasotracheal intubation. Anesth Analg. 1994;78(6):1140–3.

    CAS  PubMed  Google Scholar 

  41. Kundra P, Vasudevan A, Ravishankar M. Video assisted fiberoptic intubation for temporomandibular ankylosis. Paediatr Anaesth. 2006;16(4):458–61.

    Article  PubMed  Google Scholar 

  42. Vas L, Sawant P. A review of anaesthetic technique in 15 paediatric patients with temporomandibular joint ankylosis. Paediatr Anaesth. 2001;11(2):237–44.

    Article  CAS  PubMed  Google Scholar 

  43. Tsui BC, Cunningham K. Fiberoptic endotracheal intubation after topicalization with in-circuit nebulized lidocaine in a child with a difficult airway. Anesth Analg. 2004;98(5):1286–8. Table of contents.

    Article  PubMed  Google Scholar 

  44. Fleisher LA. Anesthesia and uncommon diseases. 5th ed. Philadelphia, PA: Saunders; 2006. 658 p.

    Google Scholar 

  45. Karabekir HS, Gocmen-Mas N, Emel E, Karacayli U, Koymen R, Atar EK, et al. Ocular and periocular injuries associated with an isolated orbital fracture depending on a blunt cranial trauma: anatomical and surgical aspects. J Craniomaxillofac Surg. 2012;40(7):e189–93.

    Article  PubMed  Google Scholar 

  46. Brucoli M, Arcuri F, Giarda M, Benech R, Benech A. Surgical management of posttraumatic intraorbital hematoma. J Craniofac Surg. 2012;23(1):e58–61.

    Article  PubMed  Google Scholar 

  47. Rha EY, Kim JH, Byeon JH. Posttraumatic delayed cranio-orbital cerebrospinal fluid leakage: case report. J Plast Reconstr Aesthet Surg. 2013;66(4):563–5.

    Article  PubMed  Google Scholar 

  48. Amadasun FE, Isesele TO. Vitreous humour extrusion after suxamethonium induction of anaesthesia in a polytraumatized patient: a case report. Case Rep Med. 2010;2010:913763.

    PubMed Central  PubMed  Google Scholar 

  49. Bakke EF, Hisdal J, Semb SO. Intraocular pressure increases in parallel with systemic blood pressure during isometric exercise. Invest Ophthalmol Vis Sci. 2009;50(2):760–4.

    Article  PubMed  Google Scholar 

  50. Robin J, Alexander R. Remifentanil obtunds intraocular pressure rises associated with suxamethonium. Br J Anaesth. 2008;101(3):432. author reply 432–3.

    Article  CAS  PubMed  Google Scholar 

  51. Hanna SF, Ahmad F, Pappas AL, Mikat-Stevens M, Jellish WS, Kleinman B, et al. The effect of propofol/remifentanil rapid-induction technique without muscle relaxants on intraocular pressure. J Clin Anesth. 2010;22(6):437–42.

    Article  CAS  PubMed  Google Scholar 

  52. Mowafi HA, Aldossary N, Ismail SA, Alqahtani J. Effect of dexmedetomidine premedication on the intraocular pressure changes after succinylcholine and intubation. Br J Anaesth. 2008;100(4):485–9.

    Article  CAS  PubMed  Google Scholar 

  53. Halstead SM, Deakyne SJ, Bajaj L, Enzenauer R, Roosevelt GE. The effect of ketamine on intraocular pressure in pediatric patients during procedural sedation. Acad Emerg Med. 2012;19(10):1145–50.

    Article  PubMed  Google Scholar 

  54. Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, et al. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2007;105(6):1615–28. table of contents.

    Article  PubMed  Google Scholar 

  55. Rhea JT, Novelline RA. How to simplify the CT diagnosis of Le Fort fractures. AJR Am J Roentgenol. 2005;184(5):1700–5.

    Article  PubMed  Google Scholar 

  56. Thompson JN, Gibson B, Kohut RI. Airway obstruction in LeFort fractures. Laryngoscope. 1987;97(3 Pt 1):275–9.

    CAS  PubMed  Google Scholar 

  57. Ng M, Saadat D, Sinha UK. Managing the emergency airway in Le Fort fractures. J Craniomaxillofac Trauma. 1998;4(4):38–43.

    CAS  PubMed  Google Scholar 

  58. Joo DT, Orser BA. External compression of a nasotracheal tube due to the displaced bony fragments of multiple LeFort fractures. Anesthesiology. 2000;92(6):1830–2.

    Article  CAS  PubMed  Google Scholar 

  59. Azenha MR, Yamaji MA, Avelar RL, de Freitas QE, Laureano Filho JR, de Oliveira Neto PJ. Retropharyngeal and cervicofacial subcutaneous emphysema after maxillofacial trauma. Oral Maxillofac Surg. 2011;15(4):245–9.

    Article  PubMed  Google Scholar 

  60. Boffano P, Roccia F, Gallesio C, Karagozoglu KH, Forouzanfar T. Bicycle-related maxillofacial injuries: a double-center study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(3):275–80.

    Article  PubMed  Google Scholar 

  61. King RE, Scianna JM, Petruzzelli GJ. Mandible fracture patterns: a suburban trauma center experience. Am J Otolaryngol. 2004;25(5):301–7.

    Article  PubMed  Google Scholar 

  62. Natu SS, Pradhan H, Gupta H, Alam S, Gupta S, Pradhan R, et al. An epidemiological study on pattern and incidence of mandibular fractures. Plast Surg Int. 2012;2012:834364.

    PubMed Central  PubMed  Google Scholar 

  63. Yamamoto K, Matsusue Y, Horita S, Murakami K, Sugiura T, Kirita T. Maxillofacial fractures in children. J Craniofac Surg. 2013;24(1):153–7.

    Article  PubMed  Google Scholar 

  64. Zachar MR, Labella C, Kittle CP, Baer PB, Hale RG, Chan RK. Characterization of mandibular fractures incurred from battle injuries in Iraq and Afghanistan from 2001-2010. J Oral Maxillofac Surg. 2013;71(4):734–42.

    Article  PubMed  Google Scholar 

  65. Goss AN, Chau KK, Mayne LH. Intermaxillary fixation: how practicable is emergency jaw release? Anaesth Intensive Care. 1979;7(3):253–7.

    CAS  PubMed  Google Scholar 

  66. Heard AM, Green RJ, Lacquiere DA, Sillifant P. The use of mandibular nerve block to predict safe anaesthetic induction in patients with acute trismus. Anaesthesia. 2009;64(11):1196–8.

    Article  CAS  PubMed  Google Scholar 

  67. Hillerup S, Jensen R. Nerve injury caused by mandibular block analgesia. Int J Oral Maxillofac Surg. 2006;35(5):437–43.

    Article  CAS  PubMed  Google Scholar 

  68. Rana M, Gellrich NC, von See C, Weiskopf C, Gerressen M, Ghassemi A, et al. 3D evaluation of postoperative swelling in treatment of bilateral mandibular fractures using 2 different cooling therapy methods: a randomized observer blind prospective study. J Craniomaxillofac Surg. 2013;41(1):e17–23.

    Article  PubMed  Google Scholar 

  69. Lindaman LM. Bone healing in children. Clin Podiatr Med Surg. 2001;18(1):97–108.

    CAS  PubMed  Google Scholar 

  70. Yu J, Dinsmore R, Mar P, Bhatt K. Pediatric maxillary fractures. J Craniofac Surg. 2011;22(4):1247–50.

    Article  PubMed  Google Scholar 

  71. Shah RK, Dhingra JK, Carter BL, Rebeiz EE. Paranasal sinus development: a radiographic study. Laryngoscope. 2003;113(2):205–9.

    Article  PubMed  Google Scholar 

  72. Imahara SD, Hopper RA, Wang J, Rivara FP, Klein MB. Patterns and outcomes of pediatric facial fractures in the United States: a survey of the National Trauma Data Bank. J Am Coll Surg. 2008;207(5):710–6.

    Article  PubMed Central  PubMed  Google Scholar 

  73. Maqusi S, Morris DE, Patel PK, Dolezal RF, Cohen MN. Complications of pediatric facial fractures. J Craniofac Surg. 2012;23(4):1023–7.

    Article  PubMed  Google Scholar 

  74. Bergeson PS, Shaw JC. Are infants really obligatory nasal breathers? Clin Pediatr (Phila). 2001;40(10):567–9.

    Article  CAS  Google Scholar 

  75. Suresh S, Voronov P. Head and neck blocks in infants, children, and adolescents. Paediatr Anaesth. 2012;22(1):81–7.

    Article  PubMed  Google Scholar 

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  1. Department of Anesthesiology and Perioperative Medicine, Case Western Reserve University, University Hospitals, 11100 Euclid Avenue, LKS 5007, Cleveland, OH, 44106, USA

    Anna Clebone M.D.

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Correspondence to Anna Clebone M.D. .

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  1. Bellevue Hospital Center, New York University, New York, New York, USA

    Corey S. Scher

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Clebone, A. (2014). Anesthetic Assessment and Treatment of Facial and Ocular Trauma. In: Scher, C. (eds) Anesthesia for Trauma. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0909-4_10

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  • DOI: https://doi.org/10.1007/978-1-4939-0909-4_10

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