Maxillofacial trauma patient: coping with the difficult airway

Establishing a secure airway in a trauma patient is one of the primary essentials of treatment. Any flaw in airway management may lead to grave morbidity and mortality. Maxillofacial trauma presents a complex problem with regard to the patient's airway. By definition, the injury compromises the patient's airway and it is, therefore, must be protected. In most cases, the patient undergoes surgery for maxillofacial trauma or for other, more severe, life-threatening injuries, and securing the airway is the first step in the introduction of general anaesthesia. In such patients, we anticipate difficult endotracheal intubation and, often, also difficult mask ventilation. In addition, the patient is usually regarded as having a "full stomach" and has not been cleared of a C-spine injury, which may complicate airway management furthermore. The time available to accomplish the task is short and the patient's condition may deteriorate rapidly. Both decision-making and performance are impaired in such circumstances. In this review, we discuss the complexity of the situation and present a treatment approach

Hypotensive Anesthesia versus Normotensive Anesthesia during Major Maxillofacial Surgery: A Review of the Literature

Steady blood pressure within normal limits during surgery is one of the markers of the ideal and skillful anesthesia. Yet, reduced blood pressure is advantageous in some settings because it can contribute to a reduction in overall blood loss and improve the surgical field conditions. Controlled hypotension during anesthesia or hypotensive anesthesia is often used in major maxillofacial operations. Since hypotensive anesthesia carries the risk of hypoperfusion to important organs and tissues, mainly the brain, heart, and kidneys, it cannot be applied safely in all patients. In this paper we review the medical literature regarding hypotensive anesthesia during major maxillofacial surgery, the means to achieve it, and the risks and benefits of this technique, in comparison to normotensive anesthesia

Three-Dimensional Technology Applications in Maxillofacial Reconstructive Surgery: Current Surgical Implications

Defects in the oral and maxillofacial (OMF) complex may lead to functional and esthetic impairment, aspiration, speech difficulty, and reduced quality of life. Reconstruction of such defects is considered one of the most challenging procedures in head and neck surgery. Transfer of different auto-grafts is still considered as the “gold standard” of regenerative and reconstructive procedures for OMF defects. However, harvesting of these grafts can lead to many complications including donor-site morbidity, extending of surgical time, incomplete healing of the donor site and others. Three-dimensional (3D) printing technology is an innovative technique that allows the fabrication of personalized implants and scaffolds that fit the precise anatomy of an individual’s defect and, therefore, has attracted significant attention during the last few decades, especially among head and neck surgeons. Here we discuss the most relevant applications of the 3D printing technology in the oral and maxillofacial surgery field. We further show different clinical examples of patients who were treated at our institute using the 3D technology and discuss the indications, different technologies, complications, and their clinical outcomes. We demonstrate that 3D technology may provide a powerful tool used for reconstruction of various OMF defects, enabling optimal clinical results in the suitable cases

Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach

According to the Advanced Trauma Life Support recommendations for managing patients with life-threatening injuries, securing the airway is the first task of a primary caregiver. Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient's survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient's airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult. Additionally, some of these patients may not yet have been cleared of a cervical spine injury, and all are regarded as having a full stomach and having an increased risk of regurgitation and pulmonary aspiration. The requirements of the intended maxillofacial operation may often preclude the use of an oral intubation tube, and alternative methods for securing the airway should be considered before the start of the surgery. In order to improve the clinical outcome of patients with maxillofacial trauma, cooperation between maxillofacial surgeons, anesthesiologists, and trauma specialists is needed. In this review, we discuss the complexity and difficulties of securing the airway of patients with maxillofacial trauma and present our approach for airway management of such patients

Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach

According to the Advanced Trauma Life Support recommendations for managing patients with life-threatening injuries, securing the airway is the first task of a primary caregiver. Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient’s survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient’s airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult. Additionally, some of these patients may not yet have been cleared of a cervical spine injury, and all are regarded as having a full stomach and having an increased risk of regurgitation and pulmonary aspiration. The requirements of the intended maxillofacial operation may often preclude the use of an oral intubation tube, and alternative methods for securing the airway should be considered before the start of the surgery. In order to improve the clinical outcome of patients with maxillofacial trauma, cooperation between maxillofacial surgeons, anesthesiologists, and trauma specialists is needed. In this review, we discuss the complexity and difficulties of securing the airway of patients with maxillofacial trauma and present our approach for airway management of such patients

Rare presentation of mandibular intraosseous cell Lipoma

Lipomas may be located in all parts of the body and may be confused clinically with other soft tissue masses. They infrequently occur in the head and neck. Surgical excision of a lipoma is often used as the definitive treatment modality, and alternative treatments described for lipomas range from liposuction to steroid injections. In the present study, a 38-year-old woman who was initially referred by her dentist due to a myofascial pain is described. An incidental finding (8*5mm mass) was successfully removed and diagnosed as intraosseous cell lipoma. The surgery produced excellent painless results and no functional or neural impairment. Clinically and radiographically, the tumor demonstrated inferior alveolar canal involvement. Such unique tumor characteristics never been previously reported, invalidating prior theories suggested for the etiological factors of this rare tumor. The current case report suggests a clear etiology for this tumor as a true primary benign neoplasm. Keywords: Lipoma, Adipose tissue, Mass, Mandibl

Surgical Complications of Orthognathic Surgery

Objectives: Orthognathic surgery is popular and provides patients with improved aesthetics and functionality. The procedure is considered safe and predictable. Possible complications do exist and can be life-threatening. The aim of this study is to assess the prevalence of intra- and post-operative complications, and to define possible correlations between diagnoses. Study Design: Medical records of 103 patients who underwent orthognathic surgery in a 4.5-year period (2013–2017), at the Baruch Padeh “Tzafon” Medical Center in Poriya (PMC), Israel, were retrospectively collected. The data were analyzed for descriptive statistics and non-parametrical tests. Results: In total, there were 56 complications in 45 patients (43.7% probability of complication per patient). Major complication occurred in only one case (1%), moderate complications appeared in 8.7% of the cases, while the most prevalent minor complications were temporary nerve injury and hardware issues (17.5% and 15.5%, respectively). Statistical analysis revealed that bi-max surgery has significantly higher (OR 1.34, CI 99% 1.05–1.69, p = 0.019) prevalence of complications than one-jaw surgery, as did skeletal class II patients (OR 2.75, CI 99% 2.25–3.35, p = 0.022), as compared to skeletal class III patients. Conclusions: Serious complications seem to be rare in orthognathic surgery at PMC

Surgical Complications of Orthognathic Surgery

Objectives: Orthognathic surgery is popular and provides patients with improved aesthetics and functionality. The procedure is considered safe and predictable. Possible complications do exist and can be life-threatening. The aim of this study is to assess the prevalence of intra- and post-operative complications, and to define possible correlations between diagnoses. Study Design: Medical records of 103 patients who underwent orthognathic surgery in a 4.5-year period (2013–2017), at the Baruch Padeh “Tzafon” Medical Center in Poriya (PMC), Israel, were retrospectively collected. The data were analyzed for descriptive statistics and non-parametrical tests. Results: In total, there were 56 complications in 45 patients (43.7% probability of complication per patient). Major complication occurred in only one case (1%), moderate complications appeared in 8.7% of the cases, while the most prevalent minor complications were temporary nerve injury and hardware issues (17.5% and 15.5%, respectively). Statistical analysis revealed that bi-max surgery has significantly higher (OR 1.34, CI 99% 1.05–1.69, p = 0.019) prevalence of complications than one-jaw surgery, as did skeletal class II patients (OR 2.75, CI 99% 2.25–3.35, p = 0.022), as compared to skeletal class III patients. Conclusions: Serious complications seem to be rare in orthognathic surgery at PMC