Airway management in maxillofacial injuries: Identifying clinical determinants requiring non-conventional strategies

Aim: Airway management in maxillofacial injuries is challenging. Conventionally, the method of securing the airway is using Macintosh laryngoscope to intubate the patients. Knowing the clinical variables associated with the need for nonconventional (nonMacintosh) laryngoscopy will aid in better airway management. The present analysis was aimed to identifying the clinical variables associated with nonconventional tracheal intubation in patients with maxillofacial injury. Materials and Methods: Medical records of maxillofacial injury patients with at least one facial bone fracture who needed tracheal intubation from January 2009 to June 2016 in a teaching institute were screened for data collection. The clinicodemographic parameters, techniques, and instruments used for tracheal intubation were noted. The INSTAT software was used for statistical analysis, and P < 0.05 was considered significant. Results: Seventy-three patients (mean age 27.47 ± 9.92 years; 94.52% male) were analyzed. A total of 61.64% of tracheal intubations required nonconventional techniques [i.e. video laryngoscope (27.4%), fiberoptic bronchoscope (26.03%), tracheostomy (6.85%), and 1.37% retrograde intubation]. Video laryngoscopy was preferred over Macintosh in patients with confirmed/suspected C-spine injury. Mouth opening <2 cm [odds ratio (OR): 7.33], multiple facial bone fracture (OR: 4.80), and concomitant mandible and maxilla fractures (OR: 6.50) were associated with tracheal intubation by nonconventional laryngoscopy (P = 0.01). Conclusion: Multiple facial bone fractures, concomitant mandible and maxilla fracture, and mouth opening <2 cm need tracheal intubation using a technique other than Macintosh laryngoscopy.