Anaesthetic Management of A Patient with Pan Facial Trauma with Restricted Mouth Opening Posted for Open Reduction and Internal Fixation of Facial Bone Fractures
Abstract:
Airway management of patients with maxillofacial
trauma remains a challenging task for an anaesthesiologist in emergency and
perioperative settings due to anatomical distortion. Appropriate planning and a
team based approach is mandatory for establishing the airway during elective
surgical procedures and in postoperative period. Here we report a 24 year old
male with alleged history of road traffic accident who sustained injury to
face. Patient had restricted mouth opening of 1 finger breadth due to pain and
multiple facial bone fractures. Patient was posted for Open reduction and
Internal fixation of facial bone fractures. In view of anticipated difficult
intubation airway management was discussed as team and planned. In OR, before
induction, USG guided bilateral maxillary and mandibular block was given, which
improved patient’s mouth opening. This approach facilitated easy intubation and
thereby avoiding airway related complication.
The tube was fixed submentally so as to allow good intraoral work space
for the surgeons. This case report suggests that use of USG guided maxillary
and mandibular blocks facilitated in airway management in this patient with
restricted mouth opening. Proper preemptive planning for difficult airway cases
and multimodal analgesia helps in managing facial trauma cases successfully
without complications.
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