Le blessé de guerre cervicofacial, de la physiopathologie à la prise en charge. Une revue de la littérature

This bibliographical review's purpose is to describe the specific aspects of the face and neck wounded soldiers: epidemiology, lesional mechanisms, injuries and management of superior airways. This literature review, made by three authors, is based on electronic database (MedLine, EMBase) and covers the last 15 years. The keywords used in this research are: “military medicine”, “neck injuries”, “maxillofacial injuries”, “blast injuries”, “gunshot wounds”, “airway management”. Informations about history, epidemiology, physiopathology, mechanism of wounds, wounds themselves and prevention are collected. Among 203 articles, 50 are included. The injuries caused in combat situations are open, resulting from explosions or gunshot wounds. Outside the fights, the traumas are blunt and caused by motor vehicle accident or falls. Protecting the wounded soldier's airways recovers the same indications as in a civilian environment. On the field, it is restrained by the necessity of rationalizing both humans and material resources. Respecting the position spontaneously adopted sometimes allows to delay an intubation. The algorithms suggest to perform a cricothyrotomy after the first or second attempt of intubation. They even advise it in the first place, if the superior airways are obstructed or if the damage to the face and neck is too severe. Airway management differs from the civilian practice, highlighting therapeutic abstention and cricothyrotomy.