Anaesthesia for facial trauma

The causes and types of facial injury are considered, specifically noting the way in which the different strength bones fracture and how they are classified in the Le Fort system. The early and late anaesthetic management of these cases is discussed with particular reference to potential airway problems. Emergency airway control and the different ways of controlling haemorrhage are described. Further management of the trauma patient with reference to the ABCDE priorities of basic life support and monitoring neurological deficit is then discussed. This is followed by information on other general issues of soft tissue injuries, pain control, prevention of infection and management of dural tears. The late management of facial fractures is different and can be complex. This article reviews the debate about the route of endotracheal intubation and gives some detail of submental intubation. The general principles of maintenance of anaesthesia are similar to those for neuroanaesthesia. Extubation strategies are discussed along with the requirement for high dependency recovery facilities.