1. Introduction

    Traumatic disruption of the bony, cartilaginous, and soft tissues of the face and upper airway challenge the anesthesia provider to recognize the nature and extent of the injury and consequent anatomic alteration. It is imperative to create an anesthetic plan for securing the airway without promoting further damage or compromising ventilation. Possible mechanisms by which the upper or lower airway may become obstructed include edema; bleeding from the oral mucosa and palate; intraoral fracture sites; the presence of foreign bodies such as avulsed teeth, blood clots, or bony fragments; distortion of the nasal passages; injury of the pharynx and sinuses; and open lacerations.

    Two common causes of maxillofacial fractures are blunt and penetrating trauma and gunshot wounds. Because of the intense forces required to cause facial fractures, other traumas (e.g., subdural hematoma, pneumothorax, cervical spine injury, and intraabdominal bleeding) often occur simultaneously with these fractures.