A SURVEY OF OPERATIVE AIRWAY MANAGEMENT-PRACTICES FOR MIDFACE FRACTURES

We surveyed 218 Level I trauma centers to determine operative airway m anagement preferences for patients with midface fractures requiring ma xillomandibular fixation. A two-page survey was distributed to anesthe siologists, plastic surgeons, otolaryngologists, and oral surgeons par ticipating in the management of major craniofacial trauma at each cent er. Specific fracture patterns were described, and the preferences for endotracheal intubation for operative management were surveyed among the respondents. We analyzed 105 responses from surgeons and 51 respon ses from anesthesiologists. Although there were differences in the pre ferences expressed by surgeons compared with anesthesiologists, more t han 50% of the respondents in each practice category chose some form o f nasotracheal intubation for fracture patterns involving the midface. Tracheostomy was a first choice for patients with panfacial fractures or those with loss of consciousness and midface fractures. This repor t serves as a basis for surgeons and anesthesiologists to review their practices and discuss planning of operative airway management for the patients with these fracture patterns. On the basis of this survey, m idface fractures need not prohibit any consideration of nasotracheal i ntubation.