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  • Print publication year: 2012
  • Online publication date: November 2012

Chapter 7 - Anesthesia for ENT trauma

from Section 1 - Introduction

Summary

An understanding of anatomy is paramount to the ability to safely anesthetize the head and neck surgery patient. The basic underlying structure of the face is formed by the skull, facial bones and mandible. The cochlear hair cells activate the cochlear nerve, resulting in hearing transmission. The labyrinthine and tympanic portions of the facial nerve lie in close proximity to these structures and may be dehiscent, necessitating lack of neuromuscular blockade and close monitoring of facial movements during certain otologic procedures. The nose projects from the face largely based on the amount of cartilage. The oral cavity therefore includes the lips, buccal mucosa, maxillary and mandibular alveolar ridges/teeth/gingiva, floor of the mouth, hard palate, the retromolar trigone and the anterior oral tongue. Neck anatomy can be significantly altered by cancer or cancer treatments including surgery and radiation or chemoradiation therapy.

References

1. ThurmanD, GuerreroJ. Trends in hospitalization associated with traumatic brain injury. JAMA 1999;282:954–7.
2. Web-Based Injury Statistics Query and Reporting System (WISQARS). National Center for Injury Prevention and Control; 2007.
3. VerschuerenDS, BellRB, BagheriSC, DierksEJ, PotterBE. Management of laryngo-tracheal injuries associated with craniomaxillofacial trauma. J Oral Maxillofac Surg 2006;64:203–14.
4. BeirneJC, ButlerPE, BradyFA. Cervical spine injuries in patients with facial fractures: a 1-year prospective study. Int J Oral Maxillofac Surg 1995;24:26–9.
5. DavidsonJS, BirdsellDC. Cervical spine injury in patients with facial skeletal trauma. J Trauma 1989;29:1276–8.
6. SinclairD, SchwartzM, GrussJ, McLellanB. A retrospective review of the relationship between facial fractures, head injuries, and cervical spine injuries. J Emerg Med 1988;6:109–12.
7. DonaldsonWF 3rd, HeilBV, DonaldsonVP, SilvaggioVJ. The effect of airway maneuvers on the unstable C1-C2 segment. A cadaver study. Spine (Phila Pa 1976) 1997;22:1215–8.
8. GreenbergRS. Facemask, nasal, and oral airway devices. Anesthesiol Clin North America 2002;20:833–61.
9. HannaAS, GrindleCR, PatelAA, RosenMR, EvansJJ. Inadvertent insertion of nasogastric tube into the brain stem and spinal cord after endoscopic skull base surgery. Am J Otolaryngol 2011.
10. ChandraR, KumarP. Intracranial introduction of a nasogastric tube in a patient with severe craniofacial trauma. Neurol India 2010;58:804–5.
11. SpurrierEJ, JohnstonAM. Use of nasogastric tubes in trauma patients – a review. J R Army Med Corps 2008;154:10–3.
12. DunhamCM, BarracoRD, ClarkDE, et al. Guidelines for emergency tracheal intubation immediately after traumatic injury. J Trauma 2003;55:162–79.
13. LennarsonPJ, SmithD, ToddMM, et al. Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization. J Neurosurg 2000;92:201–6.
14. MajernickTG, BieniekR, HoustonJB, HughesHG. Cervical spine movement during orotracheal intubation. Ann Emerg Med 1986;15:417–20.
15. McGuireG, el-BeheiryH. Complete upper airway obstruction during awake fibreoptic intubation in patients with unstable cervical spine fractures. Can J Anaesth 1999;46:176–8.
16. GabbottDA. Laryngoscopy using the McCoy laryngoscope after application of a cervical collar. Anaesthesia 1996;51:812–4.
17. TurkstraTP, CraenRA, PelzDM, GelbAW. Cervical spine motion: a fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope. Anesth Analg 2005;101:910–5, table of contents.
18. WahlenBM, GercekE. Three-dimensional cervical spine movement during intubation using the Macintosh and Bullard laryngoscopes, the bonfils fibrescope and the intubating laryngeal mask airway. Eur J Anaesthesiol 2004;21:907–13.
19. BahrW, StollP. Nasal intubation in the presence of frontobasal fractures: a retrospective study. J Oral Maxillofac Surg 1992;50:445–7.
20. GoodissonDW, ShawGM, SnapeL. Intracranial intubation in patients with maxillofacial injuries associated with base of skull fractures?J Trauma 2001;50:363–6.
21. ZmyslowskiWP, MaloneyPL. Nasotracheal intubation in the presence of facial fractures. JAMA 1989;262:1327–8.
22. JunsantoT, ChiraT. Perimortem intracranial orogastric tube insertion in a pediatric trauma patient with a basilar skull fracture. J Trauma 1997;42:746–7.
23. MasonRA, FielderCP. The obstructed airway in head and neck surgery. Anaesthesia 1999;54:625–8.
24. GillM, MaddenMJ, GreenSM. Retrograde endotracheal intubation: an investigation of indications, complications, and patient outcomes. Am J Emerg Med 2005;23:123–6.
25. CaplanRA, BenumofJL, BerryFA. Practice guidelines for management of the difficult airway. An updated report by the American Society of Anesthesiologist Task Force on management of the difficult airway. Anesthesiology 2003;98:1269.
26. TimmermannA, CremerS, EichC, et al. Prospective clinical and fiberoptic evaluation of the Supreme laryngeal mask airway. Anesthesiology 2009;110:262–5.
27. WrightMJ, GreenbergDE, HuntJP, MadanAK, McSwainNE Jr. Surgical cricothyroidotomy in trauma patients. South Med J 2003;96:465–7.
28. GoudySL, MillerFB, BumpousJM. Neck crepitance: evaluation and management of suspected upper aerodigestive tract injury. Laryngoscope 2002;112:791–5.
29. Le FortR. Etude experimentale sur les fractures de la machoire superieure. Rev Chir 1901:479–507.
30. ChiuWC, HaanJM, CushingBM, KramerME, ScaleaTM. Ligamentous injuries of the cervical spine in unreliable blunt trauma patients: incidence, evaluation, and outcome. J Trauma 2001;50:457–63; discussion 64.
31. MorrisCG, McCoyE. Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening. Anaesthesia 2004;59:464–82.
32. GriffenMM, FrykbergER, KerwinAJ, et al. Radiographic clearance of blunt cervical spine injury: plain radiograph or computed tomography scan?J Trauma 2003;55:222–6; discussion 6–7.
33. StiellIG, ClementCM, McKnightRD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 2003;349:2510–8.
34. CusmanoF, FerrozziF, UccelliM, BassiS. [Upper cervical spine fracture: sources of misdiagnosis]. Radiol Med 1999;98:230–5.
35. LinkTM, SchuiererG, HufendiekA, HorchC, PetersPE. Substantial head trauma: value of routine CT examination of the cervicocranium. Radiology 1995;196:741–5.
36. KreipkeDL, GillespieKR, McCarthyMC, et al. Reliability of indications for cervical spine films in trauma patients. J Trauma 1989;29:1438–9.
37. HoganGJ, MirvisSE, ShanmuganathanK, ScaleaTM. Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma: is MR imaging needed when multi-detector row CT findings are normal?Radiology 2005;237:106–13.