FEATURES OF THE ANAESTHETIC PROVIDING ARE IN THE HOLIATRY OF BATTLE MAXILLOFACIAL TRAUMA. CLINICAL CASE
Keywords:
maxillofacial surgery, retromolar intubation, submental intubation, alternative to tracheostomy, clinical caseAbstract
Actuality. Despite the known methods of tracheal intubation in patients with maxillofacial trauma requires a fast and efficient alternative. In case of injury of the facial skeleton neither orotracheal intubation, nor nasotracheal intubation is impossible, but also an attempt leads to complications (otitis media, sinusitis, meningitis, sepsis, epistaxis and intracranial migration). The need for intermaxillary fixation does not allow intubation. Tracheostomy is associated with a lot of complications. For retromolar intubation it is often necessary to remove the third molar with crescent osteotomy. Submental intubation, by prof. F. H. Altemir, allows avoid tracheostomy. Purpose. To present a clinical case of a variant of tracheal intubation in treatment of combined firearms shrapnel penetrating blind injured facial skull, side of the neck, fire comminuted fracture of the upper jaw Le Fort III type, an open fracture of the lower jaw in the anterior region, the angle of the mandible on the right, the nose bone, bilateral hemosinus, post-traumatic defect of the hard palate. In the treatment of a soldier with multiple gunshot woundsand fractures of the facial skull, hard palate defect, multiple fragments of soft tissue facial skull during anesthesia performed submental intubation (divided into 4 stages), without complications. Results. The necessary conditions have been determined by the analysis of the course of anesthesia and surgery: endotracheal tube should only be reinforced; check the universal connector separation from the endotracheal tube must be made in advance, before intubation, as reinforced tubes tight fixation (often adhesive); pilot cuff of the endotracheal tube is desirable to fix the proximal end of the tube, to their conduct in the submental area through the bottom of the oral cavity it was momentary; soft endotracheal tube for nasotracheal intubation (in an “Ivory”) for the submental intubation is not suitable; coordinated work of anesthetic and surgical teams. Conclusions. Thus, the submental intubation is an effective alternative to tracheostomy, orotracheal and nasotracheal intubation in securing the airway during operations in maxillofacial surgery treatment of gunshot wounds to the facial skull, fractures of the lower jaw and the upper jaw by the Le Fort type.
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