Classifying and standardizing panfacial trauma according to anatomic categories and Facial Injury Severity Scale: a 10-year retrospective study

Background The purpose of this study was to identify the epidemiologic factors of panfacial fractures (PFs), and to evaluate the significance of anatomic PF categories and the Facial Injury Severity Scale (FISS) in classifying and standardizing panfacial injuries. Methods A retrospective review of all patients treated with PFs at our institution between June 2010 and April 2021 was performed. PF was defined as a concurrent fracture in at least 3 of 4 facial subunits (frontal, upper midface, lower midface, and mandible). Data regarding patient demographics, causes of injury, location of fractures, major concomitant injuries, and postinjury complications were collected, and the FISS score was collected from each patient. Statistical analysis was performed using IBM SPSS Statistics version 22.0. Results A total of 227 patients were enrolled. The most commonly fractured bones were the maxillary sinus wall (92.1%), mandible (82.8%), and zygomatic arch (75.3%), and the most common fracture sites in PFs were graphically presented. Four PF patterns were defined: FULM (n = 60), FUL (n = 39), ULM (n = 127), and FUM (n = 1). There was a significant association between PF patterns and sex (p = 0.018), the number of concomitant injuries (p = 0.014), and early surgical airway management (p = 0.003). Different PF patterns were significantly correlated with different types of concomitant injuries and complications. The FISS score showed a significant difference with PF patterns (p = 0.000) and sex (p = 0.007), and a FISS value of 11 or more is the appropriate cutoff for the prediction of multiple concomitant injuries and complications. Conclusions Both the anatomic PF categories and FISS were significantly correlated with various concomitant injuries and complications. The combination of PF categories and FISS provided a better positive and negative prediction of concomitant injuries and complications for PF patients. Patients with FULM and FISS > 11 had an obviously higher proportion of the need for multiprofessional treatment.

1505 EASiE: ENT and Airway Simulation in Emergencies

Aim A literature review of undergraduate ENT teaching found that most final year medical students and junior doctors did not feel adequately prepared for clinical practice in ENT. Other surveys found junior doctors lack confidence in recognising or initiating management in patients with blocked tracheostomies. To improve this, we ran a simulation session designed to replicate airway emergencies that junior doctors should be able to manage. The aim was to improve confidence in and knowledge of basic management of airway emergencies, including tracheostomies. Method Groups of 4-6 final year medical students participated in 3 scenarios: 2 tracheostomy-related and 1 partially compromised airway. The students had attended a session introducing tracheostomies and the algorithms produced by the National Tracheostomy Safety Project for tracheostomy emergencies. A semi-structured debrief followed each scenario, highlighting key learning points. The students completed a pre- and post-session questionnaire, rating confidence in several domains related to the scenarios. Results Of 24 participants, the percentage of students who felt confident or very confident in the following domains were compared pre- and post-simulation respectively: recognising a potential airway problem (0% vs 71%); identifying an altered airway (0% vs 75%); managing a potentially compromised surgical airway (4% vs 71%); initially managing a compromised airway (8% vs 67%); and identifying when to escalate with a potential airway problem (25% vs 96%). Conclusions Simulation is a valuable tool that can be used to improve both knowledge and confidence in managing potential airway problems in final year medical students. This supports findings from other studies.

Airway Management in Accident and Emergency

Accidents are associated with airway complications. Tracheobronchial injury, pneumothorax, pneumomediastinum, atelectasis, and subcutaneous emphysema can be observed. Therefore airway management in emergency medicine requires skills and equipment. Rapid-sequence intubation, effective preoxygenation, apneic oxygenation, manual inline stabilization technique should be used properly. Rapid-sequence intubation consists of sedation, analgesia, and muscle paralysis components. Videolaryngoscopes, supraglottic and extraglottic airway devices, bougie and surgical airway tools are among training materials. A range of training materials have been described to improve providers’ understanding and knowledge of patient safety. In conclusion providing oxygenation, minimizing the risk of complications and choosing the appropriate devices constitute the airway management’s pearls.

Rigid Bronchoscopy and Surgical Airway Procedures, Foreign Body Aspiration, and Gastric Content Aspiration Management

The difficult airway in pediatric patients is most frequently anticipated because of anatomic anomalies from craniofacial pathology. With the increasing population of surviving premature infants who require prolonged intubation perinatally, chronic issues such as subglottic stenosis are also becoming more common. When dealing with the difficult pediatric airway, preparation and communication are key. It is essential to have a continuous dialogue between the otolaryngologist and the anesthesiologist throughout the perioperative course. When involved with a patient who is likely to have a difficult airway, it is best to involve or consult the pediatric otolaryngologist as early in the process as possible. This chapter outlines the most common invasive techniques for management of the pediatric non-normal difficult airway: rigid bronchoscopy and tracheostomy. This chapter will also review the management of an airway foreign body and aspirated gastric contents.

Epiglottic aplasia in an infant with Joubert syndrome

Congenital aplasia of the epiglottis is a rare condition with variable presentation ranging from respiratory distress requiring surgical airway to an asymptomatic finding. Epiglottic aplasia is presumed to be caused by arrest of development of laryngeal structures and is most commonly associated with syndromic conditions, though isolated episodes of aplasia of the epiglottis do exist. In this report, we present a term infant with multiple congenital anomalies who was noted to have a hoarse cry prompting laryngoscopy. This showed complete absence of the epiglottis. Subsequent genetic testing showed mutations in the CPLANE1 gene that is associated with Joubert syndrome. Our patient was able to be discharged home on a thickened formula diet and is eating and gaining weight appropriately. Here, we present a review of the currently available literature of other cases of congenital epiglottic aplasia or hypoplasia discussing the presentation, management and outcomes in these cases.

Idiopathic Subglottic Stenosis: An Institutional Review of Outcomes With a Multimodality Surgical Approach

Objectives This article reports on a unique cohort of patients with idiopathic subglottic stenosis spilt fairly equally between endoscopic and open surgical approaches. Patients’ sequence of operations and reinterventions over time are outlined, offering insight to improve surgical counseling and allow for informative, autonomous patient decision making. Study Design Retrospective cohort study. Setting Tertiary care academic center. Methods Cases of consecutive adults with idiopathic subglottic stenosis managed surgically over a 12-year period (January 2006–December 2017) were retrospectively reviewed. Surgical workflow, complications, and outcomes, including reinterventions and tracheotomy dependence, are reported. Results Seventy-two patients (71 women; mean age, 50.4 years) with idiopathic subglottic stenosis requiring surgical airway intervention were identified. Six patients underwent tracheotomy prior to attempt at airway stenosis surgery. Initial surgical approach thereafter included endoscopic (73.5%, n = 53) and open (26.4%, n = 19) procedures. Thirty-one patients underwent cricotracheal resection; the reintervention rate was 22.5%. Sixty patients underwent 147 endoscopic procedures; the reintervention rate was 75.5%, and the mean time between dilations was 83 weeks (range, 5-402). Two (2.8%) patients remain tracheotomy dependent. Adverse events were significantly higher in the cricotracheal group, especially with respect to dysphonia and temporary gastrostomy tube placement ( P < .01). Conclusions Endoscopic and open surgical airway intervention can be employed successfully to avoid tracheotomy dependence and maintain airway patency; however, multiple procedures are usually required, regardless of surgical approach. Cricotracheal reintervention rates are lower than endoscopic dilation but with increased morbidity. Quality-of-life outcomes should be clearly discussed with patients before deciding on a surgical management strategy.