Oral/Maxillofacial Surgery

airway management airway trauma dental surgery ent patient safety safety shared airway Jun 24, 2024

🌟 What and why? 🌟
General anaesthesia is used for complex dental procedures, or in paediatric, special needs, or anxious patients. Maxillofacial surgery encompasses a wide range of procedures. Common indications include trauma, corrective surgery (jaw/palate), temporomandibular joint disorders, cancer, and sleep apnoea.

🔍 Intraoperative considerations: 🔍
📍 Position: Supine, head ring or dental head support.
⏱️ Duration: 10 min - 3 hours
🌬️ Airway plan: Simple dental procedures are suited to reinforced LMA. Some require nasal intubation (nasal RAE). Throat pack may be used. (see Concept Series article on throat packs!). Awake intubation may be needed for patients with mass, infection, or poor mouth opening.

💡 Expert tips:
The preoperative management of special needs adults can be challenging. This may include premedication, the presence of a carer, and local anaesthetic skin cream. Inhalational induction may be used. Ensure your team has discussed the plan including preferred and rescue airways.

🌟 Postoperative considerations: 🌟
💥 Pain: Minimal for simple dental. Moderate to severe for some major surgeries.
❗ Airway risks: Be vigilant to blood, debris, or retained throat pack. Bleeding is possible and may require return to theatre.

🔄 Other:
Be aware of co-existing syndromes in special needs patients and prepare accordingly.

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Ref: Martin, Alastair, and John Bowden, 'Maxillofacial and dental surgery', in Rachel Freedman, and others (eds), Oxford Handbook of Anaesthesia, 5 edn, Oxford Medical Handbooks (Oxford, 2022; online edn, Oxford Academic, 1 Nov. 2021), accessed 13 June 2024.

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