Intubating LMA guided awake fibreoptic intubation in severe maxillo-facial injury

To describe control of the airway in a patient with severe maxillo-facial injury using intubating laryngeal mask guided awake fibreoptic intubation.

A 110 kg man presented with a severe facial injury due to a horse kick. Local examination showed a large transverse gaping laceration just beneath the nose, exposing the lower nasal cavities through to the posterior nasopharynx. It was planned to perform a surgical tracheostomy before surgical fixation of the maxilla and nasal bones. Considering the patient's weight, short neck and difficulty in lying flat, surgical tracheostomy under general anesthesia was considered the best option. Under topical anesthesia, an intubating laryngeal mask was introduced followed by a fibreoptic bronchscope. The endotracheal tube was threaded over the bronchoscope and airway control achieved.

The use of an intubating laryngeal mask avoids the need for manipulation of the head and neck and acts as a 'shield' for the fibreoptic bronchoscope from surrounding blood in patients with maxillo-facial injury. The use of the fibreoptic bronchoscope ensures intubation under vision.