Managing the emergency airway in Le Fort fractures

Le Fort fractures are a part of the facial fracture spectrum, sustained from significant forces of impact to the midface. The mechanism of airway obstruction in Le Fort fractures is attributed to midface instability with posterior inferior displacement into the oropharyngeal airway. Otolaryngologists often participate in the evaluation and management of such patients, securing the airway, if necessary. It is important, therefore, to understand the mechanisms responsible for acute airway obstruction in these types of fractures. A retrospective review of 64 cases of Le Fort fractures, representing a 3-year period, was performed to determine the factors responsible for acute airway obstruction. The review disclosed that airway obstruction is due most often to hemorrhage into the upper airway from multiple sources, with inability to handle blood and the oral secretions. An emergency airway was required by one third of the patients with Le Fort fractures in this review.