[Severe facial trauma: control of the upper airway?]

This is the case report of a 16-year-old male who suffered major facial trauma in a road traffic accident (unhelmeted scooter rider against signpost). During prehospital care, he was stable and awake. He was admitted to the emergency room of our university hospital and rapidly transferred, in a sitting position and breathing spontaneously, to the operating room for emergent surgical tracheostomy under local anaesthesia and sedation. This procedure turned out to be difficult (sitting position, patient uncooperative) and ventilatory compromise led us to intubate the patient without difficulties: indeed, supraphysiological mouth aperture (due to multifocal mandible fractures) and presence of supraglottic bubbling under spontaneous ventilation facilitated intubation in spite of major oropharyngeal bleeding. This allowed rapid restoration of adequate ventilation and tracheostomy was performed under standard conditions without further problems. This case report confirms the superiority of orotracheal intubation under light sedation over emergent tracheostomy in this type of situation, as stated under the SFAR guidelines.