Safety of Intubation Methods in Patients With LeFort Pattern Facial Trauma.

Area of Science:

• Maxillofacial Surgery
• Trauma Surgery
• Anesthesiology

Background:

• Airway management for LeFort fractures presents risks: tracheostomy (bleeding, infection, scarring) and nasotracheal intubation (potential intracranial complications).
• Choosing the optimal airway is critical for patient outcomes in complex facial trauma surgery.

Purpose of the Study:

• To compare complication rates among tracheostomy, nasotracheal intubation (NTI), and orotracheal intubation (OTI) in adults undergoing LeFort fracture repair.
• To identify predictors of reintervention following airway management for LeFort fractures.

Main Methods:

• Retrospective cohort study of 60 adult patients undergoing LeFort I-III fracture repair (2018-2023).
• Analysis of airway method, skull base fracture presence, complications, and reoperations.
• Equivalence testing for mean complications and multivariable regression for reintervention predictors.

Main Results:

• Mean complications per patient were equivalent between NTI and tracheostomy (0.50 vs. 0.54, P=0.019), including for severe LeFort II/III injuries (0.45 vs. 0.56, P=0.040).
• Tracheostomy was an independent predictor of reintervention (OR 2.3, P=0.025).
• Nasotracheal intubation demonstrated a comparable complication profile to tracheostomy but with a lower reoperation rate.

Conclusions:

• Nasotracheal intubation provides an airway management strategy with complication rates similar to tracheostomy for LeFort fractures.
• NTI avoids the increased reoperation risk and scarring associated with tracheostomy.
• This suggests NTI is a viable alternative to tracheostomy in select LeFort fracture cases, especially when skull base integrity is a concern.