A survey of operative airway management practices for midface fractures

We surveyed 218 Level I trauma centers to determine operative airway management preferences for patients with midface fractures requiring maxillomandibular fixation. A two-page survey was distributed to anesthesiologists, plastic surgeons, otolaryngologists, and oral surgeons participating in the management of major craniofacial trauma at each center. Specific fracture patterns were described, and the preferences for endotracheal intubation for operative management were surveyed among the respondents. We analyzed 105 responses from surgeons and 51 responses from anesthesiologists. Although there were differences in the preferences expressed by surgeons compared with anesthesiologists, more than 50% of the respondents in each practice category chose some form of nasotracheal intubation for fracture patterns involving the midface. Tracheostomy was a first choice for patients with panfacial fractures or those with loss of consciousness and midface fractures. This report serves as a basis for surgeons and anesthesiologists to review their practices and discuss planning of operative airway management for the patients with these fracture patterns. On the basis of this survey, midface fractures need not prohibit any consideration of nasotracheal intubation.