Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXIII: Maxillofacial Wounds and Injuries

Respiratory Obstruction

United States Department of Defense
Peer Review Status: Internally Peer Reviewed

Respiratory obstruction in a patient with maxillofacial injuries may be due to several causes, as follows:

1. Blockage of the airway by accumulated blood and secretions or by loose objects, such as broken teeth or dentures.
2. Prolapse of the tongue, which occurs frequently with injuries, especially when acute avulsion of the mandibular symphysis has occurred.
3. Injuries of the hyoid bone and its attached muscles, with resulting loss of control of the tongue-hyoid complex.
4. Swelling of the tongue and soft palate.
5. Laryngeal spasm, which may be caused by anesthetic agents.

No time should be lost in reversing hypoxia, which can rapidly progress to death. The patient is positioned to permit drainage by gravity, and the airway is rapidly cleared of blood, secretions, foreign bodies, or whatever else may be blocking it. Direct vision and strong suction are necessary. In the event that these non-invasive maneuvers fail to immediately relieve obstruction, there must be no hesitancy to perform endotracheal intubation or cricothyroidotomy. In certain laryngotracheal crush injuries and other wounds which transect the trachea, it may be necessary to perform emergency tracheostomy. Cervical spine in-line control must be maintained during these maneuvers.  

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