Chapter 25 - Maxillofacial and Dental Surgery

Summary

This chapter gives a presentation of the major issues to consider in maxillofacial and dental surgery when sharing the airway with the surgeon. It is essential to have knowledge of the surgical population and procedures to plan the airway handling safely to avoid potential complications. Nasal intubation gives optimal access for the surgeon and is the gold standard but is accompanied with the risk of nasal trauma. Manoeuvres to minimise complications are given. There are different considerations to take into account both for the well-planned scheduled procedure and for the urgent procedure with a threatened airway. Surgical complications such as bleeding and infection challenge the skills of the anaesthetist making the airway handling difficult. Awake flexible optical bronchoscope-guided intubation is a safe option and a plan for extubation must be made. A structured approach to handle the patient with maxillofacial trauma is given both in the emergency case and later for final surgery. Priority and timing of surgery is crucial in the patient with multiple injuries, and especially the neurotrauma patient with respect to control of intracranial pressure.