Airway Management Dilemma in a Patient with Maxillofacial Injury

A 35year old male presented at the Accident and Emergency room of our hospital with partial upper airway obstruction, dysphonea and inability to lie supine following multiple facial injuries from assault. Clinical examination revealed a young man with avulsed floor of the mouth, comminuted fracture of the mandible, ragged laceration of the lower lip and the tongue. The patient could not assume the supine position as any such attempt resulted in immediate airway compromise. He had tracheostomy and repair of the laceration under general anaesthesia. Anaesthesia was induced with intravenous ketamine with the patient in the left lateral position while traction on the tongue using a Magill’s forceps ensured patency of the airway. A classical laryngeal mask airway was subsequently inserted to manage the airway to enable a surgical airway and repair. The patient was discharged home in a satisfactory condition, six weeks after surgery.