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Safety of intubation methods in patients with LeFort pattern facial trauma
Joseph Easton
Kiersten Woodyard
Doug Dembinski
Ryan Gobble
University of Cincinnati Medical Center
2023-01-31
Presenter: Joseph Easton
Affidavit:
All work represents the original work of the resident
Director Name: Ann Schwentker
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Patients with complex facial trauma often require surgical intervention to restore facial height, width, and occlusion. There is some uncertainty regarding safety of nasotracheal intubation in this patient population. This investigation compares complications and surgical outcomes in complex facial trauma patients across prevalent intubation methods.
Methods: A retrospective chart review was conducted for patients who were surgically treated for LeFort I-III fractures between 2018-2022 at our institution. Data collection included age, fracture pattern, intubation method (oral airway, nasotracheal, or tracheostomy), surgical service, and complications. Complications specific to intubation method were examined between fracture type and intubation method. Statistical analysis included equivalence testing with one-sided t-tests, F-distribution tests, and Chi-squared analysis.
Results: 65 patients were identified who were surgically treated for LeFort I-III from 2018-2022. Intubation-related complications included bleeding from airway site, malocclusion, and need for hardware removal. The pooled complication rate in patients who had tracheostomy and nasotracheal intubation was proven to be statistically similar (p-value=0.019), a trend maintained when examining only patients with LeFort II or III fractures (p-value=0.040). There was no difference between overall complications and surgical service. However, the likelihood of a complication requiring a return to OR was significantly higher in tracheostomy compared to other intubation methods (p=0.043).
Conclusion: Nasotracheal intubation had statistically equivalent complication rates to tracheostomy regardless of LeFort fracture pattern, demonstrating safe use in patients with complex facial trauma. Nasotracheal intubation could present an equally safe alternative, with lower morbidity than tracheostomy.
