Numerous guidelines highlight the need for early airway management in facial trauma patients since specific fracture patterns may induce airway obstruction. However, the incidence of these hallmark injuries, including flail mandibles and posterior displacement of the maxilla, is contentious. We aim to evaluate specific trauma-related variables in facial fracture patients, which affect the need for on-scene versus in-hospital airway management. This retrospective cohort study included all patients with any type of facial fracture, who required early airway management on-scene or in-hospital. The primary outcome variable was the site of airway management (on-scene versus hospital) and the main predictor variable was the presence of a traumatic brain injury (TBI). The association of fracture type, mechanism, and method for early airway management are also reported. Altogether 171 patients fulfilled the inclusion criteria. Of the 171 patients included in the analysis, 100 (58.5) had combined midfacial fractures or combination fractures of facial thirds. Altogether 118 patients (69.0%) required airway management on-scene and for the remaining 53 patients (31.0%) airway was secured in-hospital. A total of 168 (98.2%) underwent endotracheal intubation, whereas three patients (1.8%) received surgical airway management. TBIs occurred in 138 patients (80.7%), but presence of TBI did not affect the site of airway management. Younger age, Glasgow Coma Scale-score of eight or less, and oro-naso-pharyngeal haemorrhage predicted airway management on-scene, whereas patients who had fallen at ground level and in patients with facial fractures but no associated injuries, the airway was significantly more often managed in-hospital. Proper preparedness for airway management in facial fracture patients is crucial both on-scene and in-hospital. Facial fracture patients need proper evaluation of airway management even when TBI is not present.

中文翻译：

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“A”代表气道——哪些因素指导面部骨折患者需要现场气道管理？

许多指南强调了面部创伤患者早期气道管理的必要性，因为特定的骨折模式可能会导致气道阻塞。然而，这些标志性损伤的发生率，包括连枷下颌骨和上颌骨后移，是有争议的。我们旨在评估面部骨折患者的特定创伤相关变量，这些变量会影响现场与院内气道管理的需求。这项回顾性队列研究包括所有类型的面部骨折患者，他们需要在现场或住院期间进行早期气道管理。主要结果变量是气道管理部位（现场与医院），主要预测变量是是否存在创伤性脑损伤（TBI）。骨折类型、机制、还报道了早期气道管理的方法和方法。共有 171 名患者符合纳入标准。在纳入分析的 171 名患者中，100 名（58.5）名合并面部中部骨折或面部三分之一合并骨折。共有 118 名患者 (69.0%) 需要在现场进行气道管理，其余 53 名患者 (31.0%) 的气道在医院内得到保障。共有 168 例 (98.2%) 接受了气管插管，而 3 例 (1.8%) 接受了外科气道管理。138 名患者 (80.7%) 发生 TBI，但 TBI 的存在不影响气道管理部位。年龄较小，格拉斯哥昏迷评分为 8 分或以下，口鼻咽出血预示现场气道管理，而在地面摔倒的患者和面部骨折但没有相关损伤的患者中，气道明显更经常在医院进行管理。为面部骨折患者的气道管理做好适当的准备对于现场和住院都至关重要。即使不存在 TBI，面部骨折患者也需要对气道管理进行适当的评估。