Air evacuation of patients with maxillofacial injuries

The facial region is a complex skeletal structure with the facial musculature forming a curtain around the four apertures, namely the orbital, nasal, auditory, and oral cavities. The area demands significance in view of the portal of entry for the airway, and any traumatic affliction may compromise the outcome for survival, especially in a polytrauma patient. Gunshot wounds (GSWs) and improvised explosive device blasts involving the facial region at forward combat zones necessitating aeromedical evacuation make it pertinent to understand the importance of airway compromise in such cases. With the increase in the incidence of road traffic accidents, more so in inebriated states, the quick evacuation to a tertiary care center for early initiation of definitive care is imperative for successful management by the trauma team. The decision for emergency air evacuation of a facial injury patient is to be seen in the light of airway compromise with the presence of life-threatening debilitation as in severe head injury or poly trauma involving extremities or abdominal injuries. In the eventuality of air evacuation being the only option for transfer as in a forward base at hilly terrain with no motorable roads or from an island base, there is no absolute contraindication except in conditions of extended Le Forte III or IV mid face fractures with anterior or middle cranial fossa fracture and cerebro spinal fluid (CSF) rhinorrhea or otorrhea, with a possible impending danger of air escape into cranial cavity. Air evacuation exposes the vulnerable patient to some peculiar situations attributable to the ill effects of pressure, altitude, sound, air turbulence, and the special aerial environment of flight. It would be pertinent to ascertain the attributes of configuration of the aircraft type, flight duration, expected cabin pressure, and altitude as well as the onboard facilities while considering a probable patient as a candidate suitable for air evacuation.