Awake fibreoptic intubation in the semi-prone position following facial trauma

Abstract

A fit 27-year-old man presented with severe facial trauma following an industrial accident. Initial assessment showed severe swelling around the lower jaw and haemorrhage from the mouth, nose, scalp and left ear. The patient was conscious with a Glasgow Coma Score of 13 but in respiratory distress. Following adoption of the prone position his air way improved. Relief of the patient's airway obstruction was a priority and the patient underwent awake fibreoptic intubation in the prone position prior to induction of anaesthesia. Computed tomography scans of his head and neck were unremarkable and after fixation of a bilateral mandibular fracture he made an uneventful recovery. Intubation in the semi-prone position may be a useful technique in injuries of this type.