J Dent Anesth Pain Med.  2018 Jun;18(3):183-187. 10.17245/jdapm.2018.18.3.183.

Airway management in a displaced comminuted fracture of the mandible and atlas with a vertebral artery injury: A case report

• Paramaswamy R

• KMID: 2415183
• DOI: http://doi.org/10.17245/jdapm.2018.18.3.183

Abstract

Complex cervical spine fractures are a serious complications of maxillofacial trauma and associated with high mortality and neurological morbidity. Strict vigilance in preventing further insult to the cervical spine is a crucial step in managing patients who are at risk for neurologic compromise. We report a rare case of a right transverse process of atlas fracture with right-sided vertebral artery injury that was associated with a comminuted fracture of the body and angle of the mandible, which restricted mouth opening. Airway management was performed by an awake fiber-optic nasotracheal intubation, where neck movement was avoided with a cervical collar. Vertebral artery injuries may have disastrous consequences, such as basilar territory infarction and death, and should be suspected in patients with head and neck trauma. After mandibular plating, the patient was on cervical collar immobilization for 12 weeks and anti-coagulant therapy.

Keyword

Mandibular Fractures; Restricted Mouth Opening; Spinal Fractures; Vertebral Artery Injury

MeSH Terms

Airway Management*
Fractures, Comminuted*
Head
Humans
Immobilization
Infarction
Intubation
Mandible*
Mandibular Fractures
Mortality
Mouth
Neck
Spinal Fractures
Spine
Vertebral Artery*

Figure

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  Fig. 1 Images of the patient before and after surgery.

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  Fig. 2 Three dimensional reconstructed CT of the face showing the comminuted fracture of the angle and body of the right hemi mandible.

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  Fig. 3 CT scan of neck showing fracture of the occipital condyle and fracture of the lateral process of the atlas, involving the transverse foramen.

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  Fig. 4 MRI of the C-spine in the sagittal view showing vertebral artery thrombosis, and the axial view showing the loss of right vertebral artery flow void at level C3-C4.

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