Airway Management in Patients with Difficult Mask Ventilation – 2 Case Reports

Facial injuries due to bear mauling or run-over accidents cause severe disfigurement of face requiring extensive reconstruction. While managing these injuries, close association with the airway and shared airway with the surgeon are important concerns for the anaesthesiologists. And airway management in such patients becomes a challenge for them because bony injuries and soft tissue deformities may pose difficulty in mask ventilation. Difficult mask ventilation may be life threatening to a patient if difficult intubation occurs. Here we report two cases of facial trauma having difficult mask ventilation, one due to bear mauling and another due to run-over accident. These patients of facial trauma were posted for surgical repair under anaesthesia. Anatomical distortion of face due to contused lacerated wounds, bulging out of eyeball, destruction of nostril and lips made mask seal inadequate and mask ventilation difficult. In both the cases, airway was secured successfully by preserving spontaneous respiration and doing oral endotracheal intubation by direct laryngoscopy and using bougie.