INTRODUCTION

Injuries to the head and maxillofacial areas cause easily jeopardize the
patient’s ability to maintain respiration. The most sophisticated of techniques
in treating facial trauma can be quite meaningless if attention is not first
directed to the victim’s airway. Because of this life threatening reality, the
primary concern of anyone providing emergency for trauma victims must be
to establish and maintain a patient airway. To provide adequate ventilation.
And to protect the victim from pulmonary aspiration.

ADVANCED TRAUMA LIFE SUPPORT (ATLS) ADVOCATED BY

AMERICAN COLLEGE OF SURGEONS.
a. Airway maintenance with cervical spine control
b. Breathing.
c. Circulation with hemorrhage controls.
d. Discerning the neurologic status of the Patient.
e. Exposing or undressing the patient to facilitate a complete physical
evaluation.

First two steps are discussed in this section.

Recognition of signal symptoms of acute respiratory failure in a patient
are -Strider, intercostal retraction, tracheal tug, hoarseness, or labored
breathing. Pallor, tachycardia, increase in BP, are early signs of hypoxia and
hypercapnia. These may be accompanied by confusion, agitation,
unconsciousness, and oreyanosis. In the patient with obvious respiratory
distress, the examination should include the following:-
Mandibular mobility size and mobility of the tongue, status and fragility of
the dentition, amount and viscosity of secretions, presence of hemorrhage or
masses in the oral cavity and pharynx.

SYSTEMATIC APPROACH TO AIRWAY MANAGEMENT.

(1) Recognize airway obstruction.

Above mentioned signs and symptoms are needed.
Clinical examinations include.
Look: whether patient shows signs and symptoms of airway
obstruction.
Uses accessory musculature to aid in respiration.
Observe for evidence of dyspnoea.
Listen: - for abnormal sounds
Feel: for symmetrical movement of air on inspiration and expiration

(2) Clear the Airway

Any foreign bodies in the oral cavities should be cleared, Hemorrhage
blood clot and secretions are suctioned tolerated by the conscious patient,
since placement does not stimulate the soft palate; both of these devices are
temporary adjuncts in establishing and maintaining an airway and should not
be considered definitive airway management.
ESOPHAGEAL AIRWAYS.
-Introduced in 1968

Esophageal Obturator Airway (EOS) and Esophageal Gastric Tube

Airway (EGTA)

EOA is a blind tube that is inserted into the esophagus. An inflatable

cuff is located just above the end, and holes located near the upper end allow
air to pass into the pharynx. EGTA is a modified EOA that allows passage of
the gastric tube for gastric emptying.
Limited to the unconscious patient as these can cause vomiting.
Ventilation and oxygenation are inferior to other methods.
Complications: false passage into the trachea and laceration or rupture of the
esophagus.

Esophageal Tracheal Combi tube (ETC)

Relatively new airway.
Is a plastic double-lumen tube designed for emergency or difficult
intubation.
Provides sufficient ventilation airway placed into esophagus or trachea.
Concept of this airway a longer tube placed into the throat must advance
down either the esophagus or trachea. And depending on the position of the
tube, the inflated distal cuff seals.
Oropharynx should be directly visualized with the laryngoscope.
(3) Reposition the patient
On occasion an alert patient with trauma will position himself or
herself to minimize respiratory effort and it is best to allow the patient to
maintain an existing airway through self posturing than to jeopardize the
airway by forcing him or her to assume another position.
If the patient is supine with decreased consciousness, obstruction from
the tongue or from injured and unsupported soft tissue prolapsing into the
hypo pharynx can be corrected by manipulation of the mandible in a chin-
lift or jaw -thrust maneuver and patient can be made to sleep in a left laternal
position.
The patients head and neck should never be hyper extended or hyper
flexed to establish or maintain the airway if the cervical spire has not been
cleared.
(4) Utilize an artificial airway if a patient’s airway cannot be
maintained.

ORAL AND NASOPHARYNGEAL AIRWAY

Both of these are designed to displaces the tongue anteriority off the
posterior pharyngeal wall, allowing the patient to breath through or around
them.
Oral airway is more efficient but should not be used in the conscious
patient because of stimulation of the gag reflex and possible vomiting.
Nasopharyngeal airway is well either the esophagus or the trachea. One of
two lamina is open (tracheal lumen) and the other is occluded at its distal
end (esophageal lumen) and the device has openings in the pharyngeal
section. A large balloon cuff is inflated in the pharynx to help secure the tube
and occlude the oral and nasal airway. Auscultation reveals which pathway
the tube has token, and the distal tube can be ventilated, if found to be in the
trachea, it has entered the esophagus, the shorter of the low tubes can be
ventilated to deliver oxygen in a fashion similar to that with the EOA. In this
Position, suction of gastric fluids can be achieved through the open tracheal
lumen. Since the occluding cuff is in pharynx, a face mask is not necessary.
Contraindication:-Patients with an intact gag reflex or known esophageal
disease.
Disadvantage: -Trachea cannot be aspirated when the device is placed in the
esophagus.
Advantage: - ventilation efficiency comparable to that of the endo tracheal
tube

PHARYNGO TRACHEAL LUMEN AIRWAY (PTLA)

A double-lumen airway, and is similar to the combi tube in that in can be

passed into either the trachea or esophagus.
Contains an occluding stylet for maintaining proper shape during insertion
and for occluding tube if it passes into the esophagus.
Advantages: - Ventilation efficiency comparable to that of the endotracheal
tube.

TRACHEO ESOPHAGEAL AIRWAY (TEA)

It is essentially face mask with an adapter attached, with holes for passage of
an endotracheal tube and for attaching an ambubag. If the endotracheal tube
passes into the esophagus, the cuff is inflated & this tube then acts as an
oropharyngeal airway. An ambubag is hen attached to the other opening of
the face mask for ventilation of the patient. Aspiration of gastric contents can
then be achieved through the open lumen of the endotracheal tube.
(5) Perform Endotracheal intubation.
(6) Perform a Cricothyrotomy
(7) Perform a tracheostomy – done under optimal conditions.

ENDOTRACHEAL INTUBATION

The most consistency reliable & time – proven method of securing a patient
airway in trauma patient with a compromised airway.
 It is the “gold standard” for securing & maintaining a reliable
airway.
 Routes: - Oral & Nasal.
Indications:
1. When airway patency is threatened & noninvasive modalities are
unsuccessful.
2 When a patient is in extremis & time urgency demands the quickest, surest
means of securing a patient airway
3. When complete control of the airway is needed for tracheal suction or
pulmonary toilet.
4. When there is a need for controlled positive – pressure ventilation
5. When the airway needs to be protected from aspiration of blood or gastric
contents.
6. If there is a probability of a future tracheostomy or cricothyrotomy.
Contra indications:-
1. Presence of CSF, rhinorrhoea or fracture of the anterior cranial fossa, in
particular the cribriform plate, are relative contraindications to the nasal
route (predisposes to meningitis)
2 Presence of a retropharyngeal swelling noted on a lateral cervical spine
film (possible repture & aspiration)
3. Fracture larynx.

Endotracheal tube:-
Available in different designs, but all have several features in common
Tube is open at both ends, with a standard 15mm adopter for connection
with a bag – value attachment or anesthesia connected. Has an inflatable cuff
at tracheal end for sealing the airway & allow for passive pressure
ventilation & protection of the airway from aspiration.

Endotracheal Tube Sizes.

Diameter (mm) Length (mm)
Interior, Exterior Minimum length
Preterm 2.5 4.0 10
3.0 4.5 11
Term 3.5 5.0 12
6 Month 4.0 5.5 13
1 year 4.5 6.0 14
5.0 6.5 15
2 years 5.0 6.5 15
4 years 5.5 7.0 16
6 years 6.0 8.0 18
8 years 6.5 8.5 20
10 years 7.0 9.0 21
12 years 7.5 9.5 22
14 years 8.0 10.0 23
Adults 8.5 11.5
9.0 12.0
10.0 13.0

DIRECT LARYNGOSCOPE:-
 Used to visualize the glottis
 Available is two basic types
(1) Those with straight blades.
(2) Those with curved blades,
 Both have a battery operated fiber optic light on the blades

Rapid – Sequence Intubation:-

Definition: - RSI is defined as the simultaneous administration of a
neuromuscular blocking agent & a potential sedative for the purpose of
facilitating endotracheal intubation.
Involves the following steps.
(1) Preoxygenation:-
-100 % oxygen by mask for 4 – 5 minutes or for duration of 4 vital capacity
breaths.
(2)Pretreatment:-
Administration of drugs that mitigate hemodynamic or intracranial
pressure effects of drugs given to induce unconsciousness or paralysis &
intubation itself.
Fentanyl: - 3-5 mg/kg IV given about 1-3 mts before laryngoscopy &
intubation.
(Helps in alternate the significant elevation in HR, mean arterial BP &
plasma catecholamine levels).
Lidocaine. IV – prevent intracranial pressure responses to intubation.
Dose: - 1-5 mg / kg at the same fentanyl is given.
Midazolam: 2 – 5mg IV.

(3) Neuromuscular paralysis:

Succinylcholine 1.5 mg/kg i.v
Advantage: rapid action and brief duration of action.
Disadvantage: cased hyperkalemia in burns and crush injury patients
(4) Intubation with cervical spine Immobilization
With bimanual stabilization of the victims head to immobilize the cervical
spine.
The tip of the straight blade is placed under the inferior (ortracheal) surface
of the epiglottis during intubation and curved blade is placed into the
vascular space and between the base of the tongue and the epiglottis
To achieve direct visualization of the trachea. Three axes need to be aligned
with respect to one another
 Those of the mouth, the pharynx and head.
 This alignment requires the neck to be fixed forward and the head
extended backward, putting the patient into the “sniffing position”.

Procedure for Endo Tracheal intubation

First adequate ventilation and oxygenation to be achieved
Insert the blade of the laryngoscope into the patient right side of the month,
displacing the tongue to the left.
Visually examine the epiglottis and vocal cords
Gently insert the endotracheal tube
Gently external pressure at the level of the thyroid cartilage (the sellick
maneuvers) to aid the operator in visualizing the code and to facilitate
passage of the tube into the trachea.
After inserting the tube into trachea, inflate the cuff with enough to air to
provide an adequate seal.
Check the placement of the tube is correct or not by mouth to mouth or bag
to tube ventilation white observing lung expansion.
Ascultate the chest and abdomen to verify bilaterally symmetrical breath
sounds.
Finally tube is stabilized.

Post-Intubation Care
Includes-verification of tube position, securing endotracheal tube with tapes,
possible institution of positive pressure ventilation with consideration of
long term neuromuscular blockage and sedation.
Indication: Patients with cervical spine and crush injuries
Advantages
1. Most rapid possible attainment of the definitive airway
2. High success rate and low complication rate
3. Controls of the combative, severely injured patient
4. Facilitation of specific diagnostic and the respective maneuvers

NASAL INTUBATION
Recommended method in early 1980’s due to concerns about the safety of
oral endotracheal intubation in the presence of cervical spine injury.
Has lower success rate 65% (oral-100%) and high complication rods 3.7%
(oral 1.3%)
Often requires multiple attempt and several minutes to complete
Should not be used in points elevated 1 C P (intensive stimulation of the
procedure attempt may exacerbate that problem

Procedure
Adequate ventilation and oxygenation –nasal passage is sprayed with an
anesthetic and vasoconstriction (4% cocaine is very effective) or i.e.
medazolam when the anesthetics are contra indicated)-> tube end lubricated
with local anesthetic jelly-> tube inserted into one nostril while an assistant
maintains manual cervical immobilization-> tube slowly and firmly guided
along the nasal floor-> the operation listens to the air flow emanating from
the tube end once the tube end is in pharynx-> tube is carefully advanced
until the sound of air is maximal, suggesting that the tip of the tube is at the
opening of the trachea-> tube is advanced through the vocal cords->once the
tube has entered the trachea, the cuff is inflated and tube placement is
verified and stabilized externally.

ALTERNATIVE METHODS OF INTUBATION

FIBERSCOPIC- ASSISTED INTUBATION
Indication
1. As an alternative to blind nasal intubation
2. When other means are not possible
3. Significant anatomic abnormalities such as mandibular deficiency, morbid
obesity or a short, thick neck and a large tongue
The bronchoscope is passed through the glottis for direct visualization of the
vocal cords, at which time the trachea is entered. An endotracheal tube may
then be passed over the bronchoscope into the trachea. the scope may
identify causes of acute hypoxia, and may help to remove secretions in the
airway.
RETROGRADE TRANSCRICOID INTUBATION
Indication
1. When conventional techniques are unsuccessful due to inability to
visualize the vocal cords
2. Stable, cooperative patients
3. Comatose patients : if there is free access to posterior pharynx
4. Patients with severe orofacial trauma in whom distortion of normal
anatomy and bloody field preclude conventional intubation.
Not suitable for patients who require immediate intubation and
ventilation - takes upto 5 minutes for completion.
Introduced in early 1960’s
Material: - Standard ETT of appropriate size, a through the needle catheter
or flexible tip guide wire and a needle (16-18 gauge intracatheter) and
syringe are obtained. length of catheter.
Procedure:
Standard skin preparation
Cricothyroid membrane punctured with a needle at its inferior aspect to
avoid Crico thyroid arteries
Aspiration of air to confirm proper placement
The catheter or wire fed through the needle into the pharynx
Catheter is guided out through the mouth with forceps or digital
manipulation while it is fed from below.
The needle is then withdrawn from the trachea and small hemostats are
utilized to secure both ends of the guide wire
The oral or nasal tube (if nasal intubation is intended) is advanced over the
upper end of the through the needle whether or guide wire protruding from
either the mouth or the nose.
The tube is then advanced over the guide and into the pharynx and from
there, to the opening of the larynx
When the tube is in the correct position, the catheter or guide wire should be
cut at the skin of the neck, and the upper half is withdrawn through the tube
to prevent unnecessary contamination of the trachea.

EXTUBATION
Assuming that the victim has been successfully resuscitated and stabilized,
he or she will need to be extubated
To avoid aspiration, the pharynx should be suctioned completely and the
tube is removed during expiration

COMPLICATIONS
I. During direct laryngoscopy and entrotracheal intubation-
Esophageal intubation
Intubations of the right mainstem bronchus
Inability to intubate
Induction of vomiting
Dislocation of the mandible.
Fracture of the epiglottis
Airway hemorrhage secondary to trauma
Avulsion of the vocal cords (usually from stylet)
Dental trauma
Hypertension, tachycardia, bradycardia or dyshythmia
Dislocation of the cervical spine during hypertension or hyperflexion
Conversion of a cervical spine injury without neurologic deficit to a cervical
spine injury with neurologic deficit
II.Complications while the endotracheal tube is in place
Obstruction.
Accidental extubation.
Rupture or leakage of the cuff, resulting in possible aspiration.
Tracheal mucosa injury or ischemia.
Infection.
III.Complications following extubation
Laryngeospasm
Aspiration
Pharyngitis, laryngitis and trachetis
Infection
Laryngeal or subglottic edema.
Laryngeal ulceration with or without formations of granulation tissue
Tracheal stenosis
Vocal cord paralysis

LARYNGEAL MASK AIRWAY (LMA)

Device consists of shortened conventional silicon tube with an elliptical cuff,
inflated through a pilot tube, attached to the distal ends, and the cuff is
designed to form a airtight seal around the posterior perimeter of the larynx.
 CHARACTERISTICS OF LARYNGEAL MASK AIRWAYS

Size Of LMA Length Size Of Patient Vol Of Cuff Largest Size

OF (ml) Of ETT that
LMA Fits Into The
LMA
1 8 Neonates and Upto 4 3.5
infants upto 6.5 kg

1.5 10 Infants 5-10 Kg Upto 7 4.0

2 11 Infants &children Upto10 4.5
1-20 Kg
2.5 12.5 Children 20-30 Upto 14 5.0
Kg
3 16 Children & small Upto 20 6.0
adults.
30-50 kg
4 16 Normal adults Upto 30 6.0
50-70 KG
4 18 Large adults Upto 40 7.0
>70kg
The mask is inserted and the cuff inflated until no air leak is detected.
The device is very effective in maintaining a patient airway in the
spontaneously breathing patient. Positive pressure ventilation can be applied
if necessary
It is not suitable for patients who are at risk from regurgitation of gastric.
Contents and should be used with caution if pharyngeal soiling is anticipated

The flexible LMA (FLMA) differs from the standard LMA in that it has a
flexible, wire reinforced tube and available in sizes of 2, 2.5,3, 4 and 5
Intubating LMA (ILMA) is an advanced form of standard LMA and has a
shorter tube and a metal handle. The handle permits single-handed insertion
without moving the head and neck and without placing fingers in the mouth.
and it can pass through an interdental gap as narrow as 20 mm.
Available in sizes 3, 4 and 5.
The tube is wide enough to allow passage of a cuffed 8 mm tracheal tube,
and the ILMA is reusable device which may be cleaned and sterilized upto
40 times.

SURGICAL AIRWAY
Indication - inability to intubate the patient with total upper airway
obstruction

Needle Cricothyrotomy and Trans Tracheal Jet Insufflations:

History
High pressure jet ventilation through an endotracheal tube-> first described
by Janders in 1967.
Spoerel and associates (1971) and Klain & smith (1977) -> defined
indications and technique
Indications
1. Conditions that obstructs the airway
Oedema of the glottis
Fracture of the larynx
Severe oropharyngeal hemorrhage
2).Unable to place the endo tracheal tube into trachea
Jet insufflations can provide upto 45 minutes of extra time. Before a
definitive airway is established.

Technique
Jet insufflations technique is performed by placing a large bore cannula, 12
or 14 gauge (16 or 18 gauges in children’s), through the cricothyroid
membrane into trachea below the level of obstruction. The cannula is
connected to an oxygen source at a flow rate of 15 L per minute (40-50 psi)
with a Y-connector, or side hole. Intermittent insufflations, 1 second on and
4 sec off, are accomplished by occluding the Y - connector, or side hole.
Gases passively leave the lungs through the trachea as a result of chest
elastic recoil, because the exhalation may be obstructed, co2 can accumulate,
which limits the use of this technique to 30-45 seconds.

Complications
Barotraumas – subcutaneous emphysema.
Pulmonary rupture and tension pneumo thorax.
Esophageal puncture, arterial perforation, bleeding and hematoma
 CRICOTHYROTOMY
Indications
Maxillofacial trauma
Oropharyngeal obstruction – edema secondary to infection or allergic
reaction, thermal and caustic injuries, foreign body, and mass lesions and
when oral or nasal intubation is not possible
Conditions in which oral and nasal intubation is a contraindicated-congenital
malformation, massive hemorrhage, aspiration that cannot be cleared or
laryngospasm,
Spinal cord injury
Contraindication
Age: genrally contraindicated in children depend on size, under the age of
10-12 years
Crush injury to the larynx
Pre existing laryngeal or Tracheal pathologic conditions obstruction
secondary to tumor or subglottic stenosis would prevent the establishment of
a functional airway

Surgical Anatomy and Procedures:-

Cricothryoid space should be identified
Thyroid cartilage hyoid bone, thyroid prominence (adom’s apple), are
present in the midline. Cricoidcartilage is found approximately 2-3 cm
inferior to the thyroid cartilage prominence. The space between the thyroid
and the cricoid cartilage-the cricothryoid membrane is the location for the
cricothyrotomy. The usual width of the membrane is 2.7 to 3.2 cm and the
height is 0.5 to 1.2 cm
After G.A is administered, a horizontal incision approximately 2 cm long is
placed through skin and subcutaneous tissue. The superficial layer of the
deep cervical fascia identified overlying the cricothryoid membrane.
Cricothyroid ligament and cricothyroid muscle is located at the lateral extent
of the conus. Using no 15 or no 11 blade a horizontal stab incision placed
through cricothyroid membrane. Opening is enlarged and Trousseaus dilator
is inserted and spread vertically to enlarge the opening. Then appropriate
sized tracheostomy tube, a NO .6 shiley in the average male and a No .4
shiley in the average female, is inserted under direct vision and the tube is
secured using umbilical tape tied among the neck. Skin in not sutured to
prevent subcutaneous emphysema and pneumo mediastenium, a chest film
should always be obtained to check the tubes position and to exclude
Pneumothroax.

Complications
Preoperative Post operative
Improper tube placement Dysphonia, hoarseness
Hemorrhage Subglottic stenosis
Prolonged execution time Infection
Subcutaneous emphysema Aspiration
Thyroid gland injury Occlusion of the tube
Esophagus injury Persistent stoma
Cartilage fracture Vocal cord paralysis
Recurrent laryngeal nerve injury

Advantage over Tracheostomy

Faster-> less than 2 min
Easier to perform with instrumentation
Fewer surgical complications
Does not require extension of the neck.

TRACHEOSTOMY
Synonym: Larygotomy, Bronchotomy, Tracheotomy
Indications: Pediatric patients
Laryngeal fractures
Tracheal transection
Subglottic stenosis
Prolonged ventilation
Facilitation of management of cervical spine injuries

Contra indications
Expanding hematoma in the neck.
Cricothyrotomy may be performed more safely emergently

Surgical anatomy and procedures

Requires thorough knowledge of neck anatomy. superficially, the thyroid
cartilage is palpable superiorly, proceeding inferiorly, the cricoid membrane
and cartilage are identified. Tracheal rings follow inferior to the cricoid
cartilage and become difficult to palpate as the trachea descends into the
chest. The suprasternal notch is palpated at the junction of the neck and
chest at this level, the trachea is 1 to 1.5 cm deeper than the cricoid cartilage.
Skin, subcutaneous tissue are found superficially, followed by investing
fascia-> above the sternum divides into two layers attached to anterior and
posterior sternum, forming the “Suprasternal space of Burns”
 This space is filled with loose connective tissues and fat and contains
the anterior jugular veins, with their anastomosis, the jugular venous arch
Infra hyoid muscles are found lateral to the midline
Beneath the intra hyoid facia and muscles can be found pretracheal
fascia and the thyroid isthmus.
Infra hyoid veins, infra thyroid artery and thyroid in artery all lie in
this space.
Skin incision - placed vertically in emergency situation and horizontal in
elective procedure.
Vertical incision is made from inferior to the cricoid cartilage to the
suprasternal notch and is carried through subcutaneous tissue and platysma
prior to the dissection
In elective procedure 4 -5 cm skin incision is made approximately 2 cm
below the cricoid cartilage
The space of burns is bluntly entered and infra thyroid veins clamped, then
infra thyroid fascia bluntly dissected, retraction and dissection exposes the
pretracheal fascia and the thyroid isthmus that overlies 2, 3 and 4th tracheal
rings. If the isthmus cannot be retracted, then it is transected. Cutting the
suspensory ligament
After clamping isthmus is cut and trachea is seen.
Cricoid cartilage and first tracheal ring should not be cut and incision into
the tracheal must not extends below the 4th ring. tracheotomy hook is placed
between first and seconds tracheal ring and gently retracted superiorly
Incisors (U, inverted U, T, and cruciform) placed, generally inverted U
shaped incision, made through 2nd and 3rd ring. and a traction suture of 2-0
silk is placed through the tip of the flap. Tracheostomy tube of No 7, or 8
shiley for adult male and no5 or 6 for adult female is inserted after dilating
with trousseaus dilator, the skin should be loosely sutured or left open
Gauge dressing is placed under the trachestomy tube and the tube is secured
with cloth tape tied around the patient’s neck.
Complications
Perioperative Postoperative
Hemorrhage Plugging of the tube with secretions
Penumothorax Hemorrhage
Subcutaneous emphysema Infection
Esophageal injury Tracheal stenosis.
False passage Tracheo esophageal fistula
Aspiration Vocal cord paralysis

Post operative Care

Cuff pressure should be maintained at 20 mm Hg
Humidified air (at 40%) is required at all time to prevent mucosal drying and
to facilitate removal of secretions
Tracheostomy tube is aspirated frequently to remove with 100% O 2 for 2 or
3 mts prior to suctioning
5 ml of sterile normal saline is injected into the tracheal tube followed by
deep suctioning. Suctioning should be intermitted and should not exceed 2-3
seconds.
This procedure is done every one hour for first day, 2 hours for 3 and 4 th day
and every 4 hour thereafter.
Tracheotomy tube should be changed weekly.
Surgical wound should be protected with sterile gauge dressings changed
frequently to keep clean and dry.
 CONTENTS

 Introduction.

 Systematic Approach to Airway Management.

 Esophageal Airway.

 Oral and Nasopharyngeal Airway.

 Endotracheal Intubation.

 Alternative methods of Intubation.

 Extubation.

 Complication of Intubation and Extubation.

 Surgical Airway.

 Conclusion.

 Bibliography.
 BIBLIOGRAPHY

Oral and Maxillofacial Trauma-Vol I

-Fonseca & Walker

Oral and Maxillofacial Injury

-Rowe & William

Maxillofacial Surgery - Vol I

-Peter Ward Booth

Oral and Maxillofacial Surgery, Trauma –Vol III

-Raymond. J.Fonseca.

Text Book of Anesthesia

-Aitkenhead
 THE OXFORD DENTAL COLLEGE AND HOSPITAL
BOMMANAHALLI, HOSUR ROAD,
BANGALORE – 68

DEPARTMENT OF ORAL AND MAXILLO FACIAL SURGERY

SEMINAR
ON
AIRWAY MANAGEMENT IN
TRAUMA PATIENTS

SUBMITTED BY SIGNATURE OF
DR. CHIDAMBAR.Y.S PROFESSOR & H.O.D
II MDS