AIRWAY MANAGEMENT IN A PATIENT WITH GUNSHOT INJURY TO THE FACE: A CASE REPORT
Formerly Published in Vol. 14 No. 2 Jan. - Jun., 2026
Keywords:
Maxillofacial, gunshot, difficult airwayAbstract
Background: Difficult Airway management may be encountered when managing a patient with a gunshot injury to the face. Injuries to the maxillofacial region present one of the most challengingproblem for the anaesthetist. Maxillofacial trauma is commonly caused by road traffic accident, firearms, assaults etc.
Case presentation: We present a case of difficult airway management in a 31yr old malebilled for re-exploration, mandibular plating and reconstruction on account of woundbreakdown and unstable mandible. The patient had a close-range gunshot injury to the face 2 months prior to the procedure. Airway examination revealed poor mouth opening, Mallampati 4, upper lip bite test 3, defect at the left side of the mandible with exposure of the plate. Thepatient was adjudged difficult airway and difficult airway adjuncts were made available. He was premedicated with glycopyrrolate, pethidine, plaster was used to cover the defect to achieve good mask ventilation. Induction was with fast offset agent propofol, test ventilation was done successfully, intubation was facilitated with fast offset agentsuxamethonium. Initial airway plan was intubating LMA. First attempt with intubating LMAfailed. However, improvement in mouth opening was noted at this point hence reverting using Macintosh size 4 blade, laryngoscopic view of Cormack and Lehane grade III was seenIlo et al., Airway management in gunshot injury gum elastic bougie was inserted, a 7.5mm cuffed endotracheal tube was railroaded into the tracheal and correct placement confirmed. The procedure continued uneventfully, and patient was extubated awake at the end of the case.
Conclusion: Late airway management in maxillofacial trauma usually poses challenge to the anaesthetist, proper evaluation, planning and experienced intervention will improve outcome
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References
1 Breeze J, Gibbons AJ. Contemporary management of maxillofacial ballistic trauma. Br J Oral Maxillofac Surg. 2020;58(6):673–680.
2 Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report. Anesthesiology. 2022;136(1):31–81
3 Adeyemo WL, Bamgbose BO, Ogunlewe MO, Ladeinde AL, Taiwo OA. Airway management in maxillofacial trauma: a review of challenges and outcomes in a Nigerian tertiary hospital. Niger J Clin Pract. 2020;23(5):607–612.
4 Thanni LO, Osinupebi OA, Deji-Agboola AM. Airway management challenges in maxillofacial trauma in a Nigerian tertiary hospital. Niger J Clin Pract. 2020;23(5):670–675
5 ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363–6.
6 The Lancet Global Health. Global mortality from firearms, 1990–2016. Lancet Glob Health. 2018;6(7):e721–e722.
7 Faponle AF, Soyannwo OA, Amanor-Boadu SD. Airway management in patients with maxillofacial trauma in a Nigerian hospital. Afr J Anaesth Intensive Care. 2020;20(1):9–15.
8 Adeyemo WL, Ladeinde AL, Ogunlewe MO, James O. Airway management challenges in maxillofacial trauma in a Nigerian tertiary hospital. Niger J Clin Pract. 2020;23(5):647–652.
9 Okafor UV, Nwokediuko SC. Maxillofacial trauma and airway management difficulties in Nigerian patients. Afr Health Sci. 2016;16(3):751–757.
10 Olumide A, Adeola O, Akinola O. Airway management challenges in Nigerian patients with limited mouth opening. Niger J Clin Pract. 2018;21(6):755–760.
11 Olatunji G, Kokori E, Aderinto N, Alsabri HM. Emergency airway management in resource limited setting. Int J Emerg Med. 2024;17:41.
12 Osinaike BB, Gbolahan OO, Olusanya AA. Intra‐operative airway management in patients with maxillofacial trauma having reduction and immobilization of facial fractures. Niger J Surg. 2015;21(1):26–30
13 Akinbami BO, Osunde OD, Okoje VN. Management of maxillofacial gunshot injuries in a Nigerian tertiary hospital: a review of treatment principles and outcomes. Niger J Surg. 2019;25(2):120–125. Pioneer Medical Journal Vol 14. No 2 Jan – Jun. 2026 Ilo et al., Airway management in gunshot injury
14 Breeze J, Gibbons AJ, Hunt NC, Shieff C. Contemporary management of maxillofacial ballistic trauma. Br J Oral Maxillofac Surg. 2020;58(9):1015–1021
15 Nwawolo CC, Asoegwu CN. Experience with managing penetrating anterior neck injuries in Lagos, Nigeria. Journal of the West African College of Surgeons. 2017;7(3):1–10
16 Schade K, Borzotta A, Micheal A. Intracranial malposition of nasopharyngeal airway . J.Trauma. 2000; 49:967-968.
17 Demetriades D, Chahwan S, Gomez H et al. Initial evaluation and management of gunshot wounds to the face. J. Trauma 1998; 45;39-41.
18 Gaszynski T. Airway management in a patient for general anaesthesia in patient with rheumatic disease ; new possibilities. Reumatologia. 2019;57(2):69-71.
19 Ilo DI, Erondu MA, Ilo IS, Desalu I. A Study of ease of Laryngeal Mask Airway insertion and Haemodynamic effects following co-induction with midazolam and propofol versus propofol alone in children.AJOI: 2020. 20(1).
20 Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827–848.
21 Ahmad I, El-Boghdadly K, Bhagrath R, Hodzovic I, McNarry AF, Mir F, et al. Difficult Airway Society guidelines for awake tracheal intubation in adults. Anaesthesia. 2020;75(4):509–528.
22 Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022;136(1):31–81.
