Airway obstruction, unconsciousness, and reduced respiratory tidal volume are the principle disturbances that give rise to airway complications. Of these, obstruction is the most frequently encountered and the most emergent. Airway difficulties may evolve from many sources, including the patient's disease, the administration of anesthetics, surgical procedures, the technique of tracheostomy, and the nursing care afforded the patient.
During the past 14 years the plastic surgery service at the University of Pittsburgh has performed more than 25,000 surgical procedures involving the head and neck. Among the patients treated on this service we have encountered 31 serious airway problems, in the course of which 3 patients died of suffocation.
In our experience, facial trauma with fractures involving the mandible, maxilla, or both provide the most frequent cause of airway complications that arise from the patient's disease. In many of these cases of traumatic disruption tracheostomy is mandatory if life