# Vigilant Fiberoptic Orotracheal Intubation in a Patient With Severe Craniofacial Trauma During the Last Morocco Earthquake

## TL;DR

A 40-year-old woman with severe facial injuries from an earthquake was successfully intubated using a fiberoptic method to manage her unstable airway.

## Contribution

Demonstrates the successful use of awake fiberoptic intubation in a complex craniofacial trauma case during an emergency.

## Key findings

- Awake fiberoptic intubation was safely performed in a patient with hemi lefort III and II fractures.
- The procedure maintained spontaneous breathing and avoided complications despite an unstable skull.
- Collaboration among emergency, anesthetic, and surgical teams was critical for successful airway management.

## Abstract

Maxillofacial trauma is prevalent, particularly among the young population, often stemming from assaults, road accidents, or sports-related mishaps. Traditional intubation methods for managing these injuries can be challenging, especially with occluso-facial fractures requiring intermaxillary blocking for dental articulation restoration. Effective management requires interdisciplinary collaboration between emergency physicians, anesthetists, and maxillofacial surgeons. Proficiency in techniques like the vigilant fiberoptic approach should be emphasized through specialized training courses. This collaborative approach ensures the best possible strategy for managing difficult airways, with input from all stakeholders including patients, students, and practitioners. In this case, we successfully conducted a rapid-sequence awake fiberoptic oral intubation on a trauma patient, during the last earthquake that hit Morocco, with severe craniofacial injuries and an unstable skull. The patient, a 40-year-old woman, presented with complex facial fractures, including hemi lefort III on the right and hemi lefort II on the left, along with minimal subarachnoid hemorrhage and frontal pneumocephalus. Due to the patient's compromised airway from diffuse facial bleeding and low oxygen saturation, we opted for awake fiberoptic intubation once immediate life-threatening issues were addressed. This approach allowed us to maintain the patient's spontaneous respirations and navigate around unstable craniofacial structures. The procedure was performed with meticulous care, considering the patient's unstable skull, and was successful without complications. Post-intubation, the patient was extubated, and her recovery was uneventful.