Early fixation of facial fractures in patients with multiple trauma was not an issue in the original question posed to JAMA to which I offered a response and I have no personal experience in this regard. While the concept of early fixation of facial fractures in patients with multiple trauma is interesting, I challenge these authors to produce definitive evidence that it results in a shorter hospital stay.I strongly disagree with their notion that one should perform blind nasotracheal intubation in patients with acute multiple trauma with a Le Fort II or III fracture because a cribriform plate fracture may be virtually impossible to rule out in the acute setting. I suggest that the paucity of cases involving "cranial intubation" may be due to widespread education of the medical community concerning the dangers of nasotracheal intubation in patients with facial fractures (ie, the Advanced Trauma Life Support
Hall DB. Nasotracheal Intubation in the Presence of Facial Fractures-Reply. JAMA. 1989;262(10):1328. doi:10.1001/jama.1989.03430100061019
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