ReviewEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
Maxillofacial, laryngeal and cervical trauma - how can we do better as the first responder? A 3-step approach for pre-emptive diagnosis and early management.
Review in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundConcomitant maxillofacial, laryngeal and cervical spine (MLC) injuries in trauma remains a rare occurrence. It can result in mortality if not diagnosed and managed expeditiously in the field. An algorithm for efficient diagnosis and early management of patients with MLC injuries can be lifesaving.
methodsWe conducted a narrative literature review of PubMed and Cochrane databases and integrated the findings with a retrospective case series of nine consecutive patients with concomitant MLC injuries over a 23-year period at the National University Hospital, Singapore. The primary objective was to develop a simple 3-step prehospital algorithm for early recognition and management of MLC injuries. Secondary objectives were to summarise key red flags and field care bundles for first responders and to describe the patterns, management and outcomes of our case series.
resultsThe literature review highlighted overlapping risk factors, typical injury patterns and high rates of airway-related morbidity and mortality, including reported prehospital death from hypoxia in up to one-third of trauma patients. Delayed or missed diagnoses of cervical spine and laryngeal injuries were also common. In our case series (nine male patients, mean age 47 years), road traffic collision was the dominant mechanism. All patients had maxillofacial, laryngeal and cervical injuries. Six patients required operative fixation of maxillofacial fractures and three required surgical repair and stenting of laryngeal fractures. Based on the literature and local experience, we developed a 3-step algorithm with diagnosis-driven care bundles for prehospital and early emergency department use.
conclusionStrengthening the “chain of survival” through increased prehospital diagnosis of MLC injuries with early intervention has the potential to save lives. The proposed 3-step algorithm offers an accessible framework for paramedics and emergency physicians to improve outcomes in this complex trauma cohort.
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