抄録
A 29-year-old male suffered high-energy trauma resulting from an automobile accident and was brought to our emergency and critical care center. Despite an airway obstruction due to massive oronasal bleeding, his SPO2 increased temporarily due to continuous aspiration. However, the SPO2 decreased after aspiration was stopped because he was in and out of consciousness. We determined that use of an illicit drug before the traffic accident was the cause of the unstable consciousness. We identified his midfacial fractures including right Le Fort Ⅰ/Ⅱ, Le Fort Ⅰ, right zygomatic, nasal and right orbital fracture without a traumatic intracranial injury on a computed tomography scan. The sustained oronasal bleeding was caused by multiple complex midfacial fractures, and surgical treatment was planned. We decided to perform emergency surgery under general anesthesia because of his unstable consciousness due to the illicit drug and upper airway obstruction due to massive bleeding. The patient underwent open reduction and internal fixation for the complex maxillofacial fractures, and hemostasis was achieved. The patient did not bleed after the surgery and was extubated the next day. He was taken to a psychiatric hospital due to drug withdrawal symptoms. His clinical course was good 2 years after the surgery. This case demonstrates that consciousness can be unstable in an illicit drug-using patient with complex maxillofacial fractures; therefore, oral and maxillofacial surgeons should be careful but must intervene quickly.
