Maxillofacial Trauma, Le Fort Fractures, and Orthognathic Surgery — WACS Viva & Clinical Scenarios (Plastics & Dental)

Exam-style maxillofacial trauma, le fort fractures, and orthognathic surgery viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 26-year-old male motorcyclist is brought to the trauma center following a high-speed collision. He has severe facial trauma with a floating midface (Le Fort II/III), marked facial edema, persistent CSF rhinorrhea, active oral hemorrhage, and a Glasgow Coma Scale (GCS) of 12. He is wearing a rigid cervical collar. How do you assess, resuscitate, prioritize cervical spine protection, and secure the airway in this patient?
• SCENARIO 2: A 30-year-old male with combined pan-facial fractures (displaced Le Fort I osteotomy, fractured zygomaticomaxillary complexes, and comminuted mandibular symphysis fracture) requires open reduction, internal fixation, and intraoperative dental occlusion checking. The surgical team requests an airway that does not interfere with the dental bite and does not require a formal tracheostomy. Detail the technique, indications, contraindications, and complications of submental endotracheal intubation.
• SCENARIO 3: A 22-year-old female is undergoing an elective bimaxillary osteotomy (Le Fort I advancement and bilateral sagittal split osteotomy) for severe craniofacial dysgnathia. The surgical team asks for deliberate (controlled) hypotension to minimize blood loss. Detail your pre-anaesthetic workup, pharmacological technique to achieve controlled hypotension, safety monitoring limits, and contraindications.
• SCENARIO 4: A 28-year-old male with open reduction and internal fixation of a bilateral mandibular fracture has his maxilla and mandible tightly wired together (maxillomandibular fixation) at the end of a 4-hour procedure. During emergence from general anaesthesia, he begins to retch and develop severe stridor with SpO2 dropping to 85%. Outline your immediate, step-by-step crisis management plan.