• Donn Marciniak and Charles E Smith.
• Department of Anesthesia, Metrohealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. dmarciniak78@yahoo.com
• Anesth. Analg. 2007 Dec 1;105(6):1720-1, table of contents.

BackgroundPatients with severe maxillofacial trauma pose a challenge when their airways must be secured. Often, emergent surgical airways are established when largyngoscopy or fiberoptic intubation are unsuccessful. When an airway cannot be surgically established, the anesthesiologist is forced to use novel approaches to airway management, but there are few descriptions of such techniques in the literature.MethodsAfter unsuccessful laryngoscopy and a failed cricothyroidotomy and tracheostomy in a patient with deforming maxillofacial trauma, a gum-elastic bougie was inserted retrograde through a tracheal defect in a cephalad manner and exited the patient's mouth.ResultsThe patient was successfully intubated using a modified retrograde technique through a tracheal defect with a gum-elastic bougie.ConclusionsWhen an uncontrolled airway cannot be secured surgically and a tracheal defect is present, retrograde intubation with a gum-elastic bougie may be considered as an emergent management option.

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