Anatomic

Jaw wired shut / mandibular fixation

Before / During / After / Pitfalls

Before

• Find wire cutters or release tool immediately; confirm who can release fixation.
• Suction and aspiration plan are essential, especially with vomiting or bleeding.
• Plan nasal/oral/surgical route based on access, trauma, and local expertise.

During

• Release fixation if airway/ventilation demands it and local protocol supports it.
• Avoid blind nasal route if basilar skull/midface trauma concern.
• Have front-of-neck access backup visible.

After

• Re-secure mandibular plan with OMFS/ENT/trauma.
• Document release timing and airway route.
• Ongoing aspiration and bleeding management.

Pitfalls

• No wire cutters at bedside.
• Trying to manage emesis with jaws fixed.
• Assuming standard oral laryngoscopy is possible.