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Clarify history to ensure any other traumatic injuries of higher priority have been adequately managed.

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Bilateral displaced mandibular fractures often allows for anterior displacement of mandible, improving the grade view during laryngoscopy.

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If there is significant bleeding or bruising, consider an elevated risk of difficult ventilation/laryngoscopy and prepare, with surgeon, for emergency surgical cricothyroidotomy.

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Warming the nasotracheal tube with warm saline reduces nasal trauma refl.in/ey

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Patient may have poor mouth opening on initial examination (limited generally by pain), that will usually improve to near normal on administration of muscle relaxant.

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Surgeons usually require a nasal endotracheal tube.

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