**2. Examination of trauma patients**

Advanced trauma life support (ATLS) is the first step that should be applied in emergency cases. Airway obstruction should be evaluated as soon as possible since the mid-face is the beginning of the respiratory pathway. Hemorrhage and secretions may obstruct the oropharynx and nasopharynx. Removal of fractured teeth, clots, and loose dental crowns or dentures is important to open the oral airway. Packing should be used to control acute bleeding. Intubation to secure the airway in instable mid-face fractures is the next step that should be considered in emergency patients [7, 8]. It is important to keep the airway open in mid-face fractures because there is always the potential of airway obstruction due to displacement of bones or severe bleeding in such cases.

Cervical spine injuries are common in facial fractures. The incidence rate of cervical spine trauma in pediatric facial fracture cases is almost 3.5% [9] whilst this number is much higher in adult trauma patients [10]. According to the possibility of spinal injuries in facial trauma patients stabilizing the cervical spine by a rigid collar is necessary until the spinal injury is ruled out.

After providing a secure airway, ATLS protocol can continued. When the patient is stable, facial examination to detect the mid-face fractures is executed as follow.
