**1. Introduction**

Trauma at the level of the head and neck represents a public health problem due to the esthetic and functional complications with major social and economic impacts. Among the possible causes for trauma stand car accidents, domestic violence, work-associated accidents, and even terrorist attacks [1].

These cases often have a legal consequence, and in this aspect, the ear, nose, and throat (ENT) surgeon represents a source of medical information important in establishing the degree of judiciary responsibility. The ENT surgeon must bear this in mind and keep accurate records of the procedures performed. Also different pathologies before trauma along with alcohol consumption and high-risk drug intoxication are mentioned [2].

Photographically documenting the case before and after surgical procedures with subsequent electronic storage for later use is particularly important. In each department, there should be a person assigned to archiving images in potential legal and scientific cases of interest associating tumors or deep neck infections with the patient's death [3].

Patients with multiple trauma lesions admitted to the emergency department undergo assessment according to the ABCDE algorithm: A, airway plus spinal cord control; B, breath and ventilation; C, circulation and hemorrhage control; D, disability/neurologic status; and E, complete exposure but preventing hypothermia [4].

Facing a patient with multiple trauma lesions, a thorough head-to-toe lesion inventory with additional consults performed by the abdominal surgeon, thoracic surgeon, orthopedic surgeon, and others is necessary. For the head lesions, opinions from the neurosurgeon, ENT surgeon, OMF surgeon, ophthalmologist, and plastic surgeon should be gathered. The central pawn in this endeavor is the emergency specialist in the first stage and afterward the anesthesiologist supervising the case in the intensive care unit (ICU). Other lesions have a priority before facial fractures unless there is massive nasal bleeding with cerebrospinal fluid (CSF) leak or lesions hindering the oral intubation for general anesthesia. In the first case, the ENT surgeon must perform emergency nasal packing and in the other scenario must submit the patient to an emergency tracheostomy [5].
