On Tuesday afternoon, the routine preoperative visit made Dr. Liu of the Anesthesiology Department very emotional. The Head and Neck Department admitted a young patient, and it is said that the orthopedic department is also required to perform joint surgery. The emotion is not that the surgery is big, but that this young man is a pity.
A preoperative examination revealed that he had a malignant tumor on his cheek. Due to the proximity to the lower jaw, mandible excision and bone grafting are required at the same time. I can't imagine what such a young face would look like.
As an anesthesiologist, the most important thing is to pay attention to some of the conditions of the patient's body related to surgical anesthesia: for example, heart rate, blood pressure, breathing, pulse and body temperature and other life indicators. Then there is the function of the various systems, organs, and which factors in the process of administering anesthesia may contribute to the risk.
Speaking of risks, the risks of this type of surgery are unusual. During oral surgery, anesthesiologists are most worried about problems with intraoperative ventilation.
In the state of general anesthesia, the patient is completely free of spontaneous breathing. At this time, it is necessary to assist and even control breathing. In most cases, an anesthesia machine is required to control breathing. If breathing is to be controlled, artificial airways need to be established.
An artificial airway is the airway in which anesthesiologists use air ducts, laryngeal masks, or oropharyngeal ventilation to maintain airway patency and connect with external pipering.
However, establishing this airway is not easy and often carries some risk.
Decades ago, many hospitals were unable to carry out general anesthesia due to the unskilled establishment of artificial airways. Even today, I often hear about which hospital has an accident.
The necessary step in assessing endotracheal intubation is the degree of mouth opening. In general, openings smaller than three fingers may indicate difficult intubation. This is done by the patient using three of his or her fingers together perpendicular to the upper and lower teeth. If you can't put it in, you think that the mouth is not open enough.
After Dr. Liu asked the patient to do this action, the patient was reluctant to move.
Looking closely, Dr. Liu inhaled a cool breath: the patient's cheek was bulging on one side, all the way to the mandible. Vaguely, the mandible is also bulging.
With years of clinical experience, Dr. Liu judged that this tumor is not small.
In this case, it is certainly not possible to intubate from the mouth anymore. Even if it can be inserted, the operation may affect the operation during surgery. More importantly, such intubation is difficult to fix. Once the catheter falls off and is not found in time, the consequences are unimaginable. So Dr. Liu turned to checking the patient's nasal cavity. If the patient's nasal passages are normal, nasal intubation is completely possible.
After examination, both nostrils are unobstructed.
During the operation, Dr. Liu chose the side that was relatively far away from the surgical area for intubation.
When the surgeon removed the tumor and the tissue that might have been violated, the scene was unbearable to look at—a big hole in the young man's face. Not only that, but the mandible is also missing a segment.
Despite his long experience, Dr. Liu couldn't help but worry about whether the surgeon could make up for it, even though he knew that the orthopedic surgeon had come to help solve this problem.
Mandibular resection is a common surgical method for the treatment of mandibular tumors, and the mandible defects caused by resection are reconstructed by vascular bone grafting. Since the blood supply of the transplant is immediately reconstructed, bone healing is similar to the fracture healing process, and vascular free iliac bone grafting and vascular free fibula grafting are currently two commonly used methods. The fibular flap provides a large length of bone repair, and the fibula muscle flap is well transported, which is conducive to the repair of the mandible with soft tissue defects; the fibula with the small head of the fibula can reconstruct the condyle.
General anesthesia is so good, surgery just do the operation, do not have to worry about the problem of insufficient anesthesia. In a state of general anesthesia, surgery can be done in all locations of the whole body.
Cutting off a piece of fibula is not difficult for orthopedics. In less than half an hour, this muscular and blood-vessel-rich fibula was cut.
In this way, after more than three hours of hard work, another chin was built for him.
Looking at the patient who was still under anesthesia, Dr. Liu asked curiously about the cause of the disease. However, after hearing the cause of the illness, Dr. Liu's mood became extremely complicated. It turned out that the reason for this guy's illness was chewing betel nut!
Suddenly, Dr. Liu's heart was pitiful and complaining. In recent years, various channels are in the science of science do not chew betel nut, why does this guy not listen?
Because it was oral surgery, in order to ensure postoperative respiratory safety, Dr. Liu sent the patient to the intensive care unit and postponed extubation.
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