A case of difficult airway ( 一例困难气道）
本帖最后由 shenxiu2 于 2010-6-6 00:25 编辑52 years old man . No previousmedical problem.
Diagnosed to have carcinoma of the leftmaxilla one year ago.
Underwent total left maxillectomy and radiotherapy to the affected areas,completed treatment7 months ago.
He was using a prosthetic obturator to fill up the cavity left behind by the left maxillectomy.
Later he developed orocutaneous fistula of the left face. The fistula was communicating a defect between the left face and the oral cavity.
Due to the radiotherapy, his jaw was fixed . He has very minimal mouth opening , about 2 to 3 cm . After taking out the obturator , he has a large defect in the left oral cavity.
Now he has presented to us to have a closure /repair of the orocutaneous fistula .
How would you anesthetize him? 老大能翻译一下不。 这是一例上颌癌术后及放疗后，面部缺损（瘘管，与口腔相通） 由于术后放射治疗，只能开口 2CM。
现在拟做瘘管缺损修补。
如何麻醉？ 气管切开不行么？纤维支气管镜下清醒插管。 气管切开不行么？纤维支气管镜下清醒插管。
joo0918 发表于 2010-6-8 00:27 http://www.xqnmz.com/images/common/back.gif
If we do not have the fibreoptic bronchoscope , can we avoid tracheostomy?
若我们没有 纤维支气管镜,有没有办法避免气管切开? 本帖最后由 shenxiu2 于 2010-6-8 19:07 编辑
Traditionally we are taught to use inhalational induction for difficult airway, but in this case, we are not able to maintain anairtight mask seal because of the big leak at the fistula.
There is a large hollow space in the oral cavity after removing the prostheticobturator, which may allow us to intubate him , but we would not know( cannot be sure )until we can visualize the larynx after induction.
传统上我们的教导是:困难气道，用吸入诱导，保持自主呼吸。可是在此个案，我们不能有效的用吸入诱导麻醉，因为有很大的漏洞（瘘管），麻醉气体都漏出来了。
左边的口腔在拿出人造的上颌后，其实有蛮大的空间可以尝试插管。不过还没尝试之前，并不能肯定。 本帖最后由 yana 于 2010-6-8 17:03 编辑
I think it's better to be tracheostomy than others because-----
1] Either oral or nasal intubation, it will interuptthe operation hands on the face ,
2] The anesthetic tube at the surgical field do not be good management by us
....and so on
我想最好还是气管切开，因为——
1，无论经口还是经鼻插管麻醉，都将影响面部手术的操作；
2，位处术野的气管导管不好管理....
等等 本帖最后由 shenxiu2 于 2010-6-11 12:14 编辑
The surgeon said that he is not going to operate intraorally. He is going to only operate on the face.
By using a rotation flap from the face (in between the eyebrows),to cover the defect below the left eyes.
外科医生说他不会在口腔内作手术。他只会在面部动刀。
他会把眉间的一块皮和组织切开，转过来，覆盖在缺损的开口上，补起缺口。 本帖最后由 shenxiu2 于 2010-6-11 12:22 编辑
In this case , we had intubated him orally using size 8 tube.This picture was taken after intubation .( You may notice the endotracheal tube on the right angle of the mouth, and his right eye was closed and taped with transparent tape). He was actually anesthetized , but his left eye was not closedbecause of the fistula & distortion of anatomy ( This eye cannot be closed naturally ). we did not tape the left eye because this was the operating field.
在此个案，我们成功用8号气管导管插管。这是插管后的照片。（你可能看到右边嘴角的气管导管，他的右眼也被透明胶布贴上了。)
这照片中的他其实已经在全麻之下了，只是他的左眼还开着，这是因为那个瘘管造成的。（左眼不能自然关上）。我们没有在左眼贴上胶布，因为这是动手术的部位。
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