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General anesthesia for mandibular cancer surgery and reconstruction with fibula free flap
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Abstract
Introduction: General anesthesia for mandibular cancer surgery and reconstruction with a microsurgical free flap is challenging for anesthetists because of the long operative duration, difficult airway control, and maintaining appropriate blood pressure to facilitate surgery. On January 16, 2023, for the first time, Military Hospital 103 performed partial mandibular resection and floor of the mouth with bilateral cervical lymphadenectomy I, II, III, and IV and reconstruction with a fibula-free flap for a patient with mandibular epithelium cancer T4N2M0, under endotracheal general anesthesia.
Case presentation: Patients Nguyen Khac D. is a male, 54 years old, with a healthy past medical history. On January 3, 2023, he was admitted to the Maxillofacial Department of Military Hospital 103 in a state of alertness, with a temperature of 37°C, respiratory and hemodynamic stability, no comorbidities, and no allergies.
Local injury: The gingival tumor on the floor of the mouth in the R31-44 area was firm, rough, painless, and non-ulcerative. Preoperative biochemical and hematological results were within normal limits.
On January 9, 2023, the patient had a biopsy of the lesion, and histopathological results concluded that it was squamous cell carcinoma, keratinized grade II. At 08:00 on January 16, 2023, the patient was transferred to the operating room with the diagnosis of mandibular epithelium cancer T4 and N2M0. The method of surgery was partial mandibular resection and floor of the mouth with bilateral cervical lymphadenectomy I, II, III, and IV and reconstruction with a fibula-free flap under endotracheal general anesthesia. General anesthesia and surgery were safe. The patient was discharged from the hospital on February 17, 2023.
Conclusion: Microsurgical free flap in the treatment of head and neck malignant tumors presents a challenge for the anesthetist, and the ultimate goal is to optimize the physiological conditions for flap survival.
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Keywords
General anesthesia, mandibular cancer, reconstructive surgery
References
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