The impact of the crash broke his helmet, as he was thrown towards the edge of the road. Motorists and pedestrians rushed to his aid and took him to a nearby hospital. Due to a lack of medical infrastructure and expertise to treat the trauma, he was shifted to SL Raheja Hospital.
It was reported upon arrival that the patient was bleeding through his nose and mouth, his upper jaw was hanging; after thorough evaluation, internal injuries were ruled out. The patient had suffered facial injuries and slight memory loss after the accident. He was immediately shifted to the operation theatre, to stabilise his jaws and to stop the bleeding.
It was noted that the lower jaw (mandible) was broken, the upper jaw (maxilla) and palate was broken in four pieces; it had dislodged outward and were barely held by soft tissues inside the mouth. His nose along with the adjoining areas of his face was also shattered.
As he was stabilised, Dr Samrat Tawde, Consultant Oral and Maxillofacial Surgery, SL Raheja Hospital evaluated the patient’s face thoroughly, to understand the possible bleeding points.
Speaking about the procedure, Dr Tawde, said, “After we stabilised him, we sutured all lacerations and managed to get the bleeding under control. His condition was then stable and we were happy with the outcome; he was later moved to the ICU for observation.”
Post-operation, the patient was observed for a few days to ensure that the brain or other organs hadn’t sustained injuries or infections. Post observation, Dr Tawde proceeded to conduct a surgery known as ‘submental intubation’, making it the first of its kind at the hospital.
This procedure is often fraught with risks such as loss of voice and severe scarring of the wind pipe and prolonged hospital stay. The team did a submental intubation which is to access to the airway or the windpipe by cutting under the chin and pulling the anaesthetic tube through the submental or the chin region.
Following the submental intubation the definitive surgery started. An inter-maxillary fixation, which involves fixing wires around the teeth, was put in place to hold the jaws together. An external nasal fracture repair was conducted, a stent was inserted to allow the area to rest and heal.
Talking about the success of the surgery, Dr Tawde adds, “The case was very complex, we were not certain of the gravity of injuries and how many pieces the bones had broken into. Luckily for the patient, he had not sustained any brain damage or internal injuries; wearing a helmet saved his life.”
“Without timely intervention, the patient would have died of extreme bleeding and suffocation. He has now been sent home is being looked-after by his family. His face will look normal; albeit there could be residual deformities which if required can be addressed later. We have advised him to come for regular follow-ups to ensure everything is in place as well as a psychiatric analysis. He should be able to resume his daily routine in about 30 to 45 days.”
What is submental intubation?
Usually putting the patient under anaesthesia involves inserting the tube through the throat or the nose. However, due to the extent of injuries, this manoeuvre would have obstructed the surgery. The next best option was to conduct a tracheostomy that involves cutting through the wind pipe and inserting the tube directly into the throat.