Monday, June 22, 2015

Extraction Under GA - A Recent Experience

Mr Raikar had a difficulty. Due to a childhood injury he was unable to open his mouth completely. And it was painful to keep his mouth even half open for more than a few minutes. Obviously dental treatment was a nightmare. I am sure so it was for his dentist. Raikar ignored all dental treatment, avoided dentists and lived a blissful life.  

Blissful life till his half erupted (impacted) wisdom tooth got infected. But now the tooth had to be removed. Immaterial whether the mouth was open or closed. He had consulted a surgeon and had been advised removing the tooth under general anaesthesia by cutting through the skin and reaching the tooth from outside. Raikar was worried. He came to me for a second opinion.

I took a look and felt that it may be possible to remove the tooth in the normal way, but under general anaesthesia. I called my young friend and budding Oral surgeon Dr Saurabh in whose capabilities I have a lot of faith. Saurabh was confident and highly enthusiastic. “You don’t worry uncle. I certainly can do it intra oral (Through the mouth). But if necessary I can go extra-oral too.” Then he added as a reassurance “If it comes to that, I can even take the jaw out, remove the tooth and put the jaw back”. Removing the jaw would certainly have ended Raikar’s trouble of not being able to open his mouth. He would only have to bother about closing it. But I wished it would not come to that.

The anaesthetist was consulted. Though she had some reservations about introducing the tube (tracheal tube - required to deliver anaesthetics and oxygen) into the throat, she felt it could be done. We scheduled the case. I was the assistant.

Hosa Chiguru HaLeberu kooDiralu mara sobagu - (New leaves and old roots make a great tree) New leave and old root of Dentistree

As it turned out the anaesthetist had considerable difficulty putting the tube in, had to struggle a lot, change tubes, increase dosage of drugs, but she remained cool and calm all the time and ultimately placed the tube in successfully. We had Raikar under anaesthesia. His pulse and pressure were normal. My pulse and pressure were rising. Saurabh had difficulty at all stages. Keeping the mouth open(Raikar's I mean), reaching the site, cutting around and releasing the tooth, so on and so forth. He had to call for extra assistants, change positions and help himself when I fumbled. But he performed commendably. I was standing there tensed, holding the suction tube in one shaking hand and irrigating syringe in the other. Saurabh had to remind me repeatedly that I am required to use them and assist him.  

Raikar had come to me because of his faith in ME. I had entrusted him to my colleagues in whom I had confidence. They were capable and responsible. But I was answerable to Raikar.

I was almost a nervous wreck when Saurabh exclaimed “The tooth is out, Uncle.” He gave me a look which said “Didn’t I tell you I would do it?”. I sat down and took deep breaths. Sutures were placed, Raikar was wheeled into the ward and was sleeping peacefully. The anaesthetist and Saurabh wrote their report, gave instructions, confirmed that the patient was fine and left.

I went to see Raikar in the evening. He was awake and fine. “Thank you very much doctor. I was worried that you may have to cut from outside and remove the tooth.” 

“Oh, you needn’t have worried” I answered nonchalantly. “I was sure that we could remove the tooth easily” I raised my collar and went out.


George Paul said...

I read out your blog to my wife who is a dentist and has been in your situation in my early years of practice as a Maxillofacial surgeon. She went through the same anxieties then and could readily relate to your situation. I went on to do a lot of cancer and advanced trauma and she retired gracefully in the early years. She ( and I ) enjoyed reading your blog! I am quite well known in OMFS circles having served as the national secretary and President and your surgeon Saurabh probably knows me! Coincidentally I conducted a workshop on morbidity and mortality in OMFS at the Goa conference in Nov 2014. Unfortunately we could not meet. But meet we must! Keep the blogs going!

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