Eipe Naveen, Neuhoefer Eva-Sabine, La Rosee Gabriele, Choudhrie Rajiv, Samman Nabil, Kreusch Thomas
Department of Anaesthesia, Padhar Hospital, Padhar, Betul Dt, Madhya Pradesh, India.
Paediatr Anaesth. 2005 Nov;15(11):1009-12. doi: 10.1111/j.1460-9592.2005.01573.x.
Cancrum oris (Noma) is a devastating gangrenous disease that leads to severe tissue destruction in the face. We describe the anesthetic management of a 12-year-old girl with cancrum oris sequelae in a Rural Secondary level Hospital in Central India (Padhar Hospital). She presented with a large defect in her upper lip on the left side that extended into the columella and the floor of the left nostril. She was scheduled to undergo reconstructive surgery and the surgeons planned to use an Abbé flap based on the lower lip. For this, access to both the mouth and the nose was required. We considered a tracheostomy but decided to attempt the submental route for orotracheal intubation. Following intravenous induction the patient's trachea was intubated with a cuffed oral tracheal tube. This was passed through the submental incision and then reconnected. The surgery proceeded uneventfully and the patient was extubated before transfer. She made a satisfactory recovery and the submental scar healed without complication or scarring. We describe briefly the features of cancrum oris and review the technique of submental intubation (described in adults with midfacial trauma). The use of submental intubation in children and for cancrum oris sequelae has not been previously reported.
走马疳（坏疽性口炎）是一种毁灭性的坏疽性疾病，可导致面部严重的组织破坏。我们描述了在印度中部一家农村二级医院（帕德哈尔医院）对一名患有走马疳后遗症的12岁女孩的麻醉管理情况。她左侧上唇有一个大的缺损，延伸至鼻小柱和左鼻孔底部。她计划接受重建手术，外科医生打算使用基于下唇的阿贝瓣。为此，需要同时进入口腔和鼻腔。我们考虑过气管切开术，但决定尝试经颏下途径进行口气管插管。静脉诱导后，用带套囊的口腔气管导管对患者进行气管插管。将导管经颏下切口插入，然后重新连接。手术顺利进行，患者在转运前拔管。她恢复良好，颏下瘢痕愈合，无并发症或瘢痕形成。我们简要描述了走马疳的特征，并回顾了颏下插管技术（在成人面中部创伤中描述）。颏下插管在儿童及走马疳后遗症中的应用此前未见报道。
