Saha Shivangi, Singh Amiteshwar, Mohammad Arbab, Chauhan Shashank, Chinta Kavya, Singhal Maneesh
Department of Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India.
Aarupadai Veedu Medical College and Hospital, Puducherry, India.
Eplasty. 2023 Aug 31;23:e57. eCollection 2023.
Microtia can occur as a standalone condition or as part of a genetic syndrome. We report the first case of microtia presenting in a patient with dextrocardia, situs inversus totalis, butterfly vertebra, and hemivertebra, and we present technical recommendations for optimizing anaesthetic and surgical harmony in this extraordinary case.Patients with situs inversus dextrocardia should be checked for signs of Kartagener syndrome. Dextrocardia requires mirroring the placement of electrocardiogram (ECG) leads and the use of shocking paddles for cardiopulmonary resuscitation. Central venous access should be performed under ultrasound guidance because of varied course. Cervical vertebral deformities necessitate a thorough airway assessment since neck mobility may be limited due to pain or aberrant curvature.
In this case, Brent's approach was used to treat the microtia, but rib cartilage was harvested from the ipsilateral side to lessen the chance of damaging the pericardium due to unfamiliar anatomy. These factors must be taken into account to perform a safe surgery on such patients.
小耳畸形可单独出现，也可作为遗传综合征的一部分出现。我们报告了首例患有右位心、全内脏转位、蝴蝶椎和半椎体的患者出现小耳畸形的病例，并针对这一特殊病例提出了优化麻醉和手术协调性的技术建议。右位心患者应检查是否有卡塔格内综合征的体征。右位心需要将心电图（ECG）导联的放置位置镜像过来，并使用除颤板进行心肺复苏。由于走行各异，中心静脉通路应在超声引导下进行。颈椎畸形需要进行全面的气道评估，因为颈部活动可能因疼痛或异常弯曲而受限。
在本病例中，采用布伦特方法治疗小耳畸形，但取自同侧的肋软骨，以降低因解剖结构不熟悉而损伤心包的几率。对此类患者进行安全手术时必须考虑这些因素。
