Maharashtra: 8 hour surgery brings jawan back from jaws of death

NAGPUR: A 33-year-old jawan from Gadchiroli, with part of his brain sticking out from a bullet wound on the forehead, was saved by a complex combination of surgeries by a team of four surgeons from Sunday midnight till 8.30am on Monday at Orange City Hospital and Research Institute (OCHRI).

Constable Prashish Channawar had accidentally sustained a bullet injury while servicing a firearm at the headquarters. He will have to undergo another round of surgeries after 48-72 hours to bring his face back into shape. ENT specialist Dr Siddharth Saoji began the procedures on Sunday night, which was taken ahead by ophthalmologist Dr Abhay Agashe, then neurosurgeon Dr Palak Jaiswal, and finally plastic reconstructive and cosmetic surgeon Dr Darshan Rewanwar, through the night.
The bullet had entered from the left side of the neck (entry wound), penetrated the lower jaw bone (mandible) before entering through the floor of the mouth and mutilating the tongue and palate. Tearing the palate apart, the bullet entered the left maxillary sinus, pierced through the nasal cavity and orbit of the left eye. After perforating the left eye, the bullet entered the left frontal sinus (above the eyebrow) and exited through the frontal forehead bone.
Dr Rewanwar said every detailed clinical examination was done within a short time and the patient was stabilized before the surgeries started in sequence. “ENT specialist (Dr Saoji) conducted the tracheostomy to restore the respiration. Then, ophthalmologist (Dr Agashe) removed the left eye ball (enucleation) following which craniotomy with duraplasty were done by Dr Jaiswal. Then began the role of reconstructive and cosmetic surgery,” said.
Dr Rewanwar said his part began with debridement of entry and exit wounds and their closure. “The tongue and palate reconstruction was done followed by the closure of the fronto-orbital defect with local flap,” he said.
Neurosurgeon Dr Jaiswal, whose surgery stretched almost four hours, said the exit wound had fractured the frontal sinuses in the forehead, and the anterior cranial fossa (where the anterior part of the brain rests). “The patient’s brain tissues were pulping out of the anterior cranial fossa and the exit wound. Bony particles had entered inside the brain parenchyma too, raising our concern,” he said. “Bi-frontal craniotomy was performed, the fractured segments were removed from the brain parenchyma, and blood clots were taken out,” he said. Then the anterior cranial fossa had to be repaired to prevent leakage of brain water (cerebro-spinal fluid).
Dr Anup Marar, director of OCHRI, said if the patient had not been managed by specialists then such compound injuries could have led to facial and neck oedema causing choking. “The sequence of emergency surgeries were lined up on priority to save life,” he said.
Senior anaesthesiologist Dr Neeta Deshpande said it was a challenge to keep the patient quiet and also not inhibit his reflexes. “As the patient was bleeding heavily from oral cavity, intubation was ruled out and we had to opt for tracheostomy,” she said adding the patient was highly irritable too. “It was a herculean task to keep the patient quiet for eight long hours and also not stop his reflexes,” she said.