Expert: JM Starkman, MD - 10/20/2009

Question
I have a question about a surgery I had some 15 years ago, it was an oral surgery so I believe they used nasotracheal intubation then switched me to standard intubation with an ng tube for post op recover.

During the surgery I bled a lot (about 2700cc I was only 9 and very small framed) During the surgery the doctor said my lung  collapsed. Howecer this is not indicated in my surgical report, instead it indicates I had an endoscope and the diagnosis was inflammation of the airway with mild larynomalacia.

Chest films indicated right upper lobe atelectasis (is this the same as a pneumothorax or caused by different means?) and a possible mucous plug.

My question is would this be a common occurrence during an oral surgery with heavy bleeding, or was my airway compromised in someway. It seems any doctor involved in my care for my oral tumors (either fibrous dysplasia or cherubism) gives me the runaround and is evasive with any direct questions.

Thank You

Answer
It sounds like your airway was compromised at some point, and then diagnosis and treatment consisted of an endoscopy to evaluate your trachea and bronchial tree.  I can think of a number of scenarios where these types of things could go together.....though they should NOT be common occurrences--they should viewed as risks that one ought to try to avoid.  The mucous plug to which you refer may have actually been a blood clot from the heavy bleeding that got below the level of your endotracheal tube or plugged it up.

A pneumothorax means a lung is collapsed by virtue of air in the space between the chest wall and the lung, which does not permit the lung to expand.  Atelectasis means an area within the lung's tissue is unfilled with air ( individual alveoli are collapsed on a microscopic level) and is therefore not participating in gas exchange.