口腔颌面外科包括除眼科、耳鼻喉科以外的颌面部及口腔内需要用手术治疗的全部疾病，其中主要为先天性畸形整形术、肿瘤切除术及外伤修复术教学大纲第一节口腔颌面外科病人与手术特点及麻醉处理一、常见口腔腭面外科病人的解剖及生理改变3)口腔肿瘤Oraltumor如肿瘤侵袭到咽、软腭、口底和翼腭韧带，不仅张口困难，也阻塞咽部，使气管插管难以施行，且常伴有低氧血症4)口腔及颌面部外伤Trauma如波及软腭、咽旁、舌根及舌底，不仅组织肿胀使咽部变窄，也极易形成血肿阻塞咽部上或下颌骨骨折的变形移位，可引起脱位性窒息5)颌－胸、颌－颈粘连Mandible-thorax,mandible-neckadherence头颈部呈固定状态，使头部极度前屈，喉头明显移位，气管也随粘连瘢痕移向左侧或右侧，使病人不能仰头，也无法行气管造口6)口周瘢痕挛缩病人scarformationandcontractionsaroundthemouth，使口裂极度变小，病人根本无法张口，喉镜与气管导管难以进入口腔7)小下颌病人Congenitalmaxillofacialdeformity舌体位于较小的下颌腔内，并且此类病人的声门位置较高，使气管插管困难二、口腔颌面外科手术的特点Characteristicsofthesurgery三、针对手术特点进行的麻醉处理HowtodealwiththementionedproblemsTofixthetrachealtubeandconnectingtubeinposition,protecttheanaesthetictubingfromdislodgement此外，为防止导管在弯曲时管腔折屈或压偏，最好采用管壁带细金属丝或尼龙丝做管壁支架的导管ChooseanappropriateintubationroutenasalintubutionOralintubutionHypotensiontechniqueUsethistechniqueinimportantprocedure.ThehypotensivedurationshouldbeshortSBP>90mmHg,MBP>60mmHgTofulfilrespirationself-regulation,thepostoperativeresuscitationshouldbequickPreventpostoperativenauseaandvomiting-relatedtopharyngealstimulation,postoperativepain,anestheticdrugsetc第二节麻醉选择及常用麻醉方法Theanestheticchoicesandcommonanestheticmethods第三节麻醉管理与麻醉后处理ManagementduringandafteranesthesiaThecriteriaofsatisfiedventilation:SpO298-100%PETCO230-45mmHgBlood-gasanalysisTV8-10ml/kg(Neonate6-7ml/kg)Rf12/min(NeonateRf)(二)ManagementafteranesthesiaDelayedextubation:①Pharyngealdamageduetotrachealintubation②Theinvolvedoperationrangeislarge③Restrictivedressings（敷料）appliedaftersurgery④Narrowedpharyngealcavityduetotrauma(2)Preventpostoperativenauseaandvomiting(3)PreventthecomplicationsrelatedtoanesthesiaNasal-pharyngealmucosalhaemorrhage（鼻咽粘膜出血）Nasal-pharyngealmucosalfalloffPharyngealedema（4）Postoperativemaxillasinus（颌窦）inflammation