ANAESTHETIC MANAGEMENT OF EXCISION AND RECONSTRUCTION OF RIGHT LOWER EYELID TUMOUR IN HIGH RISK ELDERLY PATIENT - A CASE REPO

Abstract

INTRODUCTION

Tumors of eyelid are categorized as epidermal, adnexal, stromal and metastatic tumors. Basal cell carcinomas form 85% of all eyelid tumors. Melanotic tumors fit into epidermal tumors and arises from melanocytes that are scattered in the basal layer of tarsal conjunctival epithelium. This case report involves a malignant spindle tumor of lower eyelid in a 78 year old male.

CLINICAL PRESENTATION

This elderly man presented with nodular swelling of right lower eyelid since 6 months and restricted inferior field of vision since 2 months. He is a diabetic since 3 years on insulin therapy and CKD due to diabetic nephropathy. Local examination revealed nodular swelling in right lower eyelid with blackish discolouration. BMI of 32.8. CNS: Cranial nerves: visual field restriction in inferior field. Investigations: FBS 87mg\dl, Urea 60, Creatinine 2.7, HbA1c 9.8.

PLAN

Excision of tumor, cervicofacial rotation advancement flap with palatal mucosal graft.

CHALLENGES

• Geriatric


• DM


• CKD


• Oculocardiac reflex


• Altered position for surgery and palatal graft


• Risk of aspiration

 CONDUCT OF ANAESTHESIA

Patient was premedicated with steroids, Inj Glycopyrolate 0.2 mg, Inj Midazolam 1 mg. Patient is induced with inj Fentanyl 100mcg, Inj Propofol 100 mg. Intubated under Inj. Cisatracurium 10 mg with 7.5 mm ID Flexometallic oral tube and throat was packed. With patient in supine position, the tumour was excised, and flap cover was planned. The patient was then placed in Sister Rose position for palatal mucosal graft for reconstruction of conjunctiva. Stable intraoperative period and uneventful postoperative period.

CONCLUSION

This case is presented for its rarity in an elderly man with multiple comorbidities and well managed flap cover and palatal mucosal graft by the plastic surgeon.