Lichen planus in the treatment of bipolar disorder: A case report

Abstract

O cleft deformities constitute one of the most common congenital anomalies of the craniofacial region. Plastic surgeons and orthodontists perform repetitive surgical interventions for restoring speech, feeding, facial esthetics, development of the skeleton from infancy to adulthood. Unfortunately, the wound contraction and scar tissue formation have resulted in development disturbances involving tissue components such as tissue cells, blood vessels and bone. These scars lead to regional ischemia and hypoxia. Difficult airway may develop during recurrent surgical interventions. In spite of the fact that there are some monitoring tools for tissue reorganization such as laser Doppler flowmetry, tissue reflectance spectrophotometry and near-infrared spectroscopy, the golden standart is the clinical examination of the surgeon. Preoperative evaulation includes detailed anamnese for earliar operations, nutritional status, coexisting anomalies/sydromes requiring specialized aneshetic technic and collaboration with surgical team. Sedating children before transfering to operating theatre is essential. Gentle endotracheal intubation and fixating the tube should be performed in guidence of the surgical team taking care of the vulnerable tissue. Anesthesia related airway emergencies are more common in syndromic patients especially after palatoplasty. Preparation for difficult airway is needed. Anesthesia team should pay attention for monitoring of awareness and pain perception. BIS monitoring would help for preventing overuse of anesthetic drugs. Planning an effective postoperative analgesia and extubation without giving harm to the surgical site help for success. It would be better if anesthetic considerations are made patient-based because each time we have to manage a growing child undergoing different type of surgical procedure.