Mandibulectomy is a common surgical method for treating mandibular tumors. The vast majority of malignant tumors in the mandibular region, including those originating from the mandible itself and those extending and invading into the mandible from adjacent tissues, usually have already metastasized to cervical lymph nodes in the early stages, often requiring simultaneous neck dissection. All mandibulectomies can lead to the disruption of mandibular continuity, mandibular defects, resulting in facial deformities, and impairments in eating, swallowing, and even respiratory functions. Therefore, the implantation of a prosthetic mandible is often necessary during mandibulectomy. Given the above reasons, general anesthesia is usually chosen for mandibulectomy. However, the Department of Oral and Maxillofacial Surgery at Sichuan Medical College has achieved good results in clinical practice by using acupuncture anesthesia for over a hundred cases of mandibulectomy.

Case Selection

It is more suitable for cases of unilateral mandibulectomy. If the surgical scope is extensive, such as planned total mandibulectomy or complete removal of the mandibular chin, due to the possibility of tongue base prolapse during surgery, the choice of acupuncture anesthesia should be cautious. If acupuncture anesthesia must be used, thorough preoperative preparation and emergency tracheal intubation should be ready.

Acupuncture Anesthesia Method

I. Acupoint Selection:

(1) Affected side Hegu (LI4), Fenglong (ST40), Gongsun (SP4), Taichong (LR3) (electroacupuncture).

(2) Bilateral ear-temporal, Hegu (LI4) (electroacupuncture).

II. Acupoint Injection:

(1) 0.25% promethazine 3-5ml injected into the affected side Xiaguan (ST7) acupoint. The injection should follow the method of mandibular nerve block anesthesia at the foramen ovale, targeting the third branch of the trigeminal nerve.

III. Auxiliary Medication:

Routine administration of 0.1g phenobarbital sodium intramuscularly one hour before surgery. Atropine 0.5mg intramuscularly. Intravenous injection of pethidine 1-1.5mg per kilogram of body weight 10 minutes before surgery.

IV. Stimulation Method:

Use G6805 electric stimulator for electrical stimulation. The stimulation frequency is generally 40-80Hz. The waveform can be intermittent or continuous square waves, or a combination of both. The stimulation intensity should be the maximum tolerable by the patient.

V. Induction Time:

Generally 15-30 minutes.

Methods to Improve Acupuncture Anesthesia Effect

Before making the incision, inject 1/500,000 adrenaline saline solution along both sides of the incision. When cutting the mental nerve and inferior alveolar nerve, a small amount of procaine can be injected first. The most painful steps in mandibulectomy are the separation around the coronoid process and condyle. In addition to changing stimulation parameters, 0.25% procaine 2-5ml can be injected around the condyle and coronoid process area.

For benign tumors of the mandible, when removing the mandible, it is often necessary to preserve the bone membrane. Pressurized injection of adrenaline-containing water solution under the bone membrane can often enhance the analgesic effect of acupuncture anesthesia. Sharp dissection of the mandible and surrounding tissues can reduce the intensity of nociceptive stimulation caused by surgery. After unilateral mandibulectomy, sometimes the displacement of the healthy side mandible can affect airway patency. The surgeon only needs to adjust the position of the mandible to correct this, without special treatment. For patients undergoing total mandibulectomy or mandibular chin resection, if tongue base prolapse occurs, a tongue forceps can be used to pull out the tongue, or a thick silk thread can be passed through the tongue to pull it out, preventing asphyxia. Otherwise, tracheal intubation should be performed.