From the 12th to the 16th of September 2022, I was on my second oral surgery rotation in the Adelaide Dental Hospital. Being in the Oral and Maxillofacial Surgery (OMFS) unit is such a different clinical experience from the rest our sessions, and I wanted to document it.
Coming back the second time round, I felt so rusty because the first rotation I was rostered for was in the first week of March. Going in so early in the year definitely was a confidence booster. Through the multiple mistakes and near misses, I learnt so much. Giving local anaesthetic also became natural, and I experienced what it was like to manage patients with heightened anxiety. And rightly so, because pulling teeth out is never a pleasant experience.
In that first rotation, I got to listen to the registrars talk to patients that had lesions and swellings that we had been learning about in oral pathology lectures for the past year, and also see an alveolaplasty of maxillary exostoses in the elective surgery room. I did not pull out many teeth, probably around 10, but I thoroughly enjoyed being thrown into the deep end and applying all the theoretical knowledge.
In this second rotation, I got to pull out more teeth on the first day than I did in my first rotation altogether! We were able to move at a faster pace, while still making sure we did a thorough medical history presentation. At the end of it, Dr Jensen congratulated us for being the first group in a while that did not have any safety learning incidents to report! A bit sad that the bar was so low, but a win is a win
General Theatre
Something really special I got to experience was going to the Royal Adelaide Hospital for ward rounds and general theatre surgery observation. Just walking around the hospital in the navy-blue scrubs was pretty amazing, as I never thought I would get to do something like that as a dental student. The whole OMFS team – registrars and those still finishing med school, would walk together to see the patients that previously had surgery carried out. They all commented on my bold choice to wear white shoes, because it was likely that there were going to get bloody. I definitely layered up the shoe covers and ended the day without a splash of red on it .
By 9am, we were scrubbed in and beginning the surgery for a tracheostomy, squamous cell carcinoma of the tongue removal, neck dissection to remove the right lymph nodes and a tissue graft from a forearm flap. Little did I know that it was the start of an 8-hour surgery that would end at 5pm. 3 hours in, I began to feel slightly faint while retracting tissues. I did have milo and Julie’s Peanut Butter biscuits for breakfast, but clearly that was insufficient. I kindly excused myself and quickly ran down the hall to a random break room so I could stuff my face with more biscuits and water. The neck dissection took the longest, because Dr Sunny was skilfully avoiding the major nerves and blood vessels while isolating the lymph nodes, where the tongue cancer can sometimes metastasise to. Meanwhile, Dr Bedlani, the consultant, was working on the forearm flap.
At 2pm, I went out to buy a chicken mayo sandwich and gulfed it down so I could return to see the surgery. Even though I was exhausted by that time, I knew that days like these did not come often, and I didn’t want to miss a thing. I returned to see the stitched graft from the forearm on the tongue! I had no idea that even the hairy skin could be used to replace the tongue which had slightly less than a third removed! A process called ‘metaplasia’ is how the cells transform to match the rest of the tongue.
Towards the end, when the consultant was carrying out microsurgery of stitching together the blood vessels, my legs and back were so sore. They had wheeled in a powerful microscope so they could see each vessel clearly. I think as I kept adjusting my weight from left to right, I was shaking the patient’s head mildly. At one point, my butt accidentally moved the microscope machinery, creating tremors through the scope. There were moments where I was sure I was not even needed in retracting, and so I would loosen my retraction just to see on the projected screen if that would interfere with their field of view HAHAHA. Eventually, Dr Bedlani sternly said, “whoever is shaking the patient’s head, YOU NEED TO STOP.” The assisting nurse then told me to stand further away from the microscope machine, which brought Dr Bedlani’s attention to me. He then said, “ah, you can sit down. You’re not needed anymore.” I knew it was because I was causing too many tremors, but boy was I relieved to be relieved of my duty! I sat down and had the best in-chair back stretch.
I was just retracting, and I got to go for lunch, take a toilet break all while Dr Sunny was standing over the patient working non-stop for the 7 hours until the other maxfax students took over to suture the patient. The operating room had a lingering tension, especially when things didn’t go quite right. Having Dr Sunny’s global top charts Spotify playing in the background did help to diffuse some of that energy.
Left the hospital with a deep awe for doctors and surgeons that day. These people have worked really hard and studied so much to get to where they are. Part of the process of being trained includes lots of mistakes, being reprimanded in the surgery and carrying out painstaking work while the patient is completely unaware of everything. To think, all the fatigue and skilful work of the surgery team over the 8-hours are just a blink of an eye to the patient under general anaesthesia.
Also, seeing Dr Sunny extract 3 lower molars in 2 minutes was spectacular.
All in all, it’s been very tiring, but at the same time, incredibly fascinating. That description also pretty much sums up my whole 4th year actually!
So well padded, I could have been a burglar.
Do you even dentist? 