Our Community

Name: Marmaduke

Age at time of referral: 11 

Likes: Cheese, high-speed 3 am sprints through the house, his puppy blanket, sitting on top of his carers while they sleep

Dislikes: Boundary-testing behaviour from his brother, Reggie

Why Marmaduke came to The Ralph: 

Marmaduke was brought to his primary care practice after being hit by a car and had clearly suffered significant facial trauma. Once he was stabilised, he was referred to The Ralph’s Emergency and Critical Care team for further assessment and treatment.

On arrival, it was evident that Marmaduke had a fractured jaw, several wounds on his face and chin, and a potentially serious injury to his left eye, with concerns about whether Marmaduke could still see out of the eye. He was admitted to the ICU so he could be kept comfortable while we carried out further diagnostic tests and assessments to understand the full extent of his injuries.

Because of the complexity of his trauma, several specialist teams became involved in his care.

Our ophthalmology team confirmed that his right eye was unaffected, but unfortunately, the left eye had been damaged beyond repair and would need to be removed once his jaw was stabilised. Eye ointments were prescribed to support him in the meantime.

Our Neurology team examined Marmaduke after concerns about reduced facial sensation. At this stage, it was difficult to know whether this was due to nerve damage or simply swelling from his injuries.

Before our Dentistry team could repair the damage to Marmaduke’s jaw, he required a CT scan under anaesthesia to identify all of his maxillofacial fractures. The scan revealed a tremendous amount of fractures, including a separation of the lower jaw at the symphysis, which would need stabilising with a circumferential wire. 

However, the CT procedure turned out to be not as smooth as we had hoped.

During the CT procedure, Marmaduke experienced a sudden increase in blood pressure and a marked slowing of his heart rate. Given his facial trauma, there were concerns that he was experiencing elevated intracranial pressure (a phenomenon known as the Cushing response). His anaesthetic was stopped immediately, hypertonic saline was administered, and he was monitored closely throughout his recovery. Thankfully, he recovered well. 

Marmaduke’s jaw still needed to be repaired with a procedure that involves bonding the jaw almost fully closed. 

After careful discussion with his family and allowing appropriate recovery time, the decision was made to proceed with another anaesthetic. 

Our dentistry team were able to stabilise the fractures, address damage in his oral and nasal cavities, and remove bone and tooth fragments from his nasal sinus’. Because his jaw had to be bonded nearly closed, he was also fitted with a long-term feeding tube to support his nutrition at home. His family were given full instructions and training before he was discharged from ICU.

A few weeks later, Marmaduke returned for anticipated revision surgery in his mouth due to the severity of the initial trauma. He also came back to see the ophthalmology team to have his damaged left eye removed. Both procedures went well, and he continued his recovery at home.

In time, Marmaduke began eating independently again and no longer needed his feeding tube. When he came to see our Dentistry Resident, Georgina, weeks later, he was bright, comfortable, and using his jaw well. He had also adjusted confidently to having one eye.

Marmaduke’s recovery involved multiple teams and a great deal of love from his family. Marmaduke has shown real resilience throughout his recovery, and we’re so pleased to see him doing so well 🥹💛