No Time for Doubt
Australian AO CMF Surgeon Saves Man's Chainsawed Face
12 February 2018
The surgeon was heading out of the theater complex of the Royal Melbourne Hospital, on the way to have dinner with his wife, Bernadette, and good friends. “Having had little time to socialize after returning from an aid trip on the Pacific Island of Fiji just a few days before, I promised my wife that I would not be late,” Nastri explains.
Melbourne, Australia: May, 6, 2016. It was a typical Friday autumn afternoon for Professor Alf Nastri, with a full day of trauma and orthognathic cases behind him.
Yet, Nastri had to do an about-face.“One of the senior trauma residents caught me at the exit door,” Nastri shares. “Anxious and in a hurry, he said that one of my trauma colleagues could use a hand with a case in Theater Number 2: multi-trauma with hemorrhage from a neck wound. No other details were given,” he offers.
“I walked into the theater and became immediately concerned when I saw my senior trauma colleague with a very worried look on her face, a significant amount of blood on the floor, active bleeding from the face and neck, and no tracheostomy!” Nastri reveals. “My colleague clearly needed help and the 68-year-old patient lying on the table, Mr Bill Singleton, was in trouble,” Nastri adds.
Half a face razed in two
While cutting trees out in the rural bush, Singleton’s chainsaw had jumped back and struck his face instead, slicing its bottom half nearly in two.
“The blade had entered next to the patient’s nose, and then cut down his mouth, slicing his tongue in half, and knocking out his teeth before moving on to his lower jaw,” shares Nastri. “It had just stopped short of Singleton’s larynx, and was also just a centimeter away from severing the carotid artery in his neck,” he adds.
Making life-and-death decisions in extraordinary circumstances
With typical Aussie guts, and without the ability to form words to call for help on his mobile phone, the patient managed to remove the blade, tie his head with bandages, and drive himself 25 kilometers to a local hospital, before collapsing at its entrance and being flown by Air Ambulance to Melbourne.
In the same spirit and determination, Nastri and his colleague assessed Singleton’s injuries.
“When faced with moments like these, I initially doubt my abilities—which keeps me honest, and on my toes—but I knew within seconds that I could contribute to the situation before me: my training, experience, mentors among the AO fraternity, and involvement as an AO faculty member had all prepared me for this moment,” Nastri conveys.
In less than twenty minutes after his arrival, Nastri was performing surgery on Singleton. Previous cases, mistakes made in the past, and a sense of seniority helped the surgeon to devise a definitive but simple plan to save this patient’s life: secure the airway; control bleeding; begin early bony reconstruction; and make further surgeries easier.
“It took 10 units of blood to stabilize Singleton, and our team spent hours picking bone fragments from the jaw, before securing it with a metal plate and screws, and stitching up the soft tissue, layer by layer,” shares Nastri.
"My training, experience, mentors among the AO fraternity, and involvement as an AO faculty member had all prepared me for this moment."
A return to a normal, active life
The efforts of Nastri and his team paid off.
“Singleton healed well,” Nastri shares with satisfaction. “Despite significant tongue injuries, he can speak normally again, and with further bone grafting and dental implants placed in the mandible, Singleton has been able to return to a typical, active life in rural Victoria, Australia,” he adds, chainsaw and all.
For a short time, the patient even went on to became a media celebrity, which helped to raise awareness about the dangers of chainsaw use without proper training. This also hoisted Nastri into the spotlight, with interviews on national TV and radio programs.
Answering the call to care
“Despite one’s best efforts, with all of the unpredictability that comes from being a surgeon, you never know what an average day will look like”
While Nastri’s wife was initially unhappy about his late arrival to dinner, she was completely understanding of the situation when he explained the whole story. At the end of the day, both were proud that Nastri could, again, use his expertise to make a difference in someone’s life.
About Professor Alf Nastri
Associate Professor Alf Nastri graduated first in dentistry and then in medicine from the University of Melbourne, before completing four years of specialty OMFS training in Melbourne. Mr Nastri completed additional fellowships at Massachusetts General Hospital at Harvard University (Boston, USA) and in Southampton UK in the subspecialty areas of craniofacial surgery, corrective jaw surgery, and skull base surgery. He has been in private specialist practice in Melbourne since 1999 and is Director of OMF Surgery at the Royal Melbourne Hospital. He has recently been appointed as an Associate Professor in the Faculty of Medicine, Dentistry, and Health Sciences. Nastri’s special interests include corrective jaw surgery and implantology, maxillofacial trauma, and the management of maxillofacial tumors.
Nastri is an AO CMF International Faculty member and the Australian representative on the AO CMF Asia Pacific Board.