True story -- 13 yo female having multi-stage facial reconstruction after NOMA ("disappearing face" generally seen in malnourished populations as a result of normal flora turning virulent in the face of immune compromise. About 90% die, 10% survive with significant facial defects.) She had a large defect encompassing her upper lip, soft palate, nose, maxilla.
I saw her when she had a lower lip flap graft to her upper lip, and a flap graft turned from her tongue to her soft palate. She was coming to the OR for acute bleeding after brushing her teeth. Source of the bleeding was not accessible from observation. Bleeding was brisk, but not horrendous.
She presented for exploration to stop the bleeding. The left side of her lower lip was turned and positioned on her upper lip, and the central portion of her tongue was turned and sutured to her soft palate. Her trach was closed about a week earlier.
Bloody mouth, closed trach, center of mouth opening and center of mouth not accessible due to flap grafts. How would you proceed? (To the bar is not an acceptable answer.)