Abstract The aim of this trial was to compare two techniques of maxillary dysjunction, with 10 mg/kg tranexamic acid as an adjuvant, in isolated non-segmented Le Fort I procedures. Two hundred ...patients were randomized to one of four groups: group A, pterygomaxillary dysjunction + saline; group B, tuberosity separation + saline; group C, pterygomaxillary dysjunction + tranexamic acid; and group D, tuberosity separation + tranexamic acid. Primary outcome measures were intraoperative blood loss and operating time, while the secondary outcome measures were surgical field assessment, need for blood transfusion, and duration of hospitalization. The data were analyzed using one-way analysis of variance (SPSS v. 17.0), and the level of significance was set at P < 0.05. Results revealed that group D (tuberosity separation + tranexamic acid) had the least blood loss (mean 172 ml) and shortest operating times (mean 49 min), with the best surgical field. This group also exhibited the lowest drop in postoperative haemoglobin concentration (Hb gm/dl) and packed cell volume (PCV). Five patients, all in group A, required a blood transfusion and had an extra 24 h of hospitalization. This trial revealed that the tuberosity separation technique with the use of tranexamic acid was the best protocol in producing the least blood loss, minimizing the operating time, and providing the best surgical field.
Aim
To objectively evaluate the surgical outcome of deformed cleft lip treated by Abbe’s flap using Digimizer image analysis software.
Methods
Fifteen Abbe’s flap (AF) reconstruction cases with ...satisfactory photographic records were acquired in Digimizer image analysis software. Anthropometric landmarks were marked on the lip. Bilateral lip lengths, height and width were measured preoperatively and postoperatively after AF reconstruction for comparison.
Results
It was observed that by AF reconstruction, we could increase vermillion lip length and Cupid’s bow width, hence providing adequate bulk to the middle of the lip. In addition to it, in some cases we could achieve the acceptable anatomy of the centre of the Cupid’s bow with which it was sometimes disturbed during primary cheiloplasty. Lip length and lip height became proportionately equal bilaterally, leading to adequate lip symmetry in all cases.
Conclusion
Computer-assisted anthropometric analysis of photographs using Digimizer image analysis software (MedCalc Software, Belgium) demonstrates that AF lip reconstruction technique produces aesthetic lip consistently.
Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt ...to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background
‘Temporomandibular joint disorders (TMDs)’ denote an umbrella term that includes arthritic, musculoskeletal and neuromuscular conditions involving the temporomandibular joint, the ...masticatory muscles, and the associated tissues. Occlusal devices are one of the common treatment modalities utilized in the conservative management of TMDs. The indications for the available ‘oral splints’ or ‘oral orthotic occlusal devices’ remain ambiguous.
Methods
A joint international consortium was formulated involving the subject experts at TMJ Foundation, to resolve the current ambiguity regarding the use of oral orthotic occlusal appliance therapy for the temporomandibular joint disorders based on the current scientific and clinical evidence.
Results
The recommendations and the conclusion of the clinical experts of the joint international consort has been summarized for understanding the indications of the various available oral orthotic occlusal appliances and to aid in the future research on oral occlusal orthotics.
Conclusion
The use of the oral orthotic occlusal appliances should be based on the current available scientific evidence, rather than the archaic protocols.
Abstract The aim of this study was to compare the efficacy of femoral nerve block with indwelling catheter-based multiple infiltrations of bupivacaine for postoperative pain management after iliac ...bone harvesting. Sixty paediatric patients undergoing iliac harvesting were randomized into three groups: group A, preoperative femoral nerve block; group B, multiple bolus infiltration of 0.5% bupivacaine via indwelling catheter at the donor site; group C, controls – single dose of 0.5% bupivacaine infiltration given subcutaneously. The primary outcome measure was postoperative pain intensity at rest and at function. The time to maximum pain score, time to ambulation, duration of analgesia, and length of hospital stay were also assessed. Group B patients had the best pain relief and return to function, however the duration of pain relief was longer in group A. Subjects in group A had concomitant motor blockade causing delayed ambulation. Group C showed the worst outcomes. Indwelling catheter-based infiltration of bupivacaine was the most efficient method for providing enhanced pain relief after iliac bone graft harvesting. There was no increase in operating time or hospital stay. Femoral nerve block provided the next best results, but had the significant disadvantage of motor nerve blockade.
Abstract Extra-canalicular variations of the inferior alveolar nerve are exceedingly rare and unreported. The authors report an unusual presentation of the inferior alveolar nerve perforating the ...ramus of the mandible with a very short intra-bony course and exiting laterally in a 20 year old indian female diagnosed with hemifacial microsomia. There was concomitant absence of the ipsilateral inferior alveolar canal and mental foramen. Variations in nerve architecture like these are of importance to clinicians who deal with surgery of the facial skeleton.
Objectives
The objective of this study was to cephalometrically evaluate the changes in the oro-pharyngeal airway and its correlation to the clinical outcome following mandibular distraction in ...patients with sleep disordered breathing secondary to tempero-mandibular joint (TMJ) ankylosis.
Methods
Five patients diagnosed as having nocturnal desaturations during sleep secondary to TMJ ankylosis were evaluated in this study. They were evaluated pre and post mandibular distraction using cephalometry, to determine changes in their oro-pharyngeal airway space and, upper and lower airway dimensions. An attempt was made to correlate these changes to the clinical outcome of the procedure by over-night pulse-oximetry.
Results
The patients showed a mean increase of 31.33 % in the oro-pharyngeal airway space with a 3.8 % increase in the oxygen saturation levels. The change in the airway space dimensions and area was directly proportional to the oxygen saturation observed in the patients.
Conclusion
The patients in this series did not show a very high apnoea hypopnoea index but had a compromised airway which resulted in sub-optimal sleep patterns. Mandibular distraction in these patients not only improved their esthetics but also proved to aid their functional rehabilitation by significantly increasing their oro-pharyngeal space and reducing their sleep disturbances.
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