Efficacy of tranexamic acid on side effects of rhinoplasty: A randomized double-blind study.

INTRODUCTION: The aim of this randomized double-blind study was to evaluate the efficacy of Tranexamic acid (TXA) on intraoperative bleeding, postoperative eyelid edema, and postoperative periorbital ecchymosis in rhinoplasty. MATERIALS AND METHODS: Sixty rhinoplasty patients who needed hump reduction and lateral osteotomy were included and then randomly assigned into two groups. In the intervention group (n = 30), 10 mg/kg of TXA was administered prior to the operation and in the control group, the patients were given 20 mL of normal saline. Intraoperative bleeding was evaluated by gravimetric method and pre and postoperative hemoglobin and hematocrit levels were determined. Eyelid edema and periorbital ecchymosis were evaluated using 0-4 points scoring system. Surgeon satisfaction was measured by asking questions of the surgeon. Data were analyzed by SPSS 20.0 (P < 0.05). RESULTS: In total, 10 participants were excluded from the research, and 50 patients were included in the study. Mean (SD) of intraoperative bleeding was 213 (65) mL and 254 (55) mL in the intervention and control group, respectively, based on the clinical methods (P = 0.013). Level of hemoglobin was 266.69 in the control group versus 241.25 in the TXA group, indicating that this effect on the intraoperative bleeding was not significant (P = 0.1). Hematocrit differences before and after operation were significant (P = 0.03) (247.06 mL in TXA vs. 279.2 mL in the control group). TXA had a statistically significant effect on the eyelid edema (P = 0.03), periorbital ecchymosis (P = 0.04), and surgeon satisfaction (P = 0.03). CONCLUSION: Administration of 10 mm/kg TXA had a significant effect in decreasing the intraoperative bleeding rate, eyelid edema, and periorbital ecchymosis in the rhinoplasty with minimal side effects.

Warming Endotracheal Tube in Blind Nasotracheal Intubation throughout Maxillofacial Surgeries.

INTRODUCTION: Blind nasotracheal intubation is an intubation method without observation of glottis that is used when the orotracheal intubation is difficult or impossible. One of the methods to minimize trauma to the nasal cavity is to soften the endotracheal tube through warming. Our aim in this study was to evaluate endotracheal intubation using endotracheal tubes softened by hot water at 50 °C and to compare the patients in terms of success rate and complications. METHODS: 60 patients with ASA Class I and II scheduled to undergo elective jaw and mouth surgeries under general anesthesia were recruited. RESULTS: success rate for Blind nasotracheal intubation in the control group was 70% vs. 83.3% in the study group. Although the success rate in the study group was higher than the control group, this difference was not statistically significant. The most frequent position of nasotracheal intubation tube was tracheal followed by esophageal and anterior positions, respectively. CONCLUSION: In conclusion, our study showed that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during blind nasotracheal intubation; however it could not facilitate blind nasotracheal intubation.

Application of crestal anesthesia for treatment of class I caries in posterior mandibular teeth.

BACKGROUND AND AIMS: Current infiltration techniques for achieving anesthesia in dental procedures are not applicable in posterior mandibular region because of its dense cortical bone. The aim of this study was to evaluate the efficacy of a specific infiltration anesthesia in posterior mandibular teeth instead of inferior alveolar nerve block for restorative procedures. MATERIALS AND METHODS: Crestal anesthesia (CA) was assessed both clinically and by computed tomography scan for its efficacy and side effects. A combination of an opaque material (Ultravist) and 2% lidocaine was used to trace the anesthetic solution. The combination was primarily injected in the gingival tissue of rabbit and was followed-up regularly for two weeks to assess any possible injury. After confirming its safety, a combination of these materials was injected to volunteers to assess efficacy and diffusion route. A total of 154 patients (77 female, 77 male) with matched bilateral posterior teeth in mandible were selected randomly and an IANB and CA were performed randomly and separately in different sessions for the contra lateral teeth. The onset of anesthesia, anesthesia duration, pain, blood pressure, pulse rate, and consumed volume of anesthetic solution was recorded for each technique. Data were analyzed using paired t-test. RESULTS: There were no significant differences in clinical attachment loss, pocket depth, bone level, plaque index, and free gingival margin between the two flaps (p>0.05). CONCLUSION: CA could be considered as a reliable and safe primary injection in posterior mandibular teeth for restorative treatments.