Enhanced recovery after orthognathic surgery: a retrospective comparison study of 56 patients.

Enhanced Recovery After Surgery (ERAS) protocols have been demonstrated to expedite recovery and decrease hospital stay from multiple surgical specialties. This study sought to determine how an ERAS protocol would improve patient outcomes with regards to inpatient postoperative nausea, vomiting, and pain scores following orthognathic surgeries. This was a retrospective study comparing patients who underwent orthognathic surgery with and without an ERAS protocol. The primary measurables included opioid consumption, antiemetic medical consumption, nausea and vomiting incidences, and pain scores between the two groups during their hospital stays. A total of 56 patients were retrospectively analysed comparing ERAS protocol to non-ERAS protocol. The maximum pain score of the ERAS group was 5.50 out of 10 compared to the control group of 7.50 out of 10 (p<0.001). Morphine equivalent consumption during their time in the ward was statistically significant (51.4 mg control versus 9.4 mg ERAS group). ERAS protocol is safe and effective for decreasing postoperative pain and nausea. The ERAS protocol is not only applicable for orthognathic surgery but should be highly considered for other maxillofacial surgeries.

Spectral Reflectance as a Unique Tissue Identifier in Healthy Humans and Inhalation Injury Subjects.

Tracheal intubation is the preferred method of airway management, a common emergency trauma medicine problem. Currently, methods for confirming tracheal tube placement are lacking, and we propose a novel technology, spectral reflectance, which may be incorporated into the tracheal tube for verification of placement. Previous work demonstrated a unique spectral profile in the trachea, which allowed differentiation from esophageal tissue in ex vivo swine, in vivo swine, and human cadavers. The goal of this study is to determine if spectral reflectance can differentiate between trachea and other airway tissues in living humans and whether the unique tracheal spectral profile persists in the presence of an inhalation injury. Reflectance spectra were captured using a custom fiber-optic probe from the buccal mucosa, posterior oropharynx, and trachea of healthy humans intubated for third molar extraction and from the trachea of patients admitted to a burn intensive care unit with and without inhalation injury. Using ratio comparisons, we found that the tracheal spectral profile was significantly different from buccal mucosa or posterior oropharynx, but the area under the curve values are not high enough to be used clinically. In addition, inhalation injury did not significantly alter the spectral reflectance of the trachea. Further studies are needed to determine the utility of this technology in a clinical setting and to develop an algorithm for tissue differentiation.

Temporomandibular Joint Ankylosis Can Be Successfully Treated With TMJ Concepts Patient-Fitted Total Joint Prosthesis and Autogenous Fat Grafts.

PURPOSE: To measure and identify factors associated with treatment outcomes for patients with temporomandibular joint (TMJ) ankylosis treated with TMJ Concepts patient-fitted total joint prostheses and autogenous fat grafts. PATIENTS AND METHODS: This retrospective cohort study evaluated records of patients with TMJ ankylosis from a single private practice, treated from 1992 to 2011, who met the following inclusion criteria: 1) radiographic evidence of bony ankylosis, 2) limited incisal opening, 3) minimum of 12 months' follow-up, and 4) treatment with TMJ Concepts (Ventura, CA)/Techmedica (Camarillo, CA) total joint prostheses and fat grafts. For each patient, the number of previous TMJ surgical procedures, as well as the estimated age of ankylosis onset, age at surgery, and length of postoperative follow-up, was recorded. Subjective evaluations were made with Likert-like scales (from 0 to 10) for 1) TMJ pain, 2) headache and facial pain, 3) jaw function, 4) diet, and 5) disability. Objective evaluations included maximal incisal opening and excursion movements. Nonparametric statistics were used for analysis. RESULTS: There were 32 patients (22 female and 10 male patients) with 48 ankylosed TMJs (16 bilateral and 16 unilateral) in this study, with a mean age of 39 years (range, 11 to 68 years), 2 or more previous TMJ surgical procedures in 69%, and a mean follow-up period of 68 months (range, 12 to 168 months). Trauma was the major etiology of TMJ ankylosis, occurring in 17 of 32 patients (53%). The following improvements occurred: The median value for TMJ pain changed from 8.0 preoperatively to 1.5 at longest follow-up; headache, from 8 to 3.5; facial pain, from 8 to 4; jaw function, from 8 to 2.5; diet, from 7 to 3; and disability, from 7 to 1.5. The median incisal opening was 14.5 mm (interquartile range, 6.3 to 20 mm) preoperatively and 35 mm (interquartile range, 30 to 40 mm) at longest follow-up. The median left lateral excursion improved from 0.5 to 2 mm, and the median right lateral excursion improved from 1 to 1.3 mm. All of these improvements were highly significant (P < .001, Wilcoxon tests). Equally favorable outcomes were found in patients with 12 to 48 months of maximal follow-up and patients with more than 48 months of maximal follow-up. CONCLUSIONS: The treatment of TMJ ankylosis with the TMJ Concepts patient-fitted total joint prosthesis in combination with fat grafting around the articulation area of the prosthesis is a viable and predictable method for improving pain levels, function, and quality of life, as well as prevention of reankylosis of the TMJ.

How can we as dentists minimize our contribution to the problem of antibiotic resistance?

More than 30 million pounds of antibiotics are used in the United States per year, more than 90% for nontherapeutic purposes in animals. Environmental contamination by trace amounts of antibiotics and highly resistant bacteria can lead to resistant infections in humans. Oral and maxillofacial infections are largely mediated by biofilms, which are resistant to antibiotics. Primary treatment is surgical debridement, removal of the cause of the infection, and drainage of pus. Current best practices indicate the use of antibiotics as adjunctive therapy to surgery only when regional, distant, or systemic spread of the infection is a significant risk.