Unilateral cervical plexus block for prosthetic laryngoplasty in the standing horse.

BACKGROUND: Locoregional anaesthetic techniques can facilitate certain surgeries being performed under standing procedural sedation. The second and third spinal cervical nerves (C2, C3) are part of the cervical plexus and provide sensory innervation to the peri-laryngeal structures in people; block of these nerves might permit laryngeal lateralisation surgery in horses. OBJECTIVES: To describe the anatomical basis for an ultrasound-guided cervical plexus block in horses. To compare this block with conventional local anaesthetic tissue infiltration in horses undergoing standing prosthetic laryngoplasty. STUDY DESIGN: Cadaveric study followed by a double-blinded prospective clinical trial. METHODS: A fresh equine cadaver was dissected to characterise the distribution of C2 and C3 to the perilaryngeal structures on the left side. A second cadaver was utilised to correlate ultrasound images with the previously identified structures; a tissue marker was injected to confirm the feasibility of an ultrasound-guided approach to the cervical plexus. In the clinical study, horses were assigned to two groups, CP (n = 17; cervical plexus block) and INF (n = 17; conventional tissue infiltration). Data collection and analyses included time to completion of surgical procedure, sedation time, surgical field conditions and surgeon's perception of block quality. RESULTS: We confirmed that C2 and C3 provided innervation to the perilaryngeal structures. The nerve root of C2 was identified ultrasonographically located between the longus capitis and the cleidomastoideus muscles, caudal to the parotid gland. The CP group was deemed to provide better (P<0.0002) surgical conditions with no differences in the other variables measured. MAIN LIMITATIONS: Further studies with larger numbers of horses may be necessary to detect smaller differences in surgical procedure completion time based on the improved surgical filed conditions. CONCLUSIONS: For standing unilateral laryngeal surgery, a cervical plexus block is a viable alternative to tissue infiltration and it improves the surgical field conditions.

The effect of different environmental factors on force degradation of three common systems of orthodontic space closure.

BACKGROUND: Different environmental conditions, such as high temperature or exposure to some chemical agents, may affect the force decay of different methods of space closure during orthodontic treatment. The aim of this in vitro study was to evaluate the force decay pattern in the presence of tea as a popular drink in some parts of the world and two mouthwashes that are usually prescribed by the orthodontist once the treatment is in progress. MATERIALS AND METHODS: Elastic chain (EC), nickel-titanium (Ni-Ti) closed coil spring and tie-back (TB) method were used as the means of space closure. The specimens were placed in five different media: Hot tea, hot water (65°), chlorhexidine mouthwash, fluoride mouthwash and the control group (water at 37°). The specimens were stretched 25 mm and the elastic force of three systems was measured at the beginning of the study, after 24 h, after 1 week and after 3 weeks. One-way ANOVA was used to compare the results between the groups and Duncan test was carried out to compare the sets of means in different groups (P ≤ 0.05). RESULTS: Tea increases the force decay in the EC and TB groups. Oral mouthwashes also resulted in more rapid force decay than the control group. EC and Ni-Ti groups were not much affected in the presence of oral mouthwashes. CONCLUSION: Regarding the immersion media, TB method showed the biggest variation in different media and Ni-Ti coil spring was least affected by the type of media.