Parestesia do nervo alveolar inferior decorrente de procedimentos cirúrgicos e suas formas de tratamentos / Paresthesi of the lower alveolar nerve resulting from surgical procedures and its forms of treatment

Nas cirurgias odontológicas é possível que ocorra alguns acidentes ou complicações que podem interferir no dia a dia do paciente. A lesão do nervo alveolar inferior é uma complicação decorrente de cirurgias orais que podem causar um distúrbio de sensibilidade transitória ou persistente, na região do lábio inferior e na região delimitada do forame mentoniano e hemi-arco da mucosa. O diagnóstico da parestesia pode ser feito através de testes mecanoceptivos e nocioceptivos em que o profissional escolherá para qual melhor se adapte no paciente. O objetivo do presente trabalho foi abordar por meio de uma revisão de literatura as formas de diagnóstico e tratamento da parestesia do nervo alveolar inferior decorrentes de cirurgias orais. As bases de dados utilizadas para confecção desta revisão são encontradas nas bibliotecas virtuais eletrônicas: BVS (Biblioteca Virtual em Saúde), LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e Pubmed. Como critério de inclusão foram selecionados artigos publicados de 2012 a 2022 em língua inglesa, portuguesa e espanhola. Após a leitura do título e resumo dos resultados da pesquisa e aplicação dos critérios de inclusão e exclusão dentre eles foram excluídos 883, pois não se enquadravam no nosso critério de inclusão. No final, foram selecionados 13 estudos por meio de base de dados, que serviram de base para esta revisão. Concluímos que as formas de tratamento para a parestesia na literatura, são um pouco escassas e conflitantes, mas relata que o uso da laserterapia e acupuntura tem sido uma forma de tratamento com um bom índice de sucesso, e para os casos que não sejam suficientes tais tratamentos, pode-se optar por uma cirurgia(AU)

In dental surgeries it is possible to have some accidents or complications that can interfere with the patient's day. Injury to the inferior alveolar nerve is a complication resulting from oral surgeries that can cause a disturbance of sensitivity that can be transient or persistent in the region of the lower lip and in the delimited region of the mental foramen and hemiarch of the mucosa. The diagnosis of paresthesia can be made through mechanoceptive and nocioceptive tests that the professional will choose, which best suits the patient. The objective of the present work is to approach, through a literature review, the forms of diagnosis and treatment aimed at inferior alveolar nerve paresthesia resulting from oral surgeries. The databases used for this review are found in the virtual electronic libraries: VHL (Virtual Health Library), LILACS (Latin American and Caribbean Literature on Health Sciences) and Pubmed. As inclusion criteria, articles published from 2012 to 2022 in English, Portuguese and Spanish were selected. After reading the title and summary of the research results and applying the inclusion and exclusion criteria, 883 were excluded, as they did not meet our inclusion criteria. In the end, 13 studies were selected from the database, which served as the basis for this review. We conclude that the forms of treatment for paresthesia in the literature are a little scarce and conflicting, but it reports that the use of laser therapy and acupuncture has been a form of treatment with a good success rate, and for cases that are not enough, such treatments, one can opt for surgery(AU)

Manejo del paciente anticoagulado en una cirugía dental / Management of the anticoagulated patient in dental surgery / Gerenciamento do paciente anticoagulado em cirurgia odontológica

Introducción: una adecuada hemostasia es crucial para el éxito del tratamiento odontológico invasivo, ya que los problemas de sangrado pueden dar lugar a complicaciones asociadas a una importante morbimortalidad. El tratamiento odontológico de pacientes que tienden a un mayor riesgo de sangrado debido al uso de fármacos anticoagulantes plantea un desafío en la práctica diaria de los profesionales de la odontología. El conocimiento adecuado de los mecanismos subyacentes a la hemostasia y el manejo optimizado de estos pacientes son, por lo tanto, cuestiones muy importantes. Se realiza un estudio de los fármacos anticoagulantes actualmente disponibles en el mercado, evaluando los riesgos y beneficios de suspender dicho fármaco previo a un tratamiento odontológico invasivo. Además, se hace una revisión de los protocolos de manejo actuales que se utilizan en estos pacientes. Material y métodos: se realizó una búsqueda bibliográfica en las bases de datos Epistemonikos y Medline/PubMed; en el portal Timbó y en la biblioteca virtual Scielo. Abarcando todos los estudios publicados en los últimos 15 años en inglés y español. Se encontraron 30 artículos, se seleccionaron 15 en primera instancia para finalizar con 11 artículos. En dicha selección el filtro fue que los demás artículos se referían a otros anticoagulantes que no eran parte de este trabajo. Resultados: se han desarrollado múltiples protocolos de manejo, aunque en todos los casos se requiere una historia clínica completa, junto con pruebas hemostáticas complementarias para minimizar los riesgos derivados del tratamiento odontológico. Discusión: muchos autores consideran que la medicación de los pacientes indicada para el tratamiento de una enfermedad de base no debe ser alterada o suspendida a menos que así lo indique el médico prescriptor. Se ha demostrado que las medidas hemostáticas locales son suficientes para controlar los posibles problemas de sangrado derivados del tratamiento dental.

Introduction: Adequate hemostasis is crucial for the success of invasive dental treatment, since bleeding problems can lead to complications associated with significant morbidity and mortality. The dental treatment of patients who are prone to an increased risk of bleeding due to the use of anticoagulant drugs poses a challenge in the daily practice of dental professionals. Adequate knowledge of the mechanisms underlying hemostasis and optimized management of these patients are therefore very important issues. A review is made of the anticoagulant drugs currently available on the market, evaluating the risks and benefits of suspending such a drug prior to invasive dental treatment. In addition, a review is made of the current management protocols used in these patients. Material and methods: A bibliographic search was carried out in the Epistemonikos and Medline/PubMed databases; in the Timbo portal and in the Scielo virtual library. All the studies published in the last 15 years in English and Spanish were included. Thirty articles were found, 15 were selected in the first instance to end up with 11 articles. In this selection, the filter was that the other articles referred to other anticoagulants that were not part of this work. Results: multiple management protocols have been developed, although in all cases a complete clinical history is required, together with complementary hemostatic tests to minimize the risks derived from dental treatment. Discussion: many authors consider that the patient's medication indicated for the treatment of an underlying disease should not be altered or suspended unless so indicated by the prescribing physician. It has been shown that local hemostatic measures are sufficient to control possible bleeding problems derived from dental treatment.

Introdução: A hemostasia adequada é crucial para o sucesso do tratamento dentário invasivo, pois problemas de sangramento podem levar a complicações associadas a uma morbidade e mortalidade significativas. O tratamento odontológico de pacientes que são propensos a um risco maior de sangramento devido ao uso de drogas anticoagulantes representa um desafio na prática diária dos profissionais da odontologia. O conhecimento adequado dos mecanismos subjacentes à hemostasia e o gerenciamento otimizado desses pacientes são, portanto, questões muito importantes. É realizada uma revisão dos anticoagulantes atualmente disponíveis no mercado, avaliando os riscos e benefícios de descontinuar tal medicamento antes do tratamento dentário invasivo. Além disso, é feita uma revisão dos protocolos de gerenciamento atuais usados nesses pacientes. Material e métodos: Foi realizada uma pesquisa bibliográfica nas bases de dados Epistemonikos e Medline/PubMed; no portal Timbo e na biblioteca virtual Scielo. Todos os estudos publicados nos últimos 15 anos, em inglês e espanhol, foram incluídos. Trinta artigos foram encontrados, 15 foram selecionados em primeira instância para acabar com 11 artigos. Nesta seleção, o filtro foi que os outros artigos se referiam a outros anticoagulantes que não faziam parte deste trabalho. Resultados: foram desenvolvidos múltiplos protocolos de gerenciamento, embora em todos os casos seja necessário um histórico clínico completo, juntamente com testes hemostáticos complementares para minimizar os riscos derivados do tratamento odontológico. Discussão: muitos autores consideram que a medicação os pacientes indicada para o tratamento de uma doença subjacente não deve ser alterada ou descontinuada, a menos que o médico que a prescreve dê instruções nesse sentido. Medidas hemostáticas locais demonstraram ser suficientes para controlar potenciais problemas de sangramento resultantes do tratamento odontológico.

An audit of routine practice: a prospective study on the use of mouth props in oral surgery.

Introduction Mouth props are routinely used for patients treated under general but not local anaesthesia (LA). Patient discomfort and excess operator time is an often cited argument against the routine use of mouth props.Aim and methods We surveyed patients, surgeons and assistants following the use of mouth props during minor oral surgical procedures under LA in order to assess their acceptability and utility in clinical practice.Results Forty-seven patients were included, with 24 patients treated using mouth props and 23 without. Thirty-three patients had dental extractions, three had intraoral biopsies and one underwent a tube removal following cyst marsupialisation.Discussion Patients reported less difficulty in mouth opening where a mouth prop was used. Patients reported similarly low levels of discomfort with or without a mouth prop. Ninety-five percent of patients who used a mouth prop reported they would recommend their use. The surgeon and assistant reported mouth opening as less problematic and assisting as easier where a mouth prop was used.Conclusion The results of this study demonstrate the benefits and broad acceptability of mouth prop use in the awake patient. We question current practice in that mouth props are not routinely offered to patients during oral surgical and dental procedures.

[Focus: Drug-related osteonecrosis of the jaw]. / Les médicaments inducteurs d'ostéchimionécroses des maxillaires.

Antiresorptives and antiangiogenics are treatments that have proven effective in oncology and the treatment of osteoporosis and they are increasingly prescribed. The care of these patients requires collaboration between the prescriber and the oral health professional to establish an optimized treatment plan. Therapeutic education of the patient is essential for him to understand the issues of good oral health and the adverse effects that can be caused by these treatments. The management is essentially based on the individual benefit/risk balance resulting from the general, local and inherent of the molecule risk factors. Management of drug-related osteonecrosis of the jaw should be as early as possible.

Role of diode lasers in oro-facial pain management.

With the increasing use of low level laser therapy (LLLT) in clinical dentistry, the aim of the present study was to assess the effectiveness of diode lasers in the management of orofacial pain. Indexed databases were searched without language and time restrictions up to and including July 2016 using different combinations of the following key words: oral, low level laser therapy, dental, pain, diode lasers, discomfort and analgesia. From the literature reviewed it is evident that LLLT is effective compared to traditional procedures in the management of oro-facial pain associated to soft tissue and hard tissue conditions such as premalignant lesions, gingival conditions and dental extractions. However, it remains to be determined which particular wavelength will produce the more favorable and predictable outcome in terms of pain reduction. It is highly recommended that further randomized control trials with well-defined control groups should be performed to determine the precise wavelengths of the diode lasers for the management of oro-facial pain. Within the limits of the present review, it is concluded that diode lasers therapy is more effective in the management of oro-facial pain compared to traditional procedures.

Laser Therapy in the Treatment of Paresthesia: A Retrospective Study of 125 Clinical Cases.

OBJECTIVE: The aim of this retrospective study was to evaluate the effectiveness of laser therapy for acceleration and recovery of nerve sensitivity after orthognathic or minor oral surgeries, by analysis of clinical records of patients treated at the Special Laboratory of Lasers in Dentistry (LELO, School of Dentistry, University of São Paulo), throughout the period 2007-2013. BACKGROUND DATA: Nerve tissue lesions may occur during various dental and routine surgical procedures, resulting in paresthesia. Laser therapy has been shown to be able to accelerate and enhance the regeneration of the affected nerve tissue; however, there are few studies in the literature that evaluate the effects of treatment with low-power laser on neural changes after orthognathic or minor oral surgeries. METHODS: A total of 125 clinical records were included, and the data on gender, age, origin of the lesion, nerve, interval between surgery and onset of laser therapy, frequency of laser irradiation (one or two times per week), final evolution, and if there was a need to change the irradiation protocol, were all recorded. These data were related to the recovery of sensitivity in the affected nerve area. Descriptive analyses and modeling for analysis of categorical data (α=5%) were performed. RESULTS: The results from both analyses showed that the recovery of sensitivity was correlated with patient age (p=0.015) and interval between surgery and onset of laser therapy (p=0.002). CONCLUSIONS: Within the limits of this retrospective study, it was found that low- power laser therapy with beam emission band in the infrared spectrum (808 nm) can positively affect the recovery of sensitivity after orthognathic or minor oral surgeries.

Clinical efficacy of low level laser therapy in reducing pain and swelling after periapical surgery: a preliminary report / Eficacia clínica de láser terapéutico de bajo nivel de emisión en la reducción de dolor e inflamación posterior a cirugía periapical: reporte preliminar

The objective of this study was to evaluate the efficacy of the low level laser therapy (LLLT) in postoperative pain and swelling associated with periapical surgery. A double-blind, randomized, controlled clinical trial was carried out in 2 groups of 10 patients each, undergoing periapical surgery. The experimental group was treated with an intraoral application of an 810 nm-GaAsAl-laser, having an output power of 100 mW, with overlapping movements over the wound. In the control group, the same procedure was carried out, without therapeutic laser activation. Postoperative pain, swelling, and rescue medication were registered. The experimental group exhibited a decrease in pain intensity after periapical surgery compared with control group (p<0.05). There was not significant statistical difference between the groups in terms of swelling. Six patients of the control group required rescue medication. The use of LLLT in the postoperative management of patients having periapical surgery, using the protocol of this study reduced postoperative pain...

El objetivo del estudio fue evaluar la eficacia del láser terapéutico de bajo nivel de emisión (LTBNE) en el dolor postoperatorio e inflamación asociados con cirugía periapical. Se realizó un ensayo clínico controlado aleatorizado doble ciego en 2 grupos de 10 pacientes cada uno, que requirieron de cirugía periapical. El grupo experimentalfue tratado con una aplicación intraoral de laser de GaAsAl de 810 nm, con una potencia de 100 Mw, con movimientos oscilatorios sobre la herida quirúrgica. En el grupo control, se llevó a cabo el mismo procedimiento, sin la activación del láser terapéutico. Se registraron dolor postoperatorio, inflamación y medicación de rescate. El grupo experimental mostró una disminución en la intensidad del dolor posterior a la cirugía periapical en comparacióncon el grupo control (p<0.05). No se encontró diferencia estadísticamente significativa entre los grupos entérminos de inflamación. Seis pacientes del grupo control requirieron medicación de rescate. El uso de LTBNE en el manejo postoperatorio de pacientes sometidos a cirugíaperiapical, usando el protocolo del presente estudio redujo el dolor postoperatorio...

Kinesiologic taping reduces morbidity after oral and maxillofacial surgery: a pooled analysis.

BACKGROUND: Postoperative morbidity is a major disadvantage after oral and maxillofacial (OMF) surgery, often caused by pain, trismus and swelling affecting patients' quality of life. The goal of this study was to examine the effect of kinesiologic taping (KT) on swelling, pain, trismus and patients' satisfaction after OMF surgery. MATERIALS AND METHODS: Performing a pooled analysis of 96 patients that were assigned for maxillofacial treatment (midface fractures n = 30, mandibular fractures n = 26, wisdom tooth removal n = 40) divided into treatment either with or without kinesiologic tape application. Tape was applied directly after surgery and maintained for at least 5 d postoperatively. Facial swelling was quantified at six specific points in time using a five-line measurement. Pain and degree of mouth opening was measured. Patients' objective feeling and satisfaction was queried. RESULTS: Application of KT after OMF surgery has a significant influence on the reduction of swelling decreasing the turgidity for 60% during the first 2 d after surgery. Evaluating all patients swelling was significantly lower in the KT treatment group (T2: 63.5 cm ± 4.3; T3: 62.5 cm ± 4.2; T4: 61.6 cm ± 4.2) than in the no-KT group (T2: 67.6 cm ± 5.0; T3: 67.0 cm ± 5.0; T4: 64.8 cm ± 4.8) at T2 (p < 0.001), T3 (p < 0.001), and T4 (p = 0.001). VAS Pain values were scored significantly lower for the KT group (T1: 2.5 ± 2.0 (p = 0.006); T2: 1.7 ± 2.0 (p < 0.001); T3: 1.5 ± 2.3 (p = 0.004); T4: 0.6 ± 1.1 (p = 0.001) compared to the no-KT group (T1: 3.8 ± 2.5; T2: 3.5 ± 2.7; T3: 2.9 ± 2.2; T4: 1.6 ± 1.7). A statistically significant amelioration in mean mouth opening ability was observed in the KT group (T1-BL: -0.08 cm ± 0.49 (p = 0.025); T2-BL: 0.07 cm ± 0.59 (p = 0.012); T3-BL: 0.20 ± 0.63 (p = 0.013); T4-BL: 0.42 ± 0.59 (p = 0.003)) compared to the no-KT group (T1-BL: -0.47 cm ± 0.86; T2-BL: -0.39 cm ± 0.84; T3-BL: -0.24 ± 0.89; T4-BL: -0.13 ± 1.02). CONCLUSION: KT after OMF surgery is a promising, simple, less traumatic, economical approach free from systemic adverse reaction upgrading patients' quality of life.

Reiki therapy for postoperative oral pain in pediatric patients: pilot data from a double-blind, randomized clinical trial.

PURPOSE: To examine the effects of Reiki as an adjuvant therapy to opioid therapy for postoperative pain control in pediatric patients. METHODS: This was a double-blind, randomized controlled study of children undergoing dental procedures. Participants were randomly assigned to receive either Reiki therapy or the control therapy (sham Reiki) preoperatively. Postoperative pain scores, opioid requirements, and side effects were assessed. Family members were also asked about perioperative care satisfaction. Multiple linear regressions were used for analysis. RESULTS: Thirty-eight children participated. The blinding procedure was successful. No statistically significant difference was observed between groups on all outcome measures. IMPLICATIONS: Our study provides a successful example of a blinding procedure for Reiki therapy among children in the perioperative period. This study does not support the effectiveness of Reiki as an adjuvant therapy to opioid therapy for postoperative pain control in pediatric patients.

Perioperative immunonutrition in well-nourished patients undergoing surgery for head and neck cancer: evaluation of inflammatory and immunologic outcomes.

Limited work is available on the benefits of nutritional support enriched with arginine and n-3 fatty acids in surgical patients with head and neck cancer, particularly if well-nourished. We conducted a pilot study in these patients to examine effects on inflammatory markers and clinical outcome. Patients scheduled for radical resection of the oral cavity were randomised to 5 day preoperative and 5 day postoperative Impact® (IMN, n = 4), or no preoperative supplementary nutrition and Isosource® postoperatively (STD, n = 4). Plasma fatty acids, C-reactive protein (CRP), tumour necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 were measured at baseline, day of surgery and on postoperative days (POD) 2, 4 and 10. Postoperative complications were recorded. The (eicosapentaenoic acid plus docosahexaenoic acid) to arachidonic acid ratio was significantly higher in IMN patients on POD 2, 4 and 10 (P < 0.01). While not statistically significant, CRP, TNF-α, and IL-6 concentrations were higher in the STD group on POD2 while IL-10 was lower. Median length of stay was 10 (range 10-43) days in the IMN group and 21.5 (7-24) days in the STD group. Five complications were seen in the STD group and two in the IMN group. The results support the need for a larger trial focusing on clinical outcome.

Nimodipine promotes regeneration of peripheral facial nerve function after traumatic injury following maxillofacial surgery: an off label pilot-study.

BACKGROUND: Animal tests, retro- and prospective clinical trials in neurosurgical departments have shown a beneficial effect of nimodipine on the preservation and recovery of facial and acoustic nerve function following vestibular schwannoma surgery. Encouraged by these positive results a pilot-study of nimodipine treatment in patients with a peripheral facial nerve (FN) paresis following maxillofacial surgery was performed. The rate and time of FN recovery were analysed and compared with the results in the literature. METHODS: Thirteen patients (n = 13) suffering from a moderate (1/13) up to a severe (12/13) peripheral FN paresis after maxillofacial surgery were treated with orally administered nimodipine. The anatomical main course of the FN was preserved in all patients with a 2nd to 3rd degree of Sunderland-injury (Sunderland, 1951). After no evidence of a spontaneous regeneration had shown, oral medication with nimodipine was started as an "off-label" use. RESULTS: An improvement of the FN function correlated to the start of the vasoactive medication and as a consequence a recovery of the FN function up to House-Brackmann (HB) grade I°-II° was observed in all the patients within a period of 2 months after the beginning of treatment (p = 0.00027). CONCLUSIONS: The clinical observations in these patients suggest a positive effect of nimodipine on the acceleration of peripheral FN regeneration after surgically caused trauma. The results of this pilot-study are very promising. A prospective study with a larger number of patients is planned to approve the beneficial effect of nimodipine on the peripheral FN in maxillofacial or otorhinolaryngological surgery.

'A good shepherd, but with obstructive sleep apnoea syndrome': traditional uvulectomy case series and literature review.

BACKGROUND: In the West, removal of the uvula is predominantly undertaken as part of palatal surgery, in cases of obstructive sleep apnoea. In the developing world, such as the Middle East and Africa, uvulectomy is a more common practice. The uvula is removed for curative or preventive purposes, or as part of ritual practice. Due to immigration from developing to developed world countries, and to Western doctors working abroad, such doctors are increasingly being confronted with unfamiliar traditional healing practices, within a medical context. METHODS: The Medline and Embase online databases were systematically searched for literature on traditional uvulectomy. We present a review of this literature. We also present the first report, to our best knowledge, of obstructive sleep apnoea as a late complication of traditional uvulectomy. DISCUSSION: Traditional uvulectomy may be complicated by post-operative haemorrhage and local infections, among many other problems. We report cases of obstructive sleep apnoea and snoring caused by palatal stenosis resulting from traditional uvulectomy during childhood.

Long-term outcome of trigeminal nerve injuries related to dental treatment.

PURPOSE: There is little information available on the long-term effects on patients of permanent involvement of the inferior alveolar or lingual nerve because of dental treatment. This study has attempted to document this information from patients who were reviewed between 3 and 9 years after injury. MATERIALS AND METHODS: All patients with an ICD-9 diagnosis of 951.2 (injury to the trigeminal nerve) because of dental treatment, seen in the Oral and Maxillofacial Surgery Clinic at the University of California, San Francisco between January 1, 2001 and December 31, 2006, were contacted in an attempt to complete a telephone survey of long-term effects. RESULTS: Of the 727 patients who were eligible for the study, 145 patients (95 female and 50 male) completed the telephone surveys. Many patients had sought both conventional and alternative treatments after consultation at University of California, San Francisco. A small number of patients had undergone subsequent surgery elsewhere. Many patients reported significant life changes, including adverse effects on employment (13%), relationship changes (14%), depression (37%), problems speaking (38%), and problems eating (43%). In general, however, patients reported improvement over time, often using a number of different coping mechanisms. Males had a greater decrease in symptoms than females, and those older than 40 years reported more pain in the long term than those under 40. Lingual nerve symptoms improved more than inferior alveolar nerve symptoms. CONCLUSIONS: Although most patients continue to have long-term problems that affect the overall quality of life, for most patients there has been improvement in symptoms over time.

Effects of combination treatment with ketoprofen 100 mg + acetaminophen 1000 mg on postoperative dental pain: a single-dose, 10-hour, randomized, double-blind, active- and placebo-controlled clinical trial.

BACKGROUND: A combination of analgesic drugs with different pharmacologic properties may be more effective, with fewer adverse events, than either agent used alone. OBJECTIVE: This study assessed whether the combination of acetaminophen and ketoprofen is more effective and better tolerated than either drug used alone in treating postoperative pain. METHODS: This single-dose randomized, double-blind, active- and placebo-controlled study was conducted at the Finnish Student Health Service, Oulu, Finland. Patients aged 18 to 40 years with moderate or severe pain (>or=3 on a numerical rating scale [NRS] of 0-10) after surgical removal of impacted third molars were randomly assigned to receive one of the following drugs in single oral doses: ketoprofen 100 mg + acetaminophen 1000 mg, ketoprofen 100 mg, acetaminophen 1000 mg, or placebo tablets. Effectiveness was assessed by the onset of analgesia, pain intensity difference (PID) from baseline, sum of PID (SPID), and duration of analgesic effect. Patients rated pain intensity on the NRS at rest and on dry swallowing. Onset of pain relief was measured using time to PID in >or=1 category at rest or on dry swallowing (PID >or=1). Patients recorded the occurrence of adverse events and the supplemental consumption of rescue medication (ibuprofen). RESULTS: The study included 76 patients, accounting for 78 cases (2 patients were operated on twice and were assessed as 4 individual patients) (59% women, 41% men; mean age, 22.8 years; white race, 100%; and mean weight, 68.3 kg). At 1.5 hours, mean SPIDs at rest and on swallowing were significantly greater in the combination group than in the acetaminophen, ketoprofen, and placebo groups (all, P < 0.05). Mean time to onset of pain relief (PID >or=1) at rest and on swallowing were significantly less in the combination group than the acetaminophen, ketoprofen, and placebo groups (all, P < 0.05). Median time to use of rescue medication was significantly longer in the combination group than in the acetaminophen group (P = 0.006) and the placebo group (P < 0.001) but not the ketoprofen group. At 1.5 hours after administration, maximum sedation scores were not significantly different between the study groups. The prevalences of trismus, bleeding, and edema were not significantly different between the study groups. CONCLUSIONS: The results from this study suggest that the combination of ketoprofen 100 mg + acetaminophen 1000 mg provided a significantly more rapid onset of analgesia than either drug given alone in the management of pain after oral surgery in this patient population. Adverse events were not significantly different between the study groups. These results support the clinical practice of combining ketoprofen with acetaminophen for the management of acute pain.

[Evaluation of Yunnan Baiyao capsules for reducing postoperative swelling after orthognathic surgery].

OBJECTIVE: To evaluate the effects of Yunnan Baiyao capsules on facial swelling and anti-inflammatory response after orthognathic surgery. METHODS: 87 patients scheduled for Le Fort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) and genioplasty were randomly divided into 2 groups: experiment roup (n = 43) given with Yunnan Baiyao capsules orally 4 days before operation once daily and then via nasal feeding tube after operation once a day for 5 days, and placebo group given with placebo capsules. Antibiotic was routinely given to both groups. Serum levels of C-reactive protein (CRP), interleukin 6 (IL-6), and IL-1 were quantified on postoperative days 1, 2, 3, and 5. Degrees of facial swelling were evaluated on postoperative days 3, 5, and 7. RESULTS: Peak CRP and cytokines levels were reached on the first postoperative day in both groups, and the the variables decreased. The serum concentrations of CRP and IL-6 in the Yunan Baiyao group were lower than those in the control group. The CRP levels on the postoperative day 2, 3 and 5 of the experiment group were all significantly lower than those of the placebo group, and the IL-6 level on the second postoperative day of the experiment group was significantly lower than that of the placebo group. CONCLUSION: Perioperative administration of Yunnan Baiyao capsules can reduce the magnitude of inflammatory response and facial swelling after orthognathic surgery. Yunnan Baiyao capsule has efficacy of anti-inflammatory response.

[Reverse-engineering-based quantitative three-dimensional measurement of facial swelling after administration of Yunnan Baiyao following orthognathic surgery].

OBJECTIVE: To evaluate the effects of perioperative oral administration of Yunan Baiyao on reduction of postoperative facial swelling following bimaxillary orthognathic surgery. METHODS: Patients scheduled for Le Fort I osteotomies and bilateral sagittal split ramus osteotomies were enrolled in the prospective, randomized, double-blind, placebo-controlled clinical study. Patients were orally administrated with Yunnan Baiyao capsules or placebo capsules before 3 days of operation and 5 days post-operation. Three-dimensional face images were recorded with OKIO-SC-400 Scanning System in 40 patients at pre-operation, postoperatively 3 day, 1 week and 1 month. Facial scans from different time periods were registrated to same coordinates and overlaid onto the baseline facial scan. 3D and 2D model deviations were performed with reverse engineering software to compare the differences between each two models and to quantitatively determine the reductions in facial swelling. RESULTS: There were 18 patients in Yunnan Baiyao group and 22 patients in control group. The severe swelling region was in the cheek, followed by the upper and lower lip. The average reduction of swelling thickness in Yunnan Baiyao group and control group from 3 day to 1 week postoperative was 3.6 mm and 2.3 mm respectively; there was significant difference between the two groups. Significant differences were also found in percentage changes of facial morphology from 3 day to 1 week postoperative (49.0% and 38.3% respectively). There were no significant changes in facial volumes of swelling between the two groups. CONCLUSIONS: Perioperative oral administration of Yunnan Baiyao capsules can effectively reduce the magnitude of facial swelling in bimaxillary orthognathic surgery. Yunnan Biayao has efficacy of anti-inflammatory response.

Anesthesia morbidity and mortality experience among Massachusetts oral and maxillofacial surgeons.

PURPOSE: To document the incidence of specific complications and the mortality rate for office anesthesia administered by fully qualified oral and maxillofacial surgeons in the state of Massachusetts. MATERIALS AND METHODS: A survey questionnaire was mailed to the 169 active members of the Massachusetts Society of Oral and Maxillofacial Surgeons. Using a specific method for follow-up, a 100% response was obtained. RESULTS: The frequency of office anesthetic complications occurring in 2004 were consistent with our previous studies. There was 1 office death, for a mortality rate of 1/1,733,055. The incidence of other specific anesthetic-related complications is documented. CONCLUSION: From the data presented here, we conclude that outpatient anesthesia in the oral and maxillofacial surgery office continues to be a safe therapeutic modality.

Management of patients with reduced oral aperture and mandibular hypomobility (trismus) and implications for operative dentistry.

Reduced oral aperture and mandibular mobility/trismus are relatively common conditions that can be encountered in patients attending general dental practice, community dental practice and district general or dental teaching hospitals. All dental specialties may see patients with these conditions, and regardless of which environment or specialty, both patient and clinician may experience significant problems. The purpose of this opinion-based paper is to identify and review the causes of such conditions, to review the development of problems encountered for patients and clinicians, and to identify options to treat or manage the conditions.

Manejo del sangrado en cirugía ortognática / Handling bleeding in orthognathic surgery

La magnitud y el control del sangrado, junto al requerimiento de transfusión, han sido temas muy controvertidos en la cirugía ortognática. En la literatura se menciona el uso de técnicas y criterios disímiles y contradictorios. Hemos querido actualizar los criterios sobre el manejo del sangrado en la cirugía maxilofacial en base a nuestra experiencia con el uso de técnicas quirúrgicas y anestésicas actuales. Se presenta aquí una revisión crítica de las publicaciones sustentada por la experiencia clínica del equipo quirúrgico. Se discuten temas relacionados con el sangrado intraoperatorio tales como la predonación sanguínea, la reducción del sangrado mediante técnicas de hipotensión controlada, y el uso de vasoconstrictores o antifibrinolíticos junto a los fármacos anestésicos. Se realizan recomendaciones en base a nuestra experiencia clínica. La presente revisión concluye que con las técnicas actuales, como la anestesia hipotensiva y la anestesia basada en la analgesia simpaticolítica, se logra una mínima pérdida de sangre durante la cirugía ortognática. Estas técnicas prácticamente eliminan la necesidad de transfusiones sanguíneas, predonación y el uso rutinario de antifibrinolíticos, y las posibles complicaciones que estos conllevan.

The magnitude and management of blood loss, as well as the necessity of transfusion have been controversial themes in orthognathic surgery. Different and contradictory techniques and criteria have been used and exposed in the current literature. The aim of this study is to bring up to date the criteria concerning management of blood loss in maxillofacial surgery, based on our clinical experience with recent surgical and anesthetic techniques. A critical revision of the literature is exposed, according to the experience of the surgical team of the Maxillofacial department in. Themes related to intraoperative blood loss, preoperative autologous blood donation, drugs used in the anesthetic technique, reduction of blood loss with hypotensive anesthesia, the use of epinephrine and antifibrinolytic agents are discussed. Finally we present some recommendations based on our experience. This study shows that blood loss during orthognathic surgery is minimal with techniques such as hypotensive anesthesia and the analgesic sympathicolytic based anesthesia. These techniques practically eliminate the necessity of transfusion, preoperative autologous donation, the use of habitual antifibrinolytic agents and its complications.

A intensidade e o controle do sangramento, e a necessidade de transfusao, sao assuntos muito controvertidos na cirurgia ortognática. Na literatura se menciona o uso de técnicas e critérios diferentes e contraditórios. Atualizamos os princípios do manejo do sangramento na cirurgia maxilofacial em base a nossa experiencia no uso das técnicas cirúrgicas e anestésicas atuais. Fazemos uma revisao crítica das publicaçoes sustentada pela experiencia clínica da equipe de cirurgia. Sao discutidos temas relacionados com o sangramento intra-operatório, tais como a pre-doaçao de sangue, a reduçao do sangramento mediante técnicas de hipotensao controlada, e o uso de vasoconstritores ou antifibrinolíticos junto aos fármacos anestésicos. Fazemos recomendaçoes em base a nossa experiencia clínica. Conclui-se que com as técnicas atuais, como a anestesia hipotensiva e a anestesia baseada na analgesia simpaticolítica, é possível reduzir ao mínimo a perda de sangre durante a círurgia ortognática. Estas técnicas praticamente eliminam a necessidade de transfusoes sanguíneas, a pré-doaçao e o uso rotineiro de antifibrinolíticos, e as possíveis conseqüentes complicaçoes.

The effect of tongue appliance on the nasomaxillary complex in growing cleft lip and palate patients.

Midfacial deficiency is a common feature of cleft lip and palate patients due to scar tissue of the lip and palate closure procedure. The aim of this study was to evaluate the effectiveness of the physiological force of the tongue to move the maxilla in forward position. This research has been done experimentally by, before and after treatment following up in private practice. Ten patients (6 female, 4 male) with complete bilateral cleft lip and palate were selected. All of them had Cl III malocclusion with maxillary deficiency due to scar tissue of lip and palate surgery. Their age ranged from 7.6 to 9.8 years. All the patients were delivered tongue appliance to transfer the force of the tongue to maxillary complex. The mean observation time was 13+/-2 months to achieve positive overjet. Pre- and post-lateral cephalograms were compared to evaluate the skeletal changes with paired t-test. The results showed that after the application of tongue appliance, normal sagittal maxillomandibular relationship was achieved. SN-ANS angle was increased 1.9+/-1.8 - P < 0.03. This study showed that the tongue appliance could transfer considerable force during rest and swallowing period to the maxilla. This method might be considered to improve the deficient maxilla by means of growth modification and redirect concept.