Comparative Efficacy of Granisetron and Droperidol After Orthognathic Surgery for Prophylaxis of Postoperative Nausea and Vomiting: A Retrospective Study.

BACKGROUND: In the fall of 2021, granisetron was approved for postoperative nausea and vomiting (PONV) management in Japan. However, the comparative efficacy of droperidol and granisetron in the field of orthognathic surgery has not been determined. PURPOSE: We compare the efficacy of droperidol and granisetron for PONV prophylaxis following orthognathic surgery. STUDY DESIGN, SETTING, SAMPLE: We performed a retrospective cohort study of patients who underwent orthognathic surgery at a single institution from September 2020 to December 2022. Patients who had undergone Le Fort I osteotomy with sagittal split ramus osteotomy or isolated sagittal split ramus osteotomy were included. Patients were divided into three groups; the isolated droperidol (D), isolated granisetron (G), and droperidol with granisetron (DG) groups. General anesthesia was performed using total intravenous anesthesia for all patients; however, droperidol and granisetron were administered at the anesthesiologist's discretion. PREDICTOR VARIABLE: PONV prophylactic therapy included isolated droperidol, isolated granisetron, and droperidol with granisetron administration. OUTCOME VARIABLES: Postoperative nausea (PON) and postoperative vomiting (POV) were determined through medical examination within 48 hours following surgery. Secondary outcomes included complications due to droperidol and/or granisetron administration. COVARIATES: Age, sex, body mass index, Apfel's score, duration of surgery, duration of anesthesia, intraoperative blood loss, and type of surgery. ANALYSES: Statistical analysis was conducted using Fisher exact test, Mann-Whitney U test with Bonferroni correction for univariate comparison, and modified Poisson regression for comparison of PON and POV prophylactic efficacy for multivariate analyses. P values <.05 were considered statistically significant. RESULTS: Our study included 218 participants. There were no significant differences in covariates between groups D (n = 111), G (n = 52), and DG (n = 55). No significant difference in PON incidence was observed between groups. However, POV incidence was significantly lower in group DG than group D (relative risk, 0.21; 95% confidence interval, 0.05 to 0.86; P = .03). No significant difference in complication incidence was observed between groups. CONCLUSIONS AND RELEVANCE: Granisetron was as effective as droperidol for PONV management, while droperidol combined with granisetron was more effective than isolated droperidol for POV management. As compared to the use of each drug separately, their combination was considered safe, with no increase in complication rates.

Clinical features and antimicrobial susceptibility of oral bacteria isolated from the blood cultures of patients with infective endocarditis.

Background/purpose: The epidemiology of infective endocarditis (IE) is under constant change due to the aging society and increases in antimicrobial-resistant pathogens. However, IE remains severe. This study aimed to review the current clinical characteristics of IE and the antimicrobial susceptibility of oral bacteria (OB) isolated from blood cultures to implement appropriate antimicrobial prophylaxis. Materials and methods: We retrospectively investigated the clinical features of 180 patients with IE in whom OB and pathogens except OB (eOB) were identified as causative microorganisms via blood cultures. The susceptibility of the OB group to eight antibiotics was examined by broth microdilution. Results: Among causative microorganisms, the isolation rate of staphylococci was slightly higher than that of OB; however, the difference was not significant (36.7% vs. 33.8%, p = 0.3203). The number of patients with underlying cardiac disease was significantly higher in the OB group than in the eOB group (53.7% vs. 34.1%, p = 0.0113). Only one ampicillin-resistant OB was detected (2.0%). OBs were significantly less susceptible to clarithromycin and azithromycin than to ampicillin (98.0% vs. 66.7% and 98.0% vs. 60.0%, p = 0.0003 and p = 0.0003, respectively). Moreover, OBs were significantly less susceptible to clarithromycin and azithromycin than to clindamycin (66.7% vs. 88.2% and 60.0% vs. 88.2%, p = 0.0301 and p = 0.0217, respectively). Conclusion: OBs were susceptible to ampicillin. However, the susceptibility of OBs to clarithromycin and azithromycin was significantly lower than that to ampicillin and clindamycin. These results are important and should help decisions regarding guide antimicrobial prophylaxis.

Ulcers on the bilateral palate mucosa following mRNA-based vaccination for coronavirus disease 2019 (COVID-19): A case report.

Severe acute respiratory syndrome coronavirus 2 has spread globally. Vaccination for coronavirus disease 2019 (COVID-19) is anticipated to reduce morbidity and mortality. However, the safety of vaccines against COVID-19 is a cause for concern and uncertainty, which leads to vaccine hesitancy. There have been some self-reported questionnaire studies regarding adverse effects after COVID-19 vaccination; however, adverse effects on the oral region are rare. In this report, we present one case of ulcers arising on the bilateral palate mucosa following COVID-19 vaccination, which was suspected to be an adverse effect of vaccination.

Postoperative dysphagia caused by a delay in mandibular fracture treatment in a patient with severe intellectual disability: a case report.

BACKGROUND: The postoperative complications of mandibular fracture include malocclusion, infection, nonunion, osteomyelitis, and sensorial mental nerve dysfunction. However, there are no reports regarding postoperative dysphagia as a complication of mandibular fracture. Herein, we report a rare case of postoperative dysphagia caused by delayed mandibular fracture treatment in a patient with severe intellectual disability. CASE PRESENTATION: A 46-year-old Japanese male patient with severe intellectual disability fell down and struck his chin. The patient was referred to our department 10 days after the accident. Upon examination, he could not close his mouth because of severe left mandibular body fracture. Open reduction and internal fixation was performed under general anesthesia 16 days after sustaining the injury, and normal occlusion was eventually achieved. However, the patient could not swallow well a day after surgery. He was then diagnosed with postoperative dysphagia caused by disuse atrophy of muscles for swallowing based on videoendoscopic examination findings. Adequate dysphagia rehabilitation could not be facilitated because of the patient's mental status. Postoperative dysphagia did not improve 21 days after surgery. Therefore, percutaneous endoscopic gastrostomy was required. CONCLUSIONS: The treatment course of the patient had two important implications. First, postoperative dysphagia caused by disuse atrophy may occur if treatment is delayed in severe mandibular body fracture. Second, in particular, if a patient with severe intellectual disability develops postoperative dysphagia caused by disuse atrophy, adequate dysphagia rehabilitation cannot be facilitated, and percutaneous endoscopic gastrostomy may be required. Therefore, early open reduction and internal fixation is required for mandibular fracture in a patient with severe intellectual disability.

Acquired hemophilia A that required surgical hemostasis of hematomas occupying oral cavity: a case report.

BACKGROUND: Acquired hemophilia A is a rare coagulopathy caused by inhibitors of blood coagulation factor VIII. Patients with acquired hemophilia A have a higher mortality risk (5-10%) than those with congenital hemophilia. Moreover, there is no established evidence of management recommended for patients with acquired hemophilia A. Previous studies have reported the presence of hematomas in the oral cavities of patients with acquired hemophilia A, which were treated conservatively. Here, we describe the case of a patient with acquired hemophilia A, where emergency surgical hemostasis was required for large intraoral hematomas. CASE PRESENTATION: A 65-year-old Japanese man was referred to our hospital with a chief complaint of bleeding from large intraoral hematomas. On examination, he could not close his mouth because of the hematomas, which were bleeding spontaneously. Computed tomography angiography revealed no evidence of arteriovenous malformation, and blood test results showed that the activated partial thromboplastin time was elevated beyond the normal limit. To avoid a life-threatening hemorrhage from hematomas, emergency surgical hemostasis was performed with nasotracheal intubation using fiberoptic bronchoscopy. Hemostasis was successfully performed, as the hematomas were carefully removed. Moreover, the clinical course was successfully completed using intravenously administered activated prothrombin complex concentrate for hemostasis after operation. CONCLUSIONS: Acquired hemophilia A can cause a life-threatening hemorrhage without predictive factors. Intraoral hematoma may cause airway obstruction. There is no consensus regarding the management of hemorrhage in patients with acquired hemophilia A. As shown here, exophytic hematomas in the oral cavity can be safely removed and nasotracheal intubation with fiberoptic bronchoscopy may be useful in patients with coagulopathy disease.

A Case of Infective Endocarditis Due to Oral Streptococci After Perioperative Oral Function Management.

Infective endocarditis is an extremely serious disease that can present with a variety of clinical manifestations, including infection of valves and endocardium, in patients with cardiac disease, and is associated with risk factors such as invasive dental procedures, caries, and periodontal disease. On the other hand, it has been shown that perioperative oral function management before various surgeries, such as those for malignant tumors, cardiovascular disease, and transplantation, may prevent or reduce postoperative complications. Close coordination between the dentist and cardiac surgeon is especially necessary before heart valve surgery because of the risk of severe complications. The number of perioperative oral management procedures being performed in community dental clinics is increasing. In the absence of clear guidelines, the physician-in-charge usually determines how to best perform oral management while considering the patient's needs. We report a case of infective endocarditis occurring after perioperative oral management in a young patient with good oral hygiene. This case shows that standardization of the techniques and widespread dissemination of the guidelines are required. Patients should be counseled regarding the importance of maintaining oral hygiene from a young age. This case report should act as a cautionary tale not only for hospital clinicians but also for community medical and dental practitioners, as the number of such patients is expected to increase in the future.

Development of Antiresorptive Agent-Related Osteonecrosis of the Jaw After Dental Implant Removal: A Case Report.

Dental implant treatment is a highly predictable therapy, but when potentially lethal symptoms or complications occur, dentists must remove the implant fixture. Recently, reports on antiresorptive agent-related osteonecrosis of the jaw have increased in the field of dental implants, although the relationship between dental implant treatment and antiresorptive agents remains unclear. Here, we report a case of antiresorptive agent-related osteonecrosis of the jaw that developed after dental implant removal. A 67-year-old Japanese woman with a medical history of osteoporosis and 7 years of oral bisphosphonate treatment was referred to our hospital with a chief complaint of painful right mandibular bone exposure. A family dentist removed the dental implants from the right mandible using a trephine drill without flap elevation in August 2016. However, the healing was impaired; she was referred to our hospital 3 months after the procedure. We performed a sequestrectomy of the mandible under general anesthesia. In conclusion, this patient's course has two important implications: First, the removal of dental implants from patients who are prescribed oral bisphosphonates for long durations can cause antiresorptive agent-related osteonecrosis of the jaw. Second, meticulous procedures are required to prevent and treat the development of antiresorptive agent-related osteonecrosis of the jaw after dental implant removal.

Surgical Ciliated Cyst Following Maxillary Sinus Floor Augmentation: A Case Report.

Maxillary sinus floor augmentation is considered to play a critical role in dental implant treatment. Although many complications, such as maxillary sinusitis and infection, are well known, few reports are available on the risk of surgical ciliated cyst following the procedure. Here, we report a case of surgical ciliated cyst following maxillary sinus floor augmentation. A 55-year-old Japanese woman was referred to our hospital because of alveolar bone atrophy in the bilateral maxilla. We performed bilateral maxillary sinus floor augmentation by the lateral window technique without covering the window. The Schneiderian membrane did not perforate during the operation. She returned to our hospital after 9 years due to swelling of the left buccal region. Computerized tomography revealed a well-defined radiolucent area with radiodense border intraosseously localized in the left maxilla. We performed enucleation of the cyst with the patient under general anesthesia. Histological examination of the specimen showed a surgical ciliated cyst. In conclusion, the course of this patient has 2 important implications. First, the sinus membrane entrapped in the grafted bone without visible perforation and or tearing can develop into a surgical ciliated cyst. Second, there is a possibility that covering the lateral window tightly might prevent the development of a surgical ciliated cyst.

[Time analysis of pharmacists' home visit duties].

Pharmacists' home visit duties include accepting prescriptions, making inquiries with the attending physician, preparing medication, giving guidance on medication, going on home visits(round trips), and handling insurance claims. In the present study, we measured the time required for each duty and determined work duration per visit. The study took place during September 2013; the sample included 116 subjects and 211 home visits were conducted. Pharmacists' mean work duration per visit was 73 min and 15 s; they spent an average of 36 min and 13 s of this period on round trips involving home visits and providing guidance on medication. Pharmacists are responsible for preparing medication for outpatients; therefore, it can be assumed that they can visit patients at their homes only during the estimated 2-h period after lunch and before the commencement of outpatient service in the evening. Therefore, it is difficult for one pharmacist to visit more than five patients a day. The number of patients that each pharmacist can visit in one week(6 working days)is estimated at 25-30.

[Challenge of providing pharmaceutical products for use in home care].

Due to a rapidly aging society, the exact nature and organization of medical services in Japan are now being reviewed. Consequently, medical services have been divided into three distinct sectors; hospitalization services, outpatient services, and at-home services. In such a situation, the basic function of pharmacies is about to change radically. In this study, I report on the challenge of providing pharmaceutical products for use in home care.