Outpatient anesthesia in oral and maxillofacial surgery.

An integral part of the specialty of oral and maxillofacial surgery is intra-operative anxiety and pain control with the use of inhalation and intravenous agents. The safety of these agents when used by trained practitioners and staff in properly equipped facilities is well-documented. The purpose of this article is to review the most common sedative agents currently used in the oral and maxillofacial surgery outpatient setting.

CT findings after laparoscopic pelvic lymph node dissection and transperineal radioactive seed implantation for prostatic carcinoma.

OBJECTIVE: The purpose of this paper is to describe the CT findings in patients undergoing transperineal sonographically guided radioactive seed implantation with and without laparoscopic lymph node dissection for treatment of carcinoma of the prostate gland. MATERIALS AND METHODS: Ninety-six CT scans of the pelvis were retrospectively reviewed in patients who had undergone radioactive seed implantation of the prostate gland. The CT readings were correlated with the type of procedure each patient had and the pathologic results of laparoscopic lymph node dissection. RESULTS: Of 73 patients who underwent laparoscopic lymph node dissection, 42 were found at CT to have low-attenuation masses along lymph node chains. These masses resembled necrotic nodes. Only one patient who did not undergo laparoscopic lymph node dissection had similar findings. Fourteen patients had fluid collections within the pelvis, 13 of whom had undergone laparoscopic lymph node dissection. Other imaging findings included ectopic seeds (10 patients) and subcutaneous and intrapelvic air (11 patients). All except two patients had negative pathology reports for the removed lymph nodes. CONCLUSION: A wide variety of imaging findings may be seen after radioactive seed implantation and laparoscopic lymph node dissection, including masses that resemble necrotic lymph nodes. Radiologists should be aware of these findings in asymptomatic patients.

Evaluation of the substantivity of a chlorhexidine oral rinse in irradiated head and neck cancer patients.

A trial was conducted to evaluate the substantivity of chlorhexidine in a population of patients who had undergone primary or adjunctive radiation therapy for tumors of the head and neck. Subjects were instructed to first rinse with 0.12% chlorhexidine as per manufacturer instructions, followed by a releasing rinse provided 1 minute, 1 hour, and 4 hours later. All expectorants were collected, pH adjusted, and introduced to the test microorganism. Zones of bacterial inhibition were then measured and recorded. The results suggest that 0.12% chlorhexidine is retained in the oral cavity for at least 4 hours after an initial rinsing and that the property of substantivity remains active in spite of radiation-induced changes in the oral cavity and salivary glands.

Splint appliance for the management of posttrauma lip deformities: technical note and case reports.

Trauma sustained to the commissures of the lips will result in perioral tissue deficits. Without intervention, this will lead to functional and esthetic deformities. Splinting devices have proven to be an effective and economical means of treatment. Reviews have appeared in the literature describing techniques and treatment regimens for the use of such oral commissure splints. Each has specific advantages and disadvantages in application. A variation of these previously described splints now in use at the University of Chicago Hospitals is presented. Three case histories are presented with discussion of the uses and advantages of this appliance.

A dentofacial deformity associated with incontinentia pigmenti: report of a case.

A case of IP in a 16-year-old girl has been presented. This patient manifested classic ectodermal and mesodermal anomalies. We present this case to illustrate a rare etiologic factor in the development of dentofacial deformities that can be treated in the conventional manner.

Tumoral calcinosis with unusual dental radiographic findings.

Tumor calcinosis is a rare disease of unknown cause, manifesting itself as abnormal calcifications of cystic masses in the fibrous tissues adjacent to, but not involving, the joint spaces. A family with multiple siblings affected by tumoral calcinosis and found to have unusual dental radiographic findings consistent with varying degrees of expression of dentinal dysplasia is described.

Osteomyelitis of the mandible.

The presenting characteristics and clinical courses of 60 patients with mandibular bone infections are described. Fifteen of the patients had posttraumatic osteomyelitis, 13 had odontogenic osteomyelitis, and 28 had osteoradionecrosis. Most infections (93%) were polymicrobial, and anaerobes played an important role. Types of surgical procedures and use of adjunctive hyperbaric oxygen are described. There were minimal differences in presentation or response to treatment between these four different groups. A clinical staging system for mandibular bone infections is proposed and results of treatment are retrospectively analyzed by stage. The results support the concept that initial treatment planning can be safely and successfully based on the stage of the disease.