Evaluation of pressure-controlled ventilation concepts during cardiopulmonary resuscitation (CPR) in dental chairs.

BACKGROUND: Infrequent training of lay rescuers in cardiopulmonary resuscitation may lead to stomach inflation during ventilation of the unsecured airway. This is caused by a pressure loss of the lower oesophageal sphincter (LOSP) after onset of cardiac arrest. To minimise the risk of stomach inflation, the SMART BAG® (SB), a disposable flow-limited bag-valve-mask resuscitator, has been designed. Aim The aim of this study was to evaluate the occurrence of stomach inflation by use of SB in comparison to two other ventilation devices with respect to the ventilation capability. METHOD: An Easy Grip® disposable bag-valve-mask resuscitator (EG), an SB and an EG with an interposed T-piece attached to a 0.5 l reservoir bag (EG/R) were compared in a manikin ventilation training setting. Fourteen dentists performed ventilations on a Mini Ventilation Training Analyzer using EG, SB and EG/R with lung compliance (LC) and LOSP being adjusted to 700 ml/kPa and 1.5 kPa (best case) and 500 ml/kPa and 0.5 kPa (worst case) in a randomised order. RESULTS: Sufficient tidal volumes were obtained by use of all the three test devices regardless of LC or LOSP. No statistical differences were detected between the use of SB and EG/R. Using EG led to statistically larger volumes. Stomach inflation could only be avoided using SB and EG/R at a high LOSP regardless of LC. CONCLUSION: Even in the worst case scenario, use of SB and EG/R administered sufficient tidal volumes with a significantly smaller stomach inflation compared to EG. Combination of standard bag-valve devices with a reservoir bag may provide similar protection from gastric inflation as the SMART BAG®.

Late sequelae after high midface trauma.

The upper midface area comprises mainly the naso-orbito-ethmoidal (NOE) region which plays a paramount role in facial expression. Fractures of this area often result in neglected bony defects in the fragile periorbital region with major secondary impairments such as traumatic telecanthus, orbital dystopia, and/or enophthalmos. Permanent cranial nerve deficits also can occur as the result of post-traumatic/post-operative sequelae. Seventy-one patients (age range 7-78 years) with severe high midface trauma, treated from January 1989 to December 1996, were reviewed with a minimum follow-up of 2 years. The patient population has been distributed according to the fracture type in three groups: Group 1 (n = 35): Isolated NOE with/without associated central midface injury; Group 2 (n = 22): NOE associated with craniofacial injury and Group 3 (n = 14): NOE associated with orbital displacement. The estimated post-surgical parameters included qualitative and quantitative data from the long-term clinical evaluation. Persistent headache and/or concentration difficulties were mainly noted in Group 1. Smell reduction or anosmia was reported mainly in Group 2. Deficits of the trigeminal and/or the facial nerve were found in Group 3. Enophthalmos and/or telecanthus were predominantly seen with injuries associated with orbital displacement.

Primary chronic osteomyelitis in childhood and adolescence: a retrospective analysis of 11 cases and review of the literature.

PURPOSE: Primary chronic osteomyelitis (PCO) of the jaw is a rare, nonsuppurative, chronic inflammation of an unknown cause. The disease is not age specific. So far, only case reports of this disease with an onset in childhood or adolescence have been described. PATIENTS AND METHODS: Review of the patient data of our department from the past 30 years revealed 11 patients with an early onset of PCO in childhood and during puberty. RESULTS: Demographic data, clinical course, radiologic and histologic examinations, and treatment modalities are described and compared with the literature with special emphasis on the somewhat confusing terminology used for this pathology. CONCLUSION: We present a group of 11 patients with an early onset of PCO of the mandible, which, to our knowledge, is the largest described series to date. The series shows the complexity of this disease in a young patient population, demanding a careful evaluation of each case before initiation of therapy.