Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
-
J. Oral Maxillofac. Surg. · Dec 2009
Randomized Controlled TrialBuprenorphine with bupivacaine for intraoral nerve blocks to provide postoperative analgesia in outpatients after minor oral surgery.
The demonstration that opioid receptors exist in the peripheral nervous system offers the possibility of providing postoperative analgesia in the ambulatory surgical patient. Over the previous decade, many investigators have studied this approach and have compared the efficacy of various opioids added to the local anesthetic near the brachial plexus; and it appears from several of these studies that buprenorphine provides the longest duration of analgesia, the most important parameter of postoperative analgesia in outpatients. One of these studies indicated that the agonist-antagonist, buprenorphine, added to bupivacaine provided a longer period of postoperative analgesia than the traditional opiates, but none of the studies was performed in patients undergoing minor oral surgery to check the efficacy of buprenorphine to provide postoperative analgesia in dental patients. The present study was undertaken to ascertain the efficacy of buprenorphine in providing prolonged postoperative analgesia when added to 0.5% bupivacaine with epinephrine 1:200,000. ⋯ The addition of buprenorphine to the local anesthetic used for intraoral nerve blocks in the present study provided a 3-fold increase in the duration of postoperative analgesia, with complete analgesia persisting 30 hours beyond the duration provided by the local anesthetic alone in 75% of patients. This practice can be of particular benefit to patients undergoing minor oral surgery by providing prolonged analgesia after discharge from the hospital.
-
J. Oral Maxillofac. Surg. · Dec 2009
Computer-assisted planning, stereolithographic modeling, and intraoperative navigation for complex orbital reconstruction: a descriptive study in a preliminary cohort.
Post-traumatic or postablative enophthalmos and diplopia and/or facial asymmetry resulting from inaccurate restoration of orbital anatomy remain relatively frequent sequellae of complex orbital reconstruction. Recently, preoperative computer-assisted planning with virtual correction and construction of stereolithographic models have been combined with intraoperative navigation in an attempt to more accurately reconstruct the bony orbit and optimize treatment outcomes. The purpose of the present study is to review the authors' early experience with computer planning, stereolithographic modeling, and intraoperative navigation in a series of patients who underwent surgical treatment for a variety of complex post-traumatic and postablative orbital deformities. ⋯ Preoperative computer modeling and intraoperative navigation provides a useful guide for and presumably more accurate reconstruction of complex orbital injuries and postablative orbital defects. Although probably not necessary for routine use in small orbital blowout fractures, its use in a shattered orbit or high-velocity injury resulting in severe disruption of the internal and external orbit shows promise.
-
J. Oral Maxillofac. Surg. · Dec 2009
Effect of surgical drill guide on heat generated from implant drilling.
The purpose of this study was to evaluate the heat generated in bone by 2 implant drill systems in vitro with and without using surgical drill guides. ⋯ From a heat generation standpoint, we conclude that preparing an implant site with using surgical drill guides generates heat more than classical implant site preparation regardless of the irrigation type.