Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
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J. Oral Maxillofac. Surg. · Jan 1998
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialThe accuracy of clinical neurosensory testing for nerve injury diagnosis.
The accuracy of the clinical neurosensory test to diagnose trigeminal nerve injuries has never been statistically evaluated. The purpose of this study was to determine the statistical efficacy of the clinical neurosensory test using surgical findings as the "gold" standard, and to determine whether a correlation existed between the sensory impairment score obtained by preoperative testing and the degree of nerve injury found at surgery. ⋯ The NST is a clinically useful method to diagnose IAN and LN injuries. However, the NST results are less efficient for IAN injuries than LN injuries, and have a high incidence of false-positive (23%) and false-negative (40%) results when testing patients with IAN injuries. The different rates of statistical efficiency between the two groups of patients may be attributable to differences in prevalence and biologic covariates.
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J. Oral Maxillofac. Surg. · Dec 1997
Diagnosis and management of blunt carotid artery injury in oral and maxillofacial surgery.
Traumatic occlusion of the internal carotid artery (ICA) is a rare complication of maxillofacial trauma or surgery. This investigation evaluated patient demographics, diagnostic methods, and effective therapeutic modalities associated with blunt carotid injury (BCI). ⋯ BCI is an uncommon entity. It is usually recognized when a patient develops an unexplained neurologic deficit, most often hemiplegia, subsequent to trauma or surgery of the head, face, or neck. In the early stages, the diagnosis can be missed by carotid ultrasound or computed tomography. The injury is unrelated to Glasgow Coma Scale score. Symptoms may not develop for days after injury in 50% of patients. Anticoagulation appears to be the most beneficial therapeutic modality.
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J. Oral Maxillofac. Surg. · Dec 1997
ReviewAlcohol withdrawal syndrome: current management strategies for the surgery patient.
As advances in the therapeutic management of alcohol withdrawal syndrome occur, oral and maxillofacial surgeons should be aware of the current treatment philosophies and modalities. This article provides a comprehensive review of alcohol withdrawal syndrome and presents some of the current management strategies that can be used for these patients, whether it be in the office or in the hospital.
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J. Oral Maxillofac. Surg. · Dec 1997
Comparative StudyBreathing patterns and levels of consciousness in children during administration of nitrous oxide after oral midazolam premedication.
The combination of midazolam and nitrous oxide is commonly used to achieve sedation and analgesia during pediatric oral procedures, yet there are few, if any, data that illustrate the ventilatory effects of N2O in children, especially when used in combination with additional central nervous system (CNS) depressants. It was hypothesized that the addition of N2O inhalation to oral midazolam premedication would enhance the sedative effects of the midazolam and add analgesia without causing significant respiratory depression. The purpose of this study was to test this hypothesis. ⋯ The addition of 40% N2O to oral midazolam, 0.7 mg/kg, did not result in clinically meaningful respiratory depression nor upper airway obstruction, but did, in some children, cause an increase in the level of sedation beyond simple conscious sedation.
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J. Oral Maxillofac. Surg. · Dec 1997
The free fibula bone graft for salvaging failed mandibular reconstructions.
The purpose of this study was to determine the efficacy of vascularized free fibula bone grafts for mandibular salvage reconstruction. ⋯ When the initial attempt at mandibular reconstruction is unsuccessful, mandibular function and esthetics can be salvaged with reliable vascularized soft tissue and bone flaps. As long as appropriate flap options are considered and the patient is medically stable, successful mandibular reconstruction should be achievable despite the number or cause of prior failed attempts.