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. · Oct 2008
Comparative Study Controlled Clinical TrialComparison of methohexital and propofol use in ambulatory procedures in oral and maxillofacial surgery.
Short-acting anesthetic agents, such as propofol and methohexital, are commonly used for ambulatory procedures in the practices of oral and maxillofacial surgeons (OMS). This study compares the safety and anesthetic outcomes of propofol and methohexital. In addition, the study compares the safety and outcomes of these agents when administered either by an OMS who simultaneously provides anesthesia and performs the procedure (anesthetist/surgeon), or by a non-OMS provider of anesthesia (anesthesiologist or certified registered nurse anesthetist; CRNA) whose sole obligation is to provide anesthesia. ⋯ There is a statistically significant increase in adverse events related to methohexital compared with propofol or benzodiazepine/narcotics for anesthesia. Propofol appears to have the lowest risk for adverse events. There is no statistically significant difference in the number of adverse outcomes between the administration of propofol for ambulatory surgery by OMS as an anesthetist/surgeon and anesthesiologist/nurse anesthetist. It remains critical that our specialty maintains the highest standards, to provide safe anesthesia and to reduce adverse anesthetic events.
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J. Oral Maxillofac. Surg. · Oct 2008
A biomechanical evaluation of plating techniques used for reconstructing mandibular symphysis/parasymphysis fractures.
The purpose of this investigation was to evaluate and compare the biomechanical behavior of 5 different methods used to repair mandibular symphysis/parasymphysis fractures. ⋯ Although statistically significant differences were noted between each of the fixation systems in their abilities to resist loads under the conditions tested, when placed in the context of functional parameters, all systems met the requirements for incisal edge loading. When molar loading was considered, the lag screw technique performed more favorably than the other systems.
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The fear of excessive bleeding often prompts the physician to stop long-term, low-dose antiplatelet therapy before any surgical procedure. This may put the patient at risk of an adverse thromboembolic event. We undertook an assessment of the incidence of prolonged postoperative bleeding after dental extractions among patients on uninterrupted antiplatelet therapy, and evaluated the need to stop such medications before dental extractions. ⋯ Routine dental extractions can be safely performed in patients on long-term antiplatelet medication, with no interruption or alteration of their medication. Such patients do not have an increased risk of prolonged or excessive postoperative bleeding.
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J. Oral Maxillofac. Surg. · Oct 2008
Algorithm for head computed tomography imaging in patients with mandible fractures.
Trauma to the mandible can potentially increase our predictive accuracy for intracranial injuries (ICIs) because of the mandible's strength, anatomic proximity, and direct connection to the skull base. Our goals were to: 1) investigate the association of mandible fractures with traumatic brain injury (TBI) and intracranial lesions (ICLs); and 2) determine predictors of ICIs in a level 1 Canadian trauma center with distinct patient demographics and fracture etiologies. ⋯ Some authors have advocated treating mandible fractures on an outpatient basis, with a focused workup. Our results of significant concomitant ICI in mandible-fracture patients, conversely, suggest that such management may inadvertently result in the oversight of potentially life-threatening injuries. Thus, we recommend mandatory intracranial CT imaging if the patient's neurologic status at time of injury is unknown or meets the criteria of TBI, or if positive predictors for ICL are present.
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J. Oral Maxillofac. Surg. · Oct 2008
Is the use of arch bars or interdental wire fixation necessary for successful outcomes in the open reduction and internal fixation of mandibular angle fractures?
The purpose of this retrospective cohort study was to analyze the complications associated with a series of mandibular angle fractures treated by open reduction and internal fixation and to determine if the method of intraoperative maxillomandibular fixation (MMF) affected patient outcome. ⋯ The use of Erich arch bars or interdental wire fixation to assist with MMF during the open reduction and internal fixation of noncomminuted mandibular angle fractures treated in Champy fashion is not always necessary for successful outcome.