The British journal of oral & maxillofacial surgery
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Br J Oral Maxillofac Surg · Aug 2004
Preoperative vascular assessment of the lower limb for harvest of a fibular flap: the views of vascular surgeons in the United Kingdom.
Adequate preoperative vascular assessment of the lower limb is essential before harvesting fibular free flaps to prevent ischaemic complications or failure of the flap. The best method of assessment remains controversial. Clinical examination, conventional angiography, colour flow Doppler, and magnetic resonance angiography have all been advocated. ⋯ All respondents thought that further imaging should be done in addition to clinical examination, most of whom (n = 70) favoured colour flow Doppler (82%). In addition 75 (88%) considered that the surgeon would be judged to be negligent if clinical examination was the only preoperative assessment. In the light of these findings, we suggest that an objective assessment of the vasculature of the leg should be obtained before a fibular flap is harvested.
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Br J Oral Maxillofac Surg · Aug 2004
Randomized Controlled Trial Clinical TrialA double-blind randomised controlled clinical trial of the effect of preoperative ibuprofen, diclofenac, paracetamol with codeine and placebo tablets for relief of postoperative pain after removal of impacted third molars.
We conducted a randomised double-blind placebo-controlled single-centre study to compare the effect of preoperative ibuprofen 600 mg, diclofenac 100 mg, paracetamol 1 g with codeine 60 mg or placebo (Vitamin C 50 mg) tablets for relief of postoperative pain in 119 patients who had day case operations under general anaesthesia for removal of impacted third molars. Patients were given the tablets 1 h before operation. Pain was assessed using visual analogue scales and verbal rating scales preoperatively at 15 and 30 min and 1 and 3 h postoperatively. ⋯ There was no significant difference in the extent of postoperative pain among the four groups, but the placebo group had significantly shorter times before their first request for postoperative analgesics (median 17 min, range 14-90) than the diclofenac group (median 32, range 15-150). Preoperative analgesics at the stated doses are effective in providing immediate postoperative pain control after operations on third molars. There were, however, some side-effects including nausea, vomiting, headaches, and gastrointestinal discomfort, but there were no significant differences among the active analgesic groups with respect to adverse events either shortly after operation or at 6 or 24 h.
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Br J Oral Maxillofac Surg · Aug 2004
Comparative StudyComparison of the healing process in plated and non-plated fractures of the mandible in rats.
We compared the healing process of plated and non-plated fractures. The mandibles of 72 male Wistar rats were fractured and more either plated or not plated (n = 36 in each group). The healing process of the two conditions was studied histologically and immunohistochemically using a specific antibody to bone morphogenetic protein-2 (BMP-2). ⋯ Trauma to the surrounding soft tissues affected the healing process. BMP-2 was expressed at all stages in both groups. We conclude that the healing process is disturbed by the fixing of a plate; that periosteum is one of the main sources of osteogenic cells; and that BMP-2 is an important regulator of morphogenesis.