The British journal of oral & maxillofacial surgery
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Br J Oral Maxillofac Surg · Dec 2013
Case ReportsManagement of airway and feeding difficulties in a neonate with Pierre Robin sequence: a case report.
Pierre Robin sequence is a congenital disorder that affects neonates, and is characterised by the classic triad of micrognathia, glossoptosis, and cleft of the secondary palate. We present the case of a child with Pierre Robin sequence who had severe respiratory distress and feeding problems, and describe a simple technique for forward traction of the mandible to relieve the respiratory distress and activate the tongue.
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Br J Oral Maxillofac Surg · Dec 2013
Observational StudyComputer-assisted orthognathic surgery: waferless maxillary positioning, versatility, and accuracy of an image-guided visualisation display.
There may well be a shift towards 3-dimensional orthognathic surgery when virtual surgical planning can be applied clinically. We present a computer-assisted protocol that uses surgical navigation supplemented by an interactive image-guided visualisation display (IGVD) to transfer virtual maxillary planning precisely. The aim of this study was to analyse its accuracy and versatility in vivo. ⋯ Seven hard tissue variables were chosen to compare (ΔT1-T0) the virtual maxillary planning (T0) with the postoperative result (T1) using 3-dimensional cephalometry. Clinically acceptable precision for the surgical planning transfer of the maxilla (<0.35 mm) was seen in the anteroposterior and mediolateral angles, and in relation to the skull base (<0.35°), and marginal precision was seen in the orthogonal dimension (<0.64 mm). An interactive IGV display complemented surgical navigation, augmented virtual and real-time reality, and provided a precise technique of waferless stereotactic maxillary positioning, which may offer an alternative approach to the use of arbitrary splints and 2-dimensional orthognathic planning.
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Br J Oral Maxillofac Surg · Sep 2013
Reducing the need for general anaesthesia in children: use of LAT gel in treating facial lacerations.
Facial lacerations in children are common emergencies that often require debridement and closure under general anaesthesia because of poor cooperation by the patient. General anaesthesia in children is not without risk so any technique that avoids its use is beneficial. LAT gel (lidocaine, adrenaline, and tetracaine) is a topical anaesthetic, which is ideal for suturing facial lacerations in children. In our experience its use has resulted in the effective treatment of these injuries, and has reduced distress and discomfort, and the need for hospital admission and general anaesthesia.
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Br J Oral Maxillofac Surg · Jul 2013
Oncological and functional outcomes of transoral robotic surgery for oropharyngeal cancer.
In this prospective study we analysed the oncological and functional results of transoral robotic surgery (TORS) to find out if it was suitable as a minimally invasive treatment for oropharyngeal cancer. Between April 2008 and September 2011, 39 patients with oropharyngeal cancer were treated by TORS. We assessed overall and disease-free survival by the Kaplan-Meier test, and we used videopharyngography and the functional outcome swallowing scale (FOSS) to evaluate swallowing. ⋯ Voices were maintained close to the normal range on the acoustic waveform analysis. The oncological and functional results of TORS were quite acceptable for the treatment of oropharyngeal cancer. TORS is a valid treatment for selected patients with oropharyngeal cancer.
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Br J Oral Maxillofac Surg · Jul 2013
Randomized Controlled Trial Comparative StudyComparison of dexmedetomidine and midazolam for conscious sedation in dental surgery monitored by bispectral index.
Although various sedative drugs in different regimens and given by different delivery routes have been used for conscious sedation, the ideal agent and regimen remain to be established. This study was designed to compare the efficacy (sedation, anxiolysis, analgesia, operating conditions, and patients' satisfaction) and safety of midazolam and dexmedetomidine as sedatives for dental procedures in a randomised, double-blind study in third molar and dental implant surgery. Sixty healthy patients who were American Society of Anesthesiologists (ASA) group I or II were enrolled and we recorded their personal details, the amount of drug used, their degree of satisfaction, duration of operation, and haemodynamic and respiratory variables. ⋯ The patients in the dexmedetomidine group had a slower heart rate, lower systolic and diastolic pressure, and cooperated better. There were no significant differences in their respiratory rates, bispectral index, and total volume of drugs used. We conclude that dexmedetomidine works as well as midazolam for outpatient dental procedures and can be used as an alternative to midazolam.