International journal of oral and maxillofacial surgery
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Int J Oral Maxillofac Surg · Jan 2014
Observational StudyPainDETECT: a suitable screening tool for neuropathic pain in patients with painful post-traumatic trigeminal nerve injuries?
The PainDETECT questionnaire (PD-Q), originally developed and validated in a multicentre study of neuropathic pain (NeP) patients with back pain, is increasingly being applied to other pain conditions. The present study assessed whether the PD-Q would be a suitable screening tool for detecting NeP in patients with post-traumatic inferior alveolar nerve injury (IANI) and lingual nerve injury (LNI). A prospective cohort of patients with clinically diagnosed neuropathy was given the PD-Q at their clinic appointment, or it was sent to them after their consultation. ⋯ Of the patients who completed the questionnaire fully (n = 56), allowing a summary score to be calculated, 34% were classified as having 'likely NeP' according to the PD-Q; 41% of patients scored in the uncertain classification range and the remaining quarter in the 'likely nociceptive' classification. There was a significant association between PD-Q scores and pain intensity levels across the sample, with those classified as likely NeP reporting high levels of pain. The results suggest that the PD-Q in its current format is not a suitable screening tool for NeP associated with IANI or LNI.
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Int J Oral Maxillofac Surg · Dec 2013
Orbital haemorrhage associated with orbital fractures in geriatric patients on antiplatelet or anticoagulant therapy.
Retrobulbar haemorrhage is a sight-threatening condition that can occur after orbital trauma. The aim of this study was to evaluate the frequency and outcome of orbital haemorrhages following orbital fractures in geriatric patients receiving anticoagulants. All patients aged 65 years or more suffering from orbital fractures between 2008 and 2009 were included in this study. ⋯ Two patients permanently lost vision, two partial recoveries and two total recoveries were observed. Patients receiving anticoagulants have a higher risk of orbital haemorrhage after orbital fracture and should be monitored closely. Any evidence of visual impairment should lead to further investigation and prompt treatment.
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Int J Oral Maxillofac Surg · Nov 2013
Comparative StudyOutcomes after tongue-lip adhesion or mandibular distraction osteogenesis in infants with Pierre Robin sequence and severe airway obstruction.
The objective was to review and compare outcomes after tongue-lip adhesion (TLA) and mandibular distraction osteogenesis (MDO) in infants with severe breathing difficulties related to Pierre Robin sequence (PRS). A single-centre retrospective (2002-2012) study was carried out; 18 infants with severe breathing difficulties related to PRS resistant to conservative treatment, who underwent TLA or MDO to correct airway obstruction, were enrolled. The primary outcome measures were successful weaning from respiratory support and resumption of full oral feeding. ⋯ The rate of complications was similar. Infants with severe airway obstruction related to PRS can benefit safely from either TLA or MDO. Although MDO lengthens the time to discharge, this option stabilizes airway patency of infants with PRS more efficiently and achieves full oral feeding more rapidly than TLA.
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Int J Oral Maxillofac Surg · Sep 2013
Randomized Controlled Trial Comparative StudyLightwand-guided nasotracheal intubation in oromaxillofacial surgery patients with anticipated difficult airways: a comparison with blind nasal intubation.
In oromaxillofacial surgery patients, the incidence of difficult airways is up to 15.4-16.9%. Blind nasal intubation remains a safe technique for difficult airway management in some remote areas where a fibreoptic bronchoscope is not always available. The lightwand is an easy-to-use, highly economical device, and can facilitate endotracheal intubation through illumination in the neck. ⋯ The total intubation time was 91.4±27.7s in the lightwand group and 130.7±33.4s in the blind group (P<0.001). Patients in the lightwand group also experienced more stable haemodynamic responses and less pharyngalgia. In conclusion, lightwand-guided nasotracheal intubation is superior to blind intubation in patients with difficult airways, with a higher success rate, more stable haemodynamic responses, and fewer postoperative complications.