International journal of oral and maxillofacial surgery
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Int J Oral Maxillofac Surg · Aug 2013
Randomized Controlled Trial Comparative StudyEffect of remifentanil on the hemodynamic responses and recovery profile of patients undergoing single jaw orthognathic surgery.
The aim of this study was to compare fentanyl-based versus remifentanil-based anesthesia with regards to the intraoperative hemodynamic stress response and recovery profiles in patients undergoing Le Fort I osteotomy. Seventeen patients were randomly divided into two groups: patients in the F-group received 2 μg/kg fentanyl intravenously followed by an infusion of 0.03-0.06 μg/kg/min, while patients in the R-group received a 0.5 μg/kg bolus of remifentanil followed by an infusion of 0.0625-0.250 μg/kg/min. Mean arterial pressure and heart rate were recorded at the following points: before anesthetic induction, at endotracheal intubation, 5 min after intubation, at incision, just before the osteotomy, during the osteotomy, during the maxillary fracturing, at suturing, at extubation, 5 min after extubation, and then 15 and 30 min postoperatively. ⋯ All measured recovery times were significantly shorter in the R-group (P<0.05). The incidence of postoperative side effects was comparable between groups. Remifentanil-based anesthesia is an appropriate alternative to fentanyl during Le Fort I orthognathic surgery; it promotes hemodynamic stability, blunts the stress response to noxious stimuli, and provides a better recovery profile.
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Int J Oral Maxillofac Surg · Jul 2013
Randomized Controlled TrialIntranasal atomized dexmedetomidine for sedation during third molar extraction.
The purpose of this study was to evaluate the intranasal use of 1.5 μg/kg atomized dexmedetomidine for sedation in patients undergoing mandibular third molar removal. Eighteen patients underwent third molar removal in two surgical sessions. Patients were randomly assigned to receive intranasal water (placebo group) or 1.5 μg/kg atomized dexmedetomidine (group D) at the first session. ⋯ Sedation values in group D were significantly different from placebo at 20-30 min, peaked at 40-50 min, and returned to placebo levels at 70-80 min after intranasal drug administration. Group D displayed decreased heart rate and systolic blood pressure, but the decreases did not exceed 20% of the baseline values. Intranasal administration of 1.5 μg/kg atomized dexmedetomidine is effective, convenient, and safe as a sedative for patients undergoing third molar extraction.
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Int J Oral Maxillofac Surg · Jul 2013
Prediction of neurosensory alterations after sagittal split ramus osteotomy.
Prediction of neurosensory deficit in the lower lip and chin after sagittal split ramus osteotomy (SSRO) is challenging. This study aimed to elucidate factors related to the development and improvement of neurosensory disturbance (NSD) after SSRO with respect to surgical procedure and the anatomical and structural characteristics of the craniomaxillofacial skeleton. Subjects comprised 50 patients treated by a single experienced surgeon. ⋯ Less than 15.0mm between the lingula and mandibular notch (relative risk, 6.7; 95% CI, 1.7-33.8) and 195.0mm(2) or more space on the medial side of the mandibular ramus (relative risk, 17.2; 95% CI, 3.9-100.4) indicated a significant risk of NSD development at 6 months postoperatively. These results suggested that the development of NSD is related to the surgical space on the medial side of the mandibular ramus and subsequent manipulation of the inferior alveolar nerve (IAN) in that region. Limited periosteal degloving prevents excessive stretching of the IAN during SSRO, thus lowering NSD incidence.
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Int J Oral Maxillofac Surg · Jul 2013
Self-reported hypoesthesia of the lower lip after sagittal split osteotomy.
Sagittal split osteotomy may result in sensory impairment of the inferior alveolar nerve; altered sensation in the lower lip varies from patient to patient. We evaluated individual and intraoperative risk factors of sagittal split osteotomy and correlated these findings with self-reported postoperative changes in lower-lip sensation. Follow-up data for 163 consecutive patients who underwent a bilateral sagittal split osteotomy were assessed for self-reported sensibility disturbances in the lower lip at the last follow-up visit. ⋯ Of 16 patients (9.9%) who experienced hypoesthesia on the right side and 25 patients (15.4%) who experienced hypoesthesia on the left side, 10 experienced bilateral hypoesthesia (31 patients total, 19.1%). Genioplasty and age at surgery were significant predictors of hypoesthesia; a 1-year increase in age at surgery increased the odds of hyposensitivity by 5%, and the odds of hypoesthesia in patients with concurrent genioplasty were 4.5 times higher than in patients without genioplasty. Detachment of the nerve at the left side, but not at the right side, was significantly correlated with hypoesthesia.
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Int J Oral Maxillofac Surg · Jun 2013
Decreased postoperative pain after reduction of fractured nasal bones using a nerve block of the anterior ethmoidal nerve.
There is consensus that all patients should experience minimal pain following reduction of a fractured nasal bone. The issue requiring further study is what technique will provide patients with the greatest pain relief following the reduction of nasal fractures. This study investigated the use of an anterior ethmoidal nerve block as preemptive analgesia for the management of postoperative pain associated with reduction of nasal bone fractures. ⋯ The rate of patients who received a postoperative analgesic injection was significantly lower in the nerve block group than in the control group (P=0.034). The use of an anterior ethmoidal nerve block and dorsal periosteal injection of anaesthetic solution during reduction of fractured nasal bones under general anaesthesia resulted in the effective reduction of postoperative pain. Thus, this is regarded as a good method for enhancing patient quality of care and compliance in the reduction of fractured nasal bones.