International journal of oral and maxillofacial surgery
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Int J Oral Maxillofac Surg · Oct 2009
Free-flap failures and complications in an American oral and maxillofacial surgery unit.
Free tissue transfer is a reliable surgical technique that enables primary reconstruction following ablative surgery. Widely practised in many European units, acceptance into mainstream oral and maxillofacial surgery in the USA has been slow. The authors reviewed free flap practice patterns and outcomes in a US oral and maxillofacial surgery training program with specific emphasis on failures and complications to illustrate obstacles encountered during the initial phase of practice implementation. ⋯ Prolonged hospital stay and ICU utilization was observed in patients with surgical complications. Complications in this study did not affect the overall success rates of free-flaps. Salvage rates from thrombotic events were unaffected despite rigid flap monitoring protocols.
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Int J Oral Maxillofac Surg · Oct 2009
Randomized Controlled TrialUse of nasal packs and intranasal septal splints following septoplasty.
The aim of this study was to compare the efficacy of a trans-septum suturing technique with conventional nasal packing and intranasal splints in the classic septoplasty operation. The study is a prospective, randomized clinical trial. 114 patients underwent septoplasty for septal deviation and ensuing nasal obstruction. These patients were divided into two groups: packing (using intranasal septal splints and antibiotic meshes at the end of the operation) and non-packing (using four separate trans-septum through and through horizontal mattress sutures without any mesh or intranasal splint insertion). ⋯ Patients were asked to record pain levels using a visual analogue scale. The authors found no significant statistical differences between the two groups in the parameters studied, but significantly higher pain levels were noted in the patients in the packing group. The final results confirmed that patients who underwent septoplasty, intranasal packing and septal splint insertion did not benefit more than those who had trans-septum through and through suturing.
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Int J Oral Maxillofac Surg · Aug 2009
Comparative StudyDevelopment of a tracheostomy scoring system to guide airway management after major head and neck surgery.
The use of elective tracheostomy in major head and neck surgery is well established, although practice varies between units. There is no published method that reliably predicts the need for tracheostomy. ⋯ These procedures were grouped according to the airway management plan in place at the end of the procedure: elective extubation (group E, 52 procedures, 50 patients); elective overnight ventilation via an endotracheal tube (group ETT, 55 procedures, 52 patients); and elective overnight ventilation via a tracheostomy (group T, 41 procedures, 41 patients). 8 patients from group ETT required a late tracheostomy for either medical or surgical indications. Using statistical methods, a threshold score was defined above which the high risk of upper airway obstruction should prompt consideration of an elective tracheostomy.
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Int J Oral Maxillofac Surg · Jun 2009
Clinical observations of postoperative delirium after surgery for oral carcinoma.
The aim of the present study was to clarify the clinical characteristics of postoperative delirium and to determine appropriate postoperative management for its prevention. The authors analysed 132 cases of primary surgery for oral carcinoma and observed 24 (18%) cases of postoperative delirium. Univariate analysis revealed that significant risk factors for postoperative delirium were older age, male gender, extensive surgery and morphine pain control. ⋯ There was a trend for postoperative delirium to be associated with extensive surgery. In those who had delirium, blood tests revealed that alkaline phosphatase, total protein, sodium, chlorine, red blood cell count, haemoglobin and haematocrit were significantly diminished after surgery. These results indicate that general condition is closely related to the onset of postoperative delirium, and suggest that appropriate postoperative management can reduce the incidence of this complication.
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Int J Oral Maxillofac Surg · Jun 2009
Gold weight implants in the management of paralytic lagophthalmos.
Lagophthalmos secondary to facial nerve damage can lead to corneal exposure and eventually blindness. Appropriate management depends on the severity and likely duration of recovery. Upper eyelid gold implants play an important role in the medium and long term management of this condition. ⋯ The mean weight of the implant was 0.95 g. There were no intraoperative or immediate postoperative complications. One implant (6%) was extruded and one patient (6%) had residual lagophthalmos and required a heavier implant. 15 of the 16 patients were satisfied with the outcome and all had adequate lid closure at last follow up.