The Journal of craniofacial surgery
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Randomized Controlled Trial Clinical Trial
Hypotensive anesthesia and recovery of cognitive function in long-term craniofacial surgery.
The aim of our study was to compare three different anesthesiological techniques with regard to hemodynamics, recovery, and postoperative morbidity, for craniofacial surgery. One hundred twenty patients with American Society of Anesthesiologists (ASA) classification of I or II patients, 18 to 32 years old, and undergoing maxillary and mandibular osteotomies were randomly assigned to receive anesthesia with propofol-remifentanil (group P), desflurane-remifentanil (group D), or sevoflurane-remifentanil (group S). All patients were given premedication: midazolam 0.03 mg/kg, atropine 0.007 mg/kg, desametasone 0.1 mg/kg, NaCl 0.9% 100 mL + 2 mg/kg ketoprofene + 1.5 mg/kg ranitidine + 1 microg/kg clonidine. ⋯ Hypotension was successfully obtained in all three groups with a bloodless surgical field, and there was no need for additional use of a potent hypotensive agent. Early and late recovery were faster and more complete in the D group; P < 0.05. Postoperative morbidity (nausea, vomiting, shivering, pain, and edema) was slight and did not significantly differ among the groups.
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The facial nerve branches are vulnerable during manipulation of the buccal fat pad. The aim of this study is to describe the precise anatomical interrelation among the buccal fat pad, buccal branches of the facial nerve, and parotid duct. Nineteen hemifaces of Korean cadavers (11 male and 8 female) fixed in 10% formaldehyde solution were dissected. ⋯ An interrelation of parotid duct and buccal fat pad is as follows: parotid duct crossing superficial to the buccal extension of buccal fat pad in 8 of 19 (42.1%) specimens, crossing deep to the buccal extension of buccal fat pad in 5 of 19 (26.3%) specimens and crossing along the superior border of the buccal extension of buccal fat pad in 6 of 19 (31.6%) specimens. There is a 26.3% chance of injury to the buccal branch during total removal of buccal fat pad. The parotid duct runs deep to the buccal extension of buccal fat pad in 26.3% of cases.
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Case Reports
A patient of severe cervicofacial subcutaneous emphysema associated with Munchausen's syndrome.
Subcutaneous cervicofacial emphysema is an entity with the presence of air within the fascial planes of the head and neck, which results from various causes. A case of severe subcutaneous cervicofacial emphysema associated with Munchausen's syndrome is presented. ⋯ Episodes of facial swelling were prevented by psychiatric support. Munchausen's syndrome should be kept in mind among the etiological factors of subcutaneous cervicofacial emphysema cases, in whom no organic causes can be found out.