The Journal of craniofacial surgery
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Randomized Controlled Trial
Anesthesia for pediatric day-case dental surgery: a study comparing the classic laryngeal mask airway with nasal trachea intubation.
To study sevoflurane inhalation general anesthesia using the laryngeal mask airway (LMA) and nasal endotracheal (ET) intubation to maintain the airway in pediatric day-case dental surgery. ⋯ Sevoflurane inhalation anesthesia through LMA is a safe and reliable method for pediatric day-case dental surgery.
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Comparative Study
Airway statuses and nasopharyngeal airway use for airway obstruction in syndromic craniosynostosis.
Syndromic craniosynostosis is associated with a high rate of respiratory difficulty, due mainly to midfacial hypoplasia. Nasopharyngeal airway establishment has been reported as the first-line approach to airway obstruction and may obviate the need for a highly invasive tracheotomy. No previous studies have compared airway obstruction status in syndromic craniosynostosis between cases requiring and not requiring airway managements. ⋯ Comparative examination of lateral x-ray cephalometry between cases with neither nasopharyngeal airway insertion nor tracheotomy and cases with one or both revealed oropharyngeal diameters tended to be smaller in those with interventions. Cases requiring nasopharyngeal airway insertion were able to continue nasopharyngeal airway use for more than 1 year and a considerable number avoided tracheotomy. It may be worth considering an oropharyngeal-bypass nasopharyngeal airway before performing a tracheotomy.
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We investigated the predictors and outcomes of aneurysmal subarachnoid hemorrhage in patients with shunt-dependent hydrocephalus and make a preliminary inquiry into the relationship between the two. ⋯ Patients who were older, with worse mental function status on admission, nosocomial meningitis, and longer duration of EVD, are susceptible to shunt-dependent hydrocephalus because of ruptured intracranial aneurysm and also have unfavorable outcomes after a V-P shunt. Timely and appropriate treatment can benefit such patients in recovery.
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Ankyloglossia, or tongue-tie, is a congenital condition characterized by a short, thickened, or abnormally tight lingual frenulum. This anomaly can cause a varying degree of reduced tongue mobility and has been associated with functional limitations including breastfeeding difficulties, atypical swallowing habits, speech articulation problems, mechanical problems such as inability to clean the oral cavity, and psychosocial stress. ⋯ The patient was managed by frenectomy by conventional method (scalpel and blade) under local anesthesia as an outpatient procedure without any complications. She later required speech therapy lessons for improvement of speech.
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Facial fractures are relatively uncommon in the pediatric population, especially those inflicted as a result of interpersonal violence in the form of gunshot injuries. Few studies have examined the unique management of such high-energy injuries in the pediatric population. Oftentimes the resultant damage to soft tissue and bony structures is so great that it challenges the previously accepted standards in the management of pediatric facial fractures. This study will examine a level 1 trauma center's experience with these unique injuries. ⋯ Pediatric facial fractures as a result of gunshot wounds represent a unique and fortunately rare entity that presents a challenge to all disciplines involved in treatment. In our patients, there was a tendency towards conservative management, with only 3 patients undergoing some form of fixation and only 7 undergoing some form of operative debridement. Concomitant injuries and the high-energy nature of gunshot wounds often preclude traditional management with rigid fixation to ensure adequate bony healing. However, it is important to adequately debride devitalized soft tissue and remove all foreign material to avoid future soft tissue-related complications.