The Journal of craniofacial surgery
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Randomized Controlled Trial Comparative Study
Effects of lidocaine infiltration on cost of rhinoplasty made under general anesthesia.
This study aimed to compare the effects of combined and noncombined lidocaine with adrenaline infiltration in general anesthesia (GA) procedures, in which the standard anesthesia depth is monitored by Bispectral Index monitoring, on minimum alveolar concentration (MAC) levels and the costs. Following approval by the local ethics committee, an American Society of Anesthesiologists physical status I–II group of 40 adult patients for whom elective rhinoplasties under GA were planned was divided into 2 double-blind randomized groups. In group 1, GA and lidocaine + adrenaline were administered, whereas in group 2, only GA and adrenaline were administered. ⋯ In group 1, the MAC% was 20.83% lower than that of group 2; the consumed desflurane amount was 20.29%, and the cost was 20.29% lower than that of group 2 (P < 0.05). In rhinoplasties under GA, the lidocaine + adrenaline combination infiltration not only decreased inhaled anesthetic requirement and cost but also supported the hemodynamic stability. In addition, surgical satisfaction increased in the lidocaine + adrenaline group because of small number of agitated patients during the recovery period.
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Parry-Romberg syndrome or progressive facial hemiatrophy is a rare clinical entity of an unknown etiology. We present the case of a 57-year-old Chinese woman with Parry-Romberg syndrome and hemifacial spasm both on the right side. ⋯ In our report of Parry-Romberg syndrome with hemifacial spasm, we try to explore whether there were some relations between the 2 diseases. We found an offending vessel compressing the root exit zone of the facial nerve and no evidence of vessel compression at ipsilateral trigeminal nerve motor rootlet.
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Defects on the craniofacial complex may result in aesthetic defects, functional damage, and psychologic consequences. Previously, surgeons showed no interest in reconstructing the operated area, but in the treatment of the problem, leaving bone contour is a secondary issue. Nowadays, area reconstruction with post-reestablishment of contour and local shape has become one of the surgeon's priorities. ⋯ Polyether ether ketone (PEEK) is a potential candidate because it is a linear polyaromatic semicrystalline polymer that combines strength, stiffness, durability, and resistance. Polyether ether ketone biocompatibility has been supported in literature, and subsequent medical applications of the material have been observed. The aim of this study was to describe a case of frontal bone defect reconstruction in which the PEEK was used as polymer material in a specific implant for the Synthes (PEEK-PSI) patient.
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Case Reports
Paradoxical herniation in wartime penetrating brain injury with concomitant skull-base trauma.
A case of the syndrome of the trephined progressing to paradoxical herniation is presented in a patient with a penetrating brain injury, postdecompressive craniectomy, and a delayed cerebral spinal fluid leak from a skull base defect. The patient had a penetrating head trauma from a high-velocity ballistic projectile during military wartime operations. The patient's clinical course, which demonstrates a rare presentation of central sleep apnea syndrome or Ondine's curse, is reviewed. ⋯ Medical management was directed at increasing the intracranial pressures (ICPs) by placing the patient into Trendelenburg position and increasing hydration. Surgical intervention involved correction of the skull base defect by intranasal endoscopic repair. A literature review of paradoxical herniation and delayed neurologic decline in postcraniectomy patients is conducted, and the surgical and neurocritical care management is discussed.
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The aim of this prospective study was to evaluate and compare the epidemiology and pattern of maxillofacial injuries caused by stumbling and other kinds of falls. We evaluated all patients with facial injuries due to stumbling or falls who presented to Besat Hospital in Hamedan, Iran, during the 2.5-year study period and analyzed the acquired data. Of 2990 patients with facial injuries who were referred to Besat Hospital during the study period, 733 (24.5%) were injured by stumbling, and 246 (8.2%) were injured by falls. ⋯ The rate of associated injuries in falls was higher than stumbling accidents. We concluded that the incidence, age distribution, rate, and pattern of bone fractures and the frequency and type of associated injuries in stumbling accidents were significantly different from that of fall accidents. For a good program planning to prevent and manage facial injuries, we recommend separate evaluation of stumbling and fall accidents.