Suspension and traction appliance for nasal,zygomatico-maxillary complex,and zygomatic arch fractures

The early reduction of fractures of the nasal bones, zygomatico-maxillary complex, and zygomatic arch is relatively simple in most cases. Frequently, however, patients suffer from concomitant head injuries that make immediate therapy inadvisable. Reduction after fibrosis has formed is not only difficult but often unsuccessful. Extraoral traction, suspension, supportive packing, or maxillomandibular fixation may be required in order to effect a good reduction.The traction or suspension appliances that have been used to date have been extraoral devices such as a plaster head cap, Kazanjian splint, and extraskeletal pin fixation with or without head frames.¹ The appliance to be discussed is different from those in that intraoral anchorage is used for extraoral suspension or traction.     

Comparison of sedation,amnesia, and patient comfort produced by intravenous and rectal diazepam

In a cross-over study, intravenous diazepam was compared with rectal diazepam for sedation in outpatient oral surgery. Fifty-four operations were performed on 27 patients. Recovery from sedation, experience during the postoperative course, amnesia, estimation of the sedative effect, and patient preference of method of sedation were studied. The recovery times of the sedation methods did not differ. Sedative effects after the first operation were estimated as good by 87% of patients given intravenous sedation and by 75% of those given rectal sedation. However, there was a significant relationship between the subjective experience of stronger sedative effect and preference of sedation method that favored the intravenous technique. The degree of amnesia was significantly higher during intravenous sedation, but a high degree of amnesia was not related to patients' preference for a sedation method. Neither sedation method produced any local side effects.     

The pathogenesis and microbiology of idiopathic cervicofacial abscesses

Sixty-three cases of idiopathic cervicofacial abscesses were surveyed. Several debilitating conditions, probably responsible for diminished resistance to infection, were found in association with the abscesses. The condition mainly affected children under two years of age, and the submandibular and submental regions were the most common sites of occurrence. The predominant infecting organism was Staphylococcus aureus. The abscess cavity was a statistically significant source of S. aureus, but the nose, ear, mouth, and skin did not appear to be significant sources of the pathogen. Antibiotics such as Dalacin C and gentamicin were found to be active against all the strains of S. aureus. Although incision and drainage was the most effective method of treatment for the abscesses, appropriate antibiotics may be prescribed for those cases where suppuration has not yet taken place.     

A comparison of the cardiovascular and orofacial blood flow changes resulting from hypotension induced by sodium nitroprusside and adenosine triphosphate in the rat

These experiments compared the cardiovascular effects and the alterations in orofacial blood flow resulting from hypotension induced with sodium nitroprusside and adenosine triphosphate infusions in 30 male rats. The authors found that sodium nitroprusside did not significantly change heart rate or cardiac output, while adenosine triphosphate caused a significant decrease in heart rate associated with a small increase in cardiac output. Both hypotensive agents produced similar profound decreases in total peripheral resistance. Blood flows to orofacial structures were qualitatively similar with both agents. Both adenosine triphosphate and sodium nitroprusside caused decreased flows to the maxilla and mandible. Sodium nitroprusside increased flows to masseter and suprahyoid muscles. Adenosine triphosphate caused increased flows to suprahyoid muscles but masseter muscle flows were not significantly changed. Tongue flows responded similarly to both agents, initially decreasing, then returning to normotensive levels. Finally, sodium nitroprusside-induced hypotension was associated with the development of tachyphylaxis in some animals, whereas no similar problem was observed with use of adenosine triphosphate. The demonstration of reduced blood flows to orofacial bony structures and the absence of resistance or tachyphylaxis during adenosine triphosphate-induced hypotension support its usefulness as a hypotensive agent during orthognathic and other surgery.     

Responses of periodontal tissues and cementum following transplantation of teeth

Responses of periodontal tissues, particularly cementum, were assessed histologically in teeth which had been transplanted after root formation was moderately well advanced. When the epithelial root sheath persisted, it was associated with continued root formation. In instances where the sheath disintegrated prematurely, either as a consequence of the surgery or of functional factors such as occlusal forces, normal root formation did not proceed, but there was rapid and extensive production of cellular cementum apically and along the root of the tooth. A zone of imperfect cementum formation was frequently seen between the preoperative cementum and that which developed postoperatively. Dilaceration of the tip of the root, with subsequent envelopment in a bulbous mass of cementum, commonly resulted.     

Epidermolysis bullosa dystrophica recessive: Oral surgery and anesthetic considerations

The patient with EBDR provides a unique challenge to the oral and maxillofacial surgeon and anesthesia team. After review of the literature and familiarization with the preoperative considerations, a successful and relatively atraumatic general anesthetic can be delivered in such a way that oral-facial surgery is accomplished without compromising the patient's health.     

Modified LeFort II procedure for simultaneous correction of maxillary and nasal deformities

An approach to correction of nasomaxillary dysplasia is described. Where midfacial hypoplasia is managed by surgical anteropositioning of the affected skeletal parts, this technique permits management of the associated nasal dysmorphia as well. The one-stage correction is performed with the midfacial skeleton entirely degloved, under direct vision. Details are described, and diagnostic and treatment considerations of two patients are given.     

Dental extraction in a patient with congenital deficiencies of factors V and VIII

A case of combined congenital deficiencies of factors V and VIII is reported. The patient's right mandibular first molar was extracted and a combination of local hemostatic treatment and the transfusion of fresh plasma resulted in healing of the socket without further postoperative bleeding.