Pain control after third molar surgery--a comparative study of ibuprofen (Ibumetin) and a paracetamol/codeine combination (Citodon).

Two analgesics commonly used in oral surgery, ibuprofen (Ibumetin) and a paracetamol/codeine combination (Citodon) have been compared in a single-blind multi-centre trial after third molar surgery. The study comprised 120 patients, 60 in each treatment group. The profiles of postoperative pain in the two groups were similar from the first postoperative day, but Ibumetin was better pain reliever on the day of surgery. The profiles of postoperative swelling and trismus had the same general course, but patients taking Ibumetin reported lower scores for these variables during the whole postoperative period. Citodon induced significantly more side-effects than Ibumetin.     

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骨性畸形在牙颌面畸形中占有相当高的比例,许多患者要通过正颌手术治疗.通常患者首诊到正畸科、颌面外科(整形外科、正颌外科).是否要行正颌手术治疗往往要取决于正畸科是否能通过代偿正畸治疗解决问题.若代偿矫治的结果能使患者和医生都满意,则患者可以避免更复杂、风险更大的正颌手术治疗;若患者的要求很高(可能是美观方面)或畸形非常严重,单纯正畸治疗已不能很好地解决患者对颌面部美观和功能恢复的要求,正颌手术就是惟一正确的选择、目前,在正畸和手术联合治疗开展比较好的医疗单位,是否手术以及手术如何设计几乎是由正畸医生主导.所以,这就要求正畸医生除了要全面掌握骨性牙颌面畸形术前、术后正畸治疗的理论和临床技能外,还要比较透彻地了解各种正颌手术术式、手术的最大限度、术前术后正畸、(牙合)板制作等方面知识.本文将结合临床实际,就几个正畸和手术联合治疗的重要问题进行讨论,重点在各种畸形正颌手术的术式选择策略,正畸和手术联合治疗的术前、术后正畸治疗原则等.     

Experiencing your own orthognathic surgery: A personal case report

There has been much research on minimizing the side effects of orthognathic surgery. However, there are very few doctors and researchers who themselves have undergone this surgery. This case report describes the findings of a maxillofacial surgeon who underwent combined orthodontic and orthognathic treatment for correction of Class II malocclusion. In March 2012, the surgeon was referred to an orthodontist, and an orthodontic examination revealed a Class II, division 2, malocclusion with a traumatic palatal bite and attrition of the lower front teeth. The patient underwent alignment of the upper and lower arches, followed by a bilateral sagittal split osteotomy. During this treatment, he made many interesting observations and learned much as a patient, which can have implications in improving the outcomes and quality of care for patients receiving such treatment. Thus, this case report aims to provide a critical perspective of the surgical procedure and treatment from the viewpoint of a maxillofacial surgeon who himself experienced the surgery as a patient.     

Stereophotographic measurement of change in facial soft tissue morphology following surgery

Changes in soft tissue morphology induced by surgery are generally analysed using midline profiles only, derived from photographs and cephalometric radiographs. Full face photographs supplement these records. Soft tissues and their changes can be measured in three dimensions using stereophotography. This report described how the three dimensional changes produced by facial surgery were measured for a patient undergoing surgery to the mandible.     

Estimating the time and personnel required to treat periodontal disease

Abstract A study was undertaken to estimate the time taken to carry out the common periodontal treatments. Patients attending a university dental hospital were followed up until the end of their periodontal treatment. The average patient reqtuired 3.1 hours of treatment spread over 9.3 ± 3.9 visits. The largest proportion of the time was for doing scaling (39.3 %) - that took 72.8 ± 41.0 minutes per patient. Patient education took 30.2 % of the time - 55.9 ± 21.8 min per patient, examination 18.5 % (26.2 ± 17.3 min) and surgery 11.6 % (21.4 ± 46.3 min per patient). As the number of patients requiring surgery was small, timings of surgery were done on additional groups of patients. The 75 surgical procedures took 51.9 ± 29.7 min each - an average of 14.3 ± 12 min per tooth. Most of the periodontal treatment was done by auxiliaries; they carried out 68.5 % of treatment (education, scahng and charting), whilst the dentists carried out the examinations and the surgery. The treatment of 60 patients at an industrial clinic was timed. Education took 8.0 ± 4,7 min and scaling and polish, 26.7 ± 16.1 min per patient. The examination time increased with increased severity of disease; patient education increased with increases in debris scores and periodontal scores; the scale and polish time increased with increasing debris, calculus and periodontal scores. The number of visits increased with increases in debris, calculus and periodontal scores. The results indicate that commonly used periodontal indices can be used to estimate treatment times and types of personnel required.     

老年颌面外科病人并存心脑血管病的处理

目的：探讨老年颌面外科病人并存心脑血管病的处理。方法：分析我院2000年1月-2009年2月治疗73例老年颌面外科患者的资料，其中43例并存心脑血管疾病为治疗组，无心脑血管疾病30例为对照组。结果：73例患者均安全渡过麻醉及手术，治疗组术后并发症15例次，发生率34．88％。而30例无心脑血管病的患者术后发生并发症4例，发生率13．33％。并发症发生率与对照组有显著性差异（P〈0．05）。结论：对老年颌面外科病人并存心脑血管病者，应加强围手术期管理，积极治疗并存病，可以耐受较复杂的颌面外科手术。     

External carotid artery pseudoaneurysm following microvascular free flap reconstruction. The role of endovascular thrombin injection in embolization: a case report and review

Pseudoaneurysm at the anastomosis of the free flap following ablative head and neck surgery is uncommon. We present a case of external carotid artery pseudoaneurysm in a patient who had previously undergone a subtotal glossectomy, neck dissection, and radial forearm free flap reconstruction. The traditional treatment for pseudoaneurysm has been open surgical repair. Our patient underwent successful treatment with an endovascular embolization utilizing thrombin injection of the aneurysmal sac. This case highlights the role of interventional radiology in the management of this rare but important complication of microvascular reconstructive surgery.     

The nonsurgical treatment of patients with periodontal disease: results after five years

BACKGROUND: In a previous study involving patients seen at the dental clinic of the Detroit Receiving Hospital, the authors found that 87 percent of teeth initially recommended for surgery or extraction were spared those treatments by a combination of debridement and short-term usage of antimicrobial agents. The objective of the present study was to determine how long the surgery-sparing benefits of less invasive treatment would persist. METHODS: Ninety of these patients were scheduled for maintenance therapy at three-month intervals over a five-year period. They were evaluated periodically for surgical needs by a clinician who was not aware of the nonsurgical periodontal treatment the patient had received. RESULTS: The initial treatment benefits were sustained, as the number of teeth needing periodontal surgery or extraction was 0.06 teeth per patient after 1.1 year, 0.22 after 2.3 years, 0.51 after 3.6 years and 0.86 after 5.1 years. CONCLUSIONS: A noninvasive treatment regimen for an anaerobic infection in teeth seriously compromised by periodontal disease resulted in a reduced need for surgery or tooth extraction for at least five years after completion of the initial treatment.     

Osseous resective surgery: long-term case report

This case report evaluated the long-term effects of osseous resective therapy in the treatment of a patient with moderately advanced periodontal disease. In 1984, the patient underwent initial therapy followed by a periodontal surgical phase consisting of osseous recontouring with an apically positioned flap. After 20 years, in 2003, the patient presented with a traumatic complication. An exploratory surgery revealed a fracture on the roof of the pulp chamber on the maxillary left first molar. The buccal roots were resected, preserving the palatal root, and a reevaluation of the long-term outcome of osseous resective surgery was performed. It is suggested that the positive treatment result is the consequence of the reestablishment of tissue morphology favorable for oral hygiene and plaque control by the patient.     

Dental implants placed in a patient with multiple myeloma: report of case

A 69-year-old male, under active treatment for multiple myeloma, fractured his left maxillary second premolar palatal abutment tooth and requested treatment because his upper partial denture no longer fit. Several other teeth were deemed hopeless, and construction of a maxillary complete denture presented problems. There are general contraindications regarding dental implant surgery in the terminally ill patient; however, in this case, the patient wished to maximize his quality of life and opted to undergo implant surgery. With close management, the treatment was successful.     

Evaluation of patients for preprosthetic surgery

The success of preprosthetic surgery and subsequent complete dentures depends not ony on the technical success of the procedures but also on the patient's satisfaction with the outcome. Studies of patients' satisfaction with their complete dentures confirm the experience of prosthodontists--that the problems described by patients do not always correlate with detectable anatomic deficiencies or technical faults in the prostheses. Since the responsibility for patient care is shared by both the surgeon and the prosthodontist, it is important that both specialists by involved in the screening process and evaluation of patients for preprosthetic surgery, prior to treatment. This article describes the basic criteria for patient evaluation, including signs that might indicate a poor prognosis for preprosthetic surgery. Everyone benefits if a realistic prognosis for the proposed combined treatment can be established before therapy is begun.     

Ankylosis of the temporomandibular joint developing shortly after multiple facial fractures

A 41-year-old male patient was referred for treatment of extensive facial fractures and lateral condylar dislocations. The patient underwent open reduction and fixation under general anaesthesia. Intermaxillary fixation was released in 2 weeks and mouth opening was 21 mm. Despite postoperative physical exercises, the range of motion decreased to 10 mm at 5 weeks after the surgery. MR arthrography revealed a fibrous ankylosis in the bilateral TMJs. Coronal CT scans depicted a bony outgrowth of the left TMJ tuber. The patient underwent surgery for the ankylosis including discectomy and coronoidectomy, and removal of the bony outgrowth. An interincisal distance of 30 mm on maximal mouth opening has been maintained for 14 postoperative months. The importance of imaging assessment was emphasized for diagnosing the precise pathologic state of the ankylosis and selecting an appropriate surgical treatment of choice.     

Comparison between patient expectation before and satisfaction after periodontal surgical treatment

BACKGROUND: The purposes of this study were to compare patient expectation before periodontal surgical treatment with their level of satisfaction afterward on the basis of a self-reported questionnaire, and to analyze the relationship between various satisfaction factors and periodontal surgical treatment. METHODS: Information was obtained from 33 patients initially diagnosed with chronic periodontitis. The survey was completed twice by each patient, once before and once after modified Widman flap surgery. RESULTS: The satisfaction scores of items related to patient expectation of treatment outcome decreased significantly following surgery. The patients also expressed great dissatisfaction with items regarding disease prevention such as "desire for knowledge of periodontal disease prevention" and "desire for knowledge of recurrence control methods." However, some items such as "dental pain during treatment," "dental fear of treatment," and "cost of treatment" increased significantly after treatment. The total mean score of general satisfaction before treatment was 2.65, decreasing to 2.60 after treatment. CONCLUSIONS: Among the 5 subscales, any increase in patient satisfaction related to the treatment factors is difficult to achieve, but we should be able to raise the satisfaction level of our patients through improvement of the preventive measure factors.     

Update on orthognathic surgery

This article gives an account of contemporary methods in orthognathic surgery, highlighting which patients are appropriate for such surgery. In order to make the case relevant, a single patient is tracked through her orthodontic treatment, surgery and final outcome.     

On a definition of the appropriate timing for surgical intervention in orthognathic surgery

Together with the introduction of new orthodontic techniques and minimally invasive surgery protocols, the emergence of modern patient prototypes has given way to novel timing schemes for the handling of dento-maxillofacial deformities. The aim of this study was to define, justify, and systematize the appropriate timing for orthognathic surgery. A retrospective analysis of orthognathic surgery procedures carried out over a 3-year period was performed. Six timing schemes were defined: ‘surgery first’, ‘surgery early’, ‘surgery late’, ‘surgery last’, ‘surgery only’, and ‘surgery never’. Gender, age at surgery, main motivation for treatment, orthodontic treatment length, and number of orthodontic appointments were evaluated. A total of 362 orthognathic procedures were evaluated. The most common approach was ‘surgery late’. While aesthetic improvement was the leading treatment motivation in ‘surgery first’, ‘surgery early’, and ‘surgery last’ cases, occlusal optimization was the chief aim of ‘surgery late’. Sleep-disordered breathing was the main indication for treatment in ‘surgery only’. Compared to ‘surgery late’, orthodontic treatment was substantially shorter in ‘surgery early’ and ‘surgery first’ cases, but the number of orthodontic appointments was similar. In conclusion, the skilful management of dento-maxillofacial deformities requires a comprehensive analysis of patient-, orthodontist-, and surgeon-specific variables. Each timing approach has well-defined indications, treatment planning considerations, and orthodontic and surgical peculiarities.     

Relevance of positive margins in case of adjuvant therapy of oral cancer

Positive or clean surgical margins are of great prognostic interest in the surgical treatment of oral and oropharyngeal cancer with poor survival of patients burdened with positive margins. The impact of postoperative treatment modalities on the survival of these patients is debated. The relevance of positive margins was investigated in three patient populations (a group treated by surgery only, a group with postoperative polychemotherapy, and a group with a multi-modality treatment comprising postoperative radiation with concurrent chemotherapy) which were compared retrospectively. Patients treated with adjuvant regimens following resection in healthy margins had a survival advantage as compared to the surgery only group possibly due to less local relapses and longer relapse latencies. Overall disease-free survival was better in the groups with adjuvant therapy irrespective of free or positive margins. Survival rates following positive surgical margins were worse in all three groups as compared to the respective subgroups with healthy margins. A second resection in patients with positive margins, executed in the group with postoperative radiation with concurrent chemotherapy, did not result in survival improvement. Therefore, radical resection at initial surgery in healthy and clear margins remains indispensable in multi-modality treatment strategies involving surgery. The combination of healthy margins and adjuvant treatment seems to be most favorable for patient survival.     

Orthognathic surgery of a patient with oligodontia: alternative technique for intermaxillary fixation

ABSTRACT: Oligodontia may cause various problems during orthognathic surgery because it may be difficult to fix the surgical guide splints. The aim of this clinical report was to present an alternative technique for intermaxillary fixation of a patient with oligodontia and facial deformity. A 20-year-old male patient, whose 8 maxillary and 11 mandibular teeth were congenitally missing, was treated using bimaxillary orthognathic surgery. Before the surgical approach, fixed mandibular prosthesis containing pins on the vestibule sides of the crowns was constructed to provide anchorage for intermaxillary splint and to achieve occlusal stability and vertical dimension during the surgery. This prosthesis was also used to hang intraoral elastics during the postoperative orthodontic treatment. At the end of treatment, these pins were cut, composite restoration material was applied to camouflage the places of the pins, and the patient continued to use this prosthesis. The patient gained an appropriate facial aesthetics and oral function using multidisciplinary approach.     

Assuaging postoperative effects of periodontal surgery

Responding to the patient's uncomfortable reaction following certain periodontal surgery procedures, notably the sensitivity to temperature and touch, has been a source of frustration to both the practitioner performing the surgery as well as the patient. This case demonstrates the placement of an easily applied desensitizing paste (Duraphat) at the time of surgery, which enables the patient to avoid uncomfortable sensitivity after the dressing has been removed and allows the patient to return to good oral hygiene practices quickly, thereby avoiding new accumulation of bacteria. It also prevents further periodontal destruction, which is the purpose of the periodontal treatment. This presentation and diagrammatic explanation demonstrate placing this topical paste during the surgery, just before suturing. This particular paste is easy to place, and ease of placement is not inhibited by moisture in the affected area. The desensitizing effect for the immediate postoperative period provides comfort for the patient and helps to maintain trust between the dentist and the patient.     

Patient expectations and satisfaction following orthognathic surgery

Orthognathic surgery aims to correct dentoskeletal and facial discrepancies. Treatment usually requires a minimum of 18 months, necessitating that patients are adequately satisfied with the treatment provided. This study aimed to assess the determinants of patient satisfaction following treatment. One hundred and eighteen patients who had undergone orthognathic surgery were included prospectively. All participants completed a questionnaire regarding their reasons for undergoing treatment, treatment logistics, treatment outcomes, and satisfaction throughout their journey. Most patients were ‘very satisfied’ (71.2%) or ‘satisfied’ (19.5%) with the overall treatment. The majority wished to improve their smile (78.0%); post-treatment, 89.0% of patients reported an improved smile. Almost half of the patients (46.6%) stayed in hospital for only one night, and 41.5% took over 4 weeks off work or school post-surgery. People with postoperative breathing difficulties spent more days in hospital (P = 0.021), but importantly, the duration of hospital stay did not differ between maxillary advancement, bilateral sagittal split osteotomy, and bimaxillary surgery (P = 0.78). In conclusion, patient satisfaction was high following orthognathic treatment. The results highlight areas for improvement, such as information delivery to the patient throughout the treatment journey, and show that the presence of ongoing problems is an important predictor of patient satisfaction.     

Use of an esthetic overdenture as an alternative treatment in a patient with bilateral cleft lip and palate

Stable occlusion and a pleasing esthetic appearance are often difficult to achieve in patients with congenital defects and severe midfacial deficiencies. Conventional therapy, such as orthodontic treatment followed by orthognathic surgery, is often not sufficient to fully correct the dental and esthetic problems. An interdisciplinary approach for these patients should include prosthodontic treatment that will assist in establishing a harmonious occlusion and improve facial appearance. This clinical report describes the interdisciplinary approach for a young patient with a history of bilateral cleft lip and palate, spina bifida, hydrocephalus, and ventriculoperitoneal shunt. The patient was treated with conventional orthodontic treatment and orthognathic surgery that failed to fully correct the malocclusion. A removable overlay prosthesis made of crystallized acetyl resin was used to reestablish esthetics and create a stable occlusion.