Liability of laryngeal mask airway devices to thermal damage from KTP and Nd:YAG lasers.
We have compared the liability of four laryngeal mask airway (LMA) devices (standard, flexible, intubating and reusable) and a tracheal tube to thermal damage from KTP and Nd:YAG lasers at two power densities used commonly in airway surgery: 570 W cm-2 and 1140 W cm-2. Eighty-five airway devices were tested: 24 standard LMA (silicone-based), 12 flexible LMA (silicone-based, metal wires), 24 disposable LMA (PVC-based), one intubating LMA (silicone and steel-based) and 24 PVC-based tracheal tubes. Comparisons were made during laser strike to eight different targets: the unmarked and marked part of the airway device tube; the unmarked part of the airway device tube after application of blood; the cuff filled with air or methylene blue dye; the unmarked flexible LMA tube on or between the metal wires; and the epiglottic elevator bar of the intubating LMA. The laser strike was continued for 30 s and each target was tested three times. Three different, but identical, impact sites were used for each target. There was no ignition of any airway device with either power density or laser type. The silicone-based LMA were generally more resistant to flaring and penetration than the PVC-based LMA and tracheal tube, but the intubating LMA tube flared more rapidly with the KTP laser, and the disposable LMA cuff was more resistant to penetration. Print markings, blood and the metal wires of the flexible LMA reduced the thermal resistance of the tube. Filling the cuff with methylene blue dye increased the thermal resistance of all airway devices. We conclude that the silicone-based LMA devices were more thermal resistant to KTP and Nd:YAG laser strike than PVC-based devices with the exception of the disposable LMA cuff and the intubating LMA tube. (+info)
Outcomes of irradiated polyglactin 910 Vicryl Rapide fast-absorbing suture in oral and scalp wounds.
BACKGROUND: This study evaluated the outcome of wounds closed with irradiated polyglactin 910 (IRPG) Vicryl Rapide (Ethicon, Somerville, N.J.). METHOD: Seventy-one patients with 80 oral wounds and 42 patients with 42 scalp wounds closed with IRPG were evaluated on the day of surgery, then one, seven, 14, 28 and 90 days following surgery. The incidence of inflammation, suppuration and hypertrophic scarring was recorded, along with the timing of spontaneous suture disappearance. This suture material was compared with polytetrafluoroethylene (PTFE) sutures used in dental implant patients, traditional polyglycolic acid (PGLA) sutures used in osteotomy patients and skin staples used in patients with scalp wounds. RESULTS: In the group with intraoral wounds, there were two cases of suppuration with no inflammatory reactions or hypertrophic scarring when IRPG sutures were used, compared to three cases of suppuration with the traditional PGLA sutures. In the group with scalp wounds, there was no suppuration or hypertrophic scarring with IRPG sutures and one inflammatory reaction with skin staples. IRPG sutures never required removal, while all staples, PGLA and PTFE sutures eventually required separate removal. CONCLUSION: Irradiated polyglactin 910 Vicryl Rapide is a useful suture material with both intra- and extraoral applications in the pediatric and adult populations. (+info)
Investigation and treatment of thyroglossal cysts in children.
Thyroglossal cysts are the commonest midline neck masses in children. To evaluate current practice questionnaires were sent to all ear, nose and throat (ENT) and paediatric surgeons in the UK and 72% responded. The commonest investigation requested was an ultrasound scan (54%) and the commonest operation was a variant of Sistrunk's procedure (78%). Paediatric surgeons did fewer investigations than ENT surgeons and tended to excise more of the thyroglossal tract. Review of the published work suggests that ultrasound scanning and Sistrunk's procedure are the best management policy. The scan can avoid inadvertent excision of an ectopic thyroid gland. Extensive thyroglossal tract excisions give lower recurrence rates. (+info)
Patient-centered outcomes in surgical and orthodontic treatment.
Patient-centered health care has two characteristics: it is closely congruent with and responsive to the patient's wants, needs, and preferences, and it considers the psychological, social, cultural, and economic dimensions of the patient in addition to physical findings. The ultimate benefit to the patient has always been a primary concern of clinicians providing coordinated orthodontic and orthognathic surgical treatment. However, in the past 10 years, a much greater emphasis has been placed in both medicine and dentistry on the patient as a coparticipant in decision making and the process of treatment. In addition, it has been realized the success of treatment must be defined not just in terms of the objective findings of clinicians, but also in the context of the patient's perceptions of what was achieved. This article discusses the impact of the new emphasis on patient-centered care on clinical practice and research in orthodontics and orthognathic surgery and provides two examples of how patient-centered outcomes can be assessed and used to improve the quality of care in these patients. (+info)
Surgical versus orthodontic correction for Class II patients: age and severity in treatment planning and treatment outcome.
Treatment options for Class II malocclusion include orthognathic surgery. Treatment choices are particularly difficult for young patients because of the uncertainty regarding future growth. Surgical treatment has generally been considered necessary for older patients with more severe Class II problems. The treatment records of more than 500 patients with Class II malocclusion were reviewed. Patients were grouped according to their initial treatment plan (surgery or orthodontics) and treatment outcome (overjet [OJ] reduced to < 4 mm or not). Discriminant function analyses using data from the patient's pretreatment cephalogram were used to determine whether age, in combination with malocclusion severity, could predict the choice of treatment, and whether a simple set of pretreatment variables could predict the success or failure of OJ reduction. The derived equations were tested in a similar group of growing Class II children. Although the data showed clinicians use patient's age in determining treatment choice, age did not seem to be associated with treatment outcome. The majority of the variability that determined the success or failure of OJ reduction was not explained by patient's age or malocclusion severity. These findings suggest other factors, including psychosocial variables, need to be explored if we are to gain a better understanding of why treatments succeed or fail. (+info)
Surgical mandibular setback and changes in uvuloglossopharyngeal morphology and head posture: a short- and long-term cephalometric study in males.
A detailed cephalometric analysis was conducted on a sample of 31 adult males who underwent correction of mandibular prognathism by mandibular setback osteotomy (BSRO) with rigid fixation to evaluate the changes in uvuloglossopharyngeal morphology, hyoid bone position and head posture. Lateral cephalograms were obtained 1-3 days prior to the operation and at standardized 6 months and 3 years post-operative follow-up. Statistical evaluation was performed by paired Student's t-test and Pearson product moment correlation analysis. Inferior position of the hyoid bone (AH perpendicular FH, AH perpendicular ML, AH perpendicular S) and valeculla (V perpendicular FH) was recorded at the 6-month follow-up, a transient finding as at 3 years almost complete recovery to their pre-surgical position was noted. No posterior displacement of the above structures (AH-C3 Hor, V-C3) was recorded. Soft palate length (pm-U) was increased and maintained at the long-term follow-up while its posture (NL/pm-U) became less upright. The tongue showed increased length (V-T) and sagittal area (TA) and a more upright posture (VT/FH) at the late follow-up. Increased contact length between tongue and the soft palate (CL) and less residual oropharyngeal area [area not occupied by soft tissues, (TA + SPA)/OPA] was found at the long-term follow-up. Craniocervical agulation (NSL/OPT, NSL/CVT) was increased indicating cervical hyperflexion at the 3-year follow-up. Reduction of the sagittal dimension of the oropharyngeal airway space (U-MPW) appeared at the first follow-up and was sustained at the longest follow-up which, in conjunction with the decrease in residual oropharyngeal area, could raise questions regarding airway patency after mandibular setback osteotomy. (+info)
Temporomandibular dysfunction in patients treated with orthodontics in combination with orthognathic surgery.
Fifty-two patients with malocclusions underwent orthodontic treatment in combination with orthognathic surgery involving a Le Fort I and/or sagittal split osteotomy. Approximately 5 years after surgery, the patients were examined for signs and symptoms of temporomandibular disorders (TMD). The frequencies were found to be low in comparison with epidemiological studies in this field. The aesthetic outcome and chewing ability were improved in most patients (about 80 per cent). Some of the patients had reported recurrent and daily headaches before treatment. At examination, only two patients had reported having a headache once or twice a week, while all the others suffered from headaches less often or had no headache at all. Eighty-three per cent of the patients reported that they would be prepared to undergo the orthodontic/surgical treatment again with their present knowledge of the procedure. This study shows that orthodontic/surgical treatment of malocclusions not only has a beneficial effect on the aesthetic appearance and chewing ability, but also results in an improvement in signs and symptoms of TMD, including headaches. (+info)
Dental procedures in children with severe congenital heart disease: a theoretical analysis of prophylaxis and non-prophylaxis procedures.
OBJECTIVE: To estimate the cumulative exposure to bacteraemia from dental procedures currently recommended for antibiotic prophylaxis and compare this with cumulative exposure from dental procedures not recommended for prophylaxis. DESIGN: Retrospective analysis. SETTING: University and teaching hospital maxillofacial and dental department. PATIENTS: 136 children with severe congenital cardiac disease attending for dental treatment between 1993 and 1998 and for whom full records were available. Each dental procedure was tallied. MAIN OUTCOME MEASURES: Cumulative exposure per annum to "non-prophylaxis procedures"; cumulative exposure per annum to "prophylaxis procedures". RESULTS: Cumulative exposure to bacteraemia from prophylaxis procedures was not significantly greater than from non-prophylaxis procedures. CONCLUSIONS: The data raise important questions about the appropriateness of current guidelines for antibiotic prophylaxis of bacterial endocarditis. (+info)