Applications of the island trapezius myocutaneous flap in oral maxillofacial surgery]

The experience in immediate reconstruction of oral maxillofacial defects of 23 cases by island trapezius myocutaneous flaps from April 1985 to July 1993 is presented. The smallest flap was 6 x 4 cm and the largest 12 x 8 cm, with all the cases successful. The selection of the vascular pedicle of the myocutaneous flaps, the technique of the operation, the advantages and the disadvantages of the method are discussed.     

A preliminary study into the uses of anorganic bone in oral and maxillofacial surgery

Anorganic bovine bone has been used in oral and maxillofacial surgery for several years. Its use has been limited to ridge augmentation. In this paper we have tried to evaluate its use in other settings within the speciality.     

Prevalence of markers for human immunodeficiency, hepatitis B and hepatitis C viruses in maxillofacial and oral surgery patients at Medunsa

Information on the incidence of human immunodeficiency virus (HIV) and hepatitis B (HBV) and C (HCV) virus infections is needed for the planning of preventative measures against the spreading of these blood borne pathogens through treatment in the clinic. A survey was conducted to determine the incidence for 180 patients attending the maxillofacial and oral surgery clinic at the Medunsa Dental Hospital. Antibodies to HIV were found in 1.1 per cent. Hepatitis B surface antigen in 2.8 per cent and Hepatitis B core antibodies as the sole marker in three patients who tested positive for HBV-DNA. The prevalence of anti-HCV was 1.1 per cent. The presence of these infections indicates that there is a need for dental health care workers to comply with all recommended precautionary measures, including immunization against hepatitis B.     

Review of applying implant-magnetic attachments to oral and maxillofacial prostheses]

The Postanesthesia Care Unit (PACU) is an area of high risk for the transmission of Mycobacterium tuberculosis. The Centers for Disease Control (CDC) have recommended administrative controls, engineering controls, and personal protection devices to reduce the risks; nevertheless, perianesthesia nurses inhale airborne pathogens. The CDC guidelines are enforced by the Occupational Safety and Health Administration (OSHA). If an exposure occurs, the health-care facility has an OSHA-mandated course of action. The cost of follow-up of exposed persons can be high, depending on the patient census of the PACU at the time of unprotected exposure. This report presents the CDC guidelines for follow-up of exposure and costs based on typical surgical volumes and admission patterns for a large hospital with 10 thousand or more annual surgical procedures.     

Clinical study and application of 3DCT in oral and maxillofacial regions

3DCT reconstruction as a new roentgenographic technique has not been used so much in oral and maxillofacial regions in our country. From May 1993 to May 1995, 72 cases of 3DCT reconstruction have been performed by a Siemens Plus-s CT scanner for the maxillofacial injuries and jaw bone diseases. The 3DCT reconstruction of soft tissuses has been used too. It is showed that 3DCT reconstruction is a useful technique for the diagnosis and surgical planning of diseases in oral and maxillofacial regions.     

Intensive nursing care of patients with a microvascular free flap after maxillofacial surgery

The effects of xenobiotics on CYP11B1-dependent corticosterone synthesis (11 beta-hydroxylase) in mouse adrenocortical Y1 cells were studied. 3-Methylsulfonyl-2,2-bis(4-chlorophenyl)-1,1-dichloroethene (MeSO2-DDE) and some methylsulfonyl polychlorinated biphenyls (MeSO2-PCB) inhibited the corticosterone synthesis, whereas PCBs or DDE did not. This indicates a crucial role of the methyl sulfone group for this inhibitory effect. Kinetic analyses of MeSO2-DDE and the two most potent MeSO2-PCBs were conducted using Lineweaver-Burk double-reciprocal plots. The data showed a competitive inhibition of CYP11B1 by the compounds, with apparent inhibitory constants (Ki) of 1.6, 4.6, and 6.7 microM for MeSO2-DDE, 4-MeSO2-2,3,6,4'-tetrachlorobiphenyl, and 4-MeSO2-2,3,6,3',4'-pentachlorobiphenyl, respectively. For comparison, the substrate K(m) was 3.5 microM in the cells, and metyrapone and ketoconazole had apparent Ki-values of 0.8 and 0.04 microM, respectively. In contrast to all previously known inhibitors of CYP11B1, the aryl methyl sulfones are the first examples of CYP11B1 inhibitors not being heterocyclic amines or steroids. The aryl methyl sulfones are widespread environmental pollutants and their inhibition of CYP11B1 constitutes another potential mechanism for endocrine disruption. Their influence on the synthesis of adrenocortical hormones thus merits further interest.     

The pectoralis major myocutaneous flap in oral and maxillofacial reconstruction: a retrospective analysis of 50 cases

PURPOSE: This article retrospectively reviews 50 consecutive pectoralis major flaps used in oral and maxillofacial reconstruction with respect to reliability and complications. PATIENTS AND METHODS: Fifty patients had reconstruction of postcancer resection defects of the oral cavity and maxillofacial region. The age and sex of the patients and site of defect were analyzed. The design of the pectoralis major flap and complications encountered were documented. RESULTS: There were three cases (6%) of flap failure and an additional three cases (6%) in which 40% or more of the skin paddle sloughed. Orocutaneous fistula was rare. The use of an osteomyocutaneous flap with a rib gave poor results for mandibular reconstruction. CONCLUSION: The pectoralis major flap is reliable, and the complications seen in this series were comparable to other large series in the literature. Despite the increased use of microvascular flaps, the pectoralis major flap remains an excellent reconstructive choice for large soft tissue defects in the oral cavity.     

Oral and maxillofacial surgery. A specialty altered by time and circumstance

The evolution of oral and maxillofacial surgery into a specialty was aided by international strife in the first half of the century. Today the scope of OMS practice continues to expand as the result of an educational process that is responsive to the changing needs of the specialty. But understanding and acceptance of the OMS scope of practice lags behind.     

Moderate induced hypotension provides satisfactory operating conditions in maxillofacial surgery

Patients scheduled for maxillofacial surgery were randomly assigned to receive isoflurane (n = 22) or nitroglycerin (n = 18) in order to induce hypotension. Surgeons, blinded for the actual level of blood pressure and the technique used for inducing hypotension, were asked to rate operating conditions on a scale from 1 to 5. Systolic arterial pressure (SAP) and mean arterial pressure (MAP) were reduced by 26% for both groups. Although blood pressure levels showed little variation throughout the induced hypotension period, scores of 2 to 5 were given significantly more often at incision and at 30 min compared to the following measuring points (P < 0.01). In total, the surgical field was rated significantly more often with a score of 1 and 2 than with a score of 3 to 5 (P < 0.01). A relation between score and SAP and/or MAP could not be found. There was also no relation between scores and the technique used for hypotension. Our data suggest that, with the exception of the first half hour of surgery, on average a SAP of 89 mmHg and a MAP of 65 mmHg were sufficient to produce satisfactory operating conditions.     

Comparisons of three simple nutritional assessments applied to patients with oral and maxillofacial malignancies

Percutaneous balloon angioplasty was used to dilate inferior vena cava (IVC) stenosis in 12 patients with Budd Chiari syndrome. There were seven men and five women, aged 32.8 +/- 8.5 years. Angioplasty was performed using balloon 18-20 mm in diameter. In eleven (91.6%) patients, IVC could be successfully dilated. In these eleven patients, the caval diameter at the site of stenosis increased from 2.3 +/- 1.5 to 13.1 +/- 2.8 mm (p < 0.001), the mean IVC pressure decreased from 28.2 +/- 4.1 to 10.5 +/- 3.4 mmHg (p < 0.001) and the gradient across the stenosis decreased from 23.1 +/- 2.2 to 4.2 +/- 1.9 mmHg (p < 0.001). There was appreciable clinical improvement after angioplasty. On a mean followup of 10.8 (3-18) months four (36.4%) patients had restenosis which could be successfully dilated again. These results suggest that balloon dilatation of inferior vena cava stenosis is safe and effective, however, recurrence is common and needs redilatation.