The Journal of craniofacial surgery
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Comparative Study
Comparison of the effect of 2 hypotensive anesthetic techniques on early recovery complications after orthognathic surgery.
The aim of this study was to evaluate the recovery complications following the use of 2 anesthetic protocols in orthognathic surgery, namely, propofol with remifentanil and isoflurane with remifentanil. Sixty-two patients with American Society of Anesthesiologists physical status I were selected. All underwent bimaxillary orthognathic surgery. ⋯ General anesthesia can be provided via intravenously administered medications and/or inhaled volatile anesthetics. No significant difference in early recovery time was found in patients when either isoflurane or propofol was used to maintain the anesthesia. However, the length of the operation played a major role in increasing early recovery complications.
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Case Reports
Conservative treatment of comminuted mandibular fracture involving maxillomandibular fixation with miniplates.
Bars and steel wires are the most commonly used methods to achieve maxillomandibular fixation, although there are numerous alternatives described for this same purpose. In cases of edentulous candidates for the conservative treatment of facial fractures, none of the conventional methods can be instituted for maxillomandibular fixation. Fixation in such cases is achieved with the aid of the total dentures of the patient or the confection of splints, but these methods lead to eating and oral hygiene problems. This article reports the case of an edentulous patient with a comminuted mandible fracture treated with a rarely described technique in which intermaxillary fixation was achieved with titanium miniplates.
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The most common approaches used today for the correction of sagittal synostosis involve large craniectomies and extensive cranial vault remodeling. Although these techniques ultimately yield very good cosmetic results, they have significant drawbacks. They are lengthy, expensive, associated with significant blood loss, universally require transfusions, and often result in prolonged hospitalization. ⋯ The change in cranial index from a preoperative value of 0.7 to 0.8 postoperatively was virtually stabilized 3 months after the surgical intervention. Significantly better correction rates were observed in the youngest patients. Because of its excellent attributes, minimally invasive strip craniectomy followed by postoperative helmet molding is likely to become the preferred treatment modality for the correction of sagittal synostosis.
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Prevascularization of engineered bony constructs can potentially improve in vivo viability. However, the effect of endothelial cells on osteogenesis is unknown when placed in poly(D,L-lactide) (PLA) scaffolds alone. Adipose-derived stem cells (ASCs) have the ability to differentiate into both osteoblasts and endothelial cells by culture in specific media. ⋯ There was no statistical difference between the PLA control (0.5 mm(3)) and ASC-Endo (0.28 mm(3)) constructs in bone formation. The percent area of microvessels within constructs was highest in the ASC-Endo group, although it did not reach statistical significance (0.065). Prevascularization of PLA scaffold with ASC-Endo cells will not increase bone formation by itself but may be used as a cell source for improving vascularization and potentially improving existing osteoblast function.
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Klebsiella is an opportunistic pathogen that is known to cause septicemia, pneumonia, urinary tract infections, hepatobiliary tract infections, and soft tissue infections in patients who have severe underlying diseases or are under immunosuppression. Most Klebsiella species found are Klebsiella pneumoniae, and Klebsiella oxytoca is rarely cultured in humans. We report a case of a 48-year-old man presenting with a soft fluctuating mass on his forehead. ⋯ Parenteral levofloxacin was administrated leading to resolution of infection signs. Because of the rarity of the pathogen, evaluation for underlying illnesses was done, and the patient was diagnosed with type 2 diabetes mellitus. This is the first report of a patient with previously undiagnosed diabetes who was found with an extraorbital abscess caused by K. oxytoca, which we present with a review of diagnosis, pathogenesis, and treatment.