Mund-, Kiefer- und Gesichtschirurgie : MKG
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Mund Kiefer Gesichtschir · Jul 1997
[Microneural reconstruction after iatrogenic lesions of the lingual nerve and the inferior alveolar nerve. Critical evaluation].
As microneural repair techniques of the sensory mandibular branches enter the third decade of their clinical use, there are but a few long-term investigations into the value of these procedures in the treatment of iatrogenic injury to the lingual (LN), inferior alveolar (IAN) or mental (MN) nerve. To establish the efficacy of microneural repair in lesions of the LN, IAN or MN with loss of continuity, the outcome of sensory recovery was evaluated in a series of 92 patients (LN: direct coaptation n = 39, coaptation + sural nerve grafting n = 23; IAN: direct coaptation n = 11 coaptation + sural nerve grafting n = 10; MN: direct coaptation n = 11). The minimum duration of follow-up was 14 months postoperatively. ⋯ In the LN coaptation group low scores and improved taste perception were convincingly associated with short periods since injury (i.e. timing of repair). In conclusion, we feel there is sufficient justification to optimize the potential results of microneural repair by immediate (LN/MN) or early (IAN) reexposure of the injured site in order to clarify the precise nature of the underlying nerve damage and prevent delay, if patients present with complete loss of sensory function subsequent to dentoalveolar or oral surgery. However, clinical and electrophysiologic findings suggesting impairment or partial loss of sensory function are considered a contraindication to microneural intervention, in view of the limited prospects of sensory recovery after surgical repair.
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Mund Kiefer Gesichtschir · May 1997
[Acoustic reflection position monitoring of tracheal cannulae. A contribution to quality assurance?].
Non-invasive acoustic airway monitoring was evaluated in an experimental study. Recording amplitude and travel time of acoustic pulse response, an area-distance function of the cross sectional dimensions of the endotracheal tube and the adjacent airway was calculated to obtain an acoustic pattern of the airway. Measurements on models and excised human cadaver lungs were performed to discover whether displacement or obstruction of the artificial airway can be detected in the acoustic equivalent. ⋯ Location and amount of obstruction could likewise be identified. Thus acoustic mapping provides an adequate approximation of the true geometry of tracheostomy and endotracheal tubes. We conclude that acoustic monitoring may provide a powerful tool to achieve primary prevention of airway disturbances in intubated and mechanically ventilated patients, as geometrical changes of airway configuration can be detected even before they cause substantial effects on respiratory metabolism.
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Giant cell arteritis is a systemic disease of unknown origin characterized by vasculitis of medium-sized and larger vessels, found mainly in elderly women. It presents with a variety of symptoms, including temporal pain and tenderness, headache, and neuroophthalmic features. This report describes a case of giant cell arteritis in a 78-year-old woman with a large ulceration on the right side of the tongue, painful lesion in the right temporal area, and recent visus loss of the right eye.