Unintentional hypotension from lidocaine infiltration during orthognathic surgery and general anaesthesia.

Background: A probable causal relationship between submucosal infiltration of lidocaine, with adrenaline 12.5 microg x mL(-1), and untoward arterial hypotension during general anaesthesia for orthognathic surgery was investigated in two parts.

Methods: The first part of the study was open and non-randomised.

Bone grafting to the maxillary sinus from the lateral side of the mandible.

Patients who were unable to have an implant of the maxilla without a bone graft were operated on by a modified sinus lift method, under local anaesthesia. Cortical bone grafts, harvested from the lateral side of the mandible, were forced horizontally into a slot, made in the lateral sinus wall after a mucosal sinus lift. The immediate stabilization of the graft permitted the dense packing of the space below the horizontal graft with bone chips, which probably contributed to the fast healing of the bone.

Placement of posterior mandibular and maxillary implants in patients with severe bone deficiency: a clinical report of procedure.

The purpose of this investigation was to modify the method for implant placement in the posterior parts of the arches for fixed implant-supported prostheses using minimally invasive surgery. Eighty-six implants were placed posterior to the mental foramina in patients with severely resorbed mandibles, and 75 implants were placed in the posterior severely resorbed maxilla. Bone grafting from the mandible to the maxillary sinus was performed in 9 patients with severely atrophic maxillae.

Tilting of posterior mandibular and maxillary implants for improved prosthesis support.

Rehabilitation of atrophied edentulous arches with endosseous implants in the posterior regions is often associated with anatomic problems such as jaw shape and location of the mental loop, mandibular canal, and maxillary sinuses. The purpose of this investigation was to modify the method for implant placement in the posterior part of the jaws to extend fixed implant-connected prostheses further distally, and to reduce the length of cantilevers in complete-arch prostheses without transpositioning the mandibular nerve or performing bone grafting in the maxilla. Forty-seven consecutive patients were treated with implants (25 patients/36 mandibular implants, 22 patients/30 maxillary implants) placed in tilted positions.

Effects and adverse events of a dental appliance for treatment of obstructive sleep apnoea.

In a prospective study, 95 patients with mild to moderate obstructive sleep apnoea (OSA) were randomised to receive either surgical treatment, uvulopalatopharyngoplasty, (4-6 patients) or treatment with a nocturnal dental appliance for mandibular advancement (49 patients). Of the 49 dental appliance patients, 37 completed the 12-month follow-up. The aim of this study was to evaluate the effects and adverse events of dental appliance treatment from a one-year perspective.

A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea.

The enthusiasm for uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnoea (OSA) has declined in recent years, partly because of a lower success rate over time and partly because of adverse effects. Reports on the beneficial effects of dental appliances exist, but only one prospective randomized study has been published comparing dental appliances with nasal continuous positive airway pressure (CPAP) treatment. No study has been published comparing dental appliance treatment with UPPP.

Anterior-inferior mandibular osteotomy in treatment of obstructive sleep apnea syndrome.

In a prospective randomized study on treatment of obstructive sleep apnea syndrome, anterior-inferior mandibular osteotomy with the purpose of stretching the suprahyoidal muscle was performed as one of the treatment methods. Ten men aged 20 to 65 years, without cardiovascular or neurologic disease, with normal maxillomandibular relation, and having an apnea index between 5 and 25 were included in the study. After a specially designed osteotomy of the chin, the anterior suprahyoidal muscles were detached, stretched approximately 10 to 12 mm, and sutured.

Induced hypotension may influence blood loss in orthognathic surgery, but it is not crucial.

The need for induced hypotension in orthognathic surgery was evaluated. Blood loss, duration of operation, quality of the surgical field, and surgical result were measured in 36 patients, assigned to either hypotension (mean arterial pressure, MAP, 50-64 mmHg) or normotension (MAP > or = 65 mmHg). Hypotension was achieved by increasing the amount of isoflurane given.

A modified method of simultaneous bone grafting and placement of endosseous implants in the severely atrophic maxilla.

The purpose of this investigation was to clinically evaluate the modified method for surgical rehabilitation of severely atrophied maxillae with titanium implants. In 35 patients, sinus lift, Le Fort I osteotomy, and a downtilting of the maxilla were performed. Bone grafts from the iliac crest, placed between the sinus mucosa and the sinus floor, were secured with three to four Bränemark titanium implants 10 to 20 mm in length on each side.

Reverse genioplasty.

The purpose of this investigation was to evaluate the possibility of correcting the appearance of a protruded or retruded chin through relocation of the anterior alveolar segment. Five patients with a protruded chin (group I) were treated by anterior repositioning of the alveolar segment, while five patients with a retruded chin (group II) were treated through posterior repositioning of the mandible. In the patients in group I, the convexity of the chin became less pronounced and the most anterior point of the soft tissue chin curvature (pogonion) moved superiorly.

Soft tissue response to genioplasty procedures.

The soft tissue response to genioplasty procedures was studied in 65 patients. The patients were divided into four groups depending on the direction of the genioplasty. In 17 patients straight anterior repositioning was made (group I), in 12 patients posterior repositioning of the chin (group II), in 19 patients vertical reduction of the chin (group III) and in group IV superior-anterior repositioning of the chin.

Transverse surgical correction of the maxilla. A modified procedure.

A modified surgical procedure to expand as well as reduce the width of the hard palate is described. Instead of a single sagittal osteotomy in the midline of the palate, multiple sagittal osteotomies are performed parallel to each other and maintaining the periosteal attachment to each of the fragments. The hard palate is thereby moveable and can be reduced in a transverse direction as well as expanded.

Posterior repositioning of the entire maxilla without postoperative intermaxillary fixation. A clinical and cephalometric study.

In 30 patients posterior repositioning of the entire maxilla has been performed. No postoperative intermaxillary fixation (IMF) has been applied. The surgical procedure is described and data given on the distance of repositioning.

Adverse effects on the brain in connection with isoflurane-induced hypotensive anaesthesia.

As a marker of brain cell injury, adenylate kinase (AK) was measured in cerebrospinal fluid (CSF) in 10 patients given anaesthesia with isoflurane-induced hypotension for corrective surgery of dentofacial deformities. Nine out of 10 patients displayed a marked increase in CSF-AK postoperatively compared with preoperative values. The postoperative mean value displayed a 400% increase compared to the corresponding preoperative value.

Maxillary osteotomies without postoperative intermaxillary fixation (anterior, superior and inferior repositioning of entire maxilla). A clinical and cephalometric study.

Surgical correction of maxillary anomalies with anterior-superior or anterior-inferior repositioning of the segment was performed in 50 patients. The maxillary segment was stabilized by means of steel wires as horizontal mattress sutures, which, in all cases, gave very good primary stability. In case of insufficient bone contact miniplates were used.

Sagittal split osteotomy of the mandible without postoperative intermaxillary fixation. A clinical and cephalometric study.

A modified sagittal split technique has been evaluated in 42 dentate patients, in whom no postoperative intermaxillary fixation was used. Twenty-three patients had mandible set-back performed and 19 patients mandibular advancement. The method makes possible a safe split osteotomy under controlled conditions.

Orthognathic surgery without the use of postoperative intermaxillary fixation. A clinical and cephalometric evaluation of surgical correction of mandibular and maxillary deformities.

The present series of investigations was performed in order to study the clinical and cephalometric long-term postoperative stability of the maxilla and mandible after surgical correction of jaw abnormities. The patients studied had maxillary or mandibular anomalies, alone or in combination with each other. Standardized surgical methods for correction of jaw deformities were used.

Simultaneous correction of maxillary and mandibular dentofacial deformities without the use of postoperative intermaxillary fixation. A clinical and cephalometric study.

Simultaneous correction of maxillary and mandibular anomalies was performed in 23 patients. The maxillary segment was stabilized by means of steel wires as horizontal mattress sutures, which, in all cases, gave good stability. A modified sagittal split has been applied in all cases.

Insect bite associated Kaposi's sarcoma with oral lesions.

A case of Kaposi's sarcoma with oral, pharyngeal and extremity lesions is reported. The first lesion appeared on the spot of an insect bite on the left leg during a stay in the Mediterranean area. Possible viral transmission by this route is discussed.

Miniplate osteosynthesis of infected mandibular fractures.

Miniplate osteosynthesis in cases of infected mandibular fractures in patients with reduced healing capacity and lack of cooperation has been evaluated. Thirty seven patients with 42 potentially infected mandibular fractures were treated by internal fixation with miniplates. Healing occurred in all cases.

Orthognathic surgery with no postoperative intermaxillary fixation.

In 113 patients orthognathic surgery was performed. Both maxillary, mandibular and combined procedures were used. Intermaxillary fixation was avoided in all cases.

Postoperative complications after surgical removal of mandibular third molars. Effects of penicillin V and chlorhexidine.

A random material of 112 patients, was investigated after surgical removal of impacted lower third molars. 2 experimental groups and 1 control group were studied. Prophylactic medication with penicillin V combined with preoperative rinsing using 0.

Effect of application of cold dressings on the postoperative course in oral surgery.

The effect of external application of local cold on swelling, trismus, temperature and pain postoperatively in surgical removal of impacted mandibular third molars was studied in a cross-over study comprising 45 patients. The patients were treated postoperatively with cold dressings after the first or the second operation. There were no significant differences in swelling, trismus, temperature or postoperative pain between the 2 groups of operations.

Alveolitis after operative removal of third molars in the mandible.

The aim of the investigation was to assess the importance of various factors in the aetiology of alveolitis sicca dolorosa. Two hundren partially erupted or totally impacted mandibular third molars were surgically removed. The patients were divided into four groups.