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Purpose Dexmedetomidine represents an intriguing adjunct to outpatient intravenous (IV) sedation owing to its decreased risk of respiratory depression. The purpose of the present study was to measure the incremental effect of incorporating dexmedetomidine (DXM) into an established IV sedation regimen compared with control IV sedation without the DXM infusion. Materials and Methods We designed a prospective, controlled trial in which American Society of Anesthesiologists Class 1 and 2 patients requiring both maxillary and mandibular dentoalveolar surgery would undergo 2 sedation appointments: 1 arch treated with surgery with control sedation (DXM−) using midazolam, fentanyl, and propofol as needed, and a second surgery on the opposite arch using the experimental sedation regimen (DXM+) of midazolam, fentanyl, and propofol, as needed, and a DXM infusion at 4 μg/kg/hr. The surgeon was the same for every appointment, and the patients were kept unaware regarding which sedation had included the experimental regimen. Whether the experimental sedation was used at the first or second surgery was randomized. The primary measured outcomes were efficiency in terms of anesthesia time for each sedation, the physiologic response in terms of vital signs, and the subjective patient experience. Results A total of 12 patients completed the trial. With DXM−, the patients had significantly shorter total (∼15 minutes) and adjusted anesthesia (∼10 minutes) times. With DXM+, the patients had significantly lower average systolic blood pressure (SBP), SBP low values, diastolic blood pressure (DBP) low values, average heart rate (HR), and HR low values. None of the other continuous patient outcomes differed significantly between the 2 groups. Of the 12 patients, 10 (83.3%) reported that they preferred the experimental sedation experience with DXM (95% confidence interval, 0.52 to 0.98). Conclusions Using a DXM infusion with outpatient dentoalveolar surgery allowed for acceptable levels of sedation, greater patient satisfaction, and longer anesthesia and appointment times and often resulted in lower BP and heart rate.

Objectives With advances in healthcare leading to longer life expectancy, the edentulous geriatric population is increasing. Expectantly, head and neck trauma surgeons will encounter atrophic (edentulous) mandible fractures in their practice. The objectives of this paper are to review the prevalence, etiology, and diagnosis of atrophic mandible fractures with a descriptive discussion on the different methods of treatment. Materials and Methods The review included a search using PubMed (National Library of Medicine, NCBI) and Medline from 1950–2016 with keywords such as “atrophic mandible” with the addition of the words fracture and computerised guided technology and Virtual Surgical Planning (VSP). Results This search produced 499 articles. Of those 499 articles, 18 were included in this critical review. Management discussion identified papers to provide the most powerful evidence in the decreasing order of strength by cohort studies, case-control studies, surveys, and case-series. The update provides new information on virtual surgical planning that will assist in time under general anaesthesia for complex case management. Conclusions A comprehensive update reviewed all forms of treatment from soft diet to open reduction with computerised technology to provide head and neck trauma surgeons a better basis for clinical management of these fractures.

Background Head and neck arteriovenous malformations (AVMs) are reported to occur in 0.1% of the population. Extracranial AVMs account for only 8.1% of head and neck AVMs. Of these, traumatically acquired AVMs of the face are generally reported as quite rare. When secondary to trauma, the lesion is usually supplied by a single vessel, as compared to the multiple vessels often seen with congenital etiology. Objectives Understanding of regional anatomy is paramount when assessing and managing facial injuries. As an integral health care provider for the facial trauma patient, it is the responsibility of the emergency physician to recognize this rare pathologic lesion necessary to coordinate surgical management of the traumatic AVM. Case Report We present a case report of a patient who sustained a facial laceration complicated by the development of a vascular malformation. The facial laceration in this case report highlights the complexity of wound evaluation and management when treating patients in the emergency department. Conclusion Traumatic AVMs are quite rare in the head and neck and are mostly seen in the extremities. Although rare, they have been reported after typical facial trauma as well as elective surgical procedures. The management of such lesions may include selective embolization or surgical exploration with ligation. Emergency physicians and facial trauma surgeons are challenged with recognizing and treating these rare but very real vascular lesions. It is our hope that this case report provides an overview of posttraumatic AVMs in the head and neck.

Background Heart failure (HF) is a common clinical syndrome that affects an estimated 5.7 million Americans. It is a growing health problem, particularly in people 65 years or older. Therefore, the probability that dental practitioners will have patients who have HF is increasing. Methods The authors reviewed medical literature from 2000 through 2009 to determine the incidence, classifications, pathophysiology and advances in the medical diagnosis and treatment of HF. They also reviewed available dental literature during the same period to formulate treatment recommendations for dental care of people who have HF. Results Medicine has made advances in understanding and treating HF. These advances have resulted in the development of revised classification systems, a more structured approach to patient assessment and improved therapeutic options. Conclusions Dentists need to be aware of advances in the diagnosis and treatment of HF. Keeping in mind the potential for morbidity in patients who have HF, identifying and accurately assessing these patients is imperative for clinical management. Clinical Implications Often it is necessary for dentists to consult with patients' physicians to coordinate care and determine whether treatment can be rendered appropriately in a routine dental setting or whether advanced support, monitoring or both are necessary.

Management of radiation-exposed bone in the mandible is a dilemma many oral and maxillofacial surgeons must confront and manage. Current advances in radiotherapy techniques using pin-point computerized accuracy in combination with other advances, such as morphed imaging, fractionalization protocols, minimization of scatter, and pretreatment dental examinations, have greatly decreased the late effects of radiation and osteoradionecrosis. The intent of this article is to provide a brief overview of the following topics: radiotherapy physics and radiobiology, effects of radiotherapy on normal tissues, including the pathogenesis of osteoradionecrosis, and advances in contemporary radiotherapy treatment.

Purpose The purpose of this study was to evaluate the effect of hyperbaric oxygen therapy on bone regeneration during distraction of irradiated rabbit mandibles. Materials and Methods Twenty New Zealand white rabbits were randomly sub-divided into 4 groups. Group 1 served as control, group 2 received preoperative radiation therapy, group 3 received pre- and postoperative hyperbaric oxygen (HBO) therapy, and group 4 received preoperative radiation therapy and pre- and postoperative HBO therapy. All rabbits underwent a corticotomy of the left body of the mandible after placement of a distraction device. Distraction, at a rate of 1 mm/day and a rhythm of 1 turn/day, began after a 3-day latency period for 14 days. Thirty days after completion of the distraction protocol, the animals were euthanized, and histomorphometric and radiographic data of the distraction segments were obtained. Results Histomorphometric analysis of new bone fill was greatest in the non-irradiated groups compared to groups receiving radiation therapy, regardless of HBO therapy ( P = .03). Pre-corticotomy bone density measurements showed a significant increase in bone density over time ( P = .0007). This resulted in a significant relationship between HBO therapy, radiation therapy, and time ( P = .0050). Conclusions The results of the study support the use of HBO therapy during distraction osteogenesis. Any additional therapeutic benefit of HBO therapy in irradiated bone would require additional investigation.

Fibrous cortical defect, also known as metaphyseal fibrous defect and nonossifying fibroma, among other terms, is a benign, non-neoplastic proliferative process that is relatively common in the long bones of skeletally immature adolescents. Although the lesion is thought to be a developmental abnormality or defect, the exact etiopathogenesis is largely unknown. The lesion has a limited growth potential and good treatment outcome. This process is very rare in the gnathic bones, and only a few sporadic case reports are documented. This article presents the clinicopathologic features of 2 additional cases and reviews the relevant literature in attempt to identify key features and facilitate rendering definitive diagnosis for this rare entity.

The reconstructing surgeon has a variety of options when closing defects of the hard and soft palate. Techniques can be as simple as a palatal island flap or as complex as the radial forearm flap. We present here a method of closing a medium to large defect of the palate using the temporoparietal-galeal (TPG) flap, a regional and very reliable flap for reconstructing defects of the oral cavity and face. The TPG is a thin and pliable flap with an axial blood supply and a good arc of rotation to the oral cavity. The flap can be used as a fascial flap, a fasciocutaneous flap, or an osteofascial flap. It provides an excellent source of vascularized tissue. Anatomy

Lemierre’s syndrome is an oropharyngeal infection associated with the pathogen Fusobacterium necrophorum compounded with possible septic thrombosis to the internal and external jugular veins, lungs, liver, and kidneys. Lemierre’s syndrome is a virulent infection, and its clinical presentation may be fatal if unrecognized by the clinician. Patients with this infectious entity classically present complaining of dysphagia and odynophagia associated with an acute oropharyngitis. Although uncommon, Lemierre’s syndrome is insidious and highly fatal if not treated promptly. The purpose of this case report is to stress early surgical debridement and aggressive antibiotic therapy as crucial in the management of Lemierre’s syndrome.