Complications after craniofacial reconstruction with calcium phosphate cements: a case report and review of the literature

Among different graft materials for craniofacial reconstruction, calcium phosphate cements have the advantages of alloplastic grafts and wide use. The authors report a case of foreign body reaction following frontal reconstruction with JectOS (an injectable calcium orthophosphate cement; Kasios) and reviewed the literature on complications of this material after craniofacial reconstruction from 2002 to 2017. Complications were categorized into two groups: immunologic reactions (consisting of seroma collection, chronic sinus mucosa swelling, and foreign body reaction) and non-immune events (infection, fragmentation, and ejection). It is wise to use calcium phosphate-based material only in selected cases with small defects, and long-term follow-up is needed to observe their consequences.

Skeletal stability following mandibular advancement: is it influenced by the magnitude of advancement or changes of the mandibular plane angle?

OBJECTIVES: The aim of this study was to investigate the effects of advancement magnitude and changes in mandibular plane angle on the stability of mandibular advancement. MATERIALS AND METHODS: This retrospective cohort study evaluated the postoperative stability of mandibular advancement in class II skeletal subjects who underwent bilateral sagittal split osteotomy. Radiographs taken preoperatively, immediately postoperatively and 1 year postoperatively were traced and analyzed using linear and angular measurements. To determine horizontal and vertical relapse, an X-Y coordinate system was established in which the X-axis was constructed by rotating S-N downward by 7° (approximation of the Frankfort horizontal plane) and the Y-axis was defined as a line perpendicular to the X-axis and passing through the point Sella. For certain reference points including point A, point B, pogonion and menton, the perpendicular distance between each point and both axes was determined and cephalometric variables were recorded as X and Y coordinates. RESULTS: Twenty-five subjects were studied. A significant correlation between the amount of mandibular advancement and relapse in the B point (vertical and horizontal) and the pogonion point was observed (vertical and horizontal, P<0.001). Evaluation of data demonstrated a positive correlation between the mandibular plane angle (SN/ML) change and vertical relapse in the B point (P<0.05). A simple regression model demonstrated that 74% of horizontal relapse and 42.3% of vertical relapse in the B point was related to the amount of mandibular advancement. The receiver operating characteristic test showed that 8.5 mm mandibular advancement is related to a relapse rate of 1 mm or more in the pogonion, vertically or horizontally. CONCLUSION: The magnitude of mandibular advancement is a stronger surgical predictor for horizontal rather than vertical relapse at the B point. Changes in mandibular plane angle (SN/ML) during surgery affect vertical, but not horizontal relapse at the B point.

Blood biomarkers alterations with administration of propofol for anaesthesia maintenance during long term oral and maxillofacial surgeries

Objective: This prospective study performed to evaluate blood biomarkers alterations with administration of propofol for maintenance of anaesthesia during long oral and maxillofacial surgeries in order to estimate the risk of Propofol Infusion Syndrome [PRIS]. This rare syndrome often would be happened in long duration or high dose infusion which is characterized by the combination of metabolic acidosis, acute bradycardia and/or asystole, and rhabdomyolysis and can be fatal

Methods: Patients undergoing maxillofacial surgeries [>3h] were the subjects of this quasi experimental prospective clinical trial study. Induction of anaesthesia was performed with midazolam 0.025 mg/kg, fentanyl 2 micro g/kg, thiopental sodium 5 mg/kg, and atracurium 0.5 mg/kg. Infusion of propofol was initiated [100 micro g/kg/min] for maintenance of anesthesia. Serum potassium level, creatine kinase, lactate and blood PH, were evaluated at baseline, and at 2, 4, 6 hours following the initiation of propofol infusion. Generalized estimating equation was used to evaluate the longitudinal changes for each of the evaluated biomarkers. The relation between the biomarkers and the following factors were appraised by using covariance linear [enter mode] regression analysis: age, gender, weight, administered dose of dexamethasone and epinephrine, duration of surgery, and a history of trauma prior to surgery

Results: A total of 55 participants, 31 women and 24 men, were studied. The mean duration of surgery was 4.8[1] hours. Despite the rise in the level of potassium and creatine kinase and the reduction of blood PH, no case of hyperkalemia or severe metabolic acidosis was observed. Serum lactate level gradually increased to higher than normal in few patients; though did not necessitate any intervention. All alterations were statistically significant. Potassium and creatine kinase level at baseline had relation to pre-surgical trauma

Conclusion: Maintenance of anaesthesia with 100 micro g/kg/min propofol along with administration of low-dose epinephrine and dexamethasone did not cause clinically important alterations in blood biomarkers during long-duration maxillofacial surgeries and might not cause PRIS

[Minor dental injuries [cracks] due to oral and nasal endotracheal intubation and related factors in Tehran Taleghani hospital]

Oral and dental injuries commonly occur during oral and nasal intubation and comprise one third of lawsuits against anesthesiologists. This study sought to assess dental traumas [especially minor injuries like cracks] due to oral and nasal intubation and related risk factors. This observational prospective study was conducted on 60 patients [30 patients in the oral and 30 in the nasal intubation groups] during 2010-2011 in Taleghani Hospital in Tehran. Patients were examined using a disposable sterile clinical examination kit, a periodontal probe and a light curing unit. Maxillary central incisors had the highest incidence of new cracks [60% and 63.3% in the oral and nasal intubation groups, respectively]. Gender, BMI, ASA class, Angle's classification, and experience of the operator who inserted the tube had no significant association with higher frequency of cracks in the two groups. Incidence of visible dental injuries following nasal and oral intubation was 1.7% and 10%, respectively. Invisible dental injuries due to intubation are highly prevalent. These injuries are mostly disregarded by the anesthesiologists since they are not visible and do not cause any complication or problem during anesthesia. Enhancing the knowledge of anesthesiologists about dental anatomy, physiology and pathology and use of teeth-guard are necessary measures to prevent such injuries