ABSTRACT
Abstract Introduction Early carcinomas of the oral cavity in the posterior-inferior regions poses a challenge for reconstruction due to the lack of muscle support underneath and the limited space available to use some of the frequently-used flaps. Objective This study was done to evaluate the efficacy of the superiorly based masseter muscle flap in reconstruction of intra-oral post- ablation defects in patients with early oral carcinoma of the posterior-inferior part of the oral cavity. Methods A superiorly based masseter muscle flap were used to reconstruct the post-surgical intra- oral defect in 60 patients with early squamous cell carcinoma (T < 4 cm) of the posterior-inferior part of the oral cavity. The patients were followed up at 1-week and 1-month postoperatively to check for flap viability, complications, change in mouth opening and deviation of the mandible on mouth opening. To rule out any recurrence in the oral cavity masseter flaps, the patients were followed up for 1 year. Results The flap was viable in all patients and underwent mucosalization. 7/60 patients had postoperative infections, while 2/60 patients developed an oro-cutaneous fistula which required a secondary corrective procedure. The mean ± standard deviation of change in mouth opening at 1 week postoperatively was +1.917 ± 3.36 mm, which increased to +2.633 ± 2.95 mm at 1 month after surgery. The Friedman test revealed that there was a statistically significant change in mouth opening from preoperative period to the1 week and 1 month postoperative periods (p = 0.000). Female patients showed better improvement in mouth opening postoperatively. The ipsilateral deviation of the mandible on mouth opening was between 0-5 mm in 39 patients, 5-10 mm in 17 patients and more than 10 mm in 4 patients. There were no recurrences noted in the masseter flaps used. Conclusion The study infers that the superiorly based masseter muscle flap is a reliable method for reconstruction in early oral cancer patients yielding good functional results and acceptable cosmesis with nominal postoperative complications.
Resumo Introdução Os carcinomas iniciais da cavidade oral nas regiões póstero‐inferiores representam um desafio para a reconstrução devido à falta de suporte muscular abaixo da região e ao espaço limitado disponível para o uso de alguns dos retalhos mais empregados. Objetivo Avaliar a eficácia do retalho do músculo masseter de base superior na reconstrução de defeitos intraorais pós‐ablação em pacientes com carcinoma oral inicial da parte póstero‐inferior da cavidade oral. Método Um retalho do músculo masseter de base superior foi usado para reconstruir o defeito intraoral pós‐cirúrgico em 60 pacientes com carcinoma espinocelular inicial (T < 4 cm) localizado na parte póstero‐inferior da cavidade oral. Os pacientes foram acompanhados após uma semana e um mês de pós‐operatório para verificação da viabilidade do retalho, complicações, alteração na abertura bucal e desvio da mandíbula na abertura bucal. Para descartar recidiva nos retalhos do masseter, os pacientes foram acompanhados por um ano. Resultados O retalho foi viável em todos os pacientes e foi submetido à mucolização; 7/60 pacientes tiveram infecções pós‐operatórias, enquanto 2/60 pacientes desenvolveram uma fístula orocutânea que exigiu um procedimento corretivo secundário. A média ± desvio‐padrão da alteração na abertura da boca em uma semana de pós‐operatório foi + 1,917 ± 3,36 mm, que aumentou para + 2,633 ± 2,95 mm em um mês de pós‐operatório. O teste de Friedman revelou que houve uma alteração estatisticamente significante na abertura da boca do período pré‐operatório para os períodos de uma semana e um mês de pós‐operatório (p = 0,000). Pacientes do sexo feminino apresentaram maior melhoria na abertura da boca no pós‐operatório. O desvio ipsilateral da mandíbula na abertura da boca ficou entre 0 a 5 mm em 39 pacientes, 5 a 10 mm em 17 pacientes e mais de 10 mm em 4 pacientes. Não foram observadas recidivas nos retalhos de masseter usados. Conclusão O retalho do músculo masseter com base superior é um método confiável para reconstrução em casos de câncer oral inicial, produz bons resultados funcionais e resultados cosméticos aceitáveis com complicações pós‐operatórias insignificantes.
ABSTRACT
Background: Muscle relaxants are adjuncts to good anesthesia. Neonates and infants are having less developed neuromuscular junction, larger distribution volume and poor hepatic and renal function. The aim of the present study was to define dose of Vecuronium in neonates and infants in comparison of other age groups, to observe cardiovascular effect of Vecuronium, to study adequacy of intubating condition and, Adequacy of intra-operative muscle relaxation, To observe completeness of recovery after reversal. Materials and methods: 100% patients belonging to physical status of A.S.A Group I and II for operative procedures from both routine and emergency surgeries were selected randomly for study to observe clinical Comparison of Vecuronium bromide in different age groups. Patients were divided into 4 groups each consists of 25 Patients: Group I - Patients of 0-1 year of Age, Group II - Patients of 1-5 year of Age, Group III - Patients of 6-15 year of Age, Group IV - Patients of 16-50 year of Age. Results: Mean pulse rate before induction in Group I patient was 143.92/min., it increased to 151.92 /min. after intubation and then maintained throughout the course of anesthesia between 143.68 to 146.28 / min. which was not significant. The mean arterial pressure in Group I patient was maintained between 74.32 mm of Hg, 77.24 mm of Hg in Group II from 84.21 of pre-induction value – small changes were there and MAP maintained between 79.9 to 89.3 mm of Hg. Pre-induction MAP in Group III was 87.95 mm of Hg, it maintained between 89.29 to 92.66 mm of Hg throughout and in Group IV pre-induction value of MAP was 94.62, where it was maintained between 91.78 – 98.5 mm of Hg. So, there was no any pulse rate or blood pressure changes reflecting cardiovascular stability of Vecuronium. Rajani B, Brahmbhatt H, Chaudhry H, Hiren Parmar H. Effect of Vecuronium in different age group. IAIM, 2016; 3(9): 210- 217. Page 211 Conclusion: Vecuronium is an excellent non-depolarizing muscle relaxant which is an intermediate duration of action in adult but of longer duration in neonates and infants (less than 1 year). It is having advantage of – Cardiostability, Lack of Ganglion blocking action, Lack of histamine release, Non cumulative property, Excellent conditions for intubation, Excellent muscle relaxation, Complete recovery without any complication