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BACKGROUND: Controlled hypotension (CH) provides a better surgical environment and reduces operative time. However, there are some risks related to organ hypoperfusion. The EV1000/FloTrac system can provide continuous cardiac output monitoring without the insertion of pulmonary arterial catheter. The present study investigated the efficacy of this device in double jaw surgery under CH.METHODS: We retrospectively reviewed the medical records of patients who underwent double jaw surgery between 2010 and 2015. Patients were administered conventional general anesthesia with desflurane; CH was performed with remifentanil infusion and monitored with an invasive radial arterial pressure monitor or the EV1000/FloTrac system. We allocated the patients into two groups, namely an A-line group and an EV1000 group, according to the monitoring methods used, and the study variables were compared.RESULTS: Eighty-five patients were reviewed. The A-line group reported a higher number of failed CH (P = 0.005). A significant correlation was found between preoperative hemoglobin and intraoperative packed red blood cell transfusion (r = 0.525; P < 0.001). In the EV1000 group, the mean arterial pressure (MAP) was significantly lower 2 h after CH (P = 0.014), and the cardiac index significantly decreased 1 h after CH (P = 0.001) and 2 h after CH (P = 0.007). Moreover, venous oxygen saturation (ScVO2) decreased significantly at both 1 h (P = 0.002) and 2 h after CH (P = 0.029); however, these values were within normal limits.CONCLUSION: The EV1000 group reported a lower failure rate of CH than the A-line group. However, EV1000/FloTrac monitoring did not present with any specific advantage over the conventional arterial line monitoring when CH was performed with the same protocol and same mean blood pressure. Preoperative anemia treatment will be helpful to decrease intraoperative transfusion. Furthermore, ScVO2 monitoring did not present with sufficient benefits over the risk and cost.
Subject(s)
Humans , Anemia , Anesthesia, General , Arterial Pressure , Blood Pressure , Cardiac Output , Catheters , Erythrocyte Transfusion , Hypotension, Controlled , Medical Records , Operative Time , Orthognathic Surgery , Osteotomy, Le Fort , Oxygen , Retrospective Studies , Vascular Access DevicesABSTRACT
Objective:To evaluate the surgical corrective results of maxillary hypoplasia in patients with cleft lip and palate withtranspalatal modified Le Fort Ⅰ osteotomy.Methods:In the study,1 1 patients (4 women,and 7 men)with maxillary hypoplasia secondary to cleft lip and palate underwent transpalatal modified Le Fort Ⅰ osteotomy at Peking University School of Stomatology from Jan.201 2 to Dec.201 3, with the mean age of 21 years (from 1 8 to 27 years),Bilateral sagittal split ramus osteotomy (BSSRO) and genioplasty were performed simultaneously in 9 of them for better appearance and functional occlu-sion.Lateral cephalometric radiographs were taken and traced before surgery,immediately after surgery and 6 months after surgery.The position of subspinale (A)on horizontal direction,the angle of sella-na-sion-subsipmale (SNA)and the angle of sella-nasion-supramental (SNB)were collected and analyzed to evaluate the results.Results:All the patients were uneventful with transpalatal modified Le Fort Ⅰosteotomy.All of them had a better profile and a satisfactory occlusionafter operation.The position of A was moved forward (6.6 ±1 .1 )mm on average in horizontal direction when surgery was completed,and maintained (6.0 ±1 .2)mm on average 6 months after surgery.The average of SNA was 75.9°±2.8° before surgery,81 .6°±8.6°immediately after surgery,and maintained 81 .0°±2.6°6 months after sur-gery.The average of SNB was 82.6°±3.7°before surgery,78.0°±2.4°immediately after surgery,and maintained 78.5°±2.4°6 months after surgery.Conclusion:The maxillary hypoplasia in cleft lip and palate patients can be successfully corrected with transpalatal modified Le Fort Ⅰ osteotomy and the func-tional occlusion can be achieved simultaneously.The effect of deformity correction was satisfactory. Transpalatal modified Le Fort Ⅰ osteotomy can move maxilla more sufficiently,especially applicable for the patient with severe palatal scars preoperatively.
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Objective:To investigate the effect of segmental Le FortⅠosteotomy and bilateral sagittal split ramus osteotomy ( BSSRO ) on the condyle position in skeletal class Ⅲ malocclusion patients . Methods:In this retrospective study , 19 patients with skeletal class Ⅲmalocclusion who met the inclu-sion criteria were enrolled .All the patients underwent the segmental Le FortⅠ osteotomy and BSSRO . Cone beam computed tomography ( CBCT) scans were performed in the following phases:T1:within one week before the surgeries;T2:within one week post-surgery;T3:three months post-surgery;T4:6 to 14 months post-surgery .The posterior spaces , anterior spaces and the superior spaces of the bilateral tem-poromandibular joints were measured according to the Kamelchuk method respectively .The fossa ratios of the condyle and the distribution of the condyle positions related to the glenoid fossa ( anterior , concentric and posterior position ) were calculated .The results were analyzed statistically .Results:The posterior space , the anterior space and the superior space of bilateral temporomandibular joints in T 2 phase [ right:(2.78 ±1.23) mm, (2.47 ±0.89) mm, (3.07 ±0.85) mm; left: (2.93 ±0.83) mm, (2.69 ± 1.14) mm, (3.44 ±1.16) mm] showed significantly larger spaces than those in T 1 phase [right:(1.81 ±0.95) mm, (1.65 ±0.55) mm, (2.13 ±0.52) mm;left:(2.12 ±1.05) mm, (1.79 ±0.59) mm, (2.15 ±0.93) mm],in T3 phase [right:(2.08 ±1.25) mm, (1.79 ±0.68) mm, (1.80 ±0.76) mm;left: (2.05 ±0.75) mm, (1.99 ±0.94) mm, (2.14 ±0.71) mm] and in T4 phase [right:(1.94 ±0.77) mm, (1.81 ±0.69) mm, (2.05 ±0.69) mm;left:(1.89 ±0.69) mm, (1.80 ±0.61) mm, (2.19 ±0.75) mm], P0.05).The fossa ratio and the condyle position related to the glenoid fossa had no significant difference in all the four phases (P>0.05).The results suggested that the condyle moved downward in T 2 phase and changed to the original pre-surgery position in T3 phase, then keot stable in T4 phase.Conclusion:Segmental Le FortⅠ osteotomy and BSSRO caused significant and transient changes of the condyle position in skeletal class Ⅲmalocclusion patients . However , the condyle tended to move back to the original pre-surgery position and might keep stable .
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Objective: To identify nasal width changes occurring after Le Fort Ⅰosteotomy and to compare prospectively the effect of three surgical techniques for controlling postoperative nasal width . Methods:In the study, 79 patients (22 male and 57 female, mean age 23.2 ±3.4 years), who re-ceived Le Fort Ⅰosteotomy at Peking University Hospital of Stomatology from 2011 to 2014, were ran-domly divided into three groups .Group 1 was treated with traditional intraoral alar base cinch suture ( ABCS);Group 2 with extraoral ABCS, and Group 3 with traditional ABCS plus an extra intraoral suture at points G.lat.All the patients had taken 3D photos using 3dMD camera before operation , and 3, and 6 months after operation.The nasal widths, which were indicated as distances between Sbal-Sbal, G.lat-G.lat and Al-Al, were measured by two examiners in the 3D photos three times with a time-interval of one week .SPSS 13 .0 was used to do the statistic analysis .Results: At the end of the postoperative 6 months, the nasal widths lessened as compared with the postoperative 3 months.No significant diffe-rences were found between the three groups 6 months after the operation .The degree of the postoperative nasal width widening had positive correlation with that of the intraoperative nasal width widening , and had negative correlation with the initial nasal width and the amount of post-suture narrowing .Conclusion:There is no difference between three suturing techniques for controlling nasal width widening after Le FortⅠosteotomy.The postoperative nasal width-widening can’t be totally avoided, and the alteration might last at least 6 months after the operation .For patients with narrow nasal width and need to move maxilla forward , more overcorrection of ABCS is needed to control the postoperative nasal base widening .
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O objetivo deste trabalho consiste na avaliação das alterações esqueletais ocorridas após a expansão rápida da maxila (ERM) por meio de osteotomia Le Fort I. Foram realizadas cefalometrias em norma frontal, pré e pós-operatórias, de 13 pacientes com deficiência transversal de maxila. As variáveis mensuradas foram largura maxilar efetiva e largura da abertura piriforme. Foram estabelecidas as distâncias (pré e pós-operatórias) entre os pontos Maxillare direito e esquerdo, para a largura maxilar, e Lateronasal direito e esquerdo, para a largura da abertura piriforme. Para a comprovação dos objetivos propostos neste trabalho, foram utilizados o Coeficiente de Correlação de Pearson e os testes paramétricos "t-Student". Houve um incremento médio de 4,1% na largura da abertura piriforme e de 3,8% na largura efetiva da maxila. Concluiu-se que após a ERM, ocorre um aumento na largura maxilar efetiva e na largura da abertura piriforme. Após a ERM, manteve-se uma correlação entre a largura da abertura piriforme e a largura maxilar posterior, como havia na fase pré-operatória, o que sugere que houve liberação das áreas de resistência pelas osteotomias empregadas.
The goal of this study is evaluate the skeletal changes that occurred after the rapid maxillary expansion (RME) through Le Fort I osteotomy. Posteroanterior cephalometries were held, pre and post-operative, in 13 patients with transversal maxillary defciency. The variables measured were the effective maxillary width and nasal width. The distances - pre and post-operative - between right and left Maxillare points, to the maxillary width, and right and left Lateronasal points, to the nasal width, were established. For proof of the goals raised in this work were used the Pearson's correlation coeffcient and the "t-Student" parametric test. There was an average increase of 4.1% in the nasal width and 3.8% in the effective maxillary width. It was concluded that after the RME occur an increase in the nasal and effective maxillary width. After the RME has remained a correlation between the nasal width and the posterior maxillary width, as there was in the pre-operative, suggesting that there was a release of resistance areas by employed osteotomies.