The Judgement for Development of Virtual Surgical Planning and Three-Dimensional Bio-Printing for Superior Reconstruction of Mandibular Defect by Fibular Graft on Head-Neck Cancer / 대한이비인후과학회지

Oncological resection followed by reconstruction with a free fibular graft is still considered to be the gold standard treatment for functional and prosthetic rehabilitation of oral cancer patients. But this tedious traditional process is challenging for surgeons, as they have to deal with associated curve anatomy, surrounding innervations, and maintenance of functional and aesthetical acceptability. Such manual and operator’s skill dependent surgery can commonly demand a longer treatment duration; leading to an increased risk for prolonging the period of ischemia with increased morbidity, which frequently ends with an uncertain, unsatisfactory outcome. Technological advancements in the 20th and 21st centuries present a revolutionary improvement in the field of reconstructive surgery. Virtual surgical planning (VSP) and threedimensional (3D) bio-printing incorporating computer-aided design and computer-aided modeling is a promising tech in modern head and neck reconstruction. This recent innovation is more polished regarding initiation of patient-customized models, pre-bent plates, and osteotomy guides which further increase surgical precision, improve operative efficiency, ensure proper wound healing, shorten operative time, reduce operative cost, and decrease morbidities. This review focuses on the virtual surgical planning and 3D bio-printing technologies to evaluate their efficiency of qualitative and quantitative outcomes of resection and reconstruction of mandible in head-neck cancer using fibular graft.

Do corticosteroids reduce postoperative pain following third molar intervention?

Background@#Corticosteroids have been widely used by oral surgeons for reducing swelling caused by wisdom teeth surgery. However, they have not been proven to decrease pain. This study was aimed at analyzing previous studies pertaining to corticosteroids and pain reduction following wisdom teeth surgery. @*Methods@#The Science Direct, PubMed, and MEDLINE databases were searched for relevant journals according to a systematic search strategy (Patient Intervention Comparison Outcome Study). Randomized controlled trials published in English from 1998 to 2017 were extracted. @*Results@#Twenty-seven articles were included, with a total of 36 comparative cases. Methylprednisolone and dexamethasone were the most commonly used corticosteroids. Intramuscular injections of corticosteroids were optimal for pain reduction, regardless of the time of administration. @*Conclusions@#Corticosteroids can be used as an adjuvant for pain reduction following wisdom teeth surgery.Methylprednisolone and dexamethasone delivered via the intramuscular route is the best method for effective pain reduction. The ideal time for administration of corticosteroids is the preoperative period.

Double versus single cartridge of 4% articaine infiltration into the retro-molar area for lower third molar surgery

BACKGROUND: There are no studies regarding 4% articaine infiltration injection into the retro-molar area for an impacted lower third molar (LITM) surgery. This study aimed to evaluate the efficacy of infiltration using 1.7 ml (single cartridge: SC) of 4% articaine versus 3.4 ml (double cartridges: DC) of 4% articaine with 1:100,000 epinephrine in LITM surgery. METHOD: This study involved 30 healthy patients with symmetrical LITM. The patients were assigned to receive either a DC or SC of 4% articaine with 1:100,000 epinephrine as a local anesthetic for each operation. Onset, duration, profoundness, need for additional anesthetic administration, total volume of anesthetic used, vitality of the tooth, and pain score during operation were recorded. RESULTS: The DC of 4 % articaine had a significantly higher success rate (83.3%) than did the SC (53.3%; P < 0.05). The duration of soft tissue anesthesia was longer in the DC group. The intra-operative pain was higher in the SC group with a significant (P < 0.05) requirement for a supplementary local anesthetic. CONCLUSION: We concluded that using DC for the infiltration injection had a higher success rate, longer duration of anesthesia, less intra-operative pain, and a lower amount of additional anesthesia than SC in the surgical removal of LITM. We recommend that a DC of 4% articaine and a 1:100,000 epinephrine infiltration in the retro-molar region can be an alternative anesthetic for LITM surgery.

Decreased post-operative pain using a sublingual injection of dexamethasone (8 mg) in lower third molar surgery

BACKGROUND: Every patient who undergoes mandibular third molar surgery is concerned about post-operative pain. Indeed, previous researchers have used various methods to treat such pain. This study aimed to assess the effectiveness of sublingual injection of dexamethasone (8 mg) to treat post-operative pain after mandibular third molar surgery. METHOD: This was a randomized, double-blind, split-mouth, clinical trial, involving 48 healthy patients who required surgical removal of two mandibular third molars with similar bilateral positions. All operations were performed by the same experienced surgeon. The patients were randomized into a study group (8 mg dexamethasone injection) and a placebo group (normal saline injection). Both interventions were injected into the sublingual space immediately after local anesthesia, 30 min before the first incision. The study group received an 8 mg dexamethasone injection, while the placebo group received a normal saline injection. The wash period between the patients' two operations was 3 to 4 weeks. Pain was assessed by recording the number of analgesic tablets (rescue drug) consumed, as well as by noting the patients' responses to the visual analog scale (VAS) on the first, second, and third days after surgery. RESULTS: The study group differed significantly from the placebo group in terms of VAS score and analgesic consumption. CONCLUSION: Dexamethasone (8 mg), injected sublingually, significantly eased post-operative pain after surgical removal of the mandibular third molar.