Complicações extralaríngeas das cirurgias por laringoscopia direta de suspensão / Extra-laryngeal complications of suspension laryngoscopy

Apesar do uso rotineiro da laringoscopia de suspensão (LS) na microcirurgia de laringe, poucos são os estudos na literatura que tratam das complicações deste procedimento. OBJETIVO: Avaliar as complicações extralaríngeas após a laringoscopia de suspensão e relacioná-las com o tempo de cirurgia. MATERIAL E MÉTODO: Trinta e sete procedimentos consecutivos foram analisados prospectivamente enfocando as lesões relacionadas à LS. A pesquisa incluiu análise pré e pós-operatória dos pacientes quanto aos critérios estudados. RESULTADO: O tempo cirúrgico foi menor de trinta minutos em quatorze casos, entre trinta e sessenta minutos em dezesseis casos e maior de uma hora em sete casos. Vinte e sete apresentaram lesão relacionada à LS, sendo mais comuns as lesões da mucosa oral. Lesão temporária dos nervos foi encontrada em cinco casos, e trauma dentário em um caso. Houve relação estatística entre o tempo de cirurgia e o índice de lesões de mucosa oral menores de 1 centímetro, confirmando que procedimentos mais longos apresentam maior risco para esta complicação. CONCLUSÃO: Esses achados demonstram que a LS não é um procedimento inócuo, produzindo complicações freqüentes. Ainda que não representem grande morbidade aos pacientes, tais danos são evitáveis desde que técnicas mais apuradas sejam utilizadas.

Although suspension laryngoscopy is routinely used in laryngeal surgery, there are only few studies on the complications of this procedure. AIM: to evaluate the complications outside the larynx following suspension laryngoscopy and analyze their relation with surgery duration. MATERIALS AND METHODS: Thirty-seven procedures were prospectively analyzed for intervention-related complications. The study included patient preoperative and postoperative assessment, focusing on dental, mucosal and nerve status (hypoglossal and lingual nerves). RESULTS: Most procedures (27/37) were associated to some kind of complication, and mucosal injuries were the most common; temporary nerve lesions were observed in five cases and dental injuries in one case. Statistic significance was found between surgery duration and mucosal injury (lesions smaller than 1 centimeter), showing that longer procedure pose higher risks for these complications. CONCLUSION: These findings suggest that suspension laryngoscopy is frequently associated with complications outside the larynx. Although these injuries represent a low risk of significant morbidity, they can be avoided if more accurate techniques are used.

Comparison of morbidity following the removal of mandibular third molar by lingual split, surgical bur and simplified split bone technique.

BACKGROUND: The methods frequently used for surgical removal of impacted third molars are bur technique, lingual split and simplified split bone technique. The morbidity rates following the use of these different surgical techniques are not completely resolved. The use of a surgical method with minimum postoperative complication is needed. AIM: This study was conducted to compare the morbidity rates of the three different surgical techniques and their efficacy with regard to postoperative pain, swelling, labial and lingual sensation. MATERIALS AND METHODS: Ninety patients with a symptomatic impacted mandibular third molar with the age range of 14-62 years were divided into three groups of 30 patients each for surgical bur technique, lingual split technique and simplified split bone technique. All patients were operated by the same surgeon under local anesthesia (2% lignocaine) in the dental chair. The severity of pain and swelling was recorded on a visual analogue scale and the presence or absence of sensory disturbance at 6, 24, 48 hours and seven days after operation. The pain was scored according to a visual analogue 4-point scale. Patients were asked to indicate which side was more swollen and to record this assessment on the swelling scale. RESULTS: Lingual split technique was more painful than the other two techniques. Surgical bur technique had more swelling than the other two techniques. Labial and lingual sensations were not altered in all the techniques. CONCLUSION: The simplified split bone technique had the least morbidity than the lingual split and surgical bur technique.

Lesions nerveuses en chirurgie buccale et implantaire a la mandibule: etiopathogenie, prevention, et traitement

Nerve injuries are among the most fearful complications occurring during surgical procedures in the mandible because of their symptoms and their long and often irreversible evolution. The inferior alveolar nerve as the lingual, mylohyoid and buccal ones can be injured following different surgical procedures [wisdom tooth extractions, Cyst enucleation, implant surgery ']. The surgeon, aided by different means of diagnosis put at his disposal, must appreciate their anatomy before any surgical procedure in their region. Thus, the dental radiology along with the emergence of modern techniques [dentascan, scanora '] must guide the surgical thechnique in order to prevent nerve injuries which lead to the emergence of clinical and functional signs very disabling to the patient. Managing these complications is very important in order to help the patient recover his altered sensations. The diagnosis is often evident in the presence of parestehsia or the chin, lingual or buccal level. The prognosis depends on the type of injury and on the medicinal or surgical therapeutic attitude