Perioperative effects of different hypotensive anesthesia techniques in orthognathic surgery.

BACKGROUND: This study aimed to investigate the effectiveness of combining sevoflurane with remifentanil, esmolol, or nitroglycerin for hypotensive anesthesia and determine the suitable hypotensive anesthesia method for orthognathic surgery. MATERIAL AND METHODS: This retrospective study included 60 patients who underwent orthognathic surgery for developmental malocclusion. They were divided into three groups based on the hypotensive agent preferences: Group 1 (n = 20), sevoflurane and remifentanil; Group 2 (n = 20), sevoflurane and esmolol; Group 3 (n = 20), sevoflurane and nitroglycerin. Bleeding volume, heart rate, systolic, diastolic, and mean arterial blood pressure were recorded at certain times during the perioperative period, including at stages with increased stress levels in the body, such as incision and osteotomy. The patients' blood pressure, analgesic consumption and pain level were recorded in the postoperative period. RESULTS: Bleeding volume, surgery satisfaction related to bleeding, and total operation time did not differ significantly between groups. Intraoperatively, heart rates were significantly higher in Group 3 than in Groups 1 and 2 (p = 0.001). However, hemodynamic stability was similar in Groups 1 and 2. Postoperatively, analgesic consumption, pain levels, and blood pressure dynamics did not differ significantly between groups (p > 0.05). CONCLUSIONS: Based on this study's results, it was concluded that infusing remifentanil, esmolol, or nitroglycerin with sevoflurane during orthognathic surgery successfully achieved the targeted hypotensive anesthesia and can be considered alternative methods. The decision on which method to use should consider the patient's overall health status and additional medical conditions.

Does preventive single dose of intravenous dexketoprofen reduce pain and swelling after orthognathic surgery? A prospective, randomized, double blind clinical trial.

BACKGROUND: The purpose of this study was to evaluate the effect of a single-dose intravenous dexketoprofen administration for preventive analgesia on postoperative pain and reducing swelling in double jaw surgery. MATERIAL AND METHODS: The authors designed a prospective, randomized, and double-blind cohort study. Patients who have Class III malocclusion were randomly divided in two groups. 50 mg intravenous dexketoprofen trometamol were administrated 30 minutes before incision in treatment group, while intravenous sterile saline was administrated 30 minutes before incision in placebo group. The primary predictor variable was treatment group. Primary outcomes were pain, swelling and 24-hour opioid intake. Patient- controlled analgesia with tramadol was given for management of postoperative pain. Other variables were demographic and operation related parameters. Visual analogue scale was used to evaluate postoperative pain. 3dMD Face System (3dMD, USA) was used to measure postoperative swelling. Data were analysed using two independent samples t test and Mann Whitney U test. RESULTS: The study sample was composed of 30 patients with a mean age of 20,63 years and 21 were female. Preemptive dexketoprofen administration decreased postoperative tramadol consumption by 25.9% compared to placebo group, and there was a statistically significant decrease in VAS scores (p<0,05). There was no statistically significant difference between the groups in terms of swelling (p>0,05). CONCLUSIONS: Preventive administration of intravenous dexketoprofen provides adequate analgesic effect in the postoperative 24-hour period and reduces opioid consumption in orthognathic surgery.

A case of diffuse alveolar hemorrhage after orthognathic surgery: Case report with the literature review'.

Diffuse alveolar hemorrhage (DAH) disease is a rare but acutely developing condition that may occur after general anesthesia, if not diagnosed and treated on time, could be life-threatening. Orthognathic surgeries, frequently performed for functional and esthetic correction, are generally composed of a young population in their twenties with no other disease. The aim of presenting this case report was to describe the etiology, diagnosis, and treatment of DAH to emphasize the importance of timely diagnosis.

Chondrotoxic effects of intra-articular injection of local anaesthetics in the rabbit temporomandibular joint.

The aim of this study was to investigate the chondrotoxic effects of a single-dose intra-articular injection of articaine, lidocaine, and bupivacaine on the rabbit temporomandibular joint (TMJ). Twenty-four rabbits were divided into four groups: control (group 1), articaine (group 2), lidocaine (group 3), and bupivacaine (group 4). Synovial fluid samples and venous blood were taken to evaluate matrix metalloproteinase 3 (MMP-3) levels. One millilitre of local anaesthetic solution was injected in the study groups and saline solution in the control group. The rabbits were euthanized after 4 weeks and the mandibular condyles and articular discs were evaluated. On histological examination, the study group samples had irregular joint surfaces, decreased collagen, and a thinner cartilage layer. Apoptotic cells were evaluated with the TUNEL method. TUNEL-positive apoptotic cell counts were higher in all study groups compared to the control group, and the difference was significant (P < 0.001). The mean preoperative serum MMP-3 level for all groups was 5.71 ± 3.33 ng/mL, while the mean postoperative level was 22.61 ± 6.36 ng/mL; this difference was significant (P < 0.001). A single-dose intra-articular injection of local anaesthetic had apoptotic effects on chondrocytes, leading to degenerative changes in the TMJ articular structures. Articaine was found to have less harmful effects than lidocaine and bupivacaine. Intra-articular injection of local anaesthetics should be limited in the TMJ because of the potential toxic effects.

Investigation of Vitamin D levels in medical staff in a dental clinic.

AIMS: Recently, Vitamin D deficiency is pandemic now. The main reason of vitamin D deficiency is inadequate exposure to sunlight. Vitamin D level in nutrients is low and it can be ineffective to meet the daily requirements. Vitamin D is synthesized in the skin by ultraviolent radiation. In the present study, the authors aimed to investigate serum 25(OH) D levels of the medical staff working in different positions in the Faculty of Dentistry. SUBJECTS AND METHODS: A total of 51 dentists, 28 dental assistants, 11 secretaries, and 10 nurses working in the Faculty of Dentistry, Erciyes University between November and December 2014 were included to the study. The serum 25(OH) D levels of the participants were evaluated. RESULTS: Of the participants, 62 were females and 38 were males with a mean age of 30.17 ± 5.77 (range: 20-49) years. The mean vitamin D levels were found to be 12.1 ± 8.37 ng/mL (range: 2.1-38.3). A total of 51 participants had severe vitamin D insufficiency, while three participants had normal vitamin D levels with only one dentist. CONCLUSION: According to the results of present study, dental staff should be considered as a high-risk group for vitamin D deficiency. Vitamin D deficiency and insufficiency is a common problem among medical staffs as in several working groups such as white-collar workers and bankers. Results of present study suggest that insufficient exposure to the sunlight may lead to severe vitamin D deficiency in dental professionals. Vitamin D supplementation may be recommended to the dental staff.

Comparison of the analgesic effects of pulse radiofrequency and cryoablation in rabbits with mental nerve neuropathic pain.

PURPOSE: After mental nerve injury, several sensory disorders may occur. The alterations in sensation may differ from mild paresthesia to complete anesthesia, or neuropathic pain. Neuropathic pain is a difficult clinical condition to manage. The aim of this study was to compare the analgesic effects of pulsed radiofrequency (PRF) and cryoablation in an experimental mental nerve neuropathic pain model in rabbits. MATERIALS AND METHODS: Fifteen rabbits were divided into three groups. One-third to one-half of the mental nerve was ligated with 4-0 silk sutures. In Group 1, a nonconducting PRF electrode was placed on the mental nerve for 6 min, whereas the mental nerve was exposed to PRF in Group 2. In Group 3, the cryoablation was processed. The responses to thermal and mechanical stimuli were measured at the 1st, 2nd, 3rd, and 4th weeks. RESULTS: There were no statistically significant differences among the groups for thermal withdrawal latency to heat stimulation in any weeks (P > 0.05). However, a significant difference was found between the groups (P < 0.05) in the 3rd and 4th weeks for mechanical withdrawal latency values. CONCLUSIONS: Both PRF and cryoablation therapies are successful in the treatment of experimentally induced mental nerve neuropathic pain in rabbits.