Effect of music therapy on pain and anxiety during third molar surgery

Music therapy has been used with promising results to reduce pain and anxiety in surgical specialties. It is suggested to reduce anxiety and pain perception during dental surgeries and thereby improving clinical outcomes. Aim: The aim of this study is to determine whether listening to music during trans-alveolar mandibular third molar extraction reduces pain perception and anxiety. Methods: One hundred and forty-six adult participants were randomized into music and non-music groups, with each group comprising seventy-three participants. Each participant had trans-alveolar third molar extraction with or without music intervention depending on the group randomly assigned. Pain scores of participants were measured at one minute after consent, during and after administration of local anaesthetic, during osteotomy, after tooth delivery, and one minute after flap closure. Postoperative pain scores were recorded at one-hour, 3-hour, 6-hour, 24-hour and 48-hour after the last stitch. Pre- and post-operative anxiety scores were also recorded. Descriptive statistics was used to describe sociodemographic data. Student t-test was used to compare the mean of quantitative variables between the groups while chi-square test was used to compare proportions and to investigate association between categorical variables. The statistical significance was defined at p<0.05. Results: The study showed similar sociodemographic characteristics, baseline clinical features and duration of surgery between groups. Pain score peaked during local anaesthetic administration (p = 0.254) and at 3 hours after surgery (p = 0.170) but no statistically significant difference was observed in the mean pain score. The mean anxiety scores also revealed no statistically significant differences. Conclusion: Music was found to add no significant anxiolytic and adjunctive analgesic benefit to participants who underwent third molar surgeries in this study

Burdens and predictors of the Burden experienced by Family Caregivers of Patients with Oral and Maxillofacial Tumours.

Aim: There is a dearth of knowledge on the burden of family caregivers of patients with maxillofacial tumours in Nigeria. This burden may be influenced by racial peculiarities and the disease entity of the patient. The aim of this study is to assess and document the burdens and predictors of burdens experienced by family caregivers of patients with oral maxillofacial tumours presenting at a tertiary health facility in South Western Nigeria. Materials and Methods: A descriptive cross-sectional study that included 110 consenting family caregivers of patients diagnosed with oral and maxillofacial tumours. A semi-structured questionnaire was used to collect information on their sociodemographic characteristics and caregiving burden using the Zarit burden interview tool. Data were analysed using descriptive and inferential statistics with Statistical Package for Social Sciences version 21.0. Result: The most frequent group of caregivers was patients' children (32.0%), aged 30-39 years (28.2%), females (54.5%), with secondary education (41.8%), and traders (38.2%), who earned less than national minimum wage (55.5%). Majority (42.7%) experienced mild-to-moderate burden; coping strategy was mainly prayers (76.4%), while the greatest need expressed was financial assistance (93.6%). The significant predictors of caregiver burden were the presence of pain (adjusted odds ratio [AOR] = 2.961; 95% confidence interval [CI] = 1.165-7.526; P = 0.023) and severe clinical condition (AOR = 3.342; 95% CI = 1.133-9.853; P = 0.029). Conclusion: The most common category of the burden of family caregivers of patients with maxillofacial tumours was the mild-to-moderate category, and the most significant predictors were the presence of pain and severity of clinical condition. The greatest need expressed was financial assistance. Therefore, an emphasis on adequate pain control and alternate sources of funding may appreciably relieve the burden of family caregivers of patients with maxillofacial tumours.

Clinical Parameters and Challenges of Managing Cervicofacial Necrotizing Fasciitis in a Sub-Saharan Tertiary Hospital.

INTRODUCTION: Necrotizing fasciitis is a severe soft tissue infection. In our environment, patients presenting with this infection are usually financially incapacitated and, therefore, their management can be challenging. This paper aimed to document the pattern and challenges encountered in the management of cervicofacial necrotizing fasciitis (CNF) in the University College Hospital, Ibadan. MATERIALS AND METHODS: Information such as biodata, site of infection, systemic conditions, widest span of defect, management provided, hospital stay, and outcome of management was prospectively collected on all patients with CNF who presented at the Department of Oral and Maxillofacial Surgery between January 2007 and December 2013. The patients were managed according to a devised protocol of antibiotic therapy, serial debridement and honey dressings. RESULTS: Twenty-four cases of CNF were seen. There were 9 males and 15 females while 70.9% of the patients belonged to the low socioeconomic class. The mean span of wound defect was 12.2 (±8.844) cm. The mean hospital stay was 27.8 (±23.1) days, and scar formation was the most common complication encountered. CONCLUSION: Our study represents the largest series of CNF from a Nigerian health facility presently. The management of necrotizing fascitis in the maxillofacial region poses a significant challenge to both the surgeon and the patient. However, the mortality rate of CNF in our center appears comparatively low.

Intra-Operative Airway Management in Patients with Maxillofacial Trauma having Reduction and Immobilization of Facial Fractures.

BACKGROUND: Despite advancements in airway management, treatment of fractures in the maxillofacial region under general anesthesia remains a unique anesthetic challenge. We reviewed the pattern of airway management in patients with maxillofacial fractures and assessed those challenges associated with the different airway management techniques employed. MATERIALS AND METHODS: The anesthetic chart, theatre and maxillofacial operations records of patients who had reduction and immobilization of various maxillofacial fractures over a 2-year period were reviewed. Information obtained included the patient demographics, mechanisms of injury, types of fractures and details about airway management. Statistical Package for Social Sciences, SPSS version 17.0 was utilized for all data analysis. RESULTS: Fifty-one patients were recruited during the 2-year study period. Mask ventilation was easy in 80-90% of the patients, 80% had Mallampati three or four, while 4 (7.8%) had laryngoscopy grading of 4. There was no statistically significant difference between the fracture groups in terms of the laryngoscopy grading (P = 0.153) but there was statistical significant difference in the technique of airway management (P = 0.0001). Nasal intubation following direct laryngoscopy was employed in 64.7% of the patients, fiber-optic guided nasal intubation was utilized in only 7.8%. None of the patients had tracheostomy either before or during operative management. CONCLUSION: Laryngoscopic grading and not adequacy of mouth opening predicted difficult intubation in this group of patients in the immediate preoperative period. Despite the distortions in the anatomy of the upper airway that may result from maxillofacial fractures, nasal intubation following direct laryngoscopy may be possible in many patients with maxillofacial fractures.