Will Obstructive Sleep Apnea and Apnea/Hypopnea Index Be Corrected Following Alveolar Cleft Reconstruction?

BACKGROUND: Obstructive sleep apnea is a disorder of repetitive complete or partial airway obstruction during sleep. The aim of this study was to assess the impact of alveolar cleft reconstruction on the obstructive sleep apnea (OSA) condition and apnea/hypopnea index (AHI). METHODS: In a double-blinded prospective quasi-experimental study, all healthy systemic children (n=30 female cleft patients) with unilateral alveolar cleft defects within the age range of 8-14 years and BMI less than 30 kg/m2 who admitted for alveolar cleft repair were enrolled. OSA monitoring was performed one week before surgery, and 3 months postoperatively by Apnea Link device. Sleep apnea indices such as AHI, respiratory disturbance index (RDI), oxygen desaturation index (ODI) and oxyhemoglobin saturation (SpO2) as well as pulse rate (PR) and respiratory rate (RR) were the variables. RESULTS: The patients' mean age was 11.0±1.4 years, and BMI average was 21.48±4.4 kg/m2. Mean AHI was 21.6±5.0 events/hour, preoperatively; which decreased significantly and reached 4.4±2.5 events/hour after alveolar cleft reconstruction surgery (p=0.005). Moreover, the other OSA variables (SpO2, RDI, and ODI), as well as vital signs (PR, and RR) improved postoperatively (p=0.005). In other words, the preoperative moderate OSA status relieved after alveolar cleft repair and reconstruction. CONCLUSION: Our study showed that the OSA and AHI ameliorated after bone graft surgery in alveolar cleft repair. More clinical trials including larger sample sizes may be required for relevancy.

The Comparison of Utilizing Piezotome and Surgical Disc in Ridge Splitting of Atrophic Edentulous Maxillary Ridge.

OBJECTIVE: Narrow dentoalveolar ridges remain a serious challenge for the successful placement of dental implants. The aim of this study was to compare the clinical outcomes of piezosurgery versus surgical disc on ridge splitting in the atrophic edentulous maxilla. MATERIALS AND METHODS: This was a double-blinded randomized clinical trial. The healthy subjects who were candidates for maxillary ridge expansion were included in this experiment. Patients were randomly divided into two groups: piezosurgery group and surgical disc group. The width of the bone in the surgical site was measured by surgical calliper before the osteotomy. The bone width was remeasured after ridge-split completion (before suturing) and during the implant placement (4 months later). Then data were analysed by SPSS software, and the P value was set at 0.05. RESULTS: The study sample size included 20 cases. Our outcomes showed that both techniques (surgical disc and piezotome) were effective in ridge splitting (P < 0.001). However, the average bone width which was obtained after ridge splitting was significantly higher in the piezosurgery group (P < 0.05). CONCLUSION: It can be concluded that both methods of piezosurgery and surgical disc can significantly lead to increase in the ridge width. However, the piezosurgery technique was more effective in ridge splitting.

Coregulation of sleep-pain physiological interplay by orexin system: An unprecedented review.

Accumulating evidence support the critical role of endogenous orexin system in modulation of various physiological functions. Among these, regulation of pain and wakefulness have extensively been investigated, however, by independent series of studies each focusing a distinct side. It is now well established that orexins induce potent analgesic effect via affecting their receptors within several specific brain structures. These mainly include locus coeruleus (LC), lateral paragigantocellularis (LPGi), ventral tegmental area (VTA), dorsal raphe nucleus (DRN), periaquiductal gray (PAG) and tuberomammillary nuclei (TMN). On the other hand, increased activity of orexinergic neurons enhances general wakefulness. Interestingly, a review of literature reveals that brain regions underlying orexin-mediated analgesia are most probably the site of action for orexin wake-promoting effects as well. The present study first pieces together the existing evidence supporting the rationale for the possibility of sleep-pain coregulation by orexin system and then suggests several shared mechanisms through which orexin can control the two mentioned processes. Furthermore, this study explains how imbalanced orexinergic transmission can cause progressive dysregulation of sleep-pain processing.

Is Impregnation of Xenograft with Caffeine Effective on Bone Healing Rate in Mandibular Defects? A Pilot Histological Animal Study.

INTRODUCTION AND AIM: The aim of this study was to evaluate the effect of two concentrations of caffeine (1.5% and 3%) powder added to Bio-Oss xenograft on bone healing rate of iatrogenic mandibular defects in dogs. MATERIALS AND METHOD: The researchers implemented a pilot study on ten male adult mongrel dogs. Two 4-mm circular critical-sized defects were trephined on each side of the mandibular body (a total of 4 defects for each dog). One of the defects remained empty as a control group. The other three defects in each case were randomly filled with 1.5% or 3% caffeinated Bio-Oss or pure Bio-Oss. The mandible specimens were sent for histological and histomorphometric assessments, 4 months postoperatively. Our predictor variable was the type of bone substitute. The study outcomes were new bone formation, angiogenesis, and fibrosis. The p value was set at 0.05 using SPSS 16. RESULTS: The histological assessment showed that the administration of 1.5% caffeinated Bio-Oss to mandibular defects caused more angiogenesis and more new bone formation as well as less fibrosis compared to the other groups (p < 0.05). CONCLUSION: This study suggested that the application of 1.5% caffeinated Bio-Oss in bone defects of dogs resulted in the higher new bone formation. However, further clinical trials are needed to support its relevancy.

Tapered Versus Cylindrical Implant: Which Shape Inflicts Less Pain After Dental Implant Surgery? A Clinical Trial.

PURPOSE: Because no study has evaluated the postoperative pain caused by the shape of dental implants, this study compared the level of postoperative pain between tapered and cylindrical implants inserted in the posterior region of the maxilla. MATERIALS AND METHODS: The study was designed as a double-blinded randomized clinical trial and conducted in 50 healthy patients 20 to 60 years old who were edentulous in the posterior maxilla and were candidates for single implantation. All patients had the same surgical difficulty with appropriate bone width and height. BioHorizons (Birmingham, AL) implants (tapered vs cylindrical) with 4.5-mm platform diameter were randomly selected for each group. The visual analog scale was used to evaluate the level of pain. Pain severity in each group was measured at 30-minute, 3-hour, 6-hour, 12-hour, 24-hour, 2-day, 3-day, and 1-week intervals. The predictor variable was implant shape and the outcome was postoperative pain severity. Data were statistically analyzed with SPPS 16 (SPSS, Inc, Chicago, IL) at the significance level of a P value less than .05. RESULTS: Fifty patients (n = 25 per group) with the mean age of 43.7 ± 10.9 years were included in this study. The pain level in the 2 groups reached its maximum at the 6-hour postoperative interval. Pain severity decreased significantly over time in the 2 implant groups (P < .001). Severities of postoperative pain in the tapered group at 3-, 6-, 12-, and 24-hour intervals were statistically lower than those in the cylindrical group (P < .05). CONCLUSIONS: Implant shape had an impact on postoperative pain. It can be concluded that tapered implants lead to less postoperative pain compared with cylindrical ones.

Correlation Between Lower Third Molar Impaction Types and Mandibular Angle and Condylar Fractures: A Retrospective Study.

PURPOSE: The purpose of this study was to investigate and determine the relations between mandibular third molar (M3) impaction types and mandibular angle and condylar fractures. MATERIALS AND METHODS: A retrospective study was conducted in patients with mandibular angle and condylar fractures referred to the Oral and Maxillofacial Surgery Department of the Shahid Kamyab Hospital (Mashhad, Iran) from 2013 to 2018. Data sources were patients' hospital documents and panoramic radiographs. Predictor variables were the presence and position of impacted M3s. The Pell-Gregory classification was used to identify the horizontal and vertical positions of impaction. The impaction angulation was determined using the Schiller classification. Outcome variables were the presence of angle and condylar fractures. Data were analyzed using SPSS 16 (IBM Corp, Armonk, NY) and χ2 and Fisher exact tests. RESULTS: The study sample consisted of 117 patients (63.2% with condylar fractures, 30.8% with angle fractures, and 6% with concomitant fractures of the condyle and angle). Most patients (88.9%) with angle fracture had impacted M3s; however, impacted M3s were absent in 59.5% of condylar fracture cases. Mesioangular and vertical positions were the most prevalent impaction angulation types in patients with mandibular angle fracture. Classes II and B were the most frequent horizontal and vertical impaction types, respectively, according to the Pell-Gregory classification. There was a statistically significant difference between fracture site and the presence or absence of impacted M3s (P < .001). Moreover, a significant relation was observed between horizontal impaction type and fracture site in patients with impacted M3s (P = .001). CONCLUSIONS: The presence of impacted M3s increased the risk of angle fractures and simultaneously decreased the risk of condylar fractures. Fractures of the angle region were more commonly seen in patients with superficially impacted (vs deeply impacted) M3s.

Comparison of Ondansetron versus Clonidine efficacy for prevention of postoperative pain, nausea and vomiting after orthognathic surgeries: A triple blind randomized controlled trial

BACKGROUND: The aim of this randomized controlled triple blind trial was to compare the efficacy of clonidine with dexamethasone versus ondansetron with dexamethasone for postoperative pain, nausea and vomiting prevention in orthognathic surgery patients. MATERIAL AND METHODS: In this clinical trial study, 30 consecutive patients with skeletal class III deformities were candidates for orthognathic surgery in Qaem hospital, Mashhad University of medical sciences, Mashhad, Iran from March to November 2017. These subjects were randomly assigned to two equal number groups, ondansetron or clonidine. Patients received either oral ondansetron 8 mg or oral clonidine 150 μg as premedication, 1 hour before the surgery (both dissolved in 20 cc of water). Also both groups received intravenous dexamethasone 8 mg (1 hour preoperatively and every 4 hours intraoperatively). RESULTS: In this study, a total of 30 patients (14 males and 16 females) with a mean age of 23.9 ± 3.9 were investigated. The incidence of postoperative nausea in women was more than men (p = 0.003), also the correlation between the incidence of PON and the surgery duration ≥ 3 hours was statistically significant (p = 0.050). The frequency of postoperative nausea (PON) in the ondansetron group was less than clonidine (53.3% vs 73.3% respectively). There was no postoperative vomiting (POV) in the ondansetron group, but 6.7% of cases in clonidine group suffered POV. Post-operative nausea in ondansetron group occurred significantly later than clonidine (525.0 ± 233.2 vs 100.0 ± 34.0 min; p < 0.001). On the other hand, the incidence time of post-operative severe pain or in other word the analgesia time in clonidine group was significantly more than ondansetron one (875/0 ± 68/5 vs 614.3 ± 159.1 min; p < 0.001). CONCLUSION: Ondansetron with dexamethasone premedication was more effective in controlling PONV after orthognathic surgery compared to clonidine with dexamethasone group

Intra- and Postoperative Complications of Le Fort I Maxillary Osteotomy.

BACKGROUND: The Le Fort I maxillary osteotomy is a versatile and simple procedure, which has gained popularity nowadays, to correct a wide range of malocclusion and maxillofacial deformities. This procedure is often associated with significant but rare postoperative complications. The aim of this study was to evaluate the types and frequencies of intra- and perioperative complications related to Le Fort I osteotomies in noncleft Iranian patients. MATERIALS AND METHODS: In this prospective study, all the healthy systemic patients, (ASA I, II) with the age range of 18 to 30 years from both genders, who had the skeletal class II or III deformities and required only isolated 1-piece maxillary Le Fort I osteotomy, were included in this study. These patients had no craniofacial cleft history and were candidates for orthognathic surgery in Maxillofacial Surgery Department of Qaem Hospital of Mashhad (Iran), 2015 to 2017. All of the operations were carried out or supervised by a single surgeon and anesthesiologist using the same protocol. The patients were monitored for occurrence of intra- or postoperative complications till 6 months. The t-test, Chi-squared test, and Fisher exact test were performed for data analysis using SPSS version 16 (SPSS Inc, Chicago, IL). RESULTS: In the present study, a total of 114 consecutive patients with the average age of 22 ±â€Š5 years from October 2015 to November 2017 were recruited. About 77 (67.54%) patients were presented skeletal class III deformity and 37 (32.46%) were class II. The most prevalent maxillary movement after Le Fort I osteotomy was identified to be isolated maxillary advancement in 51 (44.75%) patients. Only 10 (8.77%) of all 114 patients confronted surgical complications. Hemorrhagic complication (arterial bleeding from descending palatine artery and epistaxis) and anatomic complications (septal deviation and bad fracture) would be the most prevalent complications with the frequency of 5.25% and 3.5% in total. Maxillary setback with impaction presented the highest rate (36.4%) of complications compared to other maxillary movement types. On balance, there was a significant association between Le Fort I surgery complications and maxillary movement types in our research (P = 0.002). CONCLUSION: The rate of intra- and postoperative complications following Le Fort I osteotomy for healthy noncleft adults in our center was low. Therefore, it can be concluded that this technique is safe and reliable. The maxillofacial surgeon should pay more attention for prevention or even management of the risk of intra- and perioperative complications in patients with anatomic irregularities (previous craniofacial cleft or trauma history) and those who required maxillary setback concomitant with impaction movements.