Novel Technique for Median Cleft Lip Comprising the Simultaneous Formation of the Columella, Philtrum, and Cupid's Bow.

Numerous surgical techniques for median cleft lip repair have been described; however, most cause excessively sharp peaks or the collapse of Cupid's bow. We report a technique for median cleft lip repair using a mucosal skin flap and full-thickness skin graft and 15 years of follow-up. Our technique provides acceptable formation of the columella, philtrum, and the two peaks of Cupid's bow. In this paper, we cite our previously reported techniques and add new findings and discussion based on the long-term postoperative outcomes of this procedure. Advantages and disadvantages of this technique are discussed, and a possible solution to achieve a more satisfactory result is suggested. Advantages and disadvantages of this new technique are discussed, and a possible solution to achieve a more satisfactory result is suggested.

Risk Perception of Septic Shock with Multiple Organ Failure Due to Acute Exacerbation of an Infectious Dental Disease.

In general dental conditions such as dental caries and periodontal disease, a combination of adverse conditions can cause potentially life-threatening periodontal abscess. We treated a patient in whom an oral infection developed into septic shock, resulting in patient death. A 78-year-old woman experienced spontaneous pain around a moving tooth. Pus discharge was observed, the area was sterilized, and an analgesic was prescribed. A few days later, the swelling spread to the buccal region leading to difficulty while eating. Upon systemic status and blood examination at our dental hospital, depressed consciousness due to dehydration and septic shock were suspected. Oxygenation and infusion of acetate linger with antibiotics were immediately performed. Furthermore, a blood examination revealed malnutrition and a severe infection; therefore, the patient was transferred to a nearby general hospital. However, the patient died the next day because of advanced disseminated intravascular coagulation and multiple organ failure. When an oral infection is suspected in an elderly patient, antibiotics should be quickly administered, the patient's local and systemic state should be confirmed, and sterilization should be performed daily. If no improvement is observed, medical attention should be quickly sought.

Analysis of Dose Escalation of Propofol Associated With Frequent Sedation.

Patients with dental phobia frequently require intravenous sedation to complete dental treatment. We encountered a case of a patient who received frequent sedation by propofol, which required escalation in the dosage of propofol required. The patient was a healthy young female with severe dental phobia, and the dental procedures were initiated under intravenous sedation. Intravenous sedation was administered to the patient more than 100 times over 9 years, and the dosages were analyzed. The mean dosage of propofol administered per hour was 6.9 ± 2.4 mg/kg/h, and the dosage tended to increase with frequency (0.06-0.1 mg/kg/h in each administration). Increased dosage was needed with a shorter interval between sedations after 30 episodes of sedation. Regarding the mean dosage of propofol per hour, the step-down method exhibited the highest increase in dosage rate of 0.18 mg/kg/h per administration followed by target-controlled infusion at 0.07 mg/kg/h per administration and combination sedation at 0.06 mg/kg/h per administration. We discuss factors that may be associated with acute tolerance to propofol when frequent propofol sedations are provided.