Pre-surgical regional blocks in orthognathic surgery: prospective study evaluating their influence on the intraoperative use of anaesthetics and blood pressure control.

In orthognathic surgery, maxillary (CNV2) and mandibular (CNV3) divisions of the trigeminal nerve can be blocked successfully prior to surgery. In this study, it was hypothesized that regional blocks (nerve block over a particular region: bilateral CNV2 and CNV3 divisions of the trigeminal nerve) would decrease the total requirement for intraoperative anaesthetic agents and facilitate the process of hypotensive anaesthesia. Local anaesthesia containing 1/100,000 epinephrine and 10ml 0.5% levobupivacaine was injected into the planned incisions in 50 patients. Twenty-five patients (group A) underwent orthognathic surgery without regional blocks and another 25 patients (group B) underwent surgery with regional blocks. The anaesthetic protocol was the same in both groups and administered by a single anaesthesiologist. The mean arterial pressure was recorded at several points throughout the operation, as well as all the medications used. The blood loss and the amounts of medications administered were lower in group B than in group A. In patients receiving regional blocks, the amounts of fentanyl and nicardipine required were significantly lower. The use of pre-emptive anaesthesia in orthognathic surgery may reduce the overall amounts of medications required for hypotensive anaesthesia, facilitate the intraoperative control of blood pressure, and decrease intraoperative blood loss.

The inferior turbinate flap: a novel technique for prosthetic preparation of a total rhinectomy defect.

For total rhinectomy defects, the decision to proceed with a prosthetic versus surgical reconstruction is multifactorial, taking into account patient risk factors, availability of donor tissues, the need for tumor surveillance, and personal preferences. When a prosthetic approach is chosen, the reconstructive surgeon is tasked with preparing the defect to maximize prosthetic retention and prevent ulcerations. Stable bone coverage is critical to achieve this aim. Although skin grafting has been described previously for bone coverage, the periosteum is often stripped. We present a novel use of the inferior turbinate flap for preparation of rhinectomy defects that can be utilized regardless of the presence or absence of the periosteum and provides a more durable coverage than skin grafts.

Osteoblastoma of the hyoid bone.

Osteoblastoma is a rare bone tumor that usually affects the vertebrae. We present the first known case of osteoblastoma arising in the hyoid bone, in a patient who presented with a neck mass and dysphagia. The radiographic appearance of the tumor is similar to that of low-grade chondrosarcoma, with well-defined expansion of the bone and central chondroid matrix.