Die intraligamentäre Anästhesie. Eine wertvolle Alternative zu konventionellen Techniken?

Reliable analgesia can nowadays be achieved with several techniques and different anesthetic solutions, but side effects may be encountered. Severe and potentially fatal cardiovascular reactions can be the result of an intravascular injection. An easy to use, effective and safe alternative is the periodontal ligament injection. Nerve damage or cardiovascular side effects are not to be expected. This type of anesthesia can be of advantage for many dental procedures. With new devices like the computer-controlled local anesthetic delivery system, the periodontal ligament injection is a convenient way of local anesthesia for both patient and dentist.

Inferior alveolar nerve function after open reduction and internal fixation of mandibular fractures.

PURPOSE: Mandibular fractures are amongst the most common facial fractures and are usually treated by open reduction and internal fixation (ORIF). Inferior alveolar nerve (IAN) injuries are seen frequently in mandibular fractures as well as after ORIF of these fractures due to the exposition and the close proximity of the nerve during fracture reduction. Therefore the continuity of the IAN can be disrupted. Permanent injury to the IAN can result in diminished quality of life. This retrospective study was designed to objectively analyse the incidence and the outcome of pre- and postoperative mental nerve hypoesthesia after ORIF of mandibular fractures. MATERIAL AND METHODS: Patients who were consecutively treated at the Department of Cranio-Maxillofacial and Oral Surgery of the University Hospital Zurich between 2004 and 2010 with mandibular fractures who underwent ORIF were included. Follow-up period was 12 months. Demographic, pre-, peri- and postsurgical data were tabulated and statistically evaluated using the χ(2) test and the Kruskall-Wallis-Test. RESULTS: 340 patients met the inclusion criteria. 27% of the study population presented with postinjury (preoperative) mental nerve hypoesthesia, 46% suffered from purely postoperative hypoesthesia and 27% showed no nerve damage. Complete recovery was seen in 70% of all cases, partial recovery in 20% of the cases and less than 10% suffered from a permanent (>12 months) IAN damage. Mandibular angle fractures were accompanied with significantly higher rates of hypoesthesia (79% vs. 68%). Recovery rate was significantly worse in older patients, when preoperative hypoesthesia was present (66% vs. 73%) and in patients with multiple fractures in proximity to the IAN (36% vs. 52%). Mandibular body fractures showed worse recovery rates than fractures that did not affect the body (44% vs. 52%). CONCLUSION: The present study shows that IAN injury is seen frequently in mandibular fractures. Mental nerve hypoesthesia may influence quality of life. Nerve continuity may not be preserved due to the initial trauma or may result as a postoperative complication. Nevertheless the results of this study show a high potential for full recovery.

Outcome of comminuted mandibular fracture repair using an intraoral approach for osteosynthesis.

PURPOSE: Traditionally, the treatment of comminuted mandibular fractures involves both closed and open reduction. However, modern treatment principles increasingly tend toward open reduction and internal fixation to shorten oro-functional rehabilitation. Although this method increasingly gained popularity to date, a controversy regarding the extraoral versus the intraoral surgical approach still exists. The current study aimed to objectively evaluate the outcome of comminuted mandibular fracture treatment involving open reduction and internal fixation using an intraoral approach. PATIENTS AND METHODS: Consecutive patients treated at the Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, between 2005 and 2012 were included. Demographic, presurgical, perisurgical, and postsurgical data were tabulated and statistically evaluated using the χ test and the Mann-Whitney U test. RESULTS: Forty-five patients could be included. Excellent postoperative results were seen in 84% (38 patients) of the total cohort. Postoperative complications were seen in 16% (7 patients). These 7 patients had the following complications: wound dehiscence (7% [n = 3]), osteomyelitis (7% [n = 3]), abscess development (4% [n = 2]), bone necrosis (2% [n = 1]), and severe nonocclusion (2% [n = 1]). CONCLUSION: Present data showed that the intraoral approach for open reduction and internal fixation in comminuted mandibular fractures represents a comparable surgical technique regarding fracture repositioning and occlusal rehabilitation. Considerably, the risk of concomitant neurovascular damage or even facial scarring, as demonstrated in the extraoral approach, can be neglected by using this technique. Nevertheless, each case has to be judged on its own accord as to which technique can best treat the underlying fracture.

Medical online consultation service regarding maxillofacial surgery.

OBJECTIVE: The University Hospital of Zurich provides a medical online consultation service since 1999. Our aim was to characterise the users of an online consultation with queries regarding maxillofacial surgery, to analyse the content of their questions and to study the actions by the internet doctors with the ambition of defining whether the telemedical consultation is a useful tool in this surgical field. MATERIALS AND METHODS: The procedure of inductive category development described by MAYRING was used. A professional text analysis program MAXQDA supported the process of analysis. 204 questions were evaluated. RESULTS: Men sent 37% of the questions, 48% originated by women, mean age was 38 years. Often they asked for information about medical therapies or pharmaceuticals (n=74) and about specific disease or an injury (n=26). The three most common maxillofacial surgery topics were sinusitis (n=21), aphthae in the mouth (n=17) and basal cell carcinoma (n=14). CONCLUSIONS: Online consultation is not only understood as a first contact with the healthcare system but also as a centre to get professional further and detailed information and advice after a doctor visit, especially about chronic diseases and infections. Online consultation can complement the traditional healthcare and conventional physician-patient relationship in maxillofacial surgery.