ABSTRACT
PURPOSE: The pregnant patient who presents with a maxillofacial infection requires additional management considerations. The maternal-fetal unit requires particular attention to maintain fetal viability, assure a normal pregnancy, and obtain a desirable outcome. The purpose of this article is to inform the oral and maxillofacial surgeon of the clinically relevant material that one needs to understand and consider when treating maxillofacial infections in this particular patient population.
Subject(s)
Bacterial Infections/therapy , Pregnancy Complications, Infectious/therapy , Pregnancy/physiology , Stomatognathic Diseases/therapy , Abortion, Spontaneous/etiology , Airway Obstruction/prevention & control , Anesthesia, Dental , Bacterial Infections/complications , Clinical Protocols , Drug Therapy , Drug Utilization , Embryonic and Fetal Development , Female , Fetal Death/etiology , Humans , Nutritional Physiological Phenomena , Pulmonary Edema/etiology , Pulmonary Embolism/etiology , Respiratory Distress Syndrome/etiology , Stomatognathic Diseases/complications , Thromboembolism/etiologyABSTRACT
Based on the clinical observation that pain is experienced during parotid gland surgery under local anaesthesia, the presence of the sensory neuropeptide substance P (SP) was sought. Using a polyclonal antibody, the presence of SP was demonstrated by an indirect immunofluorescence technique, with rat parotid gland and spinal cord serving as controls. SP-containing neuronal elements occurred around acini, blood vessels and ducts. It is suggested that some of the SP-immunoreactive elements are the unmyelinated and thinly myelinated small diameter (A delta and C) fibres, which are regarded as the peripheral receptors for nociceptive information.
Subject(s)
Nerve Fibers/chemistry , Parotid Gland/innervation , Substance P/analysis , Adipose Tissue/innervation , Adult , Animals , Blood Vessels/innervation , Female , Fluorescent Antibody Technique , Humans , Parotid Gland/blood supply , Parotid Gland/chemistry , Rats , Rats, Inbred Strains , Spinal Cord/chemistry , Substantia Gelatinosa/chemistryABSTRACT
A patient with a history of a burning tongue together with discomfort of the labial and buccal mucosae was given an elimination diet and skin patch tests to determine the allergen in her diet. The patient was identified as being intolerant of an aqueous peanut extract. Three allergens in peanut butter were identified, the one with greatest reactivity being a heat-stable, water-soluble, nonglycosylated protein with a molecular weight in excess of 10 kD. Modification of her diet has resulted in resolution of the oral problem.
Subject(s)
Arachis/adverse effects , Burning Mouth Syndrome/immunology , Dietary Proteins/adverse effects , Food Hypersensitivity/etiology , Burning Mouth Syndrome/etiology , Female , Food Hypersensitivity/immunology , Humans , Immunoglobulin E/blood , Middle AgedABSTRACT
The combination of oral and intravenous sedation has not been well investigated and this study examined the combination's effect on amnesia, anxiety, cardiovascular stability and recovery in a double blind, cross-over, placebo controlled trial. Patients were given 7.5 mg oral midazolam or placebo 1 h prior to intravenous midazolam and surgery. This investigation demonstrated significant anxiolysis, amnesia and patient preference for oral midazolam compared to placebo. There was no significant effect on cardiovascular stability, the intravenous dose of midazolam used or post-operative recovery. Low dose oral midazolam prior to intravenous sedation may be beneficial in very anxious patients, particularly if surgery is delayed.
Subject(s)
Anesthesia, Intravenous , Conscious Sedation , Midazolam/administration & dosage , Molar, Third/surgery , Preanesthetic Medication , Tooth Extraction , Administration, Oral , Adolescent , Adult , Analysis of Variance , Anxiety/prevention & control , Blood Pressure/drug effects , Double-Blind Method , Female , Humans , Male , Memory/drug effects , Placebos , Psychomotor Performance/drug effects , Pulse/drug effects , TabletsABSTRACT
A 25-year-old labourer sustained submandibular and intra-oral injuries in an unusual industrial site accident. He fell from above onto steel reinforcing rods which were set in concrete and projecting two metres above the concrete floor. He was impaled by a rod which entered the mouth beneath the right side of the mandible and exited from the mouth passing upwards in front of the nose. The management of this patient is discussed with particular emphasis on the method of obtaining an airway for surgery. Due to the proximity of the rigidly embedded reinforcing rod to the nose, mouth and midline of the neck, an awake tracheostomy under local anaesthesia was conducted. The alternatives to this approach with their potential complications are discussed. In addition possible pre-, peri- and post-operative surgical complications for this case are outlined.
Subject(s)
Intubation, Intratracheal , Mandibular Injuries/surgery , Mouth Floor/injuries , Wounds, Penetrating/therapy , Accidents, Occupational , Adult , Fiber Optic Technology , Humans , Immobilization , MaleABSTRACT
A report of an aggressive, peripheral nerve-sheath tumour that presented as a lump on the alveolar mucosa near the mental foramen is presented. Although the tumour was detected in the periphery and appeared to extend centrally, extensive surgery suggested that the tumour had its origins in the infra-temporal fossa.
Subject(s)
Mandibular Neoplasms , Mouth Mucosa , Mouth Neoplasms , Neurilemmoma , Adult , Humans , Male , Mandibular Neoplasms/pathology , Mouth Mucosa/pathology , Mouth Neoplasms/pathology , Neurilemmoma/pathologyABSTRACT
A rare injury is described, in which symphyseal fracture of the mandible was associated with lateral displacement of the intact mandibular condyle into the temporal fossa and damage to the ipsilateral facial nerve with unilateral facial paralysis. Management of the injury was associated with an episode of acute laryngeal obstruction, necessitating emergency tracheostomy.
Subject(s)
Facial Paralysis/etiology , Joint Dislocations/etiology , Mandibular Condyle/injuries , Mandibular Fractures/complications , Adult , Humans , Male , Mandibular Fractures/surgery , TracheostomyABSTRACT
Detailed examinations were made of the central permanent incisors and periodontia of 30 or 40 ewes on each of one control farm and three periodontal disease (P.D.) farms. The study confirmed that incisor crown lengthening, protrusion and loosening were significant features of P.D. Periodontitis (assessed by increased sulcus depth and bleeding after probing) about the lingual sulcus was a significant feature of P.D. Labial gingivitis and labial periodontitis were not significant features. A relatively long lower jaw did not appear to be a feature of P.D. 87.
