[Third molar surgery under general anesthesia: a review of 180 patients]. / Extraction des dents de sagesse sous anesthésie générale : à propos de 180 patients.

BACKGROUND: Third molar surgery is an important part of the activity in a maxillofacial surgery department. This common activity is often under-evaluated by patients who forget its surgical aspect. The aim of this study was to evaluate our practice, and especially complications, with special consideration given to medicolegal aspects. MATERIALS AND METHODS: All the patients operated between September 2004 and July 2006 were enrolled in a retrospective study. This population is described, with the indications, follow-up, and complications. RESULTS: One hundred and eighty patients were reviewed (sex-ratio 1, mean age 27 years). The most frequent indications were impaction and pain. The mean duration of hospitalization was 1.7 days and temporary disability, one week. Local infection occurred in 8%; there was neurological complication in 2% for the inferior alveolar nerve, and 1% for the lingual nerve. These were all transient cases. DISCUSSION: Third molar surgery is an important and profitable part of the activity in a maxillofacial surgery department. Standardized information is necessary even if the rate of complications remains low.

[Effects of local infiltration of split thickness skin grafts donor site with ropivacaine: a prospective series of 30 patients]. / Diminution de la douleur au site donneur d'une greffe de peau mince par infiltration locale de ropivacaïne (Naropeine): résultats d'une série prospective de 30 patients.

AIM: The aim of this study was to evaluate the benefits and risks of local infiltration in split-thickness skin grafts donnor site with ropivacaine (Naropein. MATERIALS AND METHODS: Therefore a prospective study was conducted enrolling 30 patients assessed for split skin grafts to cover muscular flaps, burn areas or primary tumor sites. Donnor site surface ranged from 50 to 200 cm(2). Patients were randomized into two groups: with or without infiltration. Critters of inclusion were age over 18 y.o., donnor site surface below 200 cm(2), no neurological or psychiatic pathology, no contra-indication to ropivacaine. All grafts were performed under general anaesthesia, using Lagrot's razor to take 0.2 to 0.4 mm thickness skin bands. Donnor sites dressings were standardized, associating a corticoid fat dressing (Corticotulle strongly and occlusively contained with an elastic band (Elastoplast. Dressings were removed after three weeks. Immediate and late post-operative pain were evaluated using analogic visual scale (EVA) and need of analgesics during the hospitalisation in our Institution. Side-effects were collected. RESULTS: Thirty patients were enrolled in this prospective study. They were mean aged 37 years old, sex ratio was 1/1. Donor site surface was mean 157 cm(2) and graft thickness 0.35 mm. There was a significant difference in immediate and late post-operative pain between both groups. Ropivacain reduced pain for the same oral analgesics use during 36 to 48 post-operative hours. No difference was noticed after 48 hours. No side-effects were noticed. CONCLUSION: Infiltration of split skin grafts donnor site with ropivacain improves postoperative pain during 48 hours. This is a safe and efficient method to improve comfort in addition to a standardized occlusive dressing. It has become a standard routine in our Institution.

Are branched chain amino-acids beneficial for nutrition of severe surgical patients with sepsis?

UNLABELLED: This study investigated in severe sepsis the metabolic effects of two amino acid diets, including the same protein (0.3 gN/kg/day) and caloric intake (2g/kg/day glucose) but with different amino acid composition, 24% branched chain amino-acids (B.C.A.A.) for diet A (8 cases), 41% B.C.A.A. for diet B (11 cases). The two groups were obtained by randomisation at the operative day (D0) and were observed six days (D1-D6). During study, total nitrogen using a Kjeldhal method was measured. At D0 and D6, albumin, total hemolytic complement, transferrin, cholesterol, ammonaemia, insulin and amino acid pattern were studied in blood and skin tests were performed. The data were analysed by Mann-Whitney test. RESULTS: 1) The cumulative nitrogen balances of the six days are not significantly different, but at day 6 in diet B, patients started to be in an anabolic state (+3.7 gN) and in diet A catabolism persisted (-12 gN) (p<0.02). 2) Plasma B.C.A.A. are significantly higher and aromatic acids significantly lower in diet B. In order, Fischer ratio is also significantly different between the two regimens. All the other measured parameters are not significantly different. In this study, the B.C.A.A. enriched diet seems to be beneficial in surgical patients with severe sepsis.

Traumatic rupture of the pericardium with intermittent cardiac herniation in a multiple-trauma patient.

This is a case report of an 18-year-old multiply injured patient with blunt chest trauma, a total rupture of the right pericardium and an intermittent cardiac dislocation. Intermittent signs suggestive of cardiac tamponade accompanied the cardiac herniations. Acute renal failure followed these acute hemodynamic disorders. Early diagnosis and therapy were responsible for the successful outcome.

[Tracheal intubation after maxillofacial reconstruction using a pectoralis major flap]. / Intubation trachéale après reconstruction maxillo-faciale par lambeau du grand pectoral.

From 1979 to 1984, a pectoralis major musculocutaneous flap was used in 35 patients in order to cover a maxillofacial defect following either a gunshot wound or tissue loss after cancer surgery. In 50% of the cases, one or several operations were needed. 30% of the patients showed a fixed posture of the head preventing tracheal intubation by direct laryngoscopy. The measurement of the maxillopharyngeal angle helps to predict this impossibility. In such these cases intubation by fibroscopy was done to avoid tracheotomy.