Evaluation of haemodynamic changes in hypertensive patients during tooth extraction under local anaesthesia / Evaluación de los cambios hemodinámicos en pacientes hipertensos durante la extracción dental con anestesia local

OBJECTIVES: This study was conducted to determine the changes in blood pressure and the pulse rate of patients with controlled hypertension having dental extraction under local anaesthesia utilizing 2% lignocaine with adrenaline, and to evaluate whether these changes in blood pressure were are attributable to addition of adrenaline. METHODS: This prospective study was carried out in 33 consecutive hypertensive patients who presented at the exodontia clinic of the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, from December 2004 to August 2005 for intra-alveolar tooth extraction. Patients were randomly allocated to two groups according to the type of anaesthetic solution employed. Group A had tooth extraction done under 2% lignocaine with 1:80 000 adrenaline while group B had tooth extraction done under 2% lignocaine without vasoconstrictor (plain lignocaine). One tooth was extracted from each patient. Blood pressure and pulse rate measurements were recorded in the waiting room before surgery, in the surgery after local anaesthetic injection, during tooth extraction and 15 minutes after tooth extraction. RESULTS: The sample consisted of 20 females and 13 males age range 24 to 75 years (mean ± SD = 50.1 ± 11.7 years). There was no statistically significant difference between the systolic and diastolic blood pressure and pulse rate in the two groups after administration oflocal anaesthesia. However, the highest alteration in parameters was observed during tooth extraction in the two groups. CONCLUSION: The haemodynamic changes induced by injecting 2% lignocaine with adrenaline in patients with controlled hypertension during tooth extraction is within normal range and is not different from that induced by 2% lignocaine without adrenaline. We consider it essential that all precautions to prevent inadvertent intravascular injection be undertaken by the care provider.

OBJETIVO: Este estudio fue dirigido para determinar los cambios en la tensión arterial y la tasa de pulso de pacientes con hipertensión controlada, a quienes se les realiza una extracción dental bajo las condiciones de la anestesia local, utilizando lidocaína al 2% con adrenalina, y evaluar si estos cambios en la tensión arterial eran atribuibles a la adición de adrenalina. MÉTODO: Este estudio prospectivo se llevó a cabo en 33 pacientes hipertensos consecutivos que acudieron a la clínica de exodoncia del Departamento de Cirugía Oral y Maxilofacial del Hospital Docente Universitario (LUTH), Idi-Araba, Lagos, desde diciembre 2004 a agosto 2005, para extracciones intra-alveolares. Los pacientes fueron colocados de forma aleatoria en dos grupos, según el tipo de solución anestésica empleada. Al grupo A se le realizó la extracción con lidocaína al 2% con 1:80 000 adrenalina, mientras que al grupo B se le realizó la extracción con lidocaína al 2% sin vasoconstrictor (lidocaína pura). A cada paciente se le extrajo una pieza. Mediciones de la presión arterial y el pulso fueron realizadas en el salón de espera antes dela cirugía, en la cirugía tras la inyección con la anestesia local, durante la extracción del diente, y 15 minutos después de la extracción. RESULTADOS: La muestra consistió en 20 hembras y 13 varones cuyo rango de edad fluctuó de 24 a 75 años (± SD media = 50.1 ± 11.7 años). No hubo diferencia estadísticamente significativa alguna entre la tensión arterial sistólica y la diastólica, ni con respecto a la tasa del pulso en los dos grupos luego de la administración de la anestesia local. Sin embargo, la alteración más alta de los parámetros se observó durante la extracción en los dos grupos. CONCLUSIÓN: Los cambios hemodinámicos inducidos por la inyección de lidocaína al 2% con adrenalina en los pacientes con hipertensión controlada durante la extracción, están dentro del rango normal y no son distintos de los inducidos mediante lidocaína al 2% sin adrenalina. Se considera fundamental que los profesionales de la salud tomen todas las precauciones para prevenir inyecciones intravasculares inadvertidas.

Airway and respiratory complications in children undergoing cleft lip and palate repair.

OBJECTIVES: Anatomical abnormalities associated with cleft lip and palate increase the risk of airway complications. The aim of this study was to determine the incidence of intra-operative airway and respiratory complications during cleft lip and palate repair and identify risk factors. DESIGN: Observational study in which fifty consecutive patients undergoing cleft lip or/ and palate repair (CL, CP, CLP) were prospectively studied in a teaching hospital in Nigeria. Anaesthesia was achieved by the inhalational or intravenous route. Tracheal intubation was performed under deep inhalational anaesthesia or muscle relaxation. All patients were ventilated. Demographic data, airway and respiratory complications were documented. RESULTS: The mean age of the patients was 26.62± 4.71(SEM) months (median 11.50). Nineteen airway complications occurred in 16 patients (incidence - 38%) as failed and difficult intubation (2% respectively) which only occurred in CP surgeries, Tube disconnection (6%), Tube compression (2%), Accidental extubation (2%) and Desaturation (14%). Laryngeal spasm (6%) and Bronchospasm (4%) occurred in surgeries for CP repair only. Some patients had more than one complication. Complications occurred in 38.4% of patients having CP repair, 15.8% having CL repair and 50% having CLP repair (p=0.185). This was not influenced by weight nor age group (p = 0.076 and 0.400 respectively). CONCLUSION: Cleft repair had a high incidence of airway/ respiratory complications. More complications occurred with CP surgery. There is a need to ensure adequately skilled personnel and appropriate monitoring to minimise morbidity.

Tumours of the submandibular salivary gland: a clinicopathologic review of cases over a 17-year period / Tumores de la glándula salival submandibular: una revisión clínico-patológica de casos por un período de 17 Años

OBJECTIVE: This study presents a clinicopathologic review of cases of submandibular salivary gland tumours at the Lagos University Teaching Hospital, Nigeria, over a period of 17 years. METHODS: The records of all patients with histological diagnosis of submandibular salivary gland tumours at the Lagos University Teaching Hospital over a period of 17 years (January 1990 to December 2006) were retrospectively reviewed. Parameters studied were; age and gender of patients, symptoms and duration ofsymptoms, and histological diagnosis. RESULTS: A total of 36patients with submandibular gland tumours were seen during the period. Maleto-female ratio was 1.8:1 (male = 23, female = 13). Mean age (± SD) at presentation was 43 (± 19) years (age range, 17-84 years). There were 19 malignant tumours and 17 benign ones. Pleomorphic adenoma (36.1%) was the most frequent tumours, followed by adenoid cystic carcinoma (11.1%), anaplastic carcinoma (11.1%) and malignant lymphoma (11.1%). Patients with histological diagnosis of malignant tumours were significantly older than those with benign tumours (p = 0.01). Most patients (80.6%) presented with painless swelling. CONCLUSION: Malignant submandibular salivary gland tumours were slightly more than the benign ones in the studied population. Painful swelling or ulceration is indicative ofa malignant submandibular gland tumour.

OBJETIVO: Este estudio presenta una revisión clinicopatológica de casos de tumores de la glándula salival submandibular en el Hospital Docente de la Universidad de Lagos, Nigeria, por un periodo de 17 años. MÉTODOS: Se revisaron retrospectivamente las historias clínicas de todos los pacientes con el diagnóstico histológico de los tumores de la glándula salival submandibular en el Hospital Docente de la Universidad de Lagos, correspondientes a un periodo de 17 años (de enero de 1990 a diciembre de 2006). Los parámetros estudiados incluyeron: la edad y el género de los pacientes, síntomas y duración de síntomas, y diagnóstico histológico. RESULTADOS: Un total de 36 pacientes con tumores de la glándula de submandibular fueron atendidos durante ese periodo. La proporción varón:hembra fue 1.8:1 (varones = 23, hembras = 13). La edad promedio (± SD) al momento de su presentación fue 43 (± 19) años (rango de edad, 17-84 años). Hubo 19 tumores malignos y 17 benignos. El adenoma pleomórfico (36.1%) fue el tipo de tumor más frecuente, seguido por el carcinoma cístico adenoideo (11.1%), el carcinoma anaplástico (11.1%) y el linfoma maligno (11.1%). Los pacientes con diagnóstico histológico de tumores malignos eran significativamente de más edad que los que tenían tumores benignos (p = 0.01). La mayoría de los pacientes (80.6%) presentaban hinchazón sin dolor. CONCLUSIÓN: Los tumores malignos de la glándula salival submandibular fueron ligeramente mayor en número que los benignos en la población estudiada. Hinchazón dolorosa o la ulceración dolorosas son indicios de un tumor maligno de la glándula submandibular.

An unusual fracture of the mandible.

A rare case of horizontal fracture of mandibular symphysis caused by a sharp matchet cut is presented. Under local anaesthesia with sedation, the fracture site was exposed through the sutured laceration on the left submandibular region. The fracture was adequately reduced and fixed with two circum-mandibular wires. Healing was uneventful, but postoperative radiograph after six weeks revealed a bony defect in the anterior part of the lower border of the mandible, resulting from shifting of the fractured segment posteriorly during healing. Complete recovery of left lower lip sensation was found 4 months postoperatively.