Outpatient orthognathic surgery: review of 205 cases.

PURPOSE: This article reviews the evolution of outpatient orthognathic surgery from 1988 to 1995 at the University of Texas Health Science Center at San Antonio. PATIENTS AND METHODS: A total of 328 patients had orthognathic surgery from 1988 to 1995. Two hundred and five (124 females, 81 males) were treated on an outpatient basis in the surgical suite of the dental school. Procedures included bilateral sagittal split osteotomies (BSSO), Le Fort I osteotomies (LFI), horizontal mandibular osteotomies (HMO), rapid palatal expansions (RPE), and combinations of the above. Additional procedures such as submental liposuction, blepharoplasty, dorsoseptorhinoplasty, and otoplasty were performed on 22 patients. Patient age ranged from 13 to 64 years, (average age 25). RESULTS: Ninety-four (46%) of the patients were discharged the day of surgery. One hundred and two (51%) were admitted for 23-hour observation, and five (2.4%) were admitted for longer than the 23-hour observation period. Anesthesia time over 4:28 significantly correlated with admission for observation status. There was no significant difference between LFI and BSSO in relation to admission for observation status. CONCLUSIONS: The number and complexity of orthognathic procedures increased dramatically over the study period. The length of anesthesia time, but not the specific procedure, correlated significantly with admission to observation status. There were few unexpected complications, with considerable cost reduction and convenience for the patients.

Dental management of children with asthma.

Asthma affects about 1 in 10 children. The condition is characterized by acute respiratory distress brought on by environmental factors. The condition is treated with medications aimed to reduce reaction to stimulants by the airway. Dental management involves attention to the status of the patient and awareness of stimulants of the reactive airway. Clinical recommendations are provided.

Outpatient orthognathic surgery: criteria and a review of cases.

Over a 9-year period, 87 orthognathic procedures were performed in an outpatient environment. Procedures performed included horizontal mandibular osteotomies, rapid palatal expansions, bilateral sagittal split osteotomies, posterior and anterior maxillary osteotomies, and Le Fort I osteotomies. Fourteen of these patients were subsequently admitted to a hospital for either observation or full inpatient care. The rates of admission varied for each of the procedures, with length of anesthesia statistically related to the frequency of admission. Patient selection criteria and facilities used are reviewed.

Pancuronium rapid induction sequence.

Succinylcholine is traditionally used as the muscle relaxant of choice for rapid induction sequence intubation. There are, however, many absolute and relative contraindications for the use of succinylcholine necessitating the need for an alternative muscle relaxant. This study was undertaken to evaluate the effectiveness of pancuronium bromide for muscle relaxation in the rapid induction sequence in comparison to succinylcholine. A double-blind study was undertaken in 90 patients divided into two groups: One group was intubated at 60 seconds and the other at 90 seconds. Each group was divided into four subgroups by random selection and received of the following regimens: (a) succinylcholine, 1.5 mg/kg preceded by 3 mg of d-tubocurarine; (b) pancuronium bromide, 0.1 mg/kg; (c) pancuronium bromide, 0.125 mg/kg; and (d) pancuronium bromide, 0.15 mg/kg as relaxants in rapid sequence intubation. A rapid sequence intubation was performed with each intubation by a staff member or experienced house officer. Pre- and postinduction blood pressure and heart rate were taken. Postinduction blood gases were taken. The times to completion of intubation were recorded. Cord position, ease of intubation and overall relaxation were evaluated. The results indicate that in experienced hands pancuronium bromide in a dose of 0.1-0.15 mg/kg is as an effective muscle relaxant for rapid induction sequence intubation as is succinylcholine. It is an acceptable alternative when succinylcholine is contraindicated. Intubating conditions are best 90 seconds after the administration of pancuronium bromide.

Fracture of the anterior maxillary alveolar ridge with laryngoscopy.

The following case report describes a patient who suffered an anterior maxillary alveolar ridge fracture resulting from difficult laryngoscopy and intubation. An unfortunate sequelae of this injury was the loss of two maxillary central incisors due to persistent mobility despite long term dental stabilization. To the authors' knowledge, fractures involving the premaxilla have not been reported as a complication of laryngoscopy and intubation.

Unsuspected failure of nasotracheal intubation.

This report describes a patient with a clinically normal airway who could not, even with the aid of a fiberoptic bronchoscope, be intubated nasotracheally. Failure was due to a large bony prominence projecting anteriorly into the nasopharynx from the body of the first cervical vertebrae. This bony prominence deflected both the endotracheal tube and fiberoptic tube anterolaterally such that they could not be aligned with the glottic opening for passage into the trachea. To our knowledge, this is the first reported case of "failure" of nasotracheal intubation associated with this anatomic abnormality.

Unilateral mydriasis during general anesthesia.

A healthy 24-year-old woman was taken to the operating room for surgical removal of impacted third molars while under general anesthesia. During surgery, a local anesthetic was administered, resulting in mydriasis, which was initially mistaken for a central nervous system deficit secondary to a complication from general anesthetic.