Sensory changes after tongue reduction for macroglossia.

We report sensory changes after tongue reduction by the Harada-Enomoto method for macroglossia in a 20-year-old woman with Beckwith-Wiedemann syndrome. Sensory tests were performed before surgery and 1 week and 2 months after surgery. We assessed the static tactile threshold, vibration sense, static 2-point discrimination, pain threshold, and taste. No sensory loss of any category tested was observed after tongue reduction.

Risk factors with intravenous sedation for patients with disabilities.

The purpose of this study was to identify the risk factors associated with low peripheral oxygen saturation (SpO2) and delayed recovery of dental patients with disabilities after intravenous sedation. A total of 1213 patients with disabilities were retrospectively investigated with respect to demographic parameters and sedation conditions. Multivariate logistic analyses were conducted for patients with an SpO2 <90% and a recovery period of >60 minutes to identify the risk factors for poor sedation conditions. A significant odds ratio related to decreased SpO2 was observed for age, sex, midazolam and propofol levels, concurrent use of nitrous oxide, cerebral palsy, Down syndrome, and mental retardation. The most problematic patients were those diagnosed with Down syndrome (odds ratio, 3.003-7.978; 95% confidence interval; P < .001). Decision tree analysis showed an increased risk of decreased SpO2 in males with Down syndrome or after administration of >0.493 mg/kg propofol in combination with midazolam. An increased risk of delayed awakening was seen in patients aged less than 21 years and in males administered >0.032 mg/kg of midazolam. Intravenous sedation for dental patients with disabilities, particularly those with cerebral palsy, Down syndrome, or mental retardation, increases the risk of decreased SpO2. In addition, delayed recovery is expected after midazolam administration.

Accuracy and reliability of thermal threshold measurement in the chin using heat flux technique.

BACKGROUND: Neurosensory disturbance (NSD) occasionally develops in the chin following dental treatments, and evaluation of the involved nerve damage is important for treatment. The thermal-threshold test is a method of evaluating nerve sensations, but it is not widely used because its accuracy and reliability have not yet been determined. PURPOSE: This study aimed to determine the accuracy and reliability of thermal-threshold measurement of the chin by using the heat-flux technique. MATERIALS AND METHODS: The subjects were 19 healthy volunteers (7 women, 12 men), aged 21 to 36 years (mean age +/- SD, 27.2 +/- 4.5 years). The thermal thresholds, including the warm and cold heat-flux thresholds (WHF and CHF, respectively) were measured on the chin, forehead, and neck by using a thermostimulator. To evaluate test-retest reliability, we measured the thermal thresholds on 3 different days (days 1, 3, and 7). RESULTS: The WHF and CHF of the right chin were 460 +/- 165 W/m(2) (mean +/- SD W/m(2)) and 589 +/- 133 W/m(2), respectively, and those of the left chin were 446 +/- 112 W/m(2) and 576 +/- 147 W/m(2), respectively. The thermal thresholds of the right and left chin were significantly correlated (R = 0.89, P < .001). Thermal-threshold measurement was more accurate in the case of the chin than in the case of the neck. The thermal thresholds measured over the 3 days varied very little (intraclass correlation coefficient, 0.80-0.81), indicating high test-retest reliability. CONCLUSION: The heat-flux technique is accurate and highly reliable. Therefore, it may be a useful method for determining the thermal threshold of the chin.

Analysis of clinical usefulness of the heat flux technique: predictability of the recovery from neurosensory disturbances in the chin undergoing mandibular sagittal split ramus osteotomy.

OBJECTIVE: To examine the prognosis of the neurosensory disturbance (NSD) in the chin after bilateral sagittal split ramus osteotomy (BSSRO), using the heat flux technique. STUDY DESIGN: Twenty-nine patients (total 58 sides) undergoing BSSRO were examined. The warm sensory threshold (WHF) and cold sensory threshold (CHF) in the chins of these patients were measured by the heat flux technique. Touch sensory threshold (TS) was measured by an Semmes-Weinstein esthesiometer. Touch sensory disturbance was subjectively evaluated by visual analog scale. RESULTS: At all of the postoperative time points, there were no significant differences in the incidence rate among all tests (chi-squared test; P > .05). WHF, CHF, and TS were significantly correlated with the subjective evaluation. Recovery from NSD was delayed in cases that the postoperative variation of 2 weeks was >400 W/m(2) in WHF and CHF and the filament marking at 2 weeks after surgery was >3.5 in TS. CONCLUSION: The heat flux technique appears to be a useful method for the prediction of the recovery from NSD in the chin.

A new evaluation method for neurosensory disturbance in the chin of patients undergoing mandibular sagittal split ramus osteotomy: an application of the heat flux technique.

OBJECTIVE: To examine neurosensory changes in the chin following bilateral sagittal split ramus osteotomy (BSSRO) using the heat flux technique. STUDY DESIGN: Twelve healthy adults (C-group) and 23 patients undergoing BSSRO (P-group) were examined. The warm sense threshold (WHF) and cold sense threshold (CHF) in the chin of these patients were measured by the heat flux technique. In the P-group, touch sensation also was measured with a visual analog scale (VAS) and the Semmes-Weinstein monofilament test (SW test). RESULTS: Both WHF and CHF were significantly larger in the P-group than in the C-group (P = .024). Touch sensation (VAS and SW test) were damaged in some patients of the P-group. However, no correlation was revealed between thermal sensation (WHF and CHF) and touch sensation (VAS and SW test) in the P-group. CONCLUSIONS: These results suggest that the thermal sensation in the chin was damaged after BSSRO. The heat flux technique appears to be one of the useful methods for the examination of neurosensory disturbance in the chin.

Postoperative hyperthermia of unknown origin treated with dantrolene sodium.

An 11-year-old girl was scheduled for alveolar cleft bone grafting with an iliac bone under general anesthesia. Anesthesia was performed with 70% nitrous oxide, 30% oxygen, and propofol. On the first and second postoperative day, persistent hyperthermia was observed. Because the administration of diclofenac sodium had not been effective for the hyperthermia, dantrolene sodium was given. Her body temperature gradually dropped and returned to normal level on the fifth postoperative day. The hyperthermia in the present case might have been caused by a rapidly elevated muscle metabolism in response to pain and stress after the propofol anesthesia. The oral administration of dantrolene sodium successfully lowered the patient's high body temperature.