Impact of 3-dimensional anatomical changes secondary to orthognathic surgery on voice resonance and articulatory function: a prospective study.

An evaluation was made of the impact of orthognathic surgery (OS) on speech, addressing in particular the effects of skeletal and airway changes on voice resonance characteristics and articulatory function. A prospective study was carried out involving 29 consecutive patientssubjected to OS. Preoperative, and short and long-term postoperative evaluations were made of anatomical changes (skeletal and airway measurements), speech evolution (assessed objectively by acoustic analysis: fundamental frequency, local jitter, local shimmer of each vowel, and formants F1 and F2 of vowel /a/), and articulatory function (use of compensatory musculature, point of articulation, and speech intelligibility). These were also assessed subjectively by means of a visual analogue scale. Articulatory function after OS showed immediate improvement and had further progressed at one year of follow up. This improvement significantly correlated with the anatomical changes, and was also notably perceived by the patient. On the other hand, although a slight modification in vocal resonance was reported and seen to correlate with anatomical changes of the tongue, hyoid bone, and airway, it was not subjectively perceived by the patients. In conclusion, the results demonstrated that OS had beneficial effects on articulatory function and imperceptible subjective changes in a patient's voice. Patients subjected to OS, apart from benefitting from improved articulatory function, should not be afraid that they will not recognise their voice after treatment.

Buccal fat pad as a sealant in palatal mucosa tearing: technical note.

For patients with a dentofacial deformity undergoing a planned segmentation of the maxilla for the management of a transverse maxillary arch discrepancy, palatal mucosa tearing may occur during sawing or palatal expansion traction, giving rise to an oronasal communication. This technical note describes the covering of a tear in the palatal mucosa using a buccal fat pad (BFP) flap, in the context of maxillary segmentation during Le Fort I osteotomy. Through the limited buccal incision used for the Le Fort I osteotomy, a small incision is made in the right periosteum posteriorly, and a supraperiosteal dissection is performed to access the BFP. After a sufficient amount of flap is made available, it is gently introduced through the osteotomy gap until it reaches the palatal mucosa defect and is then sutured. In the patient case presented, the palatal mucosa healed fully within 18 days, and the patient reported no nasal regurgitation of food, defective speech, fetid odour, bad taste, or upper respiratory tract or ear infection during the postoperative period. This technique using a BFP flap should therefore be considered in the context of unexpected tearing of the palatal mucosa in patients undergoing a segmented Le Fort I osteotomy.

[Horner syndrome and brachial plexus blockade after epidural anesthesia for obstetric labor and cesarean section]. / Síndrome de Horner y bloqueo del plexo braquial tras anestesia epidural para trabajo de parto y cesárea.

A 30-year-old woman (ASA II, obese) in her 40th week of a first pregnancy required epidural analgesia for labor. When the cervix had dilated to 5 cm, the epidural infusion was started with a 9-mL bolus of 0.2% ropivacaine and 50 pg of fentanyl, after a negative test dose. An infusion of 0.2% ropivacaine and 1 microg/mL of fentanyl was started at a rate of 8 mL/h. A cesarean section was required after insufficient progress was made during 8 hours of labor. Eight milliliters of 0.75% ropivacaine was administered to provide anesthesia to T4; cesarean delivery was completed without complications. Early during postoperative recovery, in addition to motor blockade of the legs, the patient experienced a right brachial plexus blockade and Horner syndrome on the same side. Both effects disappeared spontaneously (1 and 4 hours later, respectively).

Síndrome de Horner y bloqueo del plexo braquial tras anestesia epidural para trabajo de parto y cesárea / Horner syndrome and brachial plexus blockade after epidural anesthesia for obstetric labor and cesarean section

Presentamos el caso de una paciente gestante de 30 años, ASA II, obesa, prímipara en la semana en la semana 40 de gestación, que requirió analgesia epidural para el trabajo de parto. Se instauró la analgesia epidural a los 5 cm de dilatación cervical con un bolus de 9 ml de ropivacaína 0,2% y 50 mg de fentanilo previa dosis test negativa. Posteriormente se inició una perfusión de ropivacaína 0,2% y fentanilo 1 mg/ml a 8 ml/h. Tras 8 horas de evolución hubo que realizar cesárea por distocia de progresión. En el quirófano se administraron 8 ml de ropivacaína 0,75% y se alcanzó un nivel anestésico T4. Se realizó la cesárea sin complicaciones. En el postoperatorio inmediato la paciente presentó además del bloqueo motor de extremidades inferiores un bloqueo del plexo braquial derecho y un síndrome de Horner ipsilateral. Tanto el bloqueo del plexo como el síndrome de Horner desaparecieron espontáneamente 1 y 4 horas después respectivamente(AU)

A 30-year-old woman (ASA II, obese) in her 40th week of a first pregnancy required epidural analgesia for labor. When the cervix had dilated to 5 cm, the epidural infusion was started with a 9-mL bolus of 0.2% ropivacaine and 50 mg of fentanyl, after a negative test dose. An infusion of 0.2% ropivacaine and 1 mg/mL of fentanyl was started at a rate of 8 mL/h. A cesarean section was required after insufficient progress was made during 8 hours of labor. Eight milliliters of 0.75% ropivacaine was administered to provide anesthesia to T4; cesarean delivery was completed without complications. Early during postoperative recovery, in addition to motor blockade of the legs, the patient experienced a right brachial plexus blockade and Horner syndrome on the same side. Both effects disappeared spontaneously (1 and 4 hours later, respectively)(AU)