Patient-controlled analgesia in orthognathic surgery: evaluation of the relationship to anxiety and anxiolytics.

BACKGROUND: Although patient-controlled analgesia' (PCA) use has been reported in oral and maxillofacial surgery,(8) it has not been evaluated for use in orthognathic surgery. In this study, we evaluated the relationship between age, gender, and preoperative anxiety and postoperative morphine intake after orthognathic surgery in the PCA environment. STUDY DESIGN: Fifty-one patients (34 female, 17 male) underwent orthognathic surgery. Patients' anxiety was evaluated preoperatively. All patients received morphine-based postoperative PCA. Relationship between preoperative anxiety and postoperative visual analog scale (VAS) and 24 hour morphine intake was evaluated. Patients were randomly grouped according to whether preoperative oral anxiolytics were prescribed. RESULTS: Age and VAS were correlated, as well as preoperative anxiety score and postoperative morphine intake (P < .05). Female patients receiving anxiolytics before surgery had less morphine consumption than those who did not. CONCLUSION: Preoperative anxiety directly influences postoperative PCA morphine intake. Anxiolytics preoperatively seem to reduce the need for postoperative analgesics.

[Is Delaire's cephalometric analysis flexible? A quantified study]. / L'analyse céphalométrique de Delaire est-elle élastique? Une étude chiffrée.

INTRODUCTION: Delaire's architectural analysis is a tool used in the maxillofacial field. Its use requires identifying landmarks teleradiographically in order to map appropriate lines dependent on these points. We studied the elasticity of the analysis. MATERIAL AND METHOD: The C0 line technique was used to vary individually the spatial position of specific landmarks and lines. The consequences on the position of the Me point and the slope of the occlusal plane were tabulated. RESULTS: Modifying the special position of the studied landmarks did not affect the final map drawn by the analysis, proving that Delaire's analysis has a certain degree of elasticity. It was noted however that the F4 line might be the determining factor. DISCUSSION: After the mathematical and geometrical demonstration, the question is raised of whether or not there is an ideal and single craniofacial architecture for a given patient, taking into consideration the elasticity of the analysis and the problem of positioning the F4 line.

[Teratoid cyst: a rare tongue tumor in children]. / Le kyste teratoïde: une tumeur linguale rare de l'enfant.

BACKGROUND: Dermoid cysts are rare benign tumours (only 20 cases have been reported) with 3 different histological types. Only 5 cases of teratoid cyst of the tongue have been described in the world literature, characterized by a respiratory cilied epithelium. OBSERVATION: We report the sixth case, in a one-year-old boy with a macroglossia and permanent protrusion of the tongue. Ultrasonography showed a kystic, ovoid, homogeneous cyst. Treatment was a surgical resection. DISCUSSION: This case is similar to the other cases reported in the literature.

[Inflammatory myofibroblastic pseudotumor of the tongue]. / Pseudotumeur myofibroblastique inflammatoire de la langue.

INTRODUCTION: Inflammatory myofibroblastic tumor (IMT) is a new entity recently described, first in the lung. IMT are found throughout the body. CASE: We report a very rare tongue localization in a 22-year-old white woman. After a first diagnosis of fibrosarcoma, a new examination of the slide and immunohistochemical examination led to the definitive diagnosis of inflammatory myofibroblastic tumor of the tongue and not fibrosarcoma. DISCUSSION: IMT are rarely encountered in the head and neck region. Only 2 cases of IMT of the tongue have been reported in the world literature. Diagnosis of IMT is immunohistochemical. Spindle cells were reacted for smooth-muscle actin and vimentin. Treatment is surgical. The contribution of radiotherapy is not clear because of the small population of patients studied.

[Lacrimal sac melanoma]. / Mélanome du sac lacrymal.

RESULTS: Mean stage (NOSPECS classification) at time of surgery was 4.5 (range 2-6). Mean stage postoperatively was 2.4 (range 0-5). Comparison of the mean stages showed significant improvement of ocular protrusion: 1.55 (range 1-2) postoperatively versus 2.4 preoperatively. Among the patients with optic neuropathy (stage 6, n=12), 83% (10/12) normalized PEV with normal or clear improvement in visual acuity three months postop. Diplopy remained unchanged in 45% (5/11) and improved in 45% (5/11), worsening in one patient. Clinical regression of the exophthalmia, irrespective of the intensity initially, was noted in 93% of patients at six months postop. All patient had overall improvement in the position of the eyelids at rest..

[The C0 line: from Delaire's analysis of craniofacial structure to modeling it on a computer spreadsheet]. / La ligne C0: de l'analyse architecturale cranio-faciale selon Delaire ou sa modélisation sur feuille de calcul électronique.

BACKGROUND: We developed a computer spreadsheet allowing mathematical modelization of Delaire's craniofacial architecture analysis. METHOD: An orthonormed drawing field was defined from the classical C1 line and the new C0 line. The cartesian coordinates defined anatomic points in this orthonormed field. Lines were drawn from the coordinate equations defined on the basis of the laws of plane geometry. These formulae were then entered into the spreadsheet. RESULTS: The spreadsheet automatically calculates the line equations, the angles separating these lines, and the coordinates of the constructed points, in the defined orthonormed field. This calculation is achieved using the coordinates of the user-measured anatomic points. A new order in line drawing allows simplification of manual drawing. DISCUSSION: We present the advantages and inconveniences of this new method which does not modify the final drawing result nor the interpretation of Delaire's analysis.