[Total intravenous anaesthesia without medical gases during economic blockade of the country]. / Totalna intravenska anestezija bez medicinskih plinova u uvjetima ekonomske blokade zemlje.

In June and July 1992, when the corridor--through which we received the necessary medical supply--was closed, 61 patients (mostly wounded persons, 62%) underwent an urgent surgery. Because of the lack of oxygen and nitric oxydul, the patients were administered the intravenous total anaesthesia without medical gases. The control group was composed of 30 patients operated on in June and July 1991. The patients received Mydasolam (0.3 mg/kg) for general anaesthesia. Anaesthesia was maintained with Phentanil (15 mg/kg) and Alcurone (0.3 mg/kg). The control group was subjected to standard balanced anaesthesia (Thiopenton + nitric oxydul/oxygen + Halotin + Pancuron). The results of the two groups were compared. The observed, analysed and compared parameters were: the introduction period to anaesthesia, systolic blood pressure, diastolic blood pressure and time elapsed from the end of surgery to extubation. The introduction to anaesthesia was markedly unfavourable (p), the systolic and diastolic blood pressures, measured in five-minute intervals during anaesthesia, were significantly lower (p). The difference was especially great in the period from the end of surgery to the time of extubation: 73 +/- 12 minutes in the studied group, and 7 +/- 5 minutes in the control group. The method of total intravenous anaesthesia without medical gases satisfied our needs and expectations during the shortage of medical supplies. However, the standard balanced anaesthesia is a better method because it provokes a faster introduction to general anaesthesia, haemodynamic effects are less compromized, revival from anaesthesia is faster, the use of anaesthetics and equipment and engagement of the personnel are not great.

Anatomical considerations relevant to implant procedures in the mandible.

The authors review anatomical facts significant for preoperative planning of implant procedures in the mandible. This planning includes the precise evaluation of distinct anatomical factors, such as the position of the mandibular canal, the width of the mandibular cortical plates and the degree of involutive changes of the inferior dental artery. The mandibular canal is usually situated centrally in the mandibular corpus, slightly closer to the lingual cortex in its distal parts; towards the front, it approaches the vestibular cortical layer. Mesially from the mental foramen, a clearly defined incisive canal is present in only one third of the edentate mandibles. Mandibular corpus of the edentate mandibles consists of cancellous bone enclosed by a shell of compact cortical bone. Cortical layers demonstrate significant variations in width; nevertheless, the widths of lateral cortical layers, generally, enable safe placement of endosseous implants. Finally, in patient's preoperative assessment, involutive changes of the inferior dental artery should also be considered. During the involution of the mandibular alveolar process, it shows changes of direction and calibre, changes in arborization and, sometimes, complete occlusion of the main trunk. The degree of these involutive changes points out the mandibular vascular supply and the regenerative capacity of the tissues needed for the success of the implant procedure.

Morphometric analysis of mandibular canal: clinical aspects.

Results of morphometric analysis of the mandibular canal (MC), carried out on 105 conserved mandibles, 70 being dentate and 35 edentate, was performed. The analysis was carried out on consecutive sections, at mutual intervals of 0.5 cm. In the mandibular ramus sections were carried out obliquely, approximately in the frontal plane, and horizontally, from mandibular foramen to the lowest region of the vertical part of the MC (all together two sections). In the mandibular corpus, consecutive transversal sections were carried out between existing teeth, or at mutual intervals of 0.5 cm in edentate regions. The obtained results pointed out the very close relationship between the MC and lingual cortical plate of the mandibular ramus. In its horizontal part, the average diameter of the MC was 2.6 mm. It was situated more lingually in the molar region; towards the front, it approached the vestibular cortical plate, being closest to it in the region of the second premolar. Similar relationships of the MC and both cortical plates existed in edentate jaws. Relationships of the MC and tooth root apices varied; however, the MC was closest to the apices of the third molar. Mesially from the mental foramen, a clearly defined incisive canal was present in 92% of the dentale mandibles, but only in 31% of the edentate ones. The nearest to the incisive canal was the apex of the first premolar. The authors point out the importance of presented results in everyday practice, especially in oral and maxillofacial surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

[The bone structure of the ramus of the mandible]. / La structure osseuse de la branche montante de la mandibule.

Osseous structure of the ramus of mandible (RM) is of a practical clinical significance. Osteosynthesis of fractured segments and the success of the sagittal or the horizontal ramus split osteotomy depends on the cortical bone disposition and thickness. After morphometric investigations of the RM, conducted on 70 mandibles of adults, consecutive horizontal and frontal sections were made. On these sections, the cortical layer was studied and the cortical bone thickness was measured at four previously marked points. In the regard of morphometry, the significant datum is that nearly half of all the cases is grouped round the mean value of any parameter. Cortical bone is continuous and its two main sheets are the buccal and the lingual cortical plates. In its entirety, the buccal cortical plate is thicker than the lingual. The thickness of both cortical plates increases in the direction from the coronoid process to the angle of mandible.

[The relations of the mandibular canal with the outer surfaces of the body of the mandible and the risks which arise from its injury]. / Les rapports du canal mandibulaire avec les faces externes du corps de la mandibule et risques qui en découlent de le léser.

The investigations of relations and position of the mandibular canal (CM) were carried out on 80 mandibles (33 dentulous, 27 partly edentulous and 20 completely edentulous). The studies of relations of CM to the sides of mandibular body were accomplished by morphometric analysis of CM on consecutive transversal sections of mandibular body (54 preparations). The relation of the CM to be buccal or to the lingual side is expressed as the distance from the surface of the correspondent side of the mandibular body, which is shown in Table 1. According to these data, the position of the canal is at first proximate to the lingual side, and from the first molar tooth (M1) it approaches the buccal surface of the mandibular body. The position of the entire CM was determined by analysis of mandibular preparations (26) after removing the buccal osseous lamina. These investigations revealed that the position of the CM is predominantly buccal. Reconstruction of relations of the CM to the sides of mandibular body, according to the data obtained from transversal sections, and the real position of the CM are presented in Scheme I. The difference in direction lines of relations and of predominant position of the CM is a consequence of morphological characteristics of mandibular body.

[The surgical anatomy of the sublingual gland]. / Anatomie chirurgicale de la glande sublinguale.

Because of its position, the sublingual gland is clinically important especially in the events of injuries and infections in the anterior part of the sublingual region. The morphology and relationships of this gland were studied by dissection methods applied on 80 fresh or formaldehyde fixed preparations of the mouth floor and of the tongue, which were partly (31 preparations) taken out together with the mandible. As for the shape of the gland, three main types were found: the cuneiform type which was the most frequent (71%), the pyramidal type which was less frequent (16%) and the fusiform type (13%) which comprised the case of a very elongated gland (up to 65 mm). The space in which the gland lied had four walls. Its internal wall consisted of the mylohyoid muscle and it comprised the hyoglossus muscle as well when the gland was very elongated. The inferior wall consisted of the mylohyoid muscle and sometimes it comprised also a narrow part of the superior surface of the geniohyoglossus muscle. An osseous depression on the internal side of the mandible represented the external wall of the sublingual gland space. The superior wall is clinically the most significant. It consists of the sublingual mucosa and a sublingual fold. This wall represents a main surgical access to the gland. In edentulous mandibles this mucous fold may be at the level of the upper mandibular border which may hinder the use of the lower dental prosthesis.

[Oroantral communications. The gold foil method]. / Comunicazioni oro-antrali. Il metodo della foglia d'oro.

The Authors propose the method of the golden leave to close oro-antral communications. The main advantages offered by this technique are the following: 1) marked reduction of the previously observed loss of vertical height of the alveolar bone (7-8% of the original values); 2) the post-operative phase is, most of the time, uneventful.

[Atherosclerotic changes of the inferior dental artery correlated with those of the carotid bifurcation and the abdominal artery]. / Altérations athéroscléreuses de l'artère dentaire inférieure en corrélation avec celles de la bifurcation carotidienne et de l'aorte abdominale.

50 corpses from adults aged 20 to 75 have been used in order to study the atherosclerotic lesions occurring in typical regions (bifurcation of the common carotid artery and the abdominal aorta) and their relationship to atherosclerotic changes in the inferior alveolar artery. Histological analysis revealed that atherosclerotic alterations of the inferior alveolar artery may appear sometimes earlier than it would be expected on the ground of age. Intima cell proliferation and thickening of elastic elements in the middle layer of the arterial wall, the first signs of atherosclerosis, were found already at the beginning of the third decade of life when the signs of this process in the typical regions were not yet evident. Atherosclerosis affects essentially the functional capacity of the inferior alveolar artery. The development of atherosclerosis in the wall of this artery favours an hypovascularization of the mandible, which must be of certain importance in every operative procedure in oral surgery, especially in those inducing a severe and long traumatism in bone and soft tissues, such as dental implantations.