Evaluation of the Effects of Exogenous Melatonin in Zygomatic Complex Fractures.

Objective: The objective of this research was to evaluate the benefits of using exogenous melatonin in the preoperative period of patients with zygomatic complex fractures. Materials and methods: A randomized, triple-blind clinical trial of independent samples was carried out. The sample was divided into two groups: G1 (melatonin) and G2 (placebo). Interventions were standardized with 10 mg melatonin or placebo the night before surgery and 1 h before the start of surgery. The studied variables were level of salivary cortisol, level of anxiety, pain, and use of rescue analgesics. Descriptive and inferential statistical analysis was performed, with a margin of error considered as 5%. Results: A total of 14 patients were included, and after using the medication, the measurement of cortisol was reduced in the melatonin group (0.48 ± 0.25 to 0.43 ± 0.13 µg/100 ml) and increased in the placebo group (0.19 ± 0.12 to 0.23 ± 0.18 µg/100 ml). There was a reduction in the level of anxiety in the melatonin group and an increase in the placebo group. After two hours of surgery, the pain was statistically less in the melatonin group (4.50 ± 1.38) compared to the placebo group (6.17 ± 0.98). Six hours after surgery, pain showed regression in both groups. Patients in the placebo group (83.3%) used more rescue analgesics than melatonin group (33.3%) in the postoperative period. Conclusions: Thus, this research demonstrated that melatonin can be effective in reducing salivary cortisol and anxiety after medication, and patients in the melatonin group needed less rescue analgesics in the postoperative period.

Is There a Benefit to the Use of Melatonin in Preoperative Zygomatic Fractures?

PURPOSE: We evaluated the effects of melatonin used in the preoperative period for patients who had undergone surgical treatment of a zygomatic fracture. PATIENTS AND METHODS: A triple-blind, randomized clinical trial of 2 groups was conducted: the melatonin group (10 mg) and the placebo group. After allocation, 1 tablet of melatonin was used the night before and another tablet 2 hours before the start of surgery. Approximately 30 minutes before anesthetic induction, the following variables were evaluated: sleep quality, degree of sedation and anxiolysis using the Richmond Agitation-Sedation Scale, and the amount of opioid analgesic used intraoperatively. At the end of surgery, the time required for safe endotracheal extubation was evaluated. Next, a descriptive and inferential statistical analysis was performed. The margin of error considered was 5%. RESULTS: Of the 68 analyzed patients, 36 had been allocated to the melatonin group and 32 to the placebo group. In the sleep quality evaluation for the night before surgery, 61.1% of the melatonin group reported better or much better sleep than usual, and 100% of the placebo group reported worse sleep or sleep as usual (P < .001). Melatonin was no better than placebo in relation to anxiolysis (P > .05). The average final dose of the opioid was lower, and the difference was statistically significant, in the melatonin group (0.296 ± 0.036 µg/kg/min vs 0.372 ± 0.037 µg/kg/min in the placebo group). The interval required for safe endotracheal extubation was longer, and the difference was statistically significant, in the melatonin group (14.84 ± 1.8 minutes vs 12.72 ± 0.99 minutes in the placebo group). CONCLUSIONS: In the present study, melatonin was effective in improving sleep quality the night before surgery and in reducing intraoperative opioid consumption. An increase in the time required for safe endotracheal extubation was found in the melatonin group, and no improvement was seen in anxiolysis.

Utilization of Intermaxilar Fixation Screws as Anchors in the Treatment of the Mandible Recurrent Dislocation.

PROPOSE: This paper aims to describe a modification of the Wolford technique by replacing the Mitek anchors with bone screws. TECHNICAL DESCRIPTION: Two intermaxillary fixation screws locking screws, with 2.0 mm in diameter and 8 mm in length, are used in each temporomandibular joint, one of which is fixed to the root of the zygomatic arch and another to the lateral pole of the mandibular condyle. Ethibond 2-0 thread is passed through the holes in the 2 ipsilateral screws, thus acting as an artificial ligament limiting the range of the mouth opening. CONCLUSION: The technique described was effective in preventing mandibular dislocation while allowing satisfactory mouth opening range. This technique has easy handling and low cost.