Bite Block Research Articles

Development of the scoliosis research society spinal deformity surgery safety checklist.

Spine deformity surgery is a complex multi-step procedure that has a relatively high complication rate. The use of surgical safety checklists has been shown to reduce perioperative adverse events, but existing lists are varied and non-specific for spinal deformity surgery. Thus, the purpose of this study was to develop a comprehensive surgical checklist for complex spinal corrective surgery. An electronic survey consisting of 187 surgical checklist items that had been developed and used by a group of SRS members over a 5-year period was distributed to the Scoliosis Research Society Safety and Value Committee membership. The survey sections included: (1) pre-operative area, (2) initial operating room visit, (3) before turning, (4) positioning, (5) prepare and drape, (6) pre-incision timeout, (7) intraoperative, (8) finishing implant placement and confirming imaging, (9) final rods and locking, (10) prior to closure, (11) closure, (12) turn to supine, and (13) checkout/debriefing. Respondents graded each item on a five-point Likert scale based on their perceived importance and feasibility for inclusion in the checklist. Features graded as "moderately important" or "very important" to include by at least 70% of respondents were considered to meet the cutoff for inclusion-based standard Delphi practices. Study data were collated using REDCap. A total of 25 surgeons completed the survey in its entirety. The overall checklist "package" was shortened to 9 individual checklist modules, with 2 to 16 items per checklist. In terms of individual checklist items, 40% of items (74 of 187) met the cutoff for inclusion; 17 of these items were graded as "very important," which included verifying the presence of implantable devices, reviewing the surgical plan and positioning with the surgical staff, securing the endotracheal tube, bite block confirmation, prone and lateral positioning, neuromonitoring baseline readings, double-checking that the implant screw caps were locked prior to closure, and confirming that the patient was moving bilateral lower extremities before leaving the operating room when possible. This study has led to the development of a specific spinal deformity surgical checklist of 74 (many specific to spine surgery) items that were considered important for inclusion; 17 were considered "very important".

Vertical Dimension Control in Two Different Treatment Protocols: Invisalign First and Bite Block-A Retrospective Study.

The aim of the present study was to compare the vertical dimension changes, before and after treatment, in two groups of growing patients, one group treated with clear aligner therapy versus a group treated with Quad-helix and bite-block therapy. The studied sample was composed of n. 40 patients (20 females and 20 males with a mean age of 8.6 ± 1.8 years), enrolled from the Department of Orthodontics at Policlinico of Rome Tor Vergata. The original sample was randomly divided into two groups: Group IF (Invisalign First) and Group BB (Quad-helix and bite block). Pre- (T0) and post-treatment (T1 after 12 months) lateral cephalograms were collected from all the selected patients. Nine cephalometric parameters, both angular and linear, were measured and recorded for each cephalogram. No statistically significant changes were found between both the IF and BB groups at T0, while statistically significant changes were observed in both groups (BB and IF) between T0 and T1 (after 12 months of active therapy), p < 0.005. Both therapies were able to control the patient's vertical condition. To date, the use of conventional appliances seems to have slightly better efficacy in controlling the vertical dimension than aligner therapy.

Laryngeal mask airway or high flow nasal cannulaversusnasal cannula for advanced bronchoscopy – a randomized controlled trial

Research QuestionAdvanced bronchoscopic procedures became a widely prevalent evaluation and treatment modality. These procedures require appropriate sedation and respiratory support. This study directly compares three respiratory support methods during advanced bronchoscopy.MethodsThis 3-arm, prospective, block randomized trial included 60 consenting adult patients that were referred for advanced bronchoscopy involving endobronchial ultrasound with transbronchial needle aspiration (EBUS – TBNA) and met inclusion / exclusion criteria. Patients were randomized to undergo a bronchoscopy through a laryngeal mask airway (LMA), or with a high-flow nasal cannula (HFNC) or low flow nasal cannula (NC), with bronchoscopy performed through a bite block. Demographic, procedural and clinical parameters were compared between the 3 groups, including complications, oxygenation, ventilation and need for intervention.ResultsAnalysis according to intention to treat was made for the 20 patients in each arm. There were no significant differences in demographic parameters, pre-morbidities, and procedure type and duration between groups. Hypoxia was significantly more common in the NC group (90%) compared with the LMA (45%) and HFNC (26%) groups (p&lt;0.01). Need for interventions and their number was also lower in the LMA (40%) and HFNC (52.6%) groups compared to the NC group (90%, p&lt; 0.01). A multivariate analysis confirmed both HFNC and LMA as independent predictors of lower rate of recurrent desaturation events and fewer complications in general compared to NC.

Does planned molar intrusion with aligners assist with closure of anterior open bite?

This study aimed to determine whether prescribed molar intrusion, with or without virtual occlusal bite-blocks (BB), resulted in actual molar intrusion and assisted with anterior open bite (AOB) correction in adult patients treated with Invisalign clear aligners (Align Technology, Santa Clara, Calif). A retrospective study was conducted with 36 adult patients with AOB. Subjects were divided into 2 treatment groups: planned molar intrusion (PMI) and no-PMI (No-PMI). PMI was obtained from the tooth movement tables in the ClinCheck software. Patients with PMI were further categorized by the presence or absence of virtual posterior BB (PMI-BB and PMI-No BB, respectively). Treatment success was determined on the basis of positive vertical incisor overlap in posttreatment cephalograms. Treatment changes were assessed using pretreatment and posttreatment cephalometric radiographs (Welch 2-sample t test, 95% confidence interval, P= 0.05). Finally, treatment stability was assessed at least 1-year posttreatment using the Photographic Open Bite Severity Index (POSI). There were 15 patients with No-PMI and 21 without PMI (total n= 36). The mean overbite change was 2.5 ± 1.0 mm for No-PMI and 3.2 ± 1.8 mm for patients with PMI (P= 0.12). All patients had positive vertical incisor overlap in posttreatment cephalograms, indicating 100% treatment success. Open bites were corrected primarily by incisor retroclination and extrusion in both treatment groups. The average measured molar intrusion for the PMI group was 0.71 mm greater than the change for the No-PMI group, but the difference was not statistically significant after controlling for potentially confounding variables (P= 0.074). A total of 14 patients from the original sample were assessed for stability using the POSI analysis. Of those, 12 (85.7%) had a POSI score of0. Regardless of whether the molar intrusion was planned or not, the modality of AOB correction with Invisalign clear aligners was primarily incisor extrusion and retroclination. Overall, aligners are an effective appliance for the treatment of adult AOB. Based on our limited sample, treatment stability was similar to that reported for fixed appliances.

Evaluating the Hounsfield unit assignment and dose differences between CT-based standard and deep learning-based synthetic CT images for MRI-only radiation therapy of the head and neck.

Magnetic resonance image only (MRI-only) simulation for head and neck (H&N) radiotherapy (RT) could allow for single-image modality planning with excellent soft tissue contrast. In the MRI-only simulation workflow, synthetic computed tomography (sCT) is generated from MRI to provide electron density information for dose calculation. Bone/air regions produce little MRI signal which could lead to electron density misclassification in sCT. Establishing the dosimetric impact of this error could inform quality assurance (QA) procedures using MRI-only RT planning or compensatory methods for accurate dosimetric calculation. The aim of this study was to investigate if Hounsfield unit (HU) voxel misassignments from sCT images result in dosimetric errors in clinical treatment plans. Fourteen H&N cancer patients undergoing same-day CT and 3T MRI simulation were retrospectively identified. MRI was deformed to the CT using multimodal deformable image registration. sCTs were generated from T1w DIXON MRIs using a commercially available deep learning-based generator (MRIplanner, Spectronic Medical AB, Helsingborg, Sweden). Tissue voxel assignment was quantified by creating a CT-derived HU threshold contour. CT/sCT HU differences for anatomical/target contours and tissue classification regions including air (<250 HU), adipose tissue (-250 HU to -51 HU), soft tissue (-50 HU to 199 HU), spongy (200 HU to 499 HU) and cortical bone(>500 HU) were quantified. t-test was used to determine if sCT/CT HU differences were significant. The frequency of structures that had a HU difference>80 HU (the CT window-width setting for intra-cranial structures) was computed to establish structure classification accuracy. Clinical intensity modulated radiation therapy (IMRT) treatment plans created on CT were retrospectively recalculated on sCT images and compared using the gamma metric. The mean ratio of sCT HUs relative to CT for air, adipose tissue, soft tissue, spongy and cortical bone were 1.7±0.3, 1.1±0.1, 1.0±0.1, 0.9±0.1 and 0.8±0.1 (value of 1 indicates perfect agreement). T-tests (significance set at t=0.05) identified differences in HU values for air, spongy and cortical bone in sCT images compared to CT. The structures with sCT/CT HU differences>80 HU of note were the left and right (L/R) cochlea and mandible (>79% of the tested cohort), the oral cavity (for 57% of the tested cohort), the epiglottis (for 43% of the tested cohort) and the L/R TM joints (occurring>29% of the cohort). In the case of the cochlea and TM joints, these structures contain dense bone/air interfaces. In the case of the oral cavity and mandible, these structures suffer the additional challenge of being positionally altered in CT versus MRI simulation (due to a non-MR safe immobilizing bite block requiring absence of bite block in MR). Finally, the epiglottis HU assignment suffers from its small size and unstable positionality. Plans recalculated on sCT yielded global/local gamma pass rates of 95.5%±2% (3mm, 3%) and 92.7%±2.1% (2mm, 2%). The largest mean differences in D95, Dmean , D50 dose volume histogram (DVH) metrics for organ-at-risk (OAR) and planning tumor volumes (PTVs) were 2.3%±3.0% and 0.7%±1.9% respectively. In this cohort, HU differences of CT and sCT were observed but did not translate into a reduction in gamma pass rates or differences in average PTV/OAR dose metrics greater than 3%. For sites such as the H&N where there are many tissue interfaces we did not observe large scale dose deviations but further studies using larger retrospective cohorts are merited to establish the variation in sCT dosimetric accuracy which could help to inform QA limits on clinical sCT usage.

Target movement according to cervical lymph node level in head and neck cancer and its clinical significance.

To evaluate set-up error for head and neck cancer (HNC) patients according to each neck lymph node (LN) level. And clinical factors affecting set-up error were analyzed. Reference points (RP1, RP2, RP3, and RP4) representing neck LN levels I to IV were designated. These RP were contoured on simulation computed tomography (CT) and cone-beam CT of 89 HNC patients with the same standard. After image registration was performed, movement of each RP was measured. Univariable logistic regression analyses were performed to analyze clinical factors related to measured movements. The mean value of deviation of all axes was 1.6 mm, 1.3 mm, 1.8 mm, and 1.5 mm for RP1, RP2, RP3, and RP4, respectively. Deviation was over 3 mm in 24 patients. Movement of more than 3 mm was observed only in RP1 and RP3. In RP1, it was related to bite block use. Movement exceeding 3 mm was most frequently observed in RP3. Primary tumor and metastatic LN volume change were clinical factors related to the RP3 movement. Planning target volume margin of 4 mm for neck LN level I, 3 mm for neck LN level II, 5 mm for neck LN level III, and 3 mm for neck LN level IV was required to include all movements of each LN level. In patients using bite block, changes in primary tumor volume, and metastatic LN volume were related to significant movement.

Application of customisable 3D-printed bite blocks combined with nano head, neck and shoulder mask to head and neck neoplasm radiotherapy

This study investigated the effectiveness of customisable 3D-printed bite blocks combined with nano head, neck and shoulder mask in radiotherapy for head and neck neoplasms. The images of 50 patients with head and neck neoplasms treated at our hospital from 2020 to 2022 were collected using CBCT. The patients were divided into two groups: 25 in the mask group and 25 in the combination group. The mask group utilized thermoplastic polyurethane (TPU) nanofiber membrane to stabilize the position of the patients’ head, shoulder, and neck. On the other hand, the combined group added a personalized bite block produced by 3D printing technology on the basis of the mask group. Cone beam CT (CBCT) was used to calibrate any errors, and the set-up errors and number of head rotations after image calibration were analyzed between the two groups. The conformation number (CN) and heterogeneity index (HI) in the target area of the intensity-modulated radiation therapy (IMRT) plan of the two groups were calculated, and the dose-volume parameters of the tongue and other organs at risk, including Dmax and Dmean, were compared using paired tests. Follow-up observations were performed to assess the occurrence of adverse reactions to radiation damage among the patients. The findings revealed a statistically significant difference in the Y -axis set-up error between the combination group and the mask group (P &lt; 0.05). Additionally, the combination group exhibited a higher proportion of set-up errors &lt; 2 mm in both the Y -axis and Z-axis directions compared to the mask group. Significantly fewer images showed head rotation in the combination group than in the mask group. In terms of the target area, there were no significant differences observed in the conformation number (CN) and heterogeneity index (HI) between the two groups. However, wearing the personalized bite block resulted in significantly lower Dmax and Dmean values for the tongue. In contrast, the mask group experienced a higher incidence of oral mucositis and taste disorders. By utilizing customizable 3D-printed bite blocks in conjunction with a nano-mask, accurate repositioning for chemotherapy was achieved, leading to a reduction in set-up error and a significant decrease in radiation dose to the tongue and its surface oral mucosa. Consequently, the occurrence of adverse reactions such as oral mucositis and taste disorders was also reduced. The production of personalized bite blocks is simple, with accurate radiotherapy, making it a technique that should be widely adopted.

An innovative approach for treatment of anterior open bite in Class II Division 1 patient with VF appliance (Zygomatic Implant and Spur Assisted) - A case report

Controlling anchorage is one of the foremost necessary aspects of treatment. Moderate anchorage is comparatively simple to manage with the use of some intraoral appliances and biomechanical procedures. On the opposite hand, cases that need the most anchorage need extraoral support to strengthen the anchorage. In some instances, 100 percent anchorage has got to be maintained, such an anchorage may be termed as absolute anchorage. It's tough and not possible to get absolute anchorage by using typical ways like extraoral force application. In this case report, we describe the treatment of Open bite by using the support of Zygomatic plates and Spurs anteriorly placed with the combination of posterior bite blocks. A 20-year-old female reported to our department of orthodontics with the chief complaint of anteriorly placed upper front teeth. There was no relevant medical history; she was having tongue thrusting habit, acute nasolabial angle and incompetent lips. Overjet of 12mm and anterior skeletal open bite from canine to canine of 5mm was present associated with anterior tongue thrusting habit, and constricted upper arch. The molar relation was end-on on the right side and class II on left side. Canine relation is end-on, on both the side. Growth pattern is vertical. Upper arch is well aligned with constriction in premolar region; lower arch has crowding of 6 mm. The treatment plan was selected as alignment of the teeth with fixed mechanotherapy and impaction of the maxillary posteriors using zygomatic anchorage with posterior bite block and spurs soldered to the anterior part of the appliance. The sutures were removed after 7 days, the appliance was inserted into the patient’s mouth and secured with a power chain to the hooks of the appliance and the hook of zygomatic implant, 400gms of force was applied on both the sides.

Stress distribution of the modified clear twin-block aligner on the temporomandibular joint, alveolar bone and teeth: A finite element analysis

The modified clear twin-block aligner (CTBA) was developed to provide a mandibular advancement appliance for the treatment of mandibular retrognathia. The objective of this study was to analyse the stress distribution changes of CTBA with 45°, 60° and 70° bite blocks. A three-dimensional model of the craniomaxillofacial bones and teeth was generated from a spiral computed tomography (CT) scan. The models of the articular disc, capsule, periodontal ligament and CTBA were constructed mathematically. After assigning the appropriate material properties and the boundary condition using ABAQUS software, we simulated the CTBA with different bite blocks to analyse the mechanical effects. In the temporomandibular joint (TMJ) region, the posterior aspect of the condyle and glenoid fossa experienced tensile stress that was approximately about 22times greater at 70° than at 45°. The Von Mises stress distribution on the articular disc tended to be uniform. The strain direction of the condyle was backward. In the maxillary bone, the stress on the labial alveolar bone was about 5.83MPa at 70° and greater than that on the lingual side. The resulting displacement of the dentition revealed a tendency for the upper teeth to shift backward and the lower teeth to move forward by 0.46 to 0.49mm. The foregoing stress and displacement rose as the angle of the bite blocks increased. CTBA with 70° bite blocks constituted an advantageous biomechanical setting for the treatment of mandibular retrognathia in teenagers and provided a superior therapeutic effect.

Histological Structure of Male Wistar Rats’ Stomach Fed with Yam Tuber Flour Supplementation

A residential rat might harm human health because it acts as a disease reservoir. It has been many efforts to control this rate using synthetic rodenticide. Nevertheless, synthetic rodenticides broke the environment and made rats resistant. Yam (Dioscorea hispida) tube application on rat’s bite could solve the problem. This study evaluated the histology of male Wistar rats (Rattus norvegicus) fed with bite block supplemented with different yam tuber flour concertation to control residential rat populations. Five different treatments were applied with five replications. The treatments were negative control and brodifacoum 0.005% (positive control), 30%, 50%, and 70% of yam tuber flour. The results show that yam tuber supplementation caused damage to male Wistar rat stomachs, as indicated by mucosal erosion and the presence of inflammatory cells. The statistical test indicated that stomach damage significantly differed among treatments, with the severest damages caused by 50% yam tuber supplementation. It could be concluded that the rat’s bite containing yam tuber flour caused stomach damage, and the feed bite containing 70% yam tuber flour was the most effective. This result proved that yam tuber has good potential as a natural rodenticide to control residential rat populations.

Occurrence and Predictors of Postoperative Preauricular and Masticatory Muscle Pain Symptoms After Surgical Removal of Third Molars: A Single-Blind Randomized Controlled Trial Comparing Dental Assistants Supporting the Mandible and the Restful Jaw Device

During third molar removal, the mandible is supported by a dental assistant (DA) to counter downward forces during surgery, and with sedation, to maintain airway patency. The Restful Jaw device (PEP Design; Saint Paul) provides this support instead of the DA. This study compared the occurrence of postoperative preauricular and masticatory muscle pain symptoms (PMMPS) between the device and DAs providing mandibular support, using two outcome measures. Secondary aims identify predictors of outcome and providers' opinions of the device. In this multisite, single-blind, two-arm parallel randomized trial, participants without preoperative PMMPS had surgical removal of third molars, with sedation and bite blocks were randomly assigned to manual support or the device. The exposed group was randomly assigned to the device and the nonexposed group to manual support. The primary outcome was patient-reported PMMPS. Two secondary outcomes were pain assessed with the temporomandibular disorder Pain Screener and providers' views on the device. Outcomes were assessed at 1-, 3-, and 6-month postsurgery. The covariates are baseline demographics (eg, sex), clinical characteristics (eg, eruption status), and third molar surgeries. For occurrence of pain, generalized estimating equations assessed differences between groups. Logistic regression analysis assessed predictors of pain at 1month, per the Screener. The level for statistical significance was 5%. Enrollment was 86 and 83 participants in the device and DA groups, respectively. The average age was 20.8years; the majority were female (65%) and Caucasian (66%). The retention rate was ≥95.9%. The groups did not differ significantly for occurrence of pain using the primary and secondary outcome measures at any follow-up (P≥.46). Fully impacted molars were associated with occurrence of pain (odds ratio=3.44; 95% confidence interval 1.49-7.92; P=.004). Occurrence of pain using the primary and secondary outcome measures did not differ significantly between groups at any follow-up and was associated with removal of fully impacted third molars. Four out of five surgeons reported wanting to use the device on a regular basis when performing this procedure in sedated patients.

An innovative approach for treatment of anterior open bite in Class II division 1 patient with zygomatic implant and spur assisted appliance - A case report

Controlling anchorage is one of the foremost necessary aspects of treatment. Moderate anchorage is comparatively simple to manage with the use of some intraoral appliances and biomechanical procedures. On the opposite hand, cases that need the most anchorage need extraoral support to strengthen the anchorage. In some instances, 100 percent anchorage has got to be maintained, such an anchorage may be termed as absolute anchorage. It's tough and not possible to get absolute anchorage by using typical ways like extraoral force application. In this case report, we describe the treatment of Open bite by using the support of Zygomatic plates and Spurs anteriorly placed with the combination of posterior bite blocks.A 20-year-old female reported to our department of orthodontics with the chief complaint of anteriorly placed upper front teeth. There was no relevant medical history; she was having tongue thrusting habit, acute nasolabial angle and incompetent lips. Overjet of 12mm and anterior skeletal open bite from canine to canine of 5mm was present associated with anterior tongue thrusting habit, and constricted upper arch. The molar relation was end-on on the right side and class II on left side. Canine relation is end-on, on both the side. Growth pattern is vertical. Upper arch is well aligned with constriction in premolar region; lower arch has crowding of 6 mm. The treatment plan was selected as alignment of the teeth with fixed mechanotherapy and impaction of the maxillary posteriors using zygomatic anchorage with posterior bite block and spurs soldered to the anterior part of the appliance. The sutures were removed after 7 days, the appliance was into the patient’s mouth and secured with a power chain to the hooks of the appliance and the hook of zygomatic implant, 400gms of force was applied on both the sides.

Composite Bite Blocks—An Indigenous, Simple, Fixed Class II Corrector

Fixed functional appliances are used at either the fag end of the growth spurt or after the completion of the same. We orthodontists are yet to come across an appliance which satisfies all the ideal requirements for a fixed functional appliance. Most disadvantages of the fixed functional appliances such as increase in lower anterior facial height, proclination of lower anteriors, constant breakages, and huge expenses were taken into consideration in the basic designing of this ingenious appliance. In this article, a simple fixed functional appliance was designed to function along with fixed appliance therapy to stimulate mandibular growth. After the initial leveling and aligning, 0.019 × 0.025 stainless steel posted arch wires were placed. The bite jumping blocks were fabricated in the upper and lower arches with light cure blue composite. Using indirect bonding trays they were bonded in position. The case finished in an ideal overjet and overbite with a balanced face. Cephalometric values demonstrate an advancement of the mandible.

Mask dependency of the lacrimal gland dose under whole brain radiotherapy when the six-degrees of freedom couch is not available.

Dry eye syndrome has been recently reported in patients who underwent whole brain radiotherapy (WBRT). WBRT based on a couch with three-degrees of freedom (3D) can occasionally be performed in which the rotational head motion is not corrected. This study assessed the dependency of the rotational errors on the mask and the dose variation of the lens and lacrimal gland in WBRT patients. Translational and rotational setup errors were obtained at the first treatment with cone-beam CT (CBCT) for patients under WBRT and frameless stereotactic radiosurgery (SRS) (n=20 each) immobilized using a conventional WB mask and an SRS mask with a bite block, respectively. For the CT sets of SRS cases, WBRT plans were generated for the study. To simulate the rotational error, rotated CT images were created with each rotational error, on which initial WBRT plans were copied and doses were recalculated. The lens and lacrimal gland doses with and without rotation errors were compared. Despite similar translational setup errors for the two masks, the SRS mask showed a dramatic reduction in rotational errors compared to those of the WB mask. The errors varied within -2.9° to 2.9° and -1.2° to 0.7° for the WB and SRS masks, respectively. Accordingly, the SRS mask confined the change in the maximum lens dose, mean dose of the lacrimal gland, and lacrimal volume receiving 15Gy to one-third of those using the WB mask. When the six-degrees of freedom (6D) couch is not available, the frameless SRS mask is beneficial to WBRT for the faithful treatment as it was planned.

Auditory and Somatosensory Development for Speech in Later Childhood.

This study collected measures of auditory-perceptual and oral somatosensory acuity in typically developing children and adolescents aged 9-15 years. We aimed to establish reference data that can be used as a point of comparison for individuals with residual speech sound disorder (RSSD), especially for RSSD affecting American English rhotics. We examined concurrent validity between tasks and hypothesized that performance on at least some tasks would show a significant association with age, reflecting ongoing refinement of sensory function in later childhood. We also tested for an inverse relationship between performance on auditory and somatosensory tasks, which would support the hypothesis of a trade-off between sensory domains. Ninety-eight children completed three auditory-perceptual tasks (identification and discrimination of stimuli from a "rake"-"wake" continuum and category goodness judgment for naturally produced words containing rhotics) and three oral somatosensory tasks (bite block with auditory masking, oral stereognosis, and articulatory awareness, which involved explicit judgments of relative tongue position for different speech sounds). Pairwise associations were examined between tasks within each domain and between task performance and age. Composite measures of auditory-perceptual and somatosensory functions were used to investigate the possibility of a sensory trade-off. Statistically significant associations were observed between the identification and discrimination tasks and the bite block and articulatory awareness tasks. In addition, significant associations with age were found for the category goodness and bite block tasks. There was no statistically significant evidence of a trade-off between auditory-perceptual and somatosensory domains. This study provided a multidimensional characterization of speech-related sensory function in older children/adolescents. Complete materials to administer all experimental tasks have been shared, along with measures of central tendency and dispersion for scores in two subgroups of age. Ultimately, we hope to apply this information to make customized treatment recommendations for children with RSSD based on sensory profiles.

The fraction of inspired oxygen does not affect the time to extubation in mechanically ventilated, sevoflurane-anesthetized green sea turtles (Chelonia mydas).

To evaluate the effects of providing 100% O2, compared with the provision of 21% O2 (equivalent to room air), in mechanically ventilated, sevoflurane-anesthetized green sea turtles (Chelonia mydas). Eleven juvenile green sea turtles. In a randomized, blinded, cross-over study (1-week interval between treatments), turtles were anesthetized with propofol (5 mg/kg, IV), orotracheally intubated, mechanically ventilated with 3.5% sevoflurane diluted in 100% O2 or 21% O2 for 90 minutes. Sevoflurane delivery immediately ceased and animals remained under mechanical ventilation with the assigned fraction of inspired oxygen until extubation. Recovery times, cardiorespiratory variables, venous blood gases, and lactate values were evaluated. Cloacal temperature, heart rate, end-tidal partial pressure of carbon dioxide, and blood gases were unremarkable between treatments. The SpO2 was higher with the provision of 100% O2 than 21% O2 during both anesthesia and recovery (P < .01). Time to bite the bite block was longer in 100% O2 (51 [39-58] minutes) than in 21% O2 (44 [31-53] minutes; P = .03), while time to first muscle movement, attempt to extubate, and extubation were comparable between treatments. Blood oxygenation appears to be lower during sevoflurane anesthesia in room air than in 100% O2, though both fractions of inspired oxygen were able to supply the aerobic metabolism of turtles based on acid-base profiles. In relation to room air, the provision of 100% O2 did not produce meaningful effects on the time to recovery in mechanically ventilated green turtles submitted to sevoflurane anesthesia.

Skeletal and Dental Fractures Associated With Electroconvulsive Therapy.

During the motor seizure associated with electroconvulsive therapy (ECT), the muscles of the trunk and limbs contract forcefully and repetitively, predisposing to injuries to muscles, joints, teeth, and bones. This motor seizure is irrelevant to the therapeutic action of the treatment. It is therefore modified by the administration of an intravenous muscle relaxant, such as succinylcholine, after the administration of the anesthesia in the ECT premedication. Well-modified ECT is associated with markedly diminished skeletal muscle contractions and hence with minimal skeletal and dental risks. In this context, anecdotal reports across a range of skeletal disorders testify to the safety of well-modified ECT in ultrahigh-risk patients. Population-based data suggest that the fracture risk with modified ECT is 2 events per 100,000 ECTs; if only recent data are examined, the risk may be as low as 0.36 events per 100,000 ECTs. Population-based data also suggest that the dental fracture risk with modified ECT is 0.02% per ECT and 0.17% per ECT course. The overall magnitude of skeletal and dental fracture risk depends on patient factors and on how well the ECT procedure is performed. Preexisting bone and dental disease increase the risk; good seizure modification, proper use of bite blocks, and effective jaw immobilization during ECT reduce the risk. Careful assessment of preexisting risk and good ECT practice can minimize the risk of skeletal and dental complications during ECT.

Effect of rapid maxillary expander with posterior bite blocks in hyperdivergent patients with adenoid hypertrophy- A cephalometric study

To analyze the effect of Rapid Maxillary Expansion (RME) with posterior bite blocks on craniofacial structures in hyperdivergent patients with adenoid hypertrophy and to compare them with control group. 32 patients of adenoid hypertrophy (mean age 11.6 yrs, range 8-12 years) with a transverse discrepancy were selected and divided into two groups in a random way - Group A: (n=16) hyrax RME with posterior bite block group, Group B: (n=16) control group. Group A- Lateral and Posteroanterior cephalograms were recorded pretreatment (T0), postexpansion (T1), and after 9 months retention (T2). Group B- Lateral and Posteroanterior cephalograms were recorded pretreatment (T0), and after 9 months (T2) concurrent with Group A. Cephalometric measurements in sagittal, vertical and transverse dimensions were taken and comparison was made using Paired and Unpaired t-test with p &amp;#60; 0.05 as statistically significant. Group A underwent insignificant increase in SN-MP angle whereas it increased significantly in Group B. The lower facial height and jarabak’s ratio decreased significantly. All transverse parameters increased significantly with maximum increase in intermolar width when compared with Group B. Significant increase in the transverse dimensions of mid face occurs with RME thus increasing the upper airway patency and effective control of the vertical growth pattern, typical of adenoid hypertrophy, was seen in the treatment group when compared with the control group.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Tongue laceration in a patient taking antiplatelet agents during transcranial motor-evoked potential monitoring: a case report

BackgroundTranscranial motor-evoked potential (Tc-MEP) monitoring is usually performed during surgeries involving a risk of damaging brain motor areas. However, it involves a risk of bite injuries. We report a case of severe tongue laceration from Tc-MEP stimulation during carotid endarterectomy (CEA) in a patient taking antiplatelet agents.Case presentationA 74-year-old man on antiplatelet therapy was scheduled for CEA under general anesthesia with intraoperative Tc-MEP monitoring. Bite blocks were not inserted. Postoperatively, we observed a tongue laceration with severe bleeding, which was sutured. The difficulties in tongue movement persisted for ≥ 1 month postoperatively.ConclusionsBite injuries during Tc-MEP may induce severe bleeding in patients on antiplatelets. The complications of tongue bite injuries may persist, decreasing the patients’ quality of life. Hence, during Tc-MEP monitoring, it is important to use soft bite blocks and to check the patient’s face and the position of the tracheal tube intraoperatively.