Presence Of Trismus Research Articles

Transoral Robotic Surgery for Oral Cancer: Evaluating Surgical Outcomes in the Presence of Trismus.

Trismus, defined as restricted mouth opening, is a common complication among Taiwanese oral cancer patients, especially those who chew betel quid. However, the impact of trismus on survival outcomes in oral cancer patients undergoing transoral robotic surgery (TORS) is unclear. This study aimed to investigate the associations between trismus and surgical outcomes in Taiwanese male oral cancer patients treated with TORS. We conducted a retrospective propensity score-matched cohort study of 40 Taiwanese male oral cancer patients who underwent TORS between 2016 and 2022. Overall, 20 patients with trismus were matched to 20 patients without trismus. TORS achieved similar operative and short-term clinical outcomes in trismus patients to non-trismus patients. There were no significant differences between groups in operation time, blood loss, margin status, flap reconstruction rates, duration of nasogastric tube feeding, or length of hospital stay. Kaplan-Meier and Cox proportional hazard regression analyses were performed to compare overall survival (OS) and disease-free survival (DFS) between the two groups. The overall survival (OS) rate at three years was significantly lower in patients with trismus than those without trismus (27.1% vs. 95.0%, log-rank p = 0.02). However, there was no significant difference in disease-free survival (DFS) rates between the trismus and non-trismus groups (36.6% vs. 62.7%, log-rank p = 0.87). After adjusting for confounders, trismus was independently associated with a 13-fold increased risk of mortality (adjusted HR 12.87, 95% CI 1.55-106.50, p < 0.05). In conclusion, trismus appears to be an independent prognostic factor for reduced long-term OS in Taiwanese male oral cancer patients undergoing TORS, though short-term surgical outcomes were non-inferior in the trismus patients. Further research is warranted to clarify the mechanisms linking trismus and survival in this population.

Analysis of Clinical Symptoms and Biochemical Parameters in Odontogenic Cellulitis of the Head and Neck Region in Children.

Many cases of cellulitis in the head and neck region among hospitalized pediatric patients are related to odontogenic infections. C-reactive protein (CRP), white blood cell (WBC) count, neutrophils to lymphocytes ratio (NLR), D-dimer, and prealbumin can be used to assess the severity of odontogenic inflammation. The aim of the study is to evaluate the biochemical parameters as a predictor factor of the severity of odontogenic cellulitis in children. This study was conducted from 2020 to 2021 on patients admitted to the Department of Pediatric Otolaryngology and Pediatric Head and Neck Surgery of the Upper Silesian Children's Health Center in Katowice. We included 40 patients aged 2-16 in the study, who were divided into two groups: research (SS-Study subject) (n = 20) and control (CS-Control subject) (n = 20). The patients underwent an interview and physical examination to assess the presence of intraoral and extraoral swelling and the presence of trismus. The patients who qualified for the study had blood taken to determine the level of CRP, WBCs, NLR, D-dimers, and prealbumin. Differences in biochemical test results in the SS and CS were statistically significant (p &lt; 0.05). In the SS group, the mean values of biochemical parameters exceeded the clinical norm. A statistically significant positive relationship was found between CRP and extraoral swelling. The NLR correlates significantly with extraoral swelling and the length of hospitalization. D-dimer statistically correlated with trismus, extraoral swelling, and the number of anatomical spaces involved. The NLR and CRP ratio can be considered a prognostic marker of the course of infection and hospitalization time.

The Growth Factors in Advanced Platelet-Rich Fibrin (A-PRF) Reduce Postoperative Complications after Mandibular Third Molar Odontectomy.

Surgical removal of impacted mandibular third molars constitutes one of the most frequently performed procedures within oral surgery. This surgery procedure is associated with many post-operative complications. Advanced platelet-rich fibrin (A-PRF) belongs to the second generation of platelet concentrates and is rich in numerous growth factors. The aim of this study was to assess the influence of A-PRF on selected clinical features following the surgical removal of impacted mandibular third molars. The research was conducted on 100 generally healthy patients, who underwent a lower third molar odontectomy in Department of Oral Surgery, Medical University of Gdańsk, Poland, between 2018 and 2019. The research group consisted of 50 patients (immediate A-PRF socket filling) and control group (50 patients without A-PRF socket filling). During the study, the following clinical features were assessed: pain (visual analog scale), analgesics intake, the presence of trismus, edema, hematomas within the surrounding tissues (e.g., cheek), prevalence of pyrexia, dry socket, secondary bleeding, presence of hematomas, skin warmth in the post-operative area, and bleeding time observed by the patient were analyzed on the 3rd, 7th, and 14th day after the procedure. There was a significant association between A-PRF socket filling and pain intensity, the analgesics intake, trismus, and edema on the 3rd and the 7th day (p < 0.05). The presence of hematomas and skin warmth on the 3rd day after the surgery (p < 0.05) were also statistically associated with A-PRF use. The study showed that in reducing the incidence of postoperative complications, A-PRF was more important than the position of the tooth or the duration of the procedure. The growth factors in A-PRF reduce postoperative complications, such as pain, trismus, edema, analgesics intake, presence of hematomas, and skin warmth, after mandibular wisdom teeth odontectomy.

OSTEOSARCOMA IN THE TEMPOROMANDIBULAR JOINT

Osteosarcomas are rare bone tumors in the buccomaxillofacial region that mainly affect the body and angle of the mandible. However, cases in the temporomandibular joint are rarely found. This report describes a case of a 30-year-old male patient with facial asymmetry on the right side referring to a volume increase in the preauricular region associated with painful symptoms and evolution of 5 months. The physical evaluation showed absence of lymph node enlargement and the presence of trismus, which enabled intra-oral examination. Computed tomography multidetector revealed a mixed lesion with imprecise limits and osteogenic corticomedular and spinal formation extending through the lateral, medial, and posterior borders of the condyle and the upper half of the mandibular ramus. An incisional biopsy was performed followed by an anatomopathologic result of osteosarcoma. The patient was referred to an oncologist and died while awaiting treatment.

Effects of sea salt rinses on subjects undergone to oral surgery: a single blinded randomized controlled trial.

It has been customary to explain the dentally beneficial effects of xylitol and certain other natural compound as lysozyme and seas salt in terms of microbiological effects only. Several studies have tested the use of natural ingredients, alcohol and fluoride free, in mouthwashes.The purpose of this study was to evaluate a combined mouthwash formulation containing natural antibiofilm agents inoral care woundhealing after routinely oral surgery (extraction) procedures. Patients were assigned following a blinded randomized controlled trial and divided into two groups, an experimental group (I = 15) and a control (placebo) group (II = 15). Any infectious complications, wound healing, plaque accumulation in the stitches, and presence of trismus and inflammation were evaluated at ten and thirty days after extraction procedure. Pain and swelling were evaluated using the well-known visual analogue scale (VAS) scale throughout study period following extraction. The mean difference in Pre and Post values were compared among the groups. The change in pre-post score was analyzed using the paired t test. An appreciable wound healing was seen in the experimental group when compared to the control sites, with no reported adverse effects. Four weeks postoperative patient's satisfaction level, to subjective and objective outcome measurements in documenting the result of a mouthwash treatment showed an interesting difference between groups. Since combined mouthwash formulations, containing natural/bioactive substances, could provide a cheap, safe and acceptable alternative in oral care, further studies will also be required to study these effects and their mechanism of action in detail.

Retrospective Outcome Analysis of Buccal Mucosal and Lower Alveolar Squamous Cell Carcinoma from a High-Volume Tertiary Cancer Centre

To evaluate treatment outcome and factors affecting locoregional control and distant metastasis in buccal mucosal and lower alveolar squamous cell carcinoma. A retrospective analysis of all diagnosed cases of buccal mucosal and lower alveolar squamous cell carcinoma in patients who underwent surgical treatment in 2011 was included from the data base. The patients were analysed for their habits, trismus, skin and bone involvement, neck nodes, type of surgery for primary and nodes, differentiation of tumour, pathological nodal status, recurrence site, and duration after completion of treatment and follow-up. A total of 114 patients were included in the study. The mean duration of follow-up was 23.8months. On follow-up, 30 patients had recurrence (26.32%) either locoregional or distant metastasis. Age less than 45years, nodal positivity, presence of perineural invasion, extracapsular spread, and degree of differentiation were found to be statistically significant by univariate analysis (p < 0.05). On multivariate analysis, node positivity and presence of perineural invasion emerged as independent predictors of recurrence. Cox regression analysis showed trismus, node positivity, and perineural invasion are significantly associated with recurrence. Aggressive multimodality treatment achieves good local control rates even in locally advanced disease, and the intent of treatment should be curative. Node positivity, presence of perineural invasion, and presence of trismus are found as independent predictors of recurrence. Clinically, presence of trismus is associated with poorer outcomes in view of higher stage.

Efficacy of intravenous dexamethasone administered preoperatively and postoperatively on pain, swelling, and trismus following third molar surgery. A comparative study

AbstractAimTo demonstrate the preventative therapeutic effect of pre‐operative and post‐operative intravenous 8 mg of dexamethasone on post‐operative pain, swelling and trismus after the surgical extraction of mandibular third molars.Materials and methodsA randomised clinical trial was conducted on of 100 healthy participants (group I pre‐operative and group II post‐operative) with unilateral impacted lower third molars, average age 27.7 ± 9.7 years with no local or systemic problems were operated under local anaesthesia. Group I received 8 mg intravenous 1 hour pre‐operatively and group II received 8 mg intravenous dose of dexamethasone at the end of procedure. Post‐operative pain was evaluated using a visual analogue scale (VAS) and the degree of swelling was evaluated through facial reference point variation. The presence of trismus was analysed through measurement of the inter‐incisal distance (IID). These assessments were obtained before the operation and 48 hour and 7th post‐operative day.ResultsNo significant differences were observed in facial swelling and trismus among pre‐operative and post‐operative IV 8 mg doses after the surgery (student t‐test; P &gt; 0.05). The visual analogue scale scores for pain assessment showed no clinically or statistically significant differences in both groups (student t test; P &gt; 0.05).ConclusionsPre‐operative administration of 8 mg intravenous dexamethasone is as effective as 8 mg IV post‐operative dexamethasone with no clinically or statistically significant differences in the final outcomes of the third molar surgery.

Pattern of noma (cancrum oris) and its risk factors in Northwestern Nigeria: A hospital-based retrospective study.

Background:Noma (cancrum oris) remains the scourge of children and the “face of poverty” in Sub-Saharan Africa. Recent data on the burden of noma and its risk factors are needed for evaluating and redesigning interventions for its prevention and control.Objectives:This study aimed to determine the pattern of noma and its risk factors in Northwestern Nigeria.Materials and Methods:It was a retrospective study that looked into cases of noma (cancrum oris) admitted into the Noma Children Hospital, Sokoto, Nigeria, between January 1999 and December 2011. Information on patients’ bio-data, the site and severity of lesions, and presence of trismus and its severity were extracted from the patients’ case files and analyzed using descriptive statistics.Results:One hundred and fifty-nine (8.3%) of the 1923 patients admitted to the hospital from January 1999 to December 2011 were diagnosed with fresh noma. The mean age of the patients was 3.0 ± 1.4 years, and majority of them, 139 (87.4%) were aged 1–5 years. The soft-tissue lesions essentially involved multiple sites but most commonly the outer and inner cheeks (84.3%). The most common risk factors identified were measles (47.2%) and protein-energy malnutrition (42.1%). There were rises and falls in the prevalence of noma in the period studied.Conclusion:This study showed a high burden of noma in Northwestern Nigeria, mostly among children aged 1–5 years, and with soft-tissue lesions involving multiple sites. Measles and malnutrition were the major risk factors identified, and the disease trend showed a wave-like pattern. There is an urgent need to eliminate the disease in Nigeria through prevention and control of infectious diseases and malnutrition.

Dose-Volume Correlates of Patient-Reported Trismus in Long-Term Oropharyngeal Cancer Survivors after IMRT

The purpose of the current study was to ascertain the dose-toxicity relationship in the development of self-reported trismus in long-term survivors following intensity modulated radiation therapy (IMRT) for oropharyngeal carcinoma (OPC). Self-reported mouth opening was ascertained from a cross-sectional survey of OPC survivors treated from January 2000 to April 2014 on an IRB approved protocol. The survey is a single item inquiring on the presence and severity of trismus, based on the number of vertically stacked fingers that could be fit between the central incisors or gums. Trismus classification were coded as follows: 3 or more fingers “no trismus,” at least 2 fingers “mild” trismus, only one finger “moderate” trismus, and the inability to fit any fingers “severe” trismus. Treatment plans were restored, and dose-volume histograms (DHVs) were generated for the following regions of interest (ROI): medial pterygoid (MP), lateral pterygoid (LP) and masseter (M) muscles with ipsilateral (I) or contralateral (C) designation relative to the primary tumor. Patient and treatment characteristics were further characterized by trismus presence and severity stratification utilizing the Kruskal-Wallis and Pearson’s chi-square test for group mean and categorical variables, respectively. Mean RT dose (Dmean) of individual ROIs was calculated and compared collectively across patient subgroups based on presence of trismus using the Kruskal-Wallis test, then investigated further via Pairwise Wilcoxon rank-sum test. Recursive partitioning analysis (RPA) was used to identify dose-volume parameters associated with persistent trismus. Of 587 eligible patients, the majority (84%) were male with mean age of 57.7. The large majority of patients had cancer of the base of tongue (49%) or tonsil (45%). A total of 37.5%, 17%, 22%, and 24% of patients underwent concurrent chemoradiation (CCRT), induction chemotherapy (IC), IC + CCRT and RT alone, respectively. The mean IMRT dose of 68.12 Gy. One hundred sixty-four of the 587 (30%) participants self-reported any degree of trismus. The advanced T stage, receipt of CCRT, and higher total RT dose were associated with higher grade of trismus. Comparison of mean RT dose between trismus and no trismus subgroups was highly significant (p<0.05) across all ROIs. On multivariate analysis, there was an association between presence of trismus and mean dose to the ILP and CMP with p values of <0.01 and 0.02, respectively. RPA showed DVH-derived parameters; ILP Dmean and V27 were associated with RT-attributed persistent trismus, specifically V27 ≥ 98.6 and Dmean of 61 Gy. Dose to muscles of mastication plays a significant role in the development of trismus following RT with 30% of this large survivorship cohort of OPC patients reported trismus after IMRT. Care should be taken by clinicians to avoid unnecessarily RT dose, when feasible, to these structures in an attempt to decrease the incidence of this treatment sequelae.

How common is post-neonatal tetanus in Rasheed Shekoni Specialist Hospital, Jigawa, North Western Nigeria?

Background: Tetanus, caused by Clostridium tetani neurotoxin, is still an important cause of morbidity and mortality in children in developing countries. Children usually present with trismus followed by spasms of skeletal muscles. Tetanus infection can easily be prevented through immunization. However, despite provision of routine immunization schedule by government-based hospital at all levels of care, there is still poor immunization uptake which in association with dangerous traditional practices in the area leads to high burden of the disease. Materials and Methods: This was a retrospective hospital-based study. It was conducted at the Department of Paediatric of Rasheed Shekoni Specialist Hospital, Dutse, Nigeria. Medical records of all children between the ages of 1 month and 13 years, who were admitted between May 2014 and April 2017, with a diagnosis of tetanus were retrieved and analyzed. Diagnosis of tetanus is clinical based on the presence of trismus and spasms. Information obtained included biodata, immunization status, onset and duration of symptoms, length of hospitalization, and outcome. Results: Children admitted with tetanus in the period of study were 25, but only 20 qualified for analysis. The prevalence of tetanus was 1.03%. Twelve (60%) were in the 5–9 years age group. Majority (75%) were males, from rural areas (75%), and did not receive any immunization (65%). Circumcision was the portal of entry in 30%. All had generalized tetanus, and mortality rate was 25%. Conclusion: There is need to strengthen routine immunization and introduce booster immunization into the area to prevent post-neonatal tetanus.

Evaluation of complications in postoperative of thirdmolar extraction

OBJECTIVE: This study aimed to analyze parameters such as the presence of trismus, facial swelling, postoperative pain, paresthesia of the inferior alveolar and lingual nerve, alveolitis, late bleeding and correct use of prescribed medications. Relating the complication rates with age, gender and proper use of medications prescribed.METHODS: This study evaluated 20 patients who have gone through removal of third molars, using questionnaires applied by researchers in the postoperative period of seven days in the graduate and professional qualifications Pós-Doc center from April to May/2015.RESULTS: It was observed that 45% of the patients had pain, 45% had trismus, 15% had paresthesia, 85% had late light bleeding, 5% had fever, malaise or discharge from the surgical site and 45% had facial swelling.CONCLUSION: The more frequent complications found were pain and late bleeding, with no association between pain and gender and pain and age.

The effects of amoxicillin with or without clavulanic acid on the postoperative complaints after third molar surgery: a retrospective chart analysis.

The aim of this chart-based retrospective study was to evaluate the effects of orally administered amoxicillin alone or amoxicillin combined with clavulanic acid on the frequency of post-operative complications and patients' comfort after mandibular third molar surgery. The records of patients who had undergone lower third molar surgery between October 2014 and December 2015 were examined. A total of 62 patients who had fully impacted teeth in mesioangular position and who had been prescribed same type and dose of anti-inflammatory drug were included in this study. Among them, 32 subjects were found to have been prescribed 500 mg amoxicillin trihydrate orally every 8 h for 5 days (Group A) and 30 patients 500 mg amoxicillin trihydrate plus 125 mg potassium clavulanate orally every 8 h for 5 days postoperatively (Group AC). Post-operative pain levels, swelling, presence of trismus, frequency of alveolar osteitis and quality of life (QoL) scores were gathered from patients' charts and were statistically compared. Analysis of the variables showed that there were no significant differences between the Groups A and AC regarding pain levels, swelling, trismus and QoL scores. The frequency of alveolar osteitis was found to be 1.6% in the Group A, however, no significant difference was observed among study groups. Within the limitations of this retrospective chart review, it can be stated that amoxicillin and amoxicillin with clavulanic acid might provide similar outcome in terms of patient comfort following third molar surgery.

Alterations found in the mouth of patients treated with head and neck radiotherapy. Medellin, Colombia

The aim of the present study was to determine which oral alterations can be found in patients with head and neck cancer treated with radiotherapy as well as to explore dentist’s involvement in treatment of these patients. An exploratory study was conducted in 52 patients who had previously received over 1,000 cGy radiation. A survey was undertaken as well as oral examination of each participant, in order to assess stimulated salivary fl ow and fl avor tests. Results revealed high prevalence of oral alterations in patients with accumulated radiation of 3,001-5,000 cGy. Dry mouth (xerostomia) was the most frequently reported alteration (78.8%). Estimated total salivary secretion rate confirmed a state of hyposalivation in 82.7% of all patients. A statistically signifi cant association was found between cancer location (p &lt; 0.01) and type of tumor with presence of trismus (p &lt; 0.05). Hyposialia was more frequently present in patients with stage IV tumors (50%) in those subjected to combined treatments (p &lt; 0.05). Periodontal assessment was possible in 50% of all patients, Of this proportion, 92% exhibited periodontitis with mainly moderate to severe insertion loss; 84.6% of all participants reported not to have been remitted to dentists either before or after treatment. Findings support high frequency of oral alterations in patients subjected to radiotherapy treatment and dental care inappropriateness to prevent or treat these effects. An alert is raised with respect to the compulsiveness to follow treatmentprotocols for cancer patients, which should include dental evaluationbefore, during and after respective treatment.

Pre-emptive effect of dexamethasone injection and consumption on post-operative swelling, pain, and trismus after third molar surgery. A prospective, double blind and randomized study

AimTo evaluate the preventative effect of intravenous 4 mg of dexamethasone and 8 mg oral dexamethasone on post-operative pain, swelling and trismus after the surgical extraction of mandibular third molars. Materials and methodsA randomized clinical trial comprised of 200 patients (control group I intravenous and experimental group II orally) with impacted lower third molars, average age 20.8 years with no local or systemic problems, with bilateral impacted lower third molars, were operated under local anesthesia. Group I was given 4 mg IV and group II was given 8 mg orally of dexamethasone 1 h before procedure. The choice of which side to operate first and the amount of concentration of medication to use was made randomly and double-blindly. Post-operative pain was evaluated using a visual analog scale (VAS) and the degree of swelling was evaluated through facial reference points' variation. The presence of trismus was analyzed through measurement of the interincisal distance (IID). These assessments were obtained before the operation and 24 h, 48 h and 7th POD. ResultsNo significant difference was found in facial swelling and trismus between IV 4 mg injection and oral 8 mg consumption after lower third molar surgery (student t test P > 0.05). The visual analogue scale scores for pain assessment showed no significant difference between IV injection and oral route of dexamethasone (student t test P > 0.05). ConclusionPatients can be administered 8 mg oral dexamethasone is as effective as 4 mg intra venous route without much difference in final outcome at any given point of time.

The effect of cigarette smoking on the severity of pain, swelling and trismus after the surgical extraction of impacted mandibular third molar

Objective: The study objective was to investigate the effect of cigarette smoking on the severity of pain, swelling and trismus on male after the surgical removal of impacted lower third molar. Material and Methods: This prospective comparative study was conducted for 150 male in two groups of patients, smokers and non-smokers. Each group consisted of 75 patients; smoking patient were the ones who smoke more than twenty cigarettes per day for more than one year of continuous smoking. Postoperative pain was evaluated using a visual analog scale (VAS) and the degree of swelling was evaluated through facial reference points’ variation. The presence of trismus was analyzed through measurement of the interincisal distance (IID). Result: Clinical and radiographic examinations were carried out. Data regarding the age, gender, angulations type, depth and width of impactions were evaluated and analyzed The severity of pain, swelling and trismus on the 1st, 2nd , 5th and 7thday postoperatively was estimated. In both groups the pain and trismus were reported to be in peak level during the first post-operative day while post-operative swelling reaches its peak level in the second postoperative day. Conclusion: Cigarettes smoking do not have any significant relationship with the severity of pain, swelling and trismus after surgical removal of lower third molar on male gender. Key words:Cigarettes smoking, pain, swelling, trismus, impacted lower third molars.

Corticosteroids or Cyclooxygenase 2-Selective Inhibitor Medication for the Management of Pain and Swelling After Third-Molar Surgery

The dental-impaction pain model is the most commonly used and widely accepted acute pain model for assessing the analgesic effect of drugs in humans. The aim of this randomized crossover clinical trial was to observe and compare the anti-inflammatory effects of corticosteroid and nonsteroidal cyclooxygenase 2-selective inhibitor medication on pain, swelling, and trismus after third-molar surgery. For this, 50 adult subjects, 25 male and 25 female, with ages ranging between 18 and 29 years (mean, 22.5 years) and no local or systemic problems, presenting bilateral impacted lower third molars in similar position with surgical extraction indicated were selected. The subjects were submitted to 1 surgical procedure for each side with interval of 3 weeks between each procedure, in which they were given 120 mg etoricoxib, nonsteroidal anti-inflammatory (group 1), or 4 mg dexamethasone, corticosteroid anti-inflammatory (group 2), 1 hour before the procedures. Data were registered at preoperative baseline and 24 and 48 hours postoperatively. Postoperative pain was evaluated using a visual analog scale, and the degree of swelling was evaluated through facial reference points' variation. The presence of trismus was analyzed through measurement of the interincisal distance. These assessments were obtained before the operation and at 24 and 48 hours after the surgeries. There was no statistically significant difference between anti-inflammatory treatments. However, at 48 hours, the facial swelling increased in both groups despite trismus reduction. The effects of nonsteroidal and steroidal anti-inflammatory drugs were similar for pain, swelling, and trismus.

Responsive Contingency Planning: a novel system for anticipated difficulty in airway management in dental abscess

This study is of a novel system for management of anticipated difficult airway (Responsive Contingency Planning). It is based on the notion that almost all problems in airway management have already been experienced, so they can be anticipated and prepared for using 'worst case' planning. Anaesthetic colleagues were introduced to the new system. Thirty-two patients with dental abscess were recruited for anaesthetic airway management based around the new scheme. Data collection involved a preoperative assessment of problems specific to dental abscess, fascia-spaces involved, details of the contingency planning process, laryngoscopy grade, and comments regarding the efficacy of the new system. No problems were encountered that had not been anticipated during planning and colleagues' comments about using the system were generally favourable. Examples are highlighted to suggest how the planning may have avoided certain complications (e.g. abscess rupture) and helped in dealing with others when they occurred. If trismus (</=2 cm inter-incisor distance) occurred with superficial infection alone, it always improved (to >2 cm) after induction of anaesthesia. In contrast, difficult laryngoscopy (grade 3 or 4) occurred in 6/15 cases of floor of mouth infection. The system fulfilled expectations for its use at this stage of development. It can be easily updated for refinements, alternative techniques, and tailoring to any difficult airway scenario. Computerization should make it easier to use and flag-up inconsistencies. Floor of mouth infections in the presence of trismus are easily underestimated and require careful assessment.

Poster 126: Mandibular Reconstruction Using the Deep Circumflex Iliac Artery Composite Free Flap

The deep circumplex iliac artery composite free flap includes the circumflex iliac vessels and incorporates the ilium, internal oblique muscle and the muscle cuff. The purpose of this study was to evaluate the results of 15 patients who underwent reconstruction of a mandibular defect using the DCIA flap and to discuss indications, advantages and disadvantages of using the DCIA flap. A retrospective analysis via chart review, imaging information and patient examination included the primary lesion type, defect size, flap survival, facial esthetics, mastication, presence of trismus, and donor site complications. All patients evaluated underwent reconstruction using the DCIA flap at SNUDH OMFS from 2002 to 2006. n/a Fifteen patients were included (M:F=10:5). The mean age was 31.4 years and the mean follow up period was 33.8 months. The diagnoses included the following: ameloblastoma (n=9), malignancy (n=3), cementifying fibroma (n=1), central ossifying fibroma (n=1) and hemifacial microsomia (n=1). All defects were of the mandible; left posterior areas with the ramus (n=8), left posterior areas without the ramus (n=5), right posterior areas (n=1) and right anterior/premolar areas with the left mandibular body (n=1). The mean defect size was 8.6 x 4.8 x 2.0 cm. The osseous flap was used in nine cases and musculo-osseous flaps in six cases. Fourteen flaps survived; one flap failed due to underperfusion detected intraoperatively. Postoperative facial esthetics were reported by patients as very satisfied (n=1), acceptable (n=11) and slightly unsatisfactory (n=2). All patients had good recovery of mastication; five patients underwent implant installation therapy. There was a slight limitation of mouth opening in all cases, which was not clinically significant. Donor site complications consisted of numbness of the thigh in four cases. The study findings show that the DCIA flap is easy to contour, has minimal complication at the recipient/donor site and achieved good functional and cosmetic repair of the mandiblular defect. Therefore, our findings support the use of the DCIA flap as the flap of choice for reconstruction of mandible defects.

Trismus Assessment In Tonsillitis And Quinsy: Does It Help?

Trismus Assessment In Tonsillitis And Quinsy: Does It Help?

Cellulties cervico-faciales d'origine dentaire et intubation trachéale

• Objectives : To evaluate the difficulty of intubation in relation with the localisation and spread of cervico-facial cellulitis of odontogenic origin and to recognize the optimal technique of intubation in such circumstances. • Study design : Prospective clinical open study. Patients : Hundred patients, including 16 children, undergoing surgical drainage of a cervico-facial cellulitis of odontogenic origin under general anesthesia were studied. • Methods : Difficulty of intubation was evaluated with the following four criteria : active mouth opening in the awake patient, Mallampati's classifying system, presence of trismus, clinical and radiological control of localisation and extension of the cellulitis (mandibular, maxillar or mouth floor). In case of a foreseen difficult intubation, a fibrescope was used in the awake patient. Otherwise the endotracheal tube was inserted after administration of propofol (3 mg·k −1) and alfentanil (10 to 20 μg·kg −1). A Cormack's grading was performed during intubation. • Results : Mouth opening depended on the localisation of the cellulitis. Trismus occurred more often with mandibular than maxillary localisations. Trismus and a Mallampati's class > 2 were associated with difficulty in intubation (Cormack's grade > 2), except in maxillary localisations. • Conclusions : The localisation of cellulitis of odontogenic origin is responsible for the difficulty grade of intubation. Awake fibreoptic intubation should be systematically performed in patients with a floor of the mouth cellulitis to reduce the risk of rupture of the abscess by a laryngoscope blade. As trismus associated with mandibular localisations is not relieved by general anaesthesia, awake fibreoptic endotracheal intubation should be preferred.