Removal Of Splints Research Articles

Impact of Intranasal Splint Removal Time on Postoperative Complications after Septoplasty.

Various types of nasal tampons are used for packing after septoplasty. Intranasal splints are widely used as they are more advantageous than other materials regarding the lower complication rates of synechia, and lesser pain during removal. However, there is no consensus on the timing of intranasal splint removal after septoplasty operations. In this study, we aimed to investigate the effects of removal time of intranasal splints on postoperative complications after septoplasty. One hundred patients who had septoplasty were randomly divided into two groups according to splint removal time. In group I, the splints were removed on the third postoperative day and in group II, splints were removed on the seventh postoperative day. Pain during splint removal was evaluated by visual analog scale (VAS). Complications of hemorrhage, septal hematoma, crusting, mucosal injury, and infection were recorded during splint removal and compared. In the first postoperative month, hemorrhage, crusting, mucosal injury, infection, synechia, and in the second postoperative month, synechia and perforation rates were compared between two groups. Mucosal crusting was significantly higher in group II during splint removal. There was no statistically significant difference between the two groups regarding the complication rates and pain scores. Our findings showed no significant difference in pain scores during splint removal and postoperative complications between the two groups except for mucosal crusting. Based on our findings, although there is no consensus on the optimal time for splint removal, earlier removal of splints can be considered a favorable option after septoplasty operations.

Fluorescence-aided identification technique using a low-cost violet flashlight and rotatory instruments for dental trauma splint removal.

Removing resin composites used for bonding dental trauma splints may result in irreversible damage to the enamel. This in vitro study evaluated the influence of additional violet illumination and different bur types on damage caused to tooth enamel. Fifteen maxillary models with four bovine incisor teeth were prepared. All models were scanned using a laboratory scanning system (s600 ARTI; Zirkonzahn). Six experimental groups (n = 10) were generated by two study factors: lighting type (three levels), (1) low-cost (5-7 US$) violet LED flashlight (LUATEK, LT 408); (2) VALO Cordless light curing unit (Ultradent) with black lens; or (3) without additional illumination; and rotatory instrument (two levels), (1) diamond bur or (2) multifluted tungsten-carbide bur. New scanning was performed after splint removal, and the generated files were superimposed on the initial scans using Cumulus software. The light emitted by both violet light sources was characterized by using integrating sphere and beam profile. A qualitative and quantitative analysis of enamel damage and two-way ANOVA followed by Tukey's post hoc was used at an α = 0.05. The use of low-cost violet flashlight that emitted the violet peak light at 385 nm and VALO Cordless with black lens at 396 nm resulted in significantly lower damage to the enamel surface than those in the groups without additional violet light (p < .001). An interaction between rotatory instruments and lighting was found. When no additional violet lighting was used, the diamond bur presented higher mean and maximum depth values. Fluorescence lighting facilitated the removal of remnant resin composite dental trauma splints, leading to less invasive treatment. The diamond bur resulted in higher enamel damage than that affected by the multifluted bur when no violet lighting was used. A low-cost violet flashlight is a useful fluorescence-aided identification technique for removing resin composite dental trauma splints.

THE EFFECT OF DIFFERENT ADHESIVE MATERIALS ON WORKING TIME OF DENTAL TRAUMA SPLINT PLACEMENT AND REMOVAL: IN-VITRO STUDY

Introduction: The placement and removal of dental trauma splints can be challenging in paediatric dental patients especially in emergency cases. An ideal adhesive material which offer simplified and time-saving dental splint procedures is preferred. Objective: This in-vitro study aimed to evaluate the effect of different adhesive materials on working time during the placement and removal of dental trauma splints. Method: Eight types of adhesive materials (packable composite resin with self-etch and etch-and-rinse, flowable composite resin with self-etch and etch-and-rinse, self-cure and light-cure RMGIC, and temporary and semi-permanent GIC) were investigated. The working time during the placement and removal of dental trauma splints was recorded in seconds(s) by using a stopwatch. Results: Data were analyzed with One-way ANOVA and showed that there were significant differences in working time during placement (p &lt;0.001) and removal (p = 0.007) of dental trauma splints between different types of adhesive materials. The shortest working time for placement of dental trauma splint can be observed with flowable composite resin self-etch and light cure RMGIC groups. Meanwhile, the shortest working time during the removal of dental trauma splint can be observed with temporary GIC and light cure RMGIC groups. Conclusion: Light cure RMGIC may offer as an ideal adhesive material for dental trauma splint especially in paediatric dental patient as it showed an advantage on time of placement and removal of the splint.

Analyze and Compare the Pain Level and Complications of Septoplasty with and without Splints and Packing

Aim: The main objective of this study is to analyze and compare the pain level and complications of septoplasty with and without splints and packing.&#x0D; Methodology: Our study comprised of 100 patients who underwent septoplasty procedure both under general and local anesthesia. They were divided into two groups. One group of 50 patient had splints and packing while the other group of 50 patients had no splints and packing post operatively. Patients were chosen randomly. Children and elderly patients were excluded from the study. Printed proforma was used to compare the result in terms of pain scores and complications. Regular follow-up was done for average six months. The study was approved by ethical review board PUMHSW Nawabshah.&#x0D; Results: Pain scores were higher in patients with splints and packing both in post-operative period and at the time of removal of splints and packing. There was no significant difference regarding other post operative complications.&#x0D; Conclusion: It is concluded that pain and discomfort associated with nasal splints and packing does not justify their application in case of certain minor to moderate nasal septal defects undergoing surgery. However when septal surgery is extensive and associated turbinate and framework procedure are done, splints and packing become mandatory in our setup.

Follow-Up Care of Distal Radius Buckle Fractures

Source: Colaco K, Willan A, Stimec J, et al. Home management versus primary care physician follow-up of patients with distal radius buckle fractures: a randomized controlled trial. Ann Emerg Med. 2021;77(2):163-173; doi:10.1016/j.annemergmed.2020.07.039Investigators from the University of Toronto conducted a randomized controlled trial to assess outcomes associated with home management versus physician follow-up in children with distal buckle fractures. Children were eligible if they were 5-17 years old and were diagnosed in the study ED within the previous 3 days with a distal radius buckle fracture during the 2018-2019 study period. The standard management for all patients diagnosed with a distal buckle fracture at the study ED is a removable splint. All participants completed a demographic survey at enrollment as well as a baseline modified Activities Scale for Kids-38 (ASKp38) scale that assessed wrist function the week before injury (with the average score for patients with no disabilities being 95%).Participants were randomized to either removal of the splint at home with physician follow-up as needed or to see their primary care physician 1-2 weeks after the ED visit. All participants were advised to wear the splint continuously (except for bathing) for the first week and then as needed to manage pain or swelling symptoms. All participants were advised to restrict activities that could lead to reinjury for 6 weeks.The primary outcome was ASKp38 scores at 3 weeks post-ED visit, assessed via telephone. A secondary outcome was health care resource use and parental expenses related to the child’s injury, assessed by parent report at 3 and 6 weeks post-ED visit and medical records. Total patient health care costs were estimated by multiplying health care resources data by corresponding unit prices. The investigators assessed outcomes by allocation arm using an intention-to-treat analysis.There were 149 participants enrolled, 73 in the home management group and 76 in the primary care physician follow-up group. Follow-up was completed for 90.4% of participants in the home management group and 88.2% of the physician follow-up group at 3 weeks, and 89% and 86.8%, respectively, at 6 weeks. There were no significant differences in baseline demographics or baseline ASKp38 scores. Mean ASKp38 scores at 3 weeks were similar between both groups (95.4% and 95.9% in the home management and physician follow-up groups, respectively). Total mean healthcare and parent costs in the physician follow-up group were greater than in the home management group ($149.10 vs $26.80, respectively).The investigators conclude that home removal of splints for distal buckle fractures is noninferior to physician follow-up and less costly.Dr Bechtel has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Buckle (torus) fractures of the distal radius are the most common fractures in children.1 There are many ways these fractures can be managed, as they are very stable and have an excellent prognosis. Primary care physicians are becoming the standard of care for follow-up of buckle fractures instead of orthopedic or fracture clinic follow-up. Primary care physician follow-up for distal forearm buckle fractures has demonstrated excellent recovery and management mainly based on patient symptoms rather than frequent radiographic follow-up common to orthopedists or fracture clinics.2 The current investigators sought to determine whether symptomatic home management versus primary care provider follow-up of torus fractures had equivalent functional outcomes in children managed with a removable splint.Indeed, the authors did find that home management was just as efficacious as primary care provider follow-up in terms of functional use scores at 3 weeks. Notably, children who were managed at home had even lower costs and fewer follow-up radiographs obtained than children who had follow-up with their primary care provider. There are, however, 2 significant limitations of the current study that should be noted. The first is that most of the population had post-secondary school education and telephone and electronic access and had a primary care provider. Thus, extrapolating the results to a different population (eg, lower parental education, lack of telephone access or a primary care provider) is not possible at this time. The second limitation is that the population was also primarily English-speaking, so it is likely not practical to expect similar results in a non-English speaking population of caregivers based on the current study.In English-speaking families with telephone and electronic access and a primary care physician, at-home management of children with torus fractures with a removable splint is less costly and just as efficacious as follow-up with a primary care physician.The benefits that accrue with home splint removal are potentially more than financial. Parental time away from employment or other priorities, as well as school absence by affected children, are obviated by home management of distal radius fractures.

Intranasal Septal Splints: Prophylactic Antibiotics and Nasal Microbiology.

Intranasal septal splints are often used in nasal septal surgeries. Routine use of postoperative antibiotics is an accepted practice, although data regarding its efficacy in preventing postsurgical complications are limited. This study aimed to examine bacterial colonization on septal splints following prophylactic antibiotic therapy and the association with postoperative infections. Fifty-five patients underwent septoplasty by a single surgeon between March 2015 and April 2016. All had intranasal septal splints and were given antibiotic prophylaxis for 7 days until removal of splints. Nasal cultures were taken before surgery, and septal splints were examined for bacterial colonization following their removal. Thirty-six patients (65%) had positive nasal culture prior to surgery. The most common isolates were Staphylococcus aureus (30%) and Enterobacteriaceae species (66%). All these patients had postoperative bacterial colonization on septal splints. In 15 patients with negative preoperative cultures, bacteria were isolated postoperatively. An increased resistance profile was documented postoperatively in 9 patients (16%), including two with multidrug resistance. In two of these patients preoperative wild-type strains acquired antibiotic resistance postoperatively. No adverse drug reactions to antibiotics were reported. Increased bacterial growth and emergence of resistant strains were observed on intranasal septal splints despite prophylactic antibiotic treatment. Nonetheless, this did not translate into clinical infection. Thus, considering antibiotics overuse and increasing bacterial resistance, further research is needed to determine the role of antibiotic prophylaxis in the setting of intranasal splints.

Removal of composite-bonded trauma splints using the Fluorescence-aided Identification Technique (FIT).

Accident-related dental dislocations must be considered as part of an emergency treatment. The use of tooth-colored fixation composites makes the splint seem less noticeable in everyday life. However, this makes it more difficult to remove without damaging the tooth's enamel surface. In order to better visualize the transition between composite and the tooth , the fluorescent properties of some composites can be advantageous. This article will explain the individual steps of a rapid and minimally invasive splint removal, using the so-called Fluorescence- aided Identification Technique.

Complex Rehabilitation of Patients with Jaw Fractures

This review article provides brief information on rehabilitation measures that improve the local and general condition of patients with jaw fractures. In the recent year the number of injuries with maxillofacial trauma has significantly increased in all countries of the world. Among maxillofacial injuries, fractures of the jaws occupy the main place (65- 80%), and most of the patients are young and able-bodied people. Despite the continuous improvement of the treatment methods of jaw fractures, the periods of immobilization and temporary disability are not reduced, and the incidence of inflammatory complications remains high, which significantly worsens the outcome of trauma. This largely depends on the lack of an effective system of rehabilitation of patients and a comprehensive approach to treatment with the use of both, pharmacological, psychotherapeutic, and physical rehabilitation measures. Complex treatment and rehabilitation of patients with jaw fractures will promote rapid stabilization and reduction of posttraumatic manifestations of the disease and, as a result, improve physical and mental health and increase the life potential and the level of their working capacity. The object of the review is to study and combine rehabilitation activities, that improve the health, working capacity and local status of patients with jaw fractures during immobilization and after removal of splints. Materials: The articles were identified using the computerized search engine PubMed, Elsevier, Cochrane Central, Google scholar, Google search, Research Gate, Ebsco Host, dissercat.com, medical-diss. com, cyberleninka.ru and other possible sites with keywords such as maxillofacial trauma, mandibular fracture, jaw fracture intermaxillar fixation and rehabilitation, recovery, physiotherapy, psychology, nutrition, feeding, diet, care, therapeutic gymnastics and in various combinations of these words in Russian and English. And they also took into account the relevant bibliographic lists. Randomized controlled trials, meta-analyzes, prospective clinical trials were selected based on their significance.

Evaluation of a Fluorescence‐aided Identification Technique (FIT) for removal of composite bonded trauma splints

Accurate removal of composite bonded titanium trauma splints (TTS) can be challenging. The aim of this study was to evaluate a Fluorescence-aided Identification Technique (FIT) compared with a conventional light source (CT) for removal of trauma splints regarding loss of tooth substance, residual composite, and time taken. Twenty maxillary models with six bovine teeth (13 - 23) were fabricated. An optical three-dimensional impression was taken and a TTS was applied from 12 to 22 with two bonding sites on every tooth under standardized conditions using an etch-and-rinse adhesive and resin composite. Two operators removed 10 splints each (5x FIT and 5x CT). For FIT, a 405nm light-emitting headlamp was used. Time was recorded. A post-operative scan was superimposed on the pre-operative scan using OraCheck software. A qualitative and quantitative analysis of tooth defects and composite remnants was performed by two operators and statistically analyzed. Compared with the CT, FIT led to significantly fewer and smaller enamel defects (mean volume: -0.04mm3 vs -0.33mm3 ) (P<0.001), significantly less composite remained (mean volume: 0.02mm3 vs 0.28mm3 ) (P<0.001), and the removal procedure with FIT was significantly quicker (mean: 162seconds vs 268seconds) (P<0.001), CONCLUSIONS: FIT facilitated the removal of composite used to bond trauma splints leading to less time-consuming as well as less invasive treatment. It left fewer composite residues on enamel surfaces.

Early Functional Treatment of Proximal Phalanx Fractures in Children: A Case Series Study.

The objective of this study was to assess proper indications a nonsurgical treatment regime for pediatric fractures of the proximal phalanx based on principles of early functional treatment. A case series (evidence level 4) of 30 pediatric patients with fractures of the proximal phalanx were treated nonsurgically using protective dynamic splinting techniques and fiberglass casting material. Assessments were performed clinically and by x-ray within 4 to 8 weeks of commencement of treatment. Outcome measures included Disabilities of the Arm, Shoulder, and Hand score questionnaire as well as fingertip palm distance (cm) and dynamic pain interval assessments. All fractures healed without any clinically apparent bony deformities. Disabilities of the Arm, Shoulder, and Hand scores were of 25.17 ± 5.29 (mean ± SD), which indicated good functional results usually within 2 weeks of removal of dynamic splints. Fingertip palm distance measurements at endpoints were of 0.17 ± 0.27 cm (mean ± SD), which indicated an almost free range of finger motion. Absence of pain perception under active finger motion (dynamic pain interval) was noted at 14.10 ± 6.79 days (mean ± SD). Well-established criteria for surgical treatment of phalangeal fractures exist. However, in our experience, a majority of pediatric fractures of the proximal phalanx can be safely treated nonsurgically with dynamic splinting along with shorter intervals of immobilization of the affected fingers and faster restoration of overall hand function compared to surgical treatment.

Rare case of choanal atresia in a 54-years-old female

Introduction: Choanal atresia is a rare disorder presenting with complete separation between the nasal cavity and the nasopharynx. There are two types of this abnormal blockage of the nasal airway – congenital and acquired. Material and Methods: This paper presents the case of a 54-years-old woman administered to the clinics for septoplasty. During the preoperative diagnostic process via CT scan and endoscope examination a coincidental finding was diagnosed – unilateral congenital choanal atresia. The medical history of the patient revealed difficult nasal breathing which is absent in the right nasal airway, also frequent rhinosinusitis, moreover orthodontic problems with her dentition and malocclusion; regarding her post-birth period she was on feeding tube and with oxygen mask in a neonatal clinic for several months; no facial traumas reported during the rest of her life. Results: Septoplasty was managed and endoscopic assisted fenestration in the choanal regional was performed viatransseptal access. Seven days postoperatively before the removal of the septal splints a CT scan was performed for evaluation of the surgical treatment and three months later – endoscopy which displayed well-formed without postoperative stenosis neochoana. Conclusion: The congenital choanal atresia is a rare abnormality which determines the insufficient clinical experience with this disorder. It is possible that many cases could have been missed or misdiagnosed because of the low incidence of the condition. The conducted literature review reveals that the case report we are presenting is one of the oldest patients diagnosed with unilateral, congenital, bony choanal atresia.

The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations

IntroductionThe main reason for nasal tampon placement after septoplasty is to prevent postoperative hemorrhage, while the secondary purpose is internal stabilization after operations involving the cartilaginous-bony skeleton of the nose. Silicone intranasal splints are as successful as other materials in controlling postoperative hemorrhages of septal origin. The possibility of leaving the splints intranasally for extended periods helps stabilize the septum in the midline. However, there is nothing in the literature about how long these splints can be retained inside the nasal cavity without increasing the risk of infection, postoperative complications, and patient discomfort. ObjectiveThe current study aimed to evaluate the association between the duration of intranasal splinting and bacterial colonization, postoperative complications, and patient discomfort. MethodsPatients who had undergone septoplasty were divided into three groups according to the day of removal of the silicone splints. The splints were removed on the fifth, seventh, and tenth postoperative days. The removed splints were microbiologically cultured. Early and late complications were assessed, including local and systemic infections, tissue necrosis, granuloma formation, mucosal crusting, synechia, and septal perforation. Postoperative patient discomfort was evaluated by scoring the levels of pain and nasal obstruction. ResultsNo significant difference was found in the rate of bacterial colonization among the different groups. Decreased mucosal crusting and synechia were detected with longer usage intervals of intranasal silicone splints. Postoperative pain and nasal obstruction were also diminished by the third postoperative day. ConclusionsSilicone splints were well tolerated by the patients and any negative effects on postoperative patient comfort were limited. In fact, prolonged splint usage intervals reduced late complications. Long-term silicone nasal splint usage is a reliable, effective, and comfortable method in patients with excessive mucosal damage and in whom long-term stabilization of the bony and cartilaginous septum is essential.

Total septal preservation for sellar approach – paving the way for future flap reconstructions

Conclusions: Despite being a single surgical channel this approach provides enough room and maneuverability for microscopic and endoscopic surgery of sellar lesions and the total septal preservation technique allows future reconstructions using the posterior nasoseptal flap. Objectives: To demonstrate the importance and feasibility of total nasal septum and anterior sphenoid preservation in transseptal approaches to the sella. Methods: Retrospective evaluation of 15 transseptal approaches for sellar lesions with or without suprasellar extensions operated under general anesthesia with a total septal preservation technique. Results: In all patients operated by this method a complete microscopic and endoscopic tumor removal was possible and an uneventful recovery was observed. Nasal congestion was mild and no episode of nasal bleeding, cerebrospinal leaks, visual loss, diabetes insipidus or death was observed. Breathing was considered normal or improved in all patients after removal of splints; this subjective sensation was confirmed at 1 month and 6 months follow-up visits. No external nose deformities or septal deviations were observed; nasal endoscopy demonstrated a preserved septum and anterior sphenoid wall anatomy on both sides of the nose at 1 month and 6 months follow-up visits. CT scans taken at 6 months after the procedure confirmed these clinical findings.

Cerebrospinal Fluid Rhinorrhea Complicating Septoplasty: A Novel Mechanism of Injury

Cerebrospinal fluid (CSF) rhinorrhea after a septoplasty procedure is very rare and potentially life-threatening. We present a case of iatrogenic postseptoplasty CSF rhinorrhea. To the best of our knowledge, only 2 other cases of CSF rhinorrhea complicating septoplasty have previously been reported. However, neither resolved in the manner that our case did, when spontaneous cessation of CSF rhinorrhea unexpectedly occurred upon removal of intranasal splints. We discuss the clinical importance of anatomic variations and potential causative mechanisms of CSF rhinorrhea during septoplasty. Our experience with this case suggests a mechanism of injury to the cribiform plate during septoplasty that has not been described previously.

Bilateral transient radial nerve palsies in an infant after cardiac surgery

To describe the case of an infant who suffered bilateral transient radial nerve palsies after cardiac surgery. A one-month-old baby was found to have bilateral wrist and finger drop after the removal of splints that has been applied to the right hand for 14 days and to the right hand for six days during perioperative management of Blalock-Taussig shunt surgery. The hand splints had been applied to the forearms with adhesive silky tape to keep peripheral vascular lines in place. The patient also suffered from several episodes of cardiogenic shock, hypoxemia and generalized edema relating to cardiac dysfunction during this fine period. Given the findings of no impairment of median or ulnar nerves and brachioradial muscle, it was suspected that bandaging with adhesive tapes caused peripheral radial nerve damage at the level of posterior interosseus nerve on forearm. Diminished oxygen delivery and edema may additionally have contributed to peripheral nerve ischemia. The aforementioned neurologic symptoms resolved spontaneously after several days. Prolonged compression by bandaging of splints on forearm may have resulted in ischemic damage to the posterior interosseus nerve branch combined with extensor carpi radialis longus nerve branch of the radial nerve. We should attempt to reduce the frequency and duration of splinting of the extremities, especially in sedated, paralyzed babies, given the potential risk of compression neuropathy.

Effects of occlusal splint therapy on TMJ dysfunction

A study was conducted to ascertain what happens to dysfunction symptoms followed only by occlusal splint therapy. Four hundred eighty-six pantograms were made on 15 experimental patients over a period of 5 months to 1 year. Five control patients were monitored over this same period but received no occlusal therapy. The experimental patients with TMJ dysfunction were treated with occlusal splint therapy. The occlusal splints were worn until the dysfunction symptoms were reduced and the pantographic PRI scores were reproducible. The occlusal splints were then removed without occlusal adjustments and the patients were monitored pantographically. A statistical analysis was performed on the PRI scores to determine the relationship between experimental and control patients. Experimental patients had an average drop of 21.7 points during occlusal splint therapy as compared to 3.8 points for control patients. All experimental patients had an increase in the PRI score levels following the removal of the occlusal splints.

Thrombectomy in Volkmann's contracture.

ARTERIAL thrombectomy is a previously untested treatment for Volkmann's contracture. A review of the literature failed to reveal any earlier employment of the procedure. Griffiths1 , 2 reported segmental arteriectomy and described embolectomy in patients who are fibrillating, but he did not mention thrombectomy at the site of injury in cases of contracture. Foisie3 advocated arteriectomy for "stubborn" cases, but he did not consider thrombectomy.Orthopedic and surgical textbooks properly emphasize prophylaxis against Volkmann's contracture rather than treatment. Most conservative therapeutic measures — for example, fasciotomy, sympathetic block and removal of splints — have been disappointing and inadequate in combating fully developed . . .

USE AND ABUSE OF POTASSIUM IODID IN OPHTHALMIC PRACTICE.

Iodid of potash was first used medicinally by veterinary surgeons for the removal of splints from horses. Its efficacy in removing these osseous growths suggested its use for the removal of tumors and exudates from man. Its value in the cure of many tertiary syphilitic lesions soon became apparent, and it is slowly but surely forcing the medical profession to acknowledge that its use is not restricted to syphilitic diseases. Many years ago I became convinced of its value in the removal of goiter. I recall a case many years since that forcibly impressed on my mind the efficacy of iodid of potash in cases other than syphilitic ones. I was in attendance on a little girl with pneumonia, but resolution failed to become established. The lung remained solid several weeks. The child was slowly but surely dying. The father, a physician, as well as myself felt helpless, and we