Seventh Postoperative Day Research Articles

A comparative study on the effects of intranasal silicone splints and silastic sheets on breathing post septal surgeries

Background: Septoplasty is a surgical procedure to straighten the bone and cartilage dividing the space between your two nostrils (septum). If septoplasty is performed alone or as a part of a rhinoplasty procedure, internal nasal splints are generally used.
 Objective: To compare silicone nasal septal splints with integral airways and silastic sheets after septal surgery in terms of patient breathing (with the splint in place).
 Patients and Methods: This study involved 50 patients who underwent septal surgery in terms of septoplasty or septo-rhinoplasty due to nasal septal deviation. They were allocated into two groups. Group A comprised 25 patients who underwent septal surgery and were packed with silicone nasal septal splints. Group B comprised 25 patients who underwent septal surgery and were packed with silastic sheets. They were removed on the seventh postoperative day. Clinical efficacy was compared using visual assessment and patients' subjective breathing status.
 Results: The patients in both groups A and B had similar mean ages: 27.8 years (range, 18-51 years) and 25.84 years (range, 18-48 years) in Group A and Group B, respectively. The study included 58% males and 42% females. The tyspe of surgery were septoplasty and septorhinoplasty in 38% and 62%, respectively. Breathing status was significantly lower in Group A than in Group B at the 7th postoperative day (p<0.004).
 Conclusion: Intranasal septal splints with silastic sheets result in less nasal obstruction while in place; thus, they can be used as an effective alternative to silicone nasal splints with integral airways after septal surgery.

Hematological and Biochemical Responses of Newly Formulated Primary Root Canal Obturating Material: An In Vivo Study.

Background and objective Any drug or medicinal agent, when implanted into the body, gets biotransformed by various organ systems and the toxic byproducts of this process alter the normal physiological process. In this experimental study, we aimed to quantify the safety of newly formulated primary root canal obturating material by investigating the hematological and biochemical parameters related to liver function. Methodology Forty-eight Wistar rats (weighing 250-350 grams) were classified into three groups (n=16) through random allocation. Preoperative blood samples were collected by puncturing the orbital venous plexus, the values of which were used as control. Zinc oxide eugenol (ZOE), calcium hydroxide iodoform paste (Metapex), and newly formulated triple antibiotic obturating paste (TAOP) were implanted (100 µg) into dorsal connective tissues. Blood samples on the seventh, 15th, and 30th postoperative days were evaluated respectively by analyzing hematological, hepatic, and, renal function tests for acute and chronic inflammatory responses. Results The intra-group and inter-group comparisons among all the test materials after seven days exhibited high significance in terms of hemoglobin (Hb), mean corpuscular volume (MCV), neutrophils, andserum glutamic-oxaloacetic transaminase (SGOT) (p<0.001), while others showed mixed responses (p<0.05 to p>0.05). After 15 days, the comparisons showed high significance with respect to packed cell volume(PCV), mean cell volume (MCV), and serum creatinine (p<0.001), while others showed significant to nonsignificant differences (p<0.05 to p>0.05). At the end of 30 days, all the parameters showed mixed responses (p<0.001 to p>0.05). Conclusion The newly formulated obturating material TAOP showed lower adverse hematological, hepatic, and renal effects in experimental animals compared to other test materials, with most parameters reverting to normal after 30 days.

Investigation of ideal ointment combination to use in septorhinoplasty or nasal flap surgeries.

We aimed to create an ideal ointment combination to provide fast wound healing with the highest patient comfort after nasal surgery and nasal flap surgery. Twenty-one male Wistar rats were included. The flap survival method was used. The rats' healing process was evaluated in all groups. After having the same surgical procedure, the following ointments were applied to flap borders twice a day for seven days in each of the groups. In group 1 (Control, n=7), Dexpanthenol 5% (Dex); in group 2, Dex, Ciprofloxacin 0.5 % (Cip) and Ephedrine hydrochloride 1% (Eph); in group 3, Dex+Cip+Eph and Ketoprofen 2.5% (Ket) was applied. On the seventh postoperative day, the size of the necrosis on the flap was evaluated. Median necrotic areas on skin flaps were 36.00% sq mm in group 1, 23.00% sq mm in group 2, and 5.00% sq mm in group 3. Flap necrosis areas on skin flaps were group 3 <group 2 <group 1 (p adjusted <0.0175). The necrosis areas of groups 2 and 3 were significantly lower than the control group, and the necrosis areas of group 3 were significantly lower than group 2 (p adjusted <0.0175). For the postoperative healing process and to prevent flap necrosis, the Dex+Cip+Eph+Ket combination was recommended in the first order. Dex+Cip+Eph combination also reduced skin necrosis in the flaps as the second order. Only Dex treatment is not enough for the completion of the healing process. The best results were provided by the Dex+Cip+Eph+Ket combination and recommended its usage after septorhinoplasty surgeries or nasal flap surgeries to prevent flap necrosis.

Correlation of Bone Strength in an Animal Model (Rabbit) After Fracture and During the Period of Fixation with a Titanium Micro Plate

Abstract The period of bone healing after trauma goes through certain physiological processes. In situations where a bone fracture occurs, our intention is to surgically position in an appropriate morpho-anatomical position. For osteosynthesis we used vipla wire and micro plates with corresponding screws. The aim of our research was to evaluate the optimal time for the removal of the osteosynthetic material, fracture site biomechanical stability, and measurement of the callus thickness. For this research ten 4 months old rabbits with right leg femur fracture were used. Osteosynthesis was done with titanium micro plates, corresponding screws and vipla wire. Experimental animals were observed through the post-operative period at the first and seventh postoperative day and there on at 2, 4, 6, 9, 12 weeks. Further additional fixation was needed in one of the rabbits in the second week. The postoperative period provided us information about the optimal moment for the removal of titanium micro plates. It showed that over a period of six weeks, the bone had almost all normal biomechanical properties. Significantly greater strength and rigidity of the recovered femur were obtained after 12 weeks. Micro plates that were removed after 4, 6 or 9 weeks, did not need furhter fixation and therefore fixation was not applied, compared to those placed during the 12 weeks. X Ray evaluation provided us with follow up results of fracture healing. The results suggest that it is acceptable to remove titanium micro plates after a period of healing, that is, after the formation of the callus and bridging of the fracture gap and diastasis with newly formed bone.

Low-concentration Povidone-iodine and Normal Saline as Irrigant on Reducing Postoperative Complications after the Third-molar Surgery: A Comparative Study

This study was conducted to compare the efficacy of using 0.5 mg/mL povidone-iodine solution as an irrigant and coolant in reducing postoperative sequelae like swelling, trismus, and pain with the conventional normal saline irrigation during the surgical removal of the impacted lower third molar. The research was conducted out toward the MES Dental College in Perinthalmanna, Kerala, in the Department of Oral and Maxillofacial Surgery. After mandibular third-molar surgical removal, researchers studied 60 individuals, 30 of whom had normal saline irrigation (group I), and 30 of whom received 0.05% povidone-iodine irrigation (group II). The postoperative discomforts were measured on the second and seventh days after surgery, respectively. After that, the data were analyzed using SPSS. The data analysis considered p-values less than 0.05 to be significant. At the second postoperative visit, patients in the povidone-iodine group reported much less pain, swelling, and reduced mouth opening than those in the normal saline group. But on the seventh postoperative day, there was not much difference between either group. Following the surgical removal of teeth, it was revealed that povidone-iodine solution (0.5 mg/mL) was more effective as irrigation and cooling aid than regular saline solution. Low-concentrated povidone-iodine is a better option in dentistry as irrigant.

Comparison of short-term recovery in children with obstructive sleep apnea undergoing tonsillotomy vs. tonsillectomy.

To compare the pain levels, degrees of pharyngeal swelling, and weight loss after tonsillectomy vs. tonsillotomy in children clinically diagnosed with obstructive sleep apnea (OSA) over the first seven postoperative days, and to determine which procedure was associated with better recovery in the early postoperative period. Between April 2021 and December 2021, 121 children with OSA (80 males and 41 females), ranging from 3 to 12 years of age with an average age of 6.7 years, were prospectively enrolled in this study conducted at Zhengzhou Central Hospital Affiliated to Zhengzhou University. The patients were randomly divided into two groups: a tonsillotomy group with 63 cases (40 males and 23 females) and a tonsillectomy group with 58 cases (40 males and 18 females). The patients' pain levels [as indicated by Parents' Postoperative Pain Measure (PPPM) scores] and degrees of pharyngeal swelling were recorded for seven days postoperatively, and the patients' body weights were recorded on postoperative day seven. In the tonsillotomy group, the PPPM scores were the highest on the day of surgery and on the first postoperative day; the patients' pain levels gradually decreased.The PPPM scores in the tonsillectomy group were higher than those in the tonsillotomy group from the day of surgery to the seventh postoperative day (p < 0.05). The degree of pharyngeal swelling was lower in the tonsillotomy group than in the tonsillectomy group. Weight loss was lower in the tonsillotomy group than in tonsillectomy group on the 7th day after surgery (p < 0.05). On the fifth, sixth, and seventh postoperative days, compared with preschool children, school-age children who had undergone tonsillotomy experienced more pain relief than those who had undergone tonsillectomy (p < 0.05). Children with OSA experienced less pain, less pharyngeal swelling, and less weight loss with tonsillotomy than with tonsillectomy. On the fifth, sixth, and seventh postoperative days, compared with preschool children, tonsillotomy in school-age children is more advantageous in school-age children.

The Effectiveness of Submucosal Dexamethasone after Third Molar Extraction. A Single Blind Randomized Clinical Trial

Objective: To evaluate the efficacy of dexamethasone in alleviating pain and trismus of the patients who underwent extraction of the third molars. Methodology: A total of 120 patients took part in this randomized, controlled trial. The wisdom teeth of patients were surgically extracted under local anesthesia. The patients were randomly assigned to one of two group and study control with 60 patients in each group. Preoperative and Postoperative measurements of edema, trismus and pain were analyzed. In study group, dexamethasone was immediately given after extraction. However, in control group, no dexamethasone was given to the patients. The paired t-test was carried out to compare the means scores of pains and trismus and. A p value of = 0.05 was judged significant. Results: The pain scores of patients in group 1 were mostly pain-free on the third post-operative day after dexamethasone administration, with complete pain resolution in all patients on the seventh post-operative day. About trismus in post operative phase almost all of the patients belonging to group 1 did not report to suffer from trismus with just two patients complaining of mild trismus. Whereas, on the 7th post-operative day, all of the group 1 patients free from trismus. About the comparison of trismus, pain and Edema in study groups, a significant difference p&lt;0.05 was found. Conclusion: Inflammatory complications are frequently associated in the post operative phase of extraction of third molars. Dexamethasone has been proven to be useful in reduction of pain, trismus and edema experienced by the patients when no intervention has been given.

Primary Closure Versus Delayed Primary Closure in Perforated Appendix: A Comparative Study

Introduction: The elimination of unpleasant and time-consuming dressing changes, as well as the potential reduction in overall hospital costs, are potential benefits of primary closure. Recent studies suggest that perforated appendicitis may usually be principally closed without an increase in the wound infection rate compared to delayed primary closure, suggesting that the disagreement surrounding the best ways of wound management has died down. Objective: Studying the efficacy of primary versus delayed primary closure for appendectomy in patients with perforations Study design: Ayyub Teaching Hospital Abbottabad and Timergara Teaching Hospital Dir Lower. Study duration from January 2021 to June 2021. Material and Methods: Perforated appendix patients undergoing appendectomy between the ages of 18 and 45 were included. When an appendectomy was performed, the appendicular stump was not invaginated as is sometimes done nowadays. Interrupted 2/0 vicryl was used to stand in for muscles. Within the PC group, the external oblique was stitched shut with a continuous vicryl 0 suture. Using only regular saline, the wound washed and disinfected. For patients having delayed primary closure, dressing changes occurred daily; in the case of infection dressing changes occurred twice daily until the wound was closed. After the third postoperative day or once the infection had subsided in cases of infected wounds, the wound was closed after rejuvenating the edges. On the seventh postoperative day patients were evaluated for wound infection and length of hospital stay using the operational definition of success. Results: The patients' mean age was 37.3± 610.49 years. The average number of days someone spent in the hospital was 7.38 (1.25). Women made up 37 (or 61.70%) of the total, while men accounted for 23 (or 38.30%). Thirteen patients, or 21.70 percent, had an infected wound. Wound infections occurred in 11 patients in Group-A (the primary closure group) but only 2 patients in Group-B (the delayed closure group) (delayed primary closure). When comparing the rate of wound infection in groups B and A, a statistically significant difference was discovered (p=0.005). Hospitalization time was shorter for those in group A (6.24± 0.47 days) compared to those in group B (8.53± 0.51 days); p 0.001. Conclusion: Patients with a perforated appendix benefit more with primary closure than from delayed primary closure. Keywords: Primary closure, delayed primary closure, and a perforated appendix

A novel therapeutic approach for reducing postoperative inflammatory complications after impacted mandibular third molar removal.

Background:This study was designed to compare effect of combined use of dexamethasone and honey versus each agent alone in controlling complications associated with removal of impacted mandibular third molar.Methods:This randomized clinical study included patients suffering from impacted mandibular wisdom teeth. Patients were divided randomly into 4 groups. Group I, control, group II, received dexamethasone injection preoperatively, group III, received honey locally in the wound after extraction, and group IV, received dexamethasone injection preoperatively and topical honey application. All patients were evaluated preoperatively and postoperatively to assess facial edema, interincisal distance, pain, and total analgesic dose used.Results:Significant edema developed in group I than other groups and improved significantly in group II and III on seventh postoperative day, and tenth postoperative day in group I. Insignificant edema developed in group IV. Significant decrease in interincisal distance occurred in all groups on third postoperative day that improved significantly on seventh postoperative days in all groups except group I, it improved on tenth postoperative day. Pain was significantly minimum in group IV than other groups and its maximum degree was in group I.Conclusion:Both dexamethasone and honey are an effective way of minimizing swelling, pain, and trismus after removal of impacted lower third molars. Both agents either alone or in combination provide simple, safe, painless, and cost-effective method to eliminate postoperative discomfort. However, dexamethasone or honey can decrease complications related to surgical extraction of mandibular third molar, the simultaneous application of both agents is more effective method in this regard.

Chilean Patients' Perception of Their Oral Health-Related Quality of Life After Bichectomy.

ObjectiveTo describe the quality of life associated with oral health in patients who have had bichectomy surgery in Chile using the Spanish version of the health-Related Quality of Life instrument (HRQOL-sp).Material and MethodsWe designed a cross-sectional study. The HRQOL-sp scale was administered to dental patients in a private clinic who had bichectomy surgery between December 2020 and June 2021. The HRQOL-sp instrument has four domains: oral function, general activity, postoperative signs, symptoms or complications, and pain level. The instrument was administered by telephone survey on days 1, 3, 5 and 7 post-surgery. Interference in quality of life was defined as when patients selected the options “quite a few problems” or “many problems” for oral function and general activity. Signs and symptoms related to post-surgical complications and pain were also described with a verbal rating scale from one to ten. All results were compared between postoperative days according to the domains of the HRQOL-sp scale.ResultsSeventy-three patients (age 27.75 ± 8.06 years; 93.15% female) participated. Bichectomy patients report the highest interference in quality of life on the first postoperative day because most were unable to chew (71.23%). On the first and third postoperative days, the most frequent complication was swelling (97.26%), and on the fifth day was ecchymosis (42.47%). The average worst perceived pain was 3.34±2.32 on the verbal analogue scale. The rest of the evaluated items significantly decreased towards the seventh postoperative day (p<0.05).ConclusionInterference in quality of life associated with bichectomy surgery is greatest on the first postoperative day. Complications and pain levels decreased significantly over time.

Primary Breast Augmentation with Silicon Implant

Introduction: Breast augmentation remains one of the most commonly performed cosmetic procedures. It is a surgery of breast in order to increase its size by placing breast implants under breast tissue or chest muscles. Silicon implant is used for both cosmetic and reconstructive reasons. The purpose of this study was to evaluate the outcomes of primary breast augmentation with silicon implant. Methods: A retrospective study was performed in patients who underwent silicon based breast augmentation through inframammary in submuscular dual plane, between February 2017 and January 2019. Surgical outcomes were evaluated and Patient satisfaction was measured using the BREAST-Q Augmentation Module.Result: This study involved a total of 32 patients (i.e. 64 breasts),19 patients were mongoloid and 12 were non mongoloid. The average age was 32.25 years (range: 20-45 years) between a follow up period of 24 months.The size of breast implant ranged from 240-340 cc. Thirty-one patients were satisfied with the outcome. Seroma was noted in two patients. One of the patients was not satisfied and was noted with capsular contracture within follow-up period. Fifteen patients were used with implant size 280 cc. All patients were able to go to normal daily activity after seventh post-operative day. Conclusion: Breast augmentation with silicon implant have potential to produce more satisfactory and aesthetically pleasing results with low revision rates. Eventhough various techniques are existing in breast augmentation but still universal standard technique is controversial.

Same-Day Discharge after Laparoscopic Appendectomy for Simple Appendicitis in Pediatric Patients-Is It Possible?

(1) Background: One-day surgery has been widely adopted for many elective laparoscopic procedures in pediatric patients. Recently, the same protocol has been investigated for some emergency procedures, such as laparoscopic appendectomy. This study aimed to evaluate the safety and effectiveness of discharge from hospital within 24 h in pediatric patients who received laparoscopic appendectomy for uncomplicated acute appendicitis. (2) Methods: From 1 March 2021 to 1 May 2022, a total of 180 pediatric patients who were discharged from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis were included in this prospective single-center study. The primary outcome of this study was the safety of discharge from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis, as well as the parental satisfaction with this protocol. Secondary outcomes included the rate of readmission or unplanned return to the operating room, the complication rate and a cost-effectiveness analysis. For each patient, demographic data, preoperative evaluation (physical examination, laboratory data, imaging), duration of surgery, intraoperative and postoperative complications, length of hospital stay and pain levels, as well as parental satisfaction with this protocol, were recorded. (3) Results: The median age was 11 years (interquartile range (IQR) 10, 14). The majority of the patients (63.8%) were males. The median length of hospital stay after surgery was 15 h (IQR 12, 19). The highest level of satisfaction, at discharge, was recorded in most of the respondents (n = 155, 86.1%), while the remaining 25 (13.9%) expressed moderate levels of satisfaction. The median pain levels according to a visual analogue scale for all postoperative days were low (range 0–4). In four patients (2.2%), unplanned readmission before the seventh postoperative day because of postoperative intraabdominal abscess was recorded. All patients with abscess formation were treated conservatively. The majority of the parents (n = 175; 97.2%) expressed the highest level of satisfaction during the outpatient follow-up examination on the seventh postoperative day. (4) Conclusions: Same-day discharge after laparoscopic appendectomy for simple appendicitis in pediatric patients was safe and feasible. Parental satisfaction with this protocol was very high. With the right protocol and parent education, pediatric patients who underwent laparoscopic appendectomy because of non-complicated acute appendicitis may be successfully treated in this way.

Efficacy of low-level laser therapy in the management of postoperative surgical sequelae after surgical removal of impacted mandibular third molars.

The study is aimed to evaluate the effectiveness of low-level laser therapy (LLLT) in the control of pain, swelling, and trismus after the surgical removal of impacted mandibular third molars. A prospective study was conducted on thirty patients requiring surgical removal of the impacted mandibular third molar. Mesioangular impacted third molar with class I level B position (according to the Pell and Gregory classification) were included in the study. The study group (n = 15) received LLLT using diode laser of wavelength 980 nm and the control group (n = 15) received routine postoperative care without LLLT. The parameters evaluated were intensity of pain, maximum mouth opening, postoperative swelling, healing at the surgical site, and presence of dry socket. The mean score of pain, swelling, and trismus in the study group were statistically lower as compared to the control groups. Healing assessment using Laury and Turnbull healing index inferred that the healing at the seventh postoperative day was superior in the study group as compared to the control group. LLLT with a diode laser of wavelength 980 nm can effectively reduce pain, swelling, and trismus in the postoperative phase after surgical extraction of the mandibular impacted third molar and promote healing at the operative site.

Effect of Music on Pain, Anxiety and Physiological Parameters among Postoperative Sternotomy Patients: A Randomized Controlled Trial.

Introduction: Music is a non-invasive, inexpensive and non-pharmacological nursing intervention that has no side effects and can be effective when provided alongside the routine care in cardiothoracic and vascular surgery (CTVS) ward and intensive care unit (ICU). The objective of the study was to assess the effect of music on pain, anxiety and physiological parameters among the post-operative sternotomy patients from CTVS ward and ICU in Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. Methods: A randomized controlled trial research design was used to conduct the study among 70 post-operative sternotomy patients. The pain score, and anxiety level were recorded using Numerical Pain Rating Scale (NPRS) and post-operative anxiety scale, with the physiological parameters recorded for both groups before the music intervention, after the first post-operative day, and after the intervention on seventh post-operative day. Data were analyzed by SPSS software version 23. Results: There was a marked reduction in the mean score of pain, anxiety, systolic and diastolic blood pressure (SBP & DBP), heart rate and respiratory rate in the study group as compared to the control group. There was a significant difference between the mean score of pain, anxiety, SBP, DBP, heart rate, respiratory rate and oxygen saturation in both groups after the intervention. Conclusion: Music was found to be effective on pain, anxiety, diastolic blood pressure, heart rate and oxygen saturation among post-operative sternotomy patients. Thus, it is essential to include music as a tool in post-operative care.

Use of ileal bypass in the surgical management of two rare cases of ileal-neobladder fistula in patients who underwent radical cystectomy

An entero-neovesical fistula (ENF) is a rare troublesome complication of an orthotopic ileal bladder substitution. We report on a novel, safe technique to close ileal neovesical fistulas without extensive adhesiolysis using an NK-stapler (ENDOPATH® ENDOCUTTER ETS; Johnson & Johnson, Cincinnati, OH, USA). We treated two cases of postoperative ENF after orthotopic ileal bladder substitution for radical cystectomy. Case 1 was a 63-year-old male with occasional fecaluria, and Case 2 was a 73-year-old male who experienced continuous fecaluria.Surgical procedureAfter laparotomy, we mobilized the ascending colon to bypass the anastomosis of the primary surgery by an ileo-ileal, ileo-ascending colon anastomosis. The distance between the fistula and bypass was about 10 cm. We made tunnels in the mesentery between the bypass and fistula, without damaging blood vessels, to insert the jaw of the NK-stapler. We closed the afferent and efferent loops using NK-staplers (45 mm ×2), followed by a Lembert anastomosis covering the stapler's suture lines. They were discharged on the ninth and seventh postoperative days, respectively. In Case 1, we experienced recanalization of the fistula after three postoperative months and required second closure with the same procedure was needed. They have not experienced any symptoms of ENF since. This technique is worth considering for the surgical treatment of ENF because it does not require unnecessary dissection and can ultimately achieve fistula closure.

Effects of platelet-rich fibrin in the surgical extraction of mandibular third molar

Background: Platelet-rich fibrin (PRF) has a wide variety of applications in the field of oral surgery due to its biological potential to accelerate the wound-healing process and tissue regeneration. Aim: The objective of this review was to find out whether the role of PRF had been reported to be efficient in the surgical extraction of mandibular third molar (M3). Methods: An electronic search of the English-language literature in the PubMed (Medline) database was performed for the period from January 2015 to September 2021. Only randomized controlled trials (RCTs) comparing the impact of PRF application were included in this review. According to the Cochrane Collaboration's standards, the reviewer assessed the risk of bias. Review Manager (version 5.4) Windows software was used for the meta-analysis. Results: A total of 39 papers were found in the computerized search, with 13 RCTs meeting the qualitative analysis requirements and 10 trials included in the meta-analysis. The results of a meta-analysis for M3 surgery showed that PRF reduces the incidence of alveolar osteitis (AO) (P = 0.005) and pain on the first (P = 0.05), third (P = 0.002), fourth (P = 0.01), and seventh (P = 0.0003) postoperative days. The meta-analysis also revealed that there was no substantial improvement (P = 0.44) in soft tissue healing with the application of PRF following M3 surgery. Conclusions: The application of PRF after M3 extraction decreased the incidence of AO and postextraction pain.

Specifics of using thoracic bandage after cardiac surgery via sternotomy and its impact on reducing pain during therapeutic exercises

Purpose: to investigate specifics of using thoracic bandage after cardiac surgery via sternotomy and its impact on reducing pain during therapeutic exercises. In order to study specifics of using a postoperative thoracic bandage on the seventh postoperative day patients (n=252) were asked two questions about the force of thorax compression exerted by the bandage. As soon as the questions were answered, the degree of thoracic bandage tension was also assessed by a physical therapist. Thereafter, some patients (n=44; who did not take painkillers within 12 hours before the examination) assessed pain on a numeric rating scale (10 points – maximum pain, 0 points – no pain) as follows: at rest, when coughing and moving their upper extremities (arms forward, sideward, upward), when wearing a bandage with and without a load (dumbbells 1 and 2 kg for each arm); then all points of the scale were assessed without wearing a thoracic bandage. Most of the patients noted that the bandage exerted light compression (184 patients) and did not restrict deep breathing (220 patients). The evaluation performed by a physical therapist found that a thoracic bandage had only a slight degree of tension in most of the patients (194 patients or 76.98%), since it was easy to slip the hand between the patient’s back and the bandage, stretching the latter with minimal effort. The use of a thoracic bandage had no impact on the pain when patients moved their upper extremities. The obtained pain rates were very low. The highest pain rates were obtained during coughing. When moving arms the level of pain did not change statistically as compared with the state of rest. Arm position and load increase within specific limits had no impact on pain level. The use of a postoperative thoracic bandage is characterized by its mild tension, which does not limit deep breathing and, consequently, cannot limit the increase of chest circumference during dehiscence. The assessment of tension performed by physical therapists was consistent with the patients’ responses. The use of a bandage did not reduce the level of pain when patients moved their upper extremities and coughed.

Feasibility and Safety of Laparoscopic Placement of Peritoneal Dialysis Catheter Using Percutaneous Endoscopic Gastrostomy Device.

We developed a novel technique of peritoneal dialysis (PD) catheter placement using an existing device originally utilized to insert a percutaneous endoscopic gastrostomy tube. We investigated the feasibility and safety of the procedure. This study included 21 consecutive patients who underwent laparoscopic placement of PD catheter between August 2021 and December 2021. We retrospectively investigated the clinical variables and perioperative results. The laparoscopic procedure was successfully performed in all patients. The duration of surgery was 21 (18-37) minutes. All patients could start PD within the seventh postoperative day. However, 1 patient had peri-catheter leakage due to exit-site infection. There were no patients with catheter migration, catheter obstruction, peritonitis, procedure-related death, and withdrawal of PD. The laparoscopic placement PD catheter using percutaneous endoscopic gastrostomy device was feasible and safe. (128 words).

Effect Of Low-Level Laser Therapy On Inflammatory Sequеlae Of Impacted Mandibular Third Molar Surgery: A Single-Blind, Placebo-Controlled, Randomized Clinical Trial

Objective — Postoperative pain, facial swelling, and limitation of mouth opening are common sequеlae of lower third molar surgery. The objective of the study was to evaluate the effect of Low- level laser irradiation in controlling these sequеlae. Material and Methods — This randomized, single-blinded, split-mouth pilot study was carried out at the department of oral and maxillofacial surgery, university affiliated hospital, Erbil, Iraq. The study was conducted on 20 patients (13 males and 7 females), with a mean age of 26.3±7.4 years, who needed surgical removal of symmetrical bilateral impacted lower third molars. In each patient, one side was treated by low level laser and the other side was control. Laser irradiation was performed by postoperative single intraoral application of 940 nm laser beam at four points. Pain, trismus, and facial swelling were evaluated at the first, third, and seventh postoperative days. The data were analyzed using Mann–Whitney U test and unpaired t -test. Results — As compared to the control sides, low- level laser irradiated sides showed a significant reduction in visual analogue pain scales (VAS) during the first three postoperative days (P&lt;0.05). The VAS scores of the laser treated sides were 4.46, 4.00, and 3.35 as compared to 6.58, 5.82, and 5.17 for the control sides. The swelling, and trismus were significantly reduced on the first and third postoperative days in the laser treated sides, as compared to the control sides (P&lt;0.05). The facial measurements during the first and third postoperative days were 108.72 mm and 114.77 mm in the laser sides and 113.57 mm and 118.43 mm in the control sides. The degree of mouth opening during the first and third postoperative days were 33.48 mm and 30.37 mm in the laser sides and 27.93 mm and 25.58 mm in the control sides Conclusions — Single intraoral application of low- level laser is effective in reducing pain, swelling and trismus after mandibular third molar surgery. Therefore, it can be used as an adjuvant in controlling postoperative complications after lower third molar surgery.

A Pilot Randomized Controlled Clinical Trial Comparing Piezo Versus Conventional Rotary Surgery for Removal of Impacted Mandibular Third Molars.

Background: The extraction of impacted mandibular third molars is a frequent dental surgery, interfering with patients’ quality of life. Ultrasonic surgery is an alternative to osteotomy with conventional rotary instruments. This study compares postoperative signals and symptoms after extracting impacted mandibular third molars using ultrasonic surgery or conventional rotary osteotomy. Methods: A pilot randomized controlled clinical trial was conducted. Thirty patients were randomly divided into the test group (ultrasonic technique) and a control group (conventional rotatory technique). All surgeries were timed. Swelling parameters, trismus and paraesthesia were evaluated on the day of surgery and the third, fifth and seventh postoperative days. Intraoperative bleeding was evaluated during surgery. Postoperative pain was evaluated daily by the patient through a visual analogue scale and the number of ingested analgesics. Results: Pain, swelling and trismus present beneficial results with the ultrasonic technique but without statistical significance. Intraoperative bleeding was significantly lower with ultrasonic surgery (t(28) = 3.258; p = 0.003). Operating time was significantly higher in extractions involving osteotomy and cutting crown and roots either with the conventional technique (p = 0.020) or ultrasonic technique (p = 0.039). Regardless of the surgical difficulty, no statistically significant results were detected between techniques regarding the procedure duration. Conclusions: The beneficial postoperative signs and symptoms make ultrasonic surgery a favourable therapeutic option, especially when the integrity of noble anatomical structures is the most important risk factor. Further studies with larger samples are needed to support the use of piezosurgery as a valid option for impacted mandibular third molar extraction.