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An update on trigeminal nerve injuries caused by local anaesthesia: a review and recommendations
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Abstracts
The new incision design was combined with primary septpoplasty to improve nasal symmetry. We called our technique Septo-cheiloperioplasty to address the 3 areas the cleft lip defect affects namely, the lip, nose and alveolus. Our incision technique was further validated using 2-dimensional and 3-dimensional photogrammetry and Intraoperative Vascular Anatomy. Findings: Our findings showed that our incision design and technique was ideally suited to treat complete unilateral cleft lip defects. Conclusions: Only a morpho-functional approach that addresses all three dimensions of the lip, nose and alveolus will positively affect the repair of the unilateral cleft lip. http://dx.doi.org/10.1016/j.ijom.2015.08.962 An update on trigeminal nerve injuries caused by local anaesthesia: a review and recommendations T. Renton University of Kings College, London, United Kingdom Background: LA nerve injuries can be avoided in the main. The long term significant problems, seen in patients with these nerve injuries, exemplifies the problem that there is no ‘fix’ for LA related nerve injuries there is only prevention. We have to wait for resolution whilst managing the patient therapeutically using medical and psychological interventions. Many studies report agent concentration as a main risk factor (Haas and Lennon, 1995; Legarth, 2005; Hillerup and Jensen, 2011;Malamed et al., 2001; Pogrel and Thamby, 2000). All studies unanimously found that the lingual nerve was most often affected during mandibular anesthesia as compared to the inferior alveolar nerve. Objectives: Literature review. Methods: Medline search and manual search of all paper containing local anaesthesia and nerve injury. Findings and conclusions: The incidence of LA nerve injuries is reported to be more common than previously estimated. Sambrook and Goss (2011) reported prolonged anaesthesia in 1 in 27.415, Haas and Lennon (1995) found the incidence of local anesthetic induced paresthesia to be 1 in 785,000 injections, Garisto et al reported a rate of 1 in13,800,970. Renton et al. (2012) reported a much higher incidence based upon surveys of dentists and aspecialiststo be 1 in 14 K with 25% of prolonged nerve injurie remaining permanent. Recommendations: Routine consent is undertaken by Anaesthetists when giving spinal injections with a higher associated nerv einjury rate. Prevention of LA related nerve injury is possible using Aspiration and infiltration LA techniques and early recognition and medical management may prevent persistence in some cases. http://dx.doi.org/10.1016/j.ijom.2015.08.963 Ear reconstruction – the Liverpool experience D. Richardson Maxillofacial Unit, University Hospital Aintree, Craniofacial Unit, Alder Hey Children’s Hospital, Liverpool, UK Background: Ear reconstruction is undertaken in cases of congenital or acquired deficiency in the structure of the external ear, and provides aesthetic and psychological benefit to patients. There
has been a surgical and prosthetic ear reconstruction service based in Liverpool for 20 years. Objectives: This presentation will relate our experience of ear reconstruction in Liverpool, and include our protocol for management of patients with microtia and acquired ear deficiencies and deformity, review of surgical techniques, complications and outcomes. Methods: Review of patients undergoing surgical and prosthetic reconstruction of the ear in Liverpool between 1995 and 2015 was undertaken by case record review, including demographic data, aetiology, age at surgery, operation details, and post operative complications. Outcomes were assessed from photographs, and patient reported outcome measures were obtained from patient completed questionnaires. Findings: More than 300 patients have undergone ear reconstruction in the Liverpool service, approximately 50% prosthetic and 50% surgical. Detailed analysis of the surgical cases will be presented, with discussion of the evolution of surgical techniques, complications and outcomes. Conclusions: Ear reconstruction techniques have been refined over the years, and reliable good quality outcomes can be expected where ear reconstruction services are provided in a multidisciplinary team setting, in units with sufficient patient numbers to allow development and maintenance of the requisite skills. This requires formal service designation in small numbers of centres based on large populations, surgical subspecialisation and cross referral from non specialists. http://dx.doi.org/10.1016/j.ijom.2015.08.964 Real problems in a virtual world – pearls and pitfalls of orthognathic virtual surgical planning K.L. Rieck University of Nebraska Medical Center, Lincoln, NE, United States Successful functional and esthetic outcomes in orthognathic surgery are a result of careful pre-operative analytical evaluation, proper data collection and interpretation as well as proper splint fabrication for use in the operating room. Transferring this preoperative data to the surgeon’s hands to complete the case requires minimalization of errors at each step in the pathway so that the anticipated and expected outcome can be realized. Traditional pre-operative evaluation and work-up involves generation of a facebow transfer, analytical model surgery on a model block or articulator and fabrication of acrylic surgical splints. This method is often labor intensive and time consuming. Small errors at each interval can accumulate into potentially substantial issues at surgery. Contemporary orthognathic surgical planning utilizing virtual surgical protocols has essentially replaced traditional methods for most surgeons treating these cases. Consistent with new techniques, there is a leaning curve associated with incorporation of this technology. Using CT based imaging and sophisticated planning software allows the surgeon to virtually “see” and treat the case in three dimensions prior to the actual operation. Detailed knowledge of the case is available then for implementation at surgery. As with traditional approaches there can be sources of error incorporation into the pre-operative work-up. These can occur at the time of data acquisition, surgical planning or in implementation. This lecture will address real and potential sources of errors as
Abstracts
The new incision design was combined with primary septpoplasty to improve nasal symmetry. We called our technique Septo-cheiloperioplasty to address the 3 areas the cleft lip defect affects namely, the lip, nose and alveolus. Our incision technique was further validated using 2-dimensional and 3-dimensional photogrammetry and Intraoperative Vascular Anatomy. Findings: Our findings showed that our incision design and technique was ideally suited to treat complete unilateral cleft lip defects. Conclusions: Only a morpho-functional approach that addresses all three dimensions of the lip, nose and alveolus will positively affect the repair of the unilateral cleft lip. http://dx.doi.org/10.1016/j.ijom.2015.08.962 An update on trigeminal nerve injuries caused by local anaesthesia: a review and recommendations T. Renton University of Kings College, London, United Kingdom Background: LA nerve injuries can be avoided in the main. The long term significant problems, seen in patients with these nerve injuries, exemplifies the problem that there is no ‘fix’ for LA related nerve injuries there is only prevention. We have to wait for resolution whilst managing the patient therapeutically using medical and psychological interventions. Many studies report agent concentration as a main risk factor (Haas and Lennon, 1995; Legarth, 2005; Hillerup and Jensen, 2011;Malamed et al., 2001; Pogrel and Thamby, 2000). All studies unanimously found that the lingual nerve was most often affected during mandibular anesthesia as compared to the inferior alveolar nerve. Objectives: Literature review. Methods: Medline search and manual search of all paper containing local anaesthesia and nerve injury. Findings and conclusions: The incidence of LA nerve injuries is reported to be more common than previously estimated. Sambrook and Goss (2011) reported prolonged anaesthesia in 1 in 27.415, Haas and Lennon (1995) found the incidence of local anesthetic induced paresthesia to be 1 in 785,000 injections, Garisto et al reported a rate of 1 in13,800,970. Renton et al. (2012) reported a much higher incidence based upon surveys of dentists and aspecialiststo be 1 in 14 K with 25% of prolonged nerve injurie remaining permanent. Recommendations: Routine consent is undertaken by Anaesthetists when giving spinal injections with a higher associated nerv einjury rate. Prevention of LA related nerve injury is possible using Aspiration and infiltration LA techniques and early recognition and medical management may prevent persistence in some cases. http://dx.doi.org/10.1016/j.ijom.2015.08.963 Ear reconstruction – the Liverpool experience D. Richardson Maxillofacial Unit, University Hospital Aintree, Craniofacial Unit, Alder Hey Children’s Hospital, Liverpool, UK Background: Ear reconstruction is undertaken in cases of congenital or acquired deficiency in the structure of the external ear, and provides aesthetic and psychological benefit to patients. There
has been a surgical and prosthetic ear reconstruction service based in Liverpool for 20 years. Objectives: This presentation will relate our experience of ear reconstruction in Liverpool, and include our protocol for management of patients with microtia and acquired ear deficiencies and deformity, review of surgical techniques, complications and outcomes. Methods: Review of patients undergoing surgical and prosthetic reconstruction of the ear in Liverpool between 1995 and 2015 was undertaken by case record review, including demographic data, aetiology, age at surgery, operation details, and post operative complications. Outcomes were assessed from photographs, and patient reported outcome measures were obtained from patient completed questionnaires. Findings: More than 300 patients have undergone ear reconstruction in the Liverpool service, approximately 50% prosthetic and 50% surgical. Detailed analysis of the surgical cases will be presented, with discussion of the evolution of surgical techniques, complications and outcomes. Conclusions: Ear reconstruction techniques have been refined over the years, and reliable good quality outcomes can be expected where ear reconstruction services are provided in a multidisciplinary team setting, in units with sufficient patient numbers to allow development and maintenance of the requisite skills. This requires formal service designation in small numbers of centres based on large populations, surgical subspecialisation and cross referral from non specialists. http://dx.doi.org/10.1016/j.ijom.2015.08.964 Real problems in a virtual world – pearls and pitfalls of orthognathic virtual surgical planning K.L. Rieck University of Nebraska Medical Center, Lincoln, NE, United States Successful functional and esthetic outcomes in orthognathic surgery are a result of careful pre-operative analytical evaluation, proper data collection and interpretation as well as proper splint fabrication for use in the operating room. Transferring this preoperative data to the surgeon’s hands to complete the case requires minimalization of errors at each step in the pathway so that the anticipated and expected outcome can be realized. Traditional pre-operative evaluation and work-up involves generation of a facebow transfer, analytical model surgery on a model block or articulator and fabrication of acrylic surgical splints. This method is often labor intensive and time consuming. Small errors at each interval can accumulate into potentially substantial issues at surgery. Contemporary orthognathic surgical planning utilizing virtual surgical protocols has essentially replaced traditional methods for most surgeons treating these cases. Consistent with new techniques, there is a leaning curve associated with incorporation of this technology. Using CT based imaging and sophisticated planning software allows the surgeon to virtually “see” and treat the case in three dimensions prior to the actual operation. Detailed knowledge of the case is available then for implementation at surgery. As with traditional approaches there can be sources of error incorporation into the pre-operative work-up. These can occur at the time of data acquisition, surgical planning or in implementation. This lecture will address real and potential sources of errors as