Evaluation of Systemic and Local Complications During Inhalation Anaesthesia in Patients With Oral Surgery Treatment

Svrha istraživanja bila je utvrditi loše strane kratkotrajne inhalacijske anestezije u duševno retardirane djece ili djece s izraženim strahom od stomatološkog ili oralnokirurškog liječenja i odraslih duševno retardiranih osoba nesposobnih za zahvat uz pomoć lokalne anestezije. Monitoring pacijenta (pulsoksimetrija, krvni tlak) rađeni se s namjerom da se zabilježe možebitna odstupanja od standardnih vrijednosti. Neposredni rezultati monitoringa indicirali su potrebu za dodatnom medikacijom, prekidom ili ponavljanjem liječenja. Također su praćene lokalne komplikacije (prijelom zuba, pojačano krvarenje, strana tijela u usnoj šupljini ili u respiratornome traktu) i kasnije komplikacije do odlaska pacijenta iz bolnice (produženo krvarenje, povraćanje). Uzorak se sastojao od 84 pacijenta kojima je bio potreban zahvat u kratkotrajnoj inhalacijskoj anesteziji. Svi su oni bili prethodno laboratorijski obrađeni i anesteziološki pregledani. Postupak su izvodili oralni kirurg, anesteziolog, tehničari i medicinske sestre. Za inhalacijsku anesteziju upotrebljeni su O2, N2O i Sevoflurane. Pacijenti su bili u dobi od 1-58 godina (s.v. 29,5). Od sustavskih komplikacija zabilježene su sljedeće: bronhospazam u dva slučaja /1,68%/, odstupanja od normalnoga srčanog ritma 3 slučaja /2,52%/, epileptičke konvulzije nakon zahvata 1 ili /0,84%/, saturacija O2 ispod 90% u 9 slučajeva ili /7,56%/, povraćanje nakon zahvata 1 ili /0,84%/, visok krvni tlak zabilježen je u 38 slučajeva ili /31,92%/, tahikardija u 45 ili /37,8%/. Potreba za ponavljanjem anestezije jedanput bila je u 16 slučajeva ili /13,44%/, dva puta u 3 ili /2,52%/ i tri puta u 1 ili /0,84%/ slučajeva. Stranih tijela u respiratornom traktu nije bilo. Od lokalnih komplikacija tijekom zahvata bilo je : fraktura zuba u 14 slučajeva ili /11,76%/, neposrednoga krvarenja u 8 ili /6,72%/ i produženoga krvarenja 3 slučaja /2,52%/. Kratkotrajna inhalacijska anestezija uspješna je zamjena za intubacijsku opću anesteziju za manje oralnokirurške zahvate, ali nosi rizik mogućih komplikacija, što treba imati na umu.The aim of the research was to define the disadvantages of short inhalation anaesthesia in children with mental retardation, children with expressive fear of dental or surgical treatment, and adults with some degree of mental retardation unsuitable for regular treatment with local anaesthesia. Monitoring of patients ( pulsoximetry, blood pressure) was done with the intention of recording eventual differences from standard values. The immediate results of monitoring indicated the eventual need for additional medication, to interrupt, stop or repeat the treatment. At the same time we recorded all local complications (fracturing of teeth, excessive bleeding, foreign body in respiratory tract etc.) and the existence of late complications (prolonged bleeding, vomiting) for 2 to 3 hours after the treatment. A group of 84 patients requiring surgical treatment in inhalation anaesthesia is presented. All of them had anaesthesiologic and laboratory examination as the preoperative standard. The treatment was carried out by an oral surgeon, anesthesiologist, technicians and nurses. O2, N2O and Sevoflurane were used for inhalation anesthesia. The age of patients was 1-58 years (av. 29.5). Systemic complications: bronchospasm in two cases /1.68%/, deviations of normal cardiac rhythm 3 /2.52%/ (VES), convulsions (epi) after treatment 1 /0.84%/, saturation O2 under 90% 9 /7.56%/, vomitig after the treatment 1 /0.84%/ high blood pressure was present in 38 /31.92%/ an tachycardia in 45 /37.8%/ of cases.The need to repeat the procedure once occured in 16 /13.44%/ twice 3 /2.52%/ and three times 1 /0.84%/. Foreign body in the respiratory tract 0 /0%/. Local complications: teeth fractures 14 /11.76%/, immediate excessive bleeding 8 /6.72%/, prolonged bleeding 3 /2.52%/. Short inhalation anaesthesia is a successual altenative to general anaesthesia for minor oral surgical interventions but the risk of possible general and local complications has to be considered

Comparative Analysis of Possible Complications During Oralsurgical Operations Under General Endotracheal and Short Inhalation Anaesthesia

Svrha je rada bila istražiti brojnost mogućih komplikacija prigodom oralnokirurških zahvata u dvjema skupinama redom pristiglih pacijenata. Pacijenti prve skupine bili su tretirani u općoj kratkotrajnoj inhalacijskoj anesteziji, tj. inhalacijskoj sedaciji, a na pacijentima druge skupine oralnokirurški zahvati rađeni su u općoj inhalacijskoj anesteziji uz intubaciju. Rezultati praćenja parametara općega fiziološkog statusa i lokalnih komplikacija pri radu bilježeni su u unaprijed pripremljen upitnik. U skupini pacijenata u inhalacijskoj sedaciji utvrdili smo veću čestoću povišenoga tlaka, ubrzanoga bila, niske oksigenacije, lomljenja zuba prigodom vađenja, pojačanoga krvarenja za vrijeme i nakon zahvata, poteškoća s disanjem zbog krvi i sekreta u dišnome traktu, postojanje stranoga tijela u dišnome traktu, nagnječenja mekih tkiva usne šupljine. Povraćanje nakon zahvata bilo je češće u skupini pacijenata u općoj inhalacijskoj anesteziji uz intubaciju, što je posljedica dužega trajanja i veće dubine anestezije. Rezultati istraživanja u usporedbi s iskustvima i istraživanjima dostupnima u literaturi upućuju na oprezniji pristup inhalacijskoj sedaciji i potrebu za daljnjim podrobnijim istraživanjima toga područja. Istraživanje je pokazalo da se tijekom kratkotrajne inhalacijske anestezije mogu očekivati opće i lokalne komplikacije koje mogu ugroziti pacijentovo zdravlje. Svaka ozbiljnija komplikacija tijekom rada uz uporabu kratkotrajne inhalacijske anestezije traži prekid rada i plan za intubaciju pacijenta kako bi se zahvat mogao dovršiti, npr. prijelom korijena koji se ne može odstraniti. Takvih primjera u ispitanome uzorku nije bilo, ali iskustveni podatci o tome u Kliničkome zavodu za oralnu kirurgiju postoje.The object of the study was to investigate the numerous possible complications during oralsurgical procedures in two groups of patients. The patients in the first group were treated under general brief inhalation anaesthesia, i.e. inhalation sedation, while the patients in the second group were treated under general inhalation anaesthesia with intubation. The results of monitoring the parameters of general physiological status and local complications during work were recorded in a previously prepared questionnaire. We determined greater frequency of raised blood pressure, rapid pulse, low oxygenation, fractured teeth during extraction, increased bleeding during and after the procedure, breathing difficulties due to blood and secretion in the respiratory tract, the presence of a foreign body in the respiratory tract, and bruising of the soft tissues of the oral cavity in the group of patients treated under inhalation sedation. Vomiting after the operation was frequently registered in the group of patients under general inhalation anaesthesia with intubation, which is a consequence of the longer duration and greater depth of anaesthesia. The results of the investigation, compared with the experience and investigations in the available literature, indicate the need for a more cautious approach to inhalation sedation and the need for further more comprehensive investigations in this field. The investigation showed that during brief inhalation anaesthesia general and local complications can be expected which may threaten the health of the patient. Every more serious complication during work with the application of short inhalation anaesthesia requires the cessation of work and plan for intubation of the patient in order for the operation to be concluded, e.g. fracture of the root which cannot be removed. There were no such examples in the examined sample, although data exists on the same in the Clinical Department of Oral Surgery

Styloid Process Syndrome

Stiloidni je sindrom stanje kada produženi stiloidni nastavak ili kalcificirani stilohioidni ligament uzrokuje povremene boli i vratu, osjećaj stranog tijela ili neki drugi oblik retromandibularno-cervikalne boli. U odraslih stiloidni nastavak dug je oko 25 mm s vrškom koji se nalazi između vanjske i unutarnje karotidne arterije postranično od zida adrijela i tonzilarne udubine. Osifikacijom stilohioidnog i stilomandibularnoga ligamenta produžuju se stiloidni nastavak i klinički simptomi. U kliničkoj slici tri su sindroma tijesno povezana sa sindromom stiloidnog nastavka: Costenov, Trotterov i miofascijalni bolni sindrom. Dijagnozu je moguće postaviti kliničkim pregledom i palpacijom tonzilarne udubine, pri čemu se javlja bol. Rendgenski nalaz može pokazati nekoliko mogućih inačica: produženi, pseudoartikularni i segmentirani stiloidni nastavak, a po načinu kalcifikacije: perifernu, djelomičnu i potpunu kalcifikaciju, te nodularni oblik kalcifikacije. Liječenje je primarno kirurško. Važno je liječnikovo znanje o mogućim kliničkim inačicama i raznolikoj simptomatologiji. Autori prikazuju primjer bolesnice s kliničkom slikom stilohidnoga sindroma liječene kirurškim zahvatom skraćivanja produženoga stiloidnog nastavka.Styloid syndrome is a condition in which an elongated styloid process or calcified stylohyoid ligament causes occasional pain in the neck, a feeling of a foreign body (in the pharynx?) or some other form of retromandibular-cervical pain. In adults the styloid process is approximately 25 mm long with a tip which is located between the external and internal carotid arteries, lateral to the pharyngeal wall and the tonsillar fossa. Ossification of the stylohyoid and stylomandibular ligament causes prolongation of the styloid process and clinical symptoms. There are three syndromes closely connected with the styloid process syndrome: Costen\u27s, Trotter\u27s and Myofacial painful syndrome. Diagnosis can be made by a clinical examination and palpation of the tonsillar fossa, during which pain is felt by the patient. Radiographic finding may show several possible variations: elongated, pseudoarticulated and segmented styloid process, and according to the calcification: peripheral, partial, complete or nodular type calcification. Treatment is primarily surgical. The physician\u27s knowledge of possible clinical variations and diverse symptomatology is important. The authors present the case of a female patient with Stylohyoid Syndrome treated by surgical shortening of the elongated styloid process

Surgical Treatment of Large Mandibular Cysts

Na temelju pregleda literature željelo se prikazati metode liječenja velikih cista donje čeljusti kako bi se utvrdilo jesu li pristupi u liječenju domaćih i svjetskih autora slični, a ako nisu, u čemu se razlikuju. Pregled literature je pokazao da se osnovna načela liječenja velikih cista donje čeljusti postupno mijenjanju i u svijetu i u nas. Metoda marsupijalizacije postupno se napušta i zamjenjuju je metode koje poput Partsch II metode primarno zatvaraju koštani defekt. Svim je tim postupcima jedinstveno to da nastoje smanjiti postoperacijski koštani defekt kako bi se mogućnosti infekcije krvnoga ugruška smanjile, a rana zacijelila primarno. Ti su postupci bitno skratili liječenje velikih koštanih cista donje čeljusti. Koju metodu izabrati ne treba predlagati. Kirurg će prema svojemu iskustvu i rezultatima postignutim odgovarajućim metodama izabrati onu od koje očekuje najmanje neugode za pacijenta i najkraći postupak liječenja.Based on a review of available literature sources on the treatment of large mandibular cysts, a comparison of various treatment approaches has been performed in order to identify similarities and differences between the treatment approaches used by domestic and foreign authors. The review shows that basic principles of the treatment of large mandibular cysts are changing in Croatia as well as abroad. Marsupialisation methods are being gradually replaced by different methods which all primarily close the bone defect, as in the Partsch II method. Methods differ only in the approach used to close it. The common goal of all these methods is to reduce the postoperative bone defect in order to reduce the possibility of coagulation, infections and to heal the wounds primarily. These methods lead to significantly reduced duration of the treatment of large mandibular cysts. The choice of the most suitable method is left to the surgeon, who, based on his experience and results obtained with a particular method in the past, has to choose the method which will pose the least possible stress on the patient and ensure the shortest treatment time

Traumatic Bone Cysts

Traumatska koštana cista (TKC) patološka je tvorba složene etiologije. Prikladnu dijagnozu i liječenje dodatno komplicira i široka paleta drugih patoloških promjena u čeljusti koji diferencijalno dijagnostički dolaze u obzir. Karakteristično je da kod TKC-a nećemo naći tipičan nalaz za cistu, tj. u patohistološkoj raščlambi neće biti cističnog epitela u obliku cistične ovojnice. U anamnezi je moguće otkriti traumu u zahvaćenom području. TKC pokazuje karakteristično prosvjetljenje na rendgenogramu i najčešće ne daje simptome. U ovome radu prikazan je pregled literature i osnovne značajke TKC-a. Tipičan nalaz u tijeku operacije, rezultat patohistološke dijagnoze (PHD) i pravilno uzeta anamneza, uz dobro poznavanje diferencijalne dijagnostike, pomoći će nam uspješno liječiti pacijenta.A traumatic bone cyst is a pathological formation of complex aetiology. Adequate diagnosis and treatment are additionally complicated by the broad palette of other pathological processes in the area of the jaw, which can differentially diagnostically be considered. Characteristically, in the case of a TBC a typical finding for a cyst will not be found, i.e. in the histopathological analysis cystic epithelia in the form of a cystic sheath will not be present. In the case history it is possible to disclose trauma in the affected area. TBC shows characteristic radiolucent areas on the radiograph, and most frequently does not have symptoms. This study presents a review of literature and basic characteristics of TBC. A typical finding during the operation, the PHD result and correct recording of the case history, together with a good knowledge of differential diagnostics will enable realisation of successful treatment of the patient

Comparison of the Bond Strengths of Zinc Phosphate, Glass-Ionomer, and Compomere Cement for Dowel Cementation

Unatoč dosad mnogim provedenim istraživanjima, ne postoji jedinstvena ocjena koji je cement najbolji za cementiranje konfekcijskih kolčića. Svrha rada bila je ispitati i usporediti retenciju konfekcijskih kolčića cementiranih s trima različitim vrstama cemenata: cink-fosfatnim, stakleno-ionomernim i kompomernim. Prikupljeno je 30 zuba i endodontski preparirano do dubine od 7 mm i ISO promjera 140. Podijeljeni su u 3 skupine od 10 uzoraka. S pomoću triju navedenih vrsta cemenata u njih su cementirani kolčići od čelične žice. Pošto se je cement stvrdnuo, izmjerena je vlačna sila potrebna za izvlačenje kolčića iz korijenskoga kanala. Za cink-fosfatni cement iznosila je 175±33,17 N, za stakleno-ionomerni 235,5±46,93 N, a za kompomerni 275,63±96,42 N. Kolčići cementirani kompomerom imaju znatno jaču retenciju od kolčića cementiranih cink-fosfatnim ili stakleno-ionomernim cementom. Stakleno-ionomerni cement mnogo jače retinira od cink-fosfatnoga cementa. Prednosti cink-fosfatnog cementa jesu manja osjetljivost na pogrješke u radu i razmjerna jeftinoća, te još uvijek u mnogim kliničkim okolnostima ostaje cement izbora.In spite of numerous previous studies, there is no final conclusion on which type of cement is the best for dowel cementation. The purpose of this study was to compare the retention of dowels cemented with three different cement types: zinc phosphate, glass-ionomer, and compomere. Thirty teeth were divided into 3 groups, root-canals were prepared to ISO 140, to 7 mm depth and dowels were cemented. After 40 hours the tensile force needed to dislodge the dowels was recorded. For zinc phosphate it was 175±33.17 N, for glass-ionomer 235.5±46.93 N, and for compomere 275.63±96.42 N. The dowels cemented with compomere had significantly higher tensile strength than those cemented with zinc phosphate or glass-ionomer cement. Glass-ionomer cement had significantly higher tensile strength than zinc phosphate cement. The advantages of zinc-phosphate are its low price and simple usage. Thus, in many clinical situations it may be the cement of choice

The Effect of Root Canal Preparation Depth on Retention of Endodontic Dowels

Ako nedostaje više od pola krune endodontski liječenoga zuba, potrebno ga je nadograditi lijevanom nadogradnjom ili konfekcijskim kolčićem. Retencija kolčića ovisi o njegovu promjeru, obliku, dubini ugradnje i upotrijebljenom cementu. Svrha rada bila je dobiti podatke o utjecaju dubine preparacije korijenskoga kanala na retenciju kolčića i usporediti postojeće preporuke. 30 je zuba podijeljeno u 3 skupine, korijenski su kanali preparirani do 5, 7 i 9 mm dubine i u njih su cementirani kolčići. Nakon 40 sati izmjerena je sila potrebna za čupanje kolčića iz korijenskoga kanala. Za kolčiće na dubini od 5 mm sila je iznosila 174,17 ± 29,45 N, na 7 mm 235,5 ± 46,93 N, a na 9 mm 255 ± 72,74 N. Produbljivanje preparacije s 1/3 na 1/2 dubine korijenskoga kanala (s 5 na 7 mm) znatno povećava retenciju. Produbljivanje s 1/2 na 2/3 dubine (s 7 na 9 mm) ne daje znatno povećanje retencije kolčića.When more than half of the crown of the endodontically treated tooth is missing, reinforcement with a cast post or a prefabricated dowel is needed. Four factors affect dowel retention: diameter, design, length, and employed cement. The purpose of this study was to measure the influence of root-canal preparation depth on retention force, and evaluate the commonly used principles. Thirty teeth were divided into 3 groups, root canals were prepared to 5.7 and 9 mm, and dowels were cemented. After 40 hours the tensile force needed to dislodge the dowels was recorded. At 5 mm depth it was 174.17 ± 29.45 N, at 7 mm 235.5 ± 46.93 N, and at 9 mm 255 ± 72.74 N. There was significant difference between dowel retention at 1/3 and at 1/2 of the root depth (5 and 7 mm). Difference between retention at 1/2 and at 2/3 of the root depth (7 and 9 mm) was not significant

The Effect of Root Canal Preparation Depth on Retention of Endodontic Dowels

Ako nedostaje više od pola krune endodontski liječenoga zuba, potrebno ga je nadograditi lijevanom nadogradnjom ili konfekcijskim kolčićem. Retencija kolčića ovisi o njegovu promjeru, obliku, dubini ugradnje i upotrijebljenom cementu. Svrha rada bila je dobiti podatke o utjecaju dubine preparacije korijenskoga kanala na retenciju kolčića i usporediti postojeće preporuke. 30 je zuba podijeljeno u 3 skupine, korijenski su kanali preparirani do 5, 7 i 9 mm dubine i u njih su cementirani kolčići. Nakon 40 sati izmjerena je sila potrebna za čupanje kolčića iz korijenskoga kanala. Za kolčiće na dubini od 5 mm sila je iznosila 174,17 ± 29,45 N, na 7 mm 235,5 ± 46,93 N, a na 9 mm 255 ± 72,74 N. Produbljivanje preparacije s 1/3 na 1/2 dubine korijenskoga kanala (s 5 na 7 mm) znatno povećava retenciju. Produbljivanje s 1/2 na 2/3 dubine (s 7 na 9 mm) ne daje znatno povećanje retencije kolčića.When more than half of the crown of the endodontically treated tooth is missing, reinforcement with a cast post or a prefabricated dowel is needed. Four factors affect dowel retention: diameter, design, length, and employed cement. The purpose of this study was to measure the influence of root-canal preparation depth on retention force, and evaluate the commonly used principles. Thirty teeth were divided into 3 groups, root canals were prepared to 5.7 and 9 mm, and dowels were cemented. After 40 hours the tensile force needed to dislodge the dowels was recorded. At 5 mm depth it was 174.17 ± 29.45 N, at 7 mm 235.5 ± 46.93 N, and at 9 mm 255 ± 72.74 N. There was significant difference between dowel retention at 1/3 and at 1/2 of the root depth (5 and 7 mm). Difference between retention at 1/2 and at 2/3 of the root depth (7 and 9 mm) was not significant