Alceu Sergio Trindade

A comparison of the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine (both with 1:200,000 epinephrine) for lower third molar removal

OBJECTIVE This study compared the clinical efficacy of 4% articaine (A200) and 0.5% bupivacaine (B200), both with 1:200,000 epinephrine, for lower third molar removal. STUDY DESIGN Fifty patients underwent removal of symmetrically positioned lower third molars, in 2 separate appointments, under local anesthesia either with A200 or B200, in a double-blind, randomized, and crossover manner. Time to onset, duration of postoperative analgesia, duration of anesthetic action on soft tissues, intraoperative bleeding, and hemodynamic parameters were evaluated. RESULTS A statistically significant difference between the time to onset of A200 (1.66 +/- 0.13 minutes) and B200 (2.51 +/- 0.21 minutes) was found (P < .05). There was no statistically significant difference in the duration of analgesia, whether the patient was subjected to osteotomy or not, regardless of the local anesthetic used (3 to 4 hours; P > .05). However, when patients received B200 they experienced a statistically significant longer period of anesthesia on the soft tissues as compared with when they had received A200 (around 5 hours and 4 hours, respectively, P < .05). The surgeons rating of intraoperative bleeding was considered very close to minimal for both anesthetics. In the surgeries with osteotomy, the comparison between A200 and B200 showed statistically significant differences in the diastolic (64 mm Hg and 68 mm Hg, respectively, P = .001) and mean arterial pressure (86 mm Hg and 89 mm Hg, respectively, P = .031) when data from all the surgical phases were pooled. Additionally, the mouth opening at the suture removal was statistically different for A200 and B200 solutions (91.90% +/- 3.00% and 88.57% +/- 2.38% of the preoperative measure, respectively) when surgeries required bone removal (P < .05). CONCLUSIONS In comparison with 0.5% bupivacaine, 4% articaine (both with 1:200,000 epinephrine) provided a shorter time to onset and comparable hemostasis and postoperative pain control with a shorter duration of soft tissue anesthesia in lower third molar removal.

Short- and long-term effect of surgically assisted maxillary expansion on nasal airway size.

Transverse maxillary deficiency (TMD) may reduce nasal dimensions and lead to oral breathing. The objective of the present study was to investigate the short- and long-term effects of surgically assisted maxillary expansion on nasal airway size of patients with TMD. Eleven subjects with TMD and skeletal maturity were submitted to posterior rhinomanometry to determine the minimum nasal cross-sectional area (CSA) before and 3, 6, and 12 months after surgery. Subjects were also investigated concerning their habitual diurnal and nocturnal breathing mode (oral, nasal, and oronasal). A statistically significant increase in mean CSA was observed in the early postoperative period (3 months), followed by a decrease to the preoperative levels in the subsequent periods (6 and 12 months). No variations were observed in the breathing mode for 63.6% of the subjects. The results showed that, in the short-term, maxillary expansion most frequently produced an increase in nasal patency. However, it was observed that the effect did not persist over time in most subjects.

Feeding-facilitating techniques for the nursing infant with Robin sequence.

Objective To determine the effectiveness of feeding-facilitating techniques in children with Robin sequence. Setting Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru, São Paulo, Brazil. Patients Twenty-six children less than 2 months of age with Robin sequence, whose only cause of respiratory obstruction was glossoptosis. Thirteen infants were treated by being placed in the prone position (Group 1), and 13 were treated by nasopharyngeal intubation (Group 2). Interventions During hospitalization, the following feeding-facilitating techniques were applied daily to all children: pacifier, massage to relax and anteriorize the tongue, long and soft bottle nipple with original or enlarged hole, global symmetric position, rhythmic movement of the nipple during suction, and insertion of the nipple on the tongue. Results During the first evaluation, Group 1 patients accepted 36.15 ± 33.05 mL milk orally within a period of 44.62 ± 42.94 minutes, whereas Group 2 ingested 20.00 ± 20.51 mL milk within 30.38 ± 25.77 minutes. A significant increase (p < .01) in the volume of ingested milk was observed for the two groups at hospital discharge after a mean treatment period of 10.7 days (Group 1: 63.46 ± 22.58 mL and Group 2: 55.00 ± 13.07 mL). The mean duration of feeding decreased in the two groups, with a value of 21.54 ± 7.18 minutes for Group 1 and of 20.28 ± 8.53 minutes for Group 2. Conclusion The results showed that feeding-facilitating techniques can foster oral feeding in infants with Robin sequence.

Electromyographic analysis of lip muscle function in operated cleft subjects.

EMG activity of the upper lip was measured with bipolar surface electrodes during speech and nonspeech tasks in order to assess labial function in subjects with repaired clefts. Eighteen patients between 15 and 23 years of age with repaired unilateral cleft lip (isolated or combined with repaired cleft palate) were compared to 24 matched noncleft subjects. Data analysis demonstrated that the amplitude of action potentials of the upper lip was significantly greater in the cleft group. We hypothesize that the enhanced activity of the repaired upper lip during function may contribute to the facial growth abnormalities usually seen in the cleft population.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: Institutional outcomes assessment and the role of the Laboratory of Physiology

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology.

Pulmonary function of individuals with congenital cleft palate.

Ventilatory pulmonary function was investigated in 160 children and adults with repaired or unrepaired congenital cleft palate in comparison with 130 normal children and adults. Pulmonary function tests included measurement of lung volumes, of maximal voluntary ventilation (MVV) and of forced spirometry parameters: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio and mean forced expiratory flow during the middle half of FVC (FEF25-75). Patients with cleft palate demonstrated significant differences from normal individuals in some of the measurements made. Functional alterations were observed at higher frequency among adult patients with unrepaired clefts and mainly consisted of a reduction in expiratory flows and MVV. However, the deviations observed were usually discrete and probably of low physiopathologic significance. The results permit us to conclude that, in contrast to data reported by others, subjects with congenital cleft palate have little impairment of pulmonary ventilatory function.

Increase in age is associated with worse outcomes in alveolar bone grafting in patients with bilateral complete cleft palate.

AbstractThis prospective study aimed at evaluating the surgical outcomes of alveolar bone grafting (ABG) in subjects with bilateral cleft lip and palate treated at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil, by means of cone-beam computed tomography. Twenty-five patients with bilateral complete cleft lip and palate, resulting in 50 clefts, were analyzed. Subjects were divided into 2 groups according to the dentition status at the time of surgery: (1) SABG group: subjects with mixed dentition operated on before or immediately after eruption of the permanent canine (10–13 years); (2) TABG group: subjects with permanent dentition (15–23 years). Cone-beam computed tomography analysis was performed in the buccal, intermediate, and palatal views, 2 and 6 to 12 months postoperatively. In the SABG group, 96% of the grafts were classified as successful, and no failure cases were observed. In the TABG group, successful cases decreased to 65%, and failures were seen in 27% of the cleft sites. In both postoperative periods, significantly better outcomes (lower mean scores) were observed for the SABG group in all the cone-beam computed tomography views (P < 0.05). Results show that the timing of surgery is an important factor in determining the outcomes of ABG in patients with bilateral cleft lip and palate, with increasing age being associated with the worse outcomes.