Edward A. Dolan

Pain behavior and pain coping strategies in low back pain and myofascial pain dysfunction syndrome patients

&NA; Pain behavior and pain coping strategies were systematically measured in a group of 32 chronic low back pain (LBP) and 32 myofascial pain dysfunction (MPD) syndrome patients. Both groups reported high levels of psychological distress on the SCL‐90R. The LBP patients were significantly less active, took more narcotic and sedative‐hypnotic medications, and showed higher levels of motor pain behavior (guarding, rubbing, and bracing) than the MPD patients. The LBP patients used attention diversion, and praying or hoping as pain coping skills to a much greater extent than the MPD patients. The relationship of these findings to prior research is described, and future research needs in this area are identified.

Synovial chondromatosis of the temporomandibular joint diagnosed by magnetic resonance imaging: Report of a case

A case of synovial chondromatosis of the temporomandibular joint with extracapsular extension is described. Temporomandibular joint magnetic resonance imaging proved invaluable in establishing a definitive diagnosis.

The surgical correction of vertical maxillary excess (long face syndrome).

The surgical correction of vertical maxillary excess is a relatively new technique. Vertical maxillary excess (VME) may exist alone or in combination with a horizontal mandibular deficiency with or without an anterior open bite. The facial contour is characterized by a long, tapering face with anterior and posterior maxillary overgrowth, a narrow alar base, and lip incompetence. Cephalometric analysis demonstrates steep mandibular and occlusal planes in relationship to the cranial base, an increase in facial height, and retroposition of the mandible. Evaluation of study models exhibits increased alveolar bone height, a high palatal vault, and a narrow maxillary arch. The dental relationship may be Class I, II, or III, with Class II being the most common. Orthodontic treatment before surgery consists of correct alignment of the teeth and removal of those dental compensations that preclude good dental interdigitation at surgery. Regardless of the surgical procedure, accurate preoperative planning based on careful evaluation of skeletal, dental, and soft tissue features in conjunction with correct orthodontic surgical sequencing is the key to a satisfactory result. The “downfracturing” or Le Fort I maxillary osteotomy for superior repositioning of the maxilla is the surgical procedure of choice for vertical maxillary excess. Two-, three-, or four-segment maxillary osteotomies can be done in conjunction with the Le Fort I osteotomy without jeopardizing healing capacity.

Recurrent ameloblastoma in autogenous rib graft. Report of a case.

Recurrent tumors in previously placed bone grafts are rare. A case of recurrent ameloblastoma in a rib graft 13 years after resection and reconstruction is presented. A review of the literature discloses only one cases of ameloblastoma recurring within a bone graft. Considering that the recurrence rate is substantial in these tumors, prudent planning and meticulous surgery is mandatory prior to any attempt at reconstruction to minimize the risk of failure due to recurrence.

Continuous infusion of methohexital and alfentanil hydrochloride for general anesthesia in outpatient third molar surgery

Three anesthetic techniques were compared in this study: 1) Intermittent Brevital boluses supplemented with fentanyl and midazolam all titrated to patient movement, 2) constant infusion of Brevital supplemented with fentanyl and midazolam all delivered in calculated mg/kg doses based on total body weight, and 3) constant infusion of methohexital (Brevital) and alfentanil (Alfenta) supplemented by midazolam (Versed), droperidol, and glycopyrolate (Robinul) delivered in calculated mg/kg doses based on lean body mass. Nitrous oxide was delivered in all cases via nasal mask in a 30% to 50% concentration. The mean total dose of Brevital in group 1 (intermittent Brevital bolus) was 0.17 mg/kg/min (SD = 0.07), group 2 (Brevital infusion) was 0.23 mg/kg/min (SD = 0.06), and group 3 (alfentanil/Brevital infusion) was 0.12 mg/kg/min (SD = 0.07). Mean total dose of alfentanil in group 3 equaled 1.58 mcg/kg/min (SD = 0.73). In group 1, 94% of the patients experienced moderate to severe movement intraoperatively. Twenty-three percent of the patients in group 2, and only 7% of group 3 exhibited moderate to severe movement. Emergence in group 3 averaged 4.5 minutes (SD = 1.6). Three patients (7%) in group 3 had postoperative nausea. Additional subjective findings in group 3 included easier airway maintenance during administration of the anesthetic, lack of unpleasant emergence phenomena such as crying, and prompt readiness for discharge. It was concluded that continuous alfentanil and Brevital infusion satisfied the objectives of safety, stability, predictability, and rapid recovery, while improving operating conditions (less patient movement) when compared with more traditional anesthetic techniques.

Comparison of nalbuphine and fentanyl in combination with diazepam for outpatient oral surgery

Nalbuphine and fentanyl were compared as analgesic components of intravenous conscious sedation with diazepam in a double-blind, prospective trial of 50 patients undergoing elective oral surgery. Subjects were evaluated for intensity of pain, pain relief, sedation, anxiety, recall, and vital signs at systematic observation points intraoperatively and postoperatively. At the conclusion of surgery, 88% who received nalbuphine and 87% treated with fentanyl indicated complete pain relief. One observed adverse reaction was attributed to the combination of fentanyl and the sedative component diazepam. No statistically significant differences were observed between nalbuphine and fentanyl treatments.

Double-blind comparison of nalbuphine and meperidine in combination with diazepam for intravenous conscious sedation in oral surgery outpatients.

Nalbuphine and meperidine were compared as analgesic components of intravenous conscious sedation in a double-blind, prospective trial of 47 patients undergoing elective oral surgery. Subjects were evaluated for pain intensity, pain relief, anxiety, sedation, recall, and vital signs at systematic observation points intraoperatively and postoperatively. At the conclusion of surgery 83% of patients who had received nalbuphine and 86% of patients treated with meperidine indicated complete pain relief. One observed adverse reaction was attributed to meperidine and another to the sedative component diazepam. No statistically significant differences were observed between nalbuphine and meperidine treatments.

A simplified technique for drilling intraosseous holes in orbital rim fractures

No short term complications have been detected. None of these patients have been observed long enough postoperatively to assess the potential problem of the plate becoming palpable because of remodeling of the lateral aspect of the mandible at the lateral osteotomy sites. It is certainly possible that removal of some plates may become necessary. If so, it should readily be accomplished as an office procedure.