Jonathon S. Jundt

Submental intubation: a literature review

A literature review was performed to analyse the evidence supporting submental intubation and to aid in the development of a new airway algorithm in craniofacial surgery patients. A systematic search of Pub Med, OVID, the Cochrane Database and Google Scholar between January 1984 and April 2011 was performed. Measured variables included the outcome, complications, publishing specialty journal and method of intubation including technique modifications, indications for the procedure, devices utilized and the total procedure time to complete the submental intubation. Of the 842 patient cases from 41 articles represented in the review, the success rate was 100%. Minor complications were reported in 60 patients and included superficial skin infections (N=23), damage to the tube apparatus (N=10), fistula formation (N=10), right mainstem bronchus tube dislodgement/obstruction (N=5), hypertrophic scarring (N=3), accidental extubation in paediatric patients (N=2), excessive bronchial flexion (N=2), lingual nerve paresthesia (N=1), venous bleeding (N=2), mucocele (N=1), and dislodgement of the throat pack sticker in the submental wound (N=1). The average reported time to complete a submental intubation was 9.9 min. Submental intubation is a safe, effective and time efficient method for securing an airway when increased surgical exposure or restoration of occlusion is a priority.

Characteristics and cost impact of severe odontogenic infections

OBJECTIVE The objective of this study was to retrospectively analyze the clinical presentation, surgical management, and cost implications of inpatients treated for odontogenic infections at a public tertiary care hospital. STUDY DESIGN Specific analysis from 3 years of chart review included length of stay, cost of hospitalization, site of infection, number of infected spaces, microbiology profile, antibiotics administered, intensive care unit (ICU) stay, number of days intubated, comorbidities, number of operating room visits, imaging studies, and whether the patients received preadmission treatment. RESULTS Multiple fascial spaces were involved in most of the infections. The average length of stay was 4.57 days and average time in the ICU was 3.1 days. Ninety percent of the patients had a coexisting medical comorbidity. The overall hospital costs totaled

Oculocardiac Reflex in an Orbital Fracture Without Entrapment

749,382 averaging

Intraoral Split-Thickness Skin Grafts: A New Approach Using Vinyl Polysiloxane

17,842 per person. CONCLUSIONS This study reveals a staggering cost burden on a public health care facility as a result of odontogenic infections.

Invasive Cutaneous Facial Mucormycosis in a Trauma Patient

Large orbital fractures in older patients are infrequently associated with an exaggerated oculocardiac reflex. This report describes the case of a patient in his 40s with a large right orbital floor and medial wall fracture without radiographic evidence of extraocular muscle compression or entrapment who developed severe nausea and bradycardia with movement of his affected eye. The patient exhibited bradycardia to 17 beats per minute during the initial examination and was taken urgently to the operating room for reconstruction of the right orbital floor and medial wall. Additional episodes of bradycardia intraoperatively were responsive to glycopyrrolate. After the procedure, the patients pain was decreased, a normal range of motion was restored, and the bradycardia and nausea resolved. An explanation for induction of the oculocardiac reflex is considered in the absence of clinical or radiologic entrapment because large orbital fractures are not often considered to induce this reflex.

Use of Botox (OnabotulinumtoxinA) for the Treatment of Parotid Sialocele and Fistula After Extirpation of Buccal Squamous Cell Carcinoma With Immediate Reconstruction Using Microvascular Free Flap: A Report of 3 Cases

Multiple approaches for immobilizing skin grafts intraorally have been described in the literature. In 1975, Goshgarian and Miller described a parachute tent technique that secures intraoral skin grafts via ranscutaneous sutures. In 1981, Friedlander and Miler described a technique using eye patches and a denture soft liner, securing the split-thickness skin graft (STSG) to the cheek using transbuccal bolster sutures. Since then, many materials have been used, including foam, gauze, sutures, silicone, foam rubber pads, and eye patches, in addition to a myriad of different bolstering techniques. Typical problems with current methods include debris accumulation, graft mobility, lack of stent rigidity, cutaneous pressure sores from bolster sutures, and early graft contracture. Vinyl polysiloxane (VPS), also known as polyvinyl siloxane, is an addition silicone used extensively in dentistry for dental impressions, and its use has been reported in the literature as a temporary obturator for orocutaneous fistulas. The method decribed in this case report secures and protects the raft site intraorally, saves time intraoperatively, mainains the integrity of the graft, allows for early openng and mobilization, and is comfortable for the paient postoperatively. The purpose of this article is to ntroduce a technique using VPS to immobilize and rotect an STSG intraorally.

The NTI appliance for TMD and headache therapy.

Mucormycosis, also known as zygomycosis, is an aggressive infection caused by a ubiquitous group of molds known as mucormycetes and is often associated with immune suppression or trauma among immunocompetent populations. We present the case of a 19-year-old woman who was involved in a motor vehicle accident in whom rapidly progressive invasive cutaneous facial mucormycosis subsequently developed. The diagnosis, treatment options, and incidence of this disease process are discussed in the context of trauma.