Kjell Sveen

Paracetamol/codeine in relieving pain following removal of impacted mandibular third molars.

A double-blind clinical study of analgesic drugs was conducted involving 47 healthy adults requiring removal of 90 bony impacted mandibular third molars. The analgesic effect of paracetamol plus codeine (P + C) 350 + 20 mg was compared to that of acetylsalicylic acid (ASA) 500 mg and placebo. A standardized surgical procedure under local anesthesia was used. Insufficient analgesic effect was noted in 16% of the ASA group and in 69% of the placebo group but in none in the P+C group. On the first postoperative day, patients given P+C suffered less pain compared with those given ASA (P less than 0.01). No relationship could be demonstrated between the type of impaction and intensity of pain. Trismus, however, was found to be associated with difficulty of extirpation. Drowsiness and an increased sleeping tendency were the main side effects found in the P+C group. The incidence of secondary hemorrhage was high in the ASA group, compared with the P+C group a significance of 0.01 less than P less than 0.05 was found on various postoperative days. Registration of swelling revealed less postoperative edema in the P+C group than in the ASA group (0.01less thanPless than0.05). The main conclusion from this study is that the analgesic effect of P+C orally administered after a specific oral surgical procedure is superior to ASA and placebo. P+C also appears to have a more marked antiphologistic effect than ASA.

Effect of the addition of a vasoconstrictor to local anesthetic solution on operative and postoperative bleeding, analgesia and wound healing

A clinical study of local anesthetic solutions with and without epinephrine was conducted involving 32 healthy adults requiring removal of bony impacted mandibular third molars. The time elapsing from the administration of the anesthetic solution until analgesia was obtained was significantly shorter in the vasoconstrictor group (P less than 0.001). Additional anesthetic was necessary in 44% of the patients in the control group. The blood loss in the vasoconstrictor group was significantly lower (P less than 0.001) than in the group receiving anesthetic solution without the vasoconstrictor. No statistically significant difference in operation time between the groups was found, although the profuse bleeding in the control group impeded to some extent the surgical procedure. A positive correlation coefficient between operation time and blood loss of r = 0.65 in the vasoconstrictor group (P less than 0.006) and r = 0.77 in the control group (P less than 0.001) was found. Hemorrhage occurring 24 h postoperatively was recorded in 37% of the subjects in the vasoconstrictor group, and of these 83% revealed a healing of the socket by second intention.

Changes of lateral soft tissue profile after surgical correction of mandibular prognathism

The lateral soft tissue profile was recorded in 10 patients with slight to moderate degrees of mandibular prognathism, preoperatively, and 6 weeks after subcondylar sliding osteotomy had been performed. The recording method was mechanical. Only small and insignificant profile changes were found in the submandibular and occlusal plane regions as well as in the ramus region. The only significant change of profile was found in the mandibular body region, probably as a result of firm connection between soft tissue and underlying distally moved bone. The lack of significant profile change in the osteotomy region was in accordance with subjective observations and was probably due to local remodelling and adaptation processes. The facial width was thus found to be unaltered 6 weeks postoperatively.

Incomplete branchial arch syndromes, branchial cleft cyst and vascular hamartoma in a patient with multiple neurofibromatosis

A case report with simultaneous occurrence of neurofibromatosis, incomplete branchial arch syndromes, a branchial cleft cyst and a pseudocyst in connection with a vascular hamartoma anterior to the right ear of a 38-year-old woman is presented. A possible common pathogenesis of the vascular hamartoma and the incomplete branchial arch syndromes as well as that of the neurofibromatosis is suggested. The pseudocyst is interpreted as a branchial cleft cyst showing inflammatory changes due to a pharyngitis shortly before the preauricular tumor appeared.

Giant ranula causing mandibular prognathism

This is a case report of a 20-year-old man with ranula, the size of an orange, in the floor of the mouth causing mandibular prognathism with fan-shaped mandibular teeth anterior to the premolars. The tumor was extirpated. The pathogenesis, differential diagnosis and treatment of ranulas are discussed.