Leonard Krekmanov

A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea.

The enthusiasm for uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnoea (OSA) has declined in recent years, partly because of a lower success rate over time and partly because of adverse effects. Reports on the beneficial effects of dental appliances exist, but only one prospective randomized study has been published comparing dental appliances with nasal continuous positive airway pressure (CPAP) treatment. No study has been published comparing dental appliance treatment with UPPP. Ninety-five male patients with confirmed OSA, subjective daytime sleepiness and an apnoea index (AI) > 5 were randomized for subsequent treatment with either a dental appliance or UPPP. There were 49 patients in the dental appliance group and 46 in the UPPP group. Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 12-month follow-up. The success rate (rate of patients with at least a 50% reduction in AI) for the dental appliance group was 95%, which was significantly higher (p < 0.01) than the 70% success rate for the UPPP group. According to the criteria for OSA (apnoea index > or = 5 or apnoea/hypopnoea index > or = 10), 78% of the dental appliance group and 51% of the UPPP group were normalized after 12 months. The difference between the groups was significant (p < 0.05). These findings suggest that the dental appliance technique is useful in the treatment of mild to moderate OSA.

Postoperative complications after surgical removal of mandibular third molars: Effects of penicillin V and chlorhexidine

A random material of 112 patients, was investigated after surgical removal of impacted lower third molars. 2 experimental groups and 1 control group were studied. Prophylactic medication with penicillin V combined with preoperative rinsing using 0.2% chlorhexidine gluconate (Hibitane) was found to reduce postoperative symptoms, when compared with preoperative rinsing alone. In both cases, patients were compared with the control group.

Alveolitis after operative removal of third molars in the mandible

The aim of the investigation was to assess the importance of various factors in the aetiology of alveolitis sicca dolorosa. Two hundren partially erupted or totally impacted mandibular third molars were surgically removed. The patients were divided into four groups. The patients in group 1 were premedicated with a single dose of penicillin-V (phenoxymethylpenicillin), those in group 2 with an antisialogogue (methylscopolamine nitrate), and those in group 3 with an antifibrinolytic agent (tranexamic acid). Group 4 were non-premedicated controls. The frequency of alveolitis in the groups 1 and 2 was significantly less than in the groups 3 and 4. This indicates the importance of salivary contamination of the surgical field and of infection as aetiologic factors in alveolitis.

Miniplate osteosynthesis of infected mandibular fractures

Miniplate osteosynthesis in cases of infected mandibular fractures in patients with reduced healing capacity and lack of cooperation has been evaluated. Thirty seven patients with 42 potentially infected mandibular fractures were treated by internal fixation with miniplates. Healing occurred in all cases. Postoperative infection was noted in 9 patients. Aspects of healing and indications for the method are discussed.

Induced hypotension may influence blood loss in orthognathic surgery, but it is not crucial

The need for induced hypotension in orthognathic surgery was evaluated. Blood loss, duration of operation, quality of the surgical field, and surgical result were measured in 36 patients, assigned to either hypotension (mean arterial pressure, MAP, 50-64 mmHg) or normotension (MAP > or = 65 mmHg). Hypotension was achieved by increasing the amount of isoflurane given. The hypotensive group had significantly less bleeding over time (mean 0.9 ml/minute, 95% confidence interval (CI) of mean 0.6 to 1.2, compared with 1.8, 95% CI 1.3 to 2.4, p = 0.005). The corresponding difference in total blood loss did not differ significantly between the groups (mean 186 ml, 95% CI 98 to 275, compared with 304, 95% CI 210 to 399). No patient required transfusion of red cells. Neither the duration of surgery, nor the quality of the surgical field, nor the final result were significantly influenced by hypotension. The clinical relevance of induced hypotension in orthognathic surgery must be considered to be doubtful. A mean reduction of less than 150 ml will be of limited value at the low levels of blood loss reported.

Sagittal Split Osteotomy of the Mandible without Postoperative Intermaxillary Fixation: A Clinical and Cephalometric Study

A modified sagittal split technique has been evaluated in 42 dentate patients, in whom no postoperative intermaxillary fixation was used. Twenty-three patients had mandible set-back performed and 19 patients mandibular advancement. The method makes possible a safe split osteotomy under controlled conditions. The design of the osteotomy and screw osteosynthesis counteracts relapse. Omitting intermaxillary fixation facilitates postoperative handling of the patient and promotes rehabilitation.

Simultaneous correction of maxillary and mandibular dentofacial deformities without the use of postoperative intermaxillary fixation. A clinical and cephalometric study

Simultaneous correction of maxillary and mandibular anomalies was performed in 23 patients. The maxillary segment was stabilized by means of steel wires as horizontal mattress sutures, which, in all cases, gave good stability. A modified sagittal split has been applied in all cases. The method makes a safe split osteotomy possible under controlled conditions. The design of the osteotomy and the screw osteosynthesis counteract relapse. Postoperatively, no rigid intermaxillary fixation (IMF) was used. Masticatory function was started from the 1st postoperative day and in most cases was normalized 2-3 weeks after surgery according to the patients own judgement. Cephalometric analysis was performed on 15 patients by a superimposition technique. There was an overall good postoperative stability of the maxilla and mandible in the horizontal and vertical planes. We conclude that omitting IMF has no negative effect on the postoperative stability of the fragments.

Effect of application of cold dressings on the postoperative course in oral surgery.

The effect of external application of local cold on swelling, trismus, temperature and pain postoperatively in surgical removal of impacted mandibular third molars was studied in a cross-over study comprising 45 patients. The patients were treated postoperatively with cold dressings after the first or the second operation. There were no significant differences in swelling, trismus, temperature or postoperative pain between the 2 groups of operations. It is concluded that the external application of cold after the surgical removal of impacted mandibular third molars does not appear to improve the postoperative course, either on a short or long term basis.

Posterior repositioning of the entire maxilla without postoperative intermaxillary fixation. A clinical and cephalometric study.

In 30 patients posterior repositioning of the entire maxilla has been performed. No postoperative intermaxillary fixation (IMF) has been applied. The surgical procedure is described and data given on the distance of repositioning. Results of cephalometric analysis indicate good long-term stability after surgery. We concluded that omitting IMF not only enhances patient comfort, but has no deleterious effect on postoperative stability of the maxilla.

Transverse surgical correction of the maxilla: A modified procedure

A modified surgical procedure to expand as well as reduce the width of the hard palate is described. Instead of a single sagittal osteotomy in the midline of the palate, multiple sagittal osteotomies are performed parallel to each other and maintaining the periosteal attachment to each of the fragments. The hard palate is thereby moveable and can be reduced in a transverse direction as well as expanded. The expansion will, however, be limited to the height of the curvature of the palate. Minor complications with the method are described. Long-term postoperative follow-up shows stable results with the method.