Ole Gilhuus-Moe

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.

Immune response to nickel and some clinical observations after stainless steel miniplate osteosynthesis

Fifteen patients undergoing internal fixation for mandibular fractures were examined for delayed type hypersensitivity (DTH) reaction to nickel before and after implantation of stainless steel miniplates. A lymphocyte transformation test (LTT) was used to measure the immune response before implantation and at removal of plates and screws. The clinical complications during fracture healing were also recorded. The results show that the in vitro LTT may be useful in nickel hypersensitivity testing. A significant increase in lymphocyte transformation was found as a response to nickel stimulation (0.5 microgram Ni/ml) at removal of the implants. We conclude that, despite an increase in LTT after stainless steel implantation, no adverse clinical complications related to DTH could be recorded after short-time observation.

Per- and post-operative variables of mandibular third-molar surgery by four general practitioners and one oral surgeon

Per- and post-operative indicators in 25 patients who had lower third-molar surgery performed by 4 general practitioners (GP) in their own practices were compared with those of a control group of 25 patients operated on by an oral surgeon. The preoperative variables age; sex; general health; use of medications, alcohol, and tobacco; and depth, position, and presence of infection of the third molar were considered in individual matching of the patients. The operations performed by the GPs lasted 17.9 min (p = 0.0001) longer than those of the oral surgeon. Increased rates of postoperative alveolitis (p = 0.03) and secondary healing (p = 0.0005) were found in the GP patient group, as was a tendency for increased postoperative pain and consumption of strong analgesics. The number of days unable to work was 1.9 in the GP group, compared with 0.6 in the surgeon group (p = 0.0012). No differences in swelling and trismus were found.

Correction of jaw deformities subsequent to treatment of acromegaly

In acromegaly, growth of facial bones and changes of oral and laryngeal mucosa are well accepted facts. Orthognathic surgical procedures should in these cases be postponed until the acromegalic process is well controlled. 2 cases of mandibular osteotomies (patients aged 61 and 38 years) are reported. The surgical procedures and the postoperative course of these patients were uneventful and did not deviate from those of otherwise healthy patients.

The surgical technique of vertical subcondylar osteotomy for correction of mandibular prognathism: A 10-year survey

In the period 1975-1985 extraoral vertical, subcondylar osteotomies of the mandibular ramus (EVSO) were performed in 203 patients with mandibular prognathism at Haukeland University Hospital, Bergen. Refinements of this surgical technique are described. Clinical and surgical observations were analyzed as to preoperative orthodontic treatment, operation time, pre-/post-operative complications, and hospital stay. The findings confirm that the EVSO procedure is a safe technique, with minimal discomfort and morbidity for the patients. Even though intraoral procedures are the trend for surgical correction of mandibular prognathism at present, there are substantial indications for the use of EVSO.

Surgical treatment of chronic hyperplastic sinusitis and maxillary sinus empyema of oral/dental origin.

Twelve patients with maxillary hyperplastic sinusitis or maxillary sinus empyema of oral/dental etiology have been treated according to a modified surgical technique. The treatment was initiated by several oro-nasal irrigations and drainage facilitated by an intact semilunar hiatus. This was followed by a surgical procedure including conservative curettage of inflamed sinus mucosa, adequate closure of the oro/antral communication, with establishment of a postoperative oral antrostomy. This antrostomy, through the canine fossa, was established by a vacuum drain, enabling continuous postoperative irrigation and aspiration. The rationale for this technique is discussed. A total of 12 patients operated according to this technique are described. Complete clinical and radiographic healing in all patients was observed over a postoperative period ranging from 6-12 months.