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Xu T, Yi X, Xia S, Wu S. Comparison of outcomes for general and local anesthesia in the management of nasal bone fractures: a meta-analysis. Eur J Med Res 2024; 29:306. [PMID: 38825676 PMCID: PMC11145784 DOI: 10.1186/s40001-024-01896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND This meta-analysis aimed to perform a head-to-head comparison of the role of general anesthesia (GA) and local anesthesia (LA) in the management of patients with nasal bone fractures (NBFs). METHODS PubMed, Embase, and Web of Science were comprehensively searched. Studies investigating the clinical outcomes of GA and LA in the management of NBFs were included. Pooled odds ratios (OR) with the respective 95% confidence intervals (CIs) were calculated. Heterogeneity between the included studies was evaluated. The risk of bias in the included studies was assessed. RESULTS Eight studies were included in this meta-analysis. The pooled ORs for cosmetic results, residual septal deformity, the need for further surgery, patients' satisfaction with the anesthesia procedure, and patients' satisfaction with the surgery results were 0.70 (95% CI 0.18, 2.64; z = - 0.53, p = 0.5957), 1.11 (95% CI 0.37, 3.30; z = 0.18, p = 0.8558), 1.19 (95% CI 0.65, 2.20; z = 0.56, p = 0.5760), 1.57 (95% CI 0.92, 2.69; z = 1.65, p = 0.0982), and 1.00 (95% CI 0.55, 1.80; z = - 0.00, p = 0.9974). CONCLUSIONS Insignificant difference on clinical outcomes was observed between GA and LA in the manipulation of patients with NBFs, and the choice of anesthetic approach should be based on the tolerability of the methods and the severity of nasal fractures.
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Affiliation(s)
- Ting Xu
- Department of Otolaryngology Head and Neck Surgery, Wuxi Clinical College, Nantong University, No. 68 Zhongshan Road, Liangxi District, Wuxi, 214002, Jiangsu, China.
- Department of Otolaryngology Head and Neck Surgery, The Second People's Hospital of Wuxi, Wuxi, China.
| | - Xinsheng Yi
- Department of Otolaryngology Head and Neck Surgery, The Second People's Hospital of Wuxi, Wuxi, China
| | - Shitong Xia
- Department of Otolaryngology Head and Neck Surgery, The Second People's Hospital of Wuxi, Wuxi, China
| | - Sihai Wu
- Department of Otolaryngology Head and Neck Surgery, The Second People's Hospital of Wuxi, Wuxi, China
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Trujillo O, Lee C. Nasal Fractures: Acute, Subacute, and Delayed Management. Otolaryngol Clin North Am 2023; 56:1089-1099. [PMID: 37353368 DOI: 10.1016/j.otc.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Nasal fractures are very common. The literature describes early intervention (<14 days) with closed techniques as cost-effective, minimizing the need for possible secondary surgeries and improved early patient satisfaction. However, the authors observe a measurably high rate of subsequent open treatment after closed treatment, particularly where there is significant septal involvement in the fracture. Moreover, delayed intervention (>3 months) with an open approach has many advantages over early closed technique, including lower revision rate, improved ability for rigid fixation and support, and the ability to correct severe dorsal or caudal L-strut deformities, nasal valve issues, and severe nasal bony deviation/deformities.
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Affiliation(s)
- Oscar Trujillo
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, 180 Fort Washington Avenue HP8, New York, NY 10032, USA.
| | - Clara Lee
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, 180 Fort Washington Avenue HP8, New York, NY 10032, USA
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Trauma Surgery. J Oral Maxillofac Surg 2023; 81:E147-E194. [PMID: 37833022 DOI: 10.1016/j.joms.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Hollins A, Pyfer B, Breeze J, Zhang G, Lohmeier SJ, Powers DB. Closed reduction of nasoseptal fractures: key concepts for predictable results. Br J Oral Maxillofac Surg 2023; 61:344-350. [PMID: 37230825 DOI: 10.1016/j.bjoms.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 05/27/2023]
Abstract
Nasal complex injuries are the most common facial fracture encountered in the trauma population. Multiple surgical techniques for treatment of these fractures have been described with varying results. The goal of this study was to review the efficacy of closed reduction of nasal and septal fractures using a technique based upon several key concepts. We reviewed the records of patients who had undergone isolated nasal and/or septal fractures with closed reduction at our institution between January 2013 and November 2021. Inclusion criteria consisted of preoperative CT imaging, surgical treatment within fourteen days of initial injury, and follow up of at least one year. All patients were treated under general or deep sedation. The same surgical technique was applied with closed reduction of the septum and nasal bones with internal and external postoperative splints. Of the 232 records initially reviewed, 103 met inclusion criteria. Four patients had undergone revision septorhinoplasty (3.9%). Mean (range) follow up was 2.7 (1-8.2) years. Three patients had undergone revision nasal repair due to persistent airflow obstruction with complete resolution of symptoms after revision. The other patient received multiple revisions at another institution as a result of their dissatisfaction with cosmesis without improvement. Closed reduction of nasal and septal fractures can be a highly successful procedure and yield predictable results, limiting the need for post-traumatic open septorhinoplastic surgery. Five critical concepts of nasal fracture repair can help surgeons achieve predictable functional and cosmetic results: selection, timing, anaesthesia, reduction, and support.
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Affiliation(s)
- Andrew Hollins
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital, Durham, NC, United States
| | - Bryan Pyfer
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital, Durham, NC, United States
| | - John Breeze
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital, Durham, NC, United States; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Medical Centre, Birmingham, England, United Kingdom(1)
| | - Gloria Zhang
- Duke University Medical School, Durham, NC, United States
| | - Steven J Lohmeier
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital, Durham, NC, United States; US Air Force Dental Corps, United States(1)
| | - David B Powers
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital, Durham, NC, United States.
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Patient Discomfort After Rhinoplasty With and Without Osteotomy Under Conscious Sedation. J Craniofac Surg 2022; 33:e788-e791. [PMID: 35882239 DOI: 10.1097/scs.0000000000008590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Many rhinoplasty techniques, including dorsum augmentation and tip surgery, could be performed under conscious sedation rather than general anesthesia. However, as osteotomy is an invasive procedure, it is burdensome for surgeons to perform osteotomy under conscious sedation. As patient ratings of pain and satisfaction when osteotomy is performed under conscious sedation are unknown, this study aimed to determine discomfort of osteotomy performed under conscious sedation. METHODS Patients who underwent rhinoplasty with conscious sedation were prospectively included in the study. The patients were classified into an osteotomy and a nonosteotomy group. Questionnaires with a visual analog scale ranging from 0 to 10 were utilized to assess patient pain and satisfaction. Patients were also asked whether they would choose conscious sedation for future rhinoplasty operations. To evaluate adverse events, cardiopulmonary vital signs and nausea or vomiting were assessed. RESULTS Forty-five patients with a mean age of 32.7 years were included in the study. The mean patients' visual analog scale scores for pain and satisfaction were 3.3±2.0 and 7.2±1.9, respectively. Most of the patients [42, (93%)] stated that they would choose conscious sedation again if they had further operations in the future. No significant adverse effects occurred, and there were no significant differences in patients' ratings of pain and satisfaction between osteotomy and nonosteotomy groups when conscious sedation was used. CONCLUSION Patients' ratings of pain and satisfaction, and a lack of significant adverse effects, indicated that rhinoplasty can be performed under conscious sedation, even with osteotomy.
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Pitak-Arnnop P, Tangmanee C, Meningaud JP, Neff A. Prolonged viral shedding identified from external splints and intranasal packings in immediately cured COVID-19 patients with nasal fractures: A retrospective study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:287-291. [PMID: 35413460 PMCID: PMC8994412 DOI: 10.1016/j.jormas.2022.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Our aim was to measure and compare prolonged viral shedding (PVS) identified from external splints (ES) and intranasal packings (IP) for isolated nasal fracture (INF) repair in immediately cured asymptomatic vs. mildly symptomatic COVID-19 patients (AS-COVID vs. MS-COVID). METHODS We designed a retrospective cohort study and enroled a sample of post-AS-COVID and post-MS-COVID patients, whose INF were treated at a German level 1 trauma centre. The primary predictor variable was COVID severity presurgery (AS-COVD vs. MS-COVID). The main outcome variable was PVS detected in ES/IP. Other study variables were separated into demographic, clinical, and operative. Descriptive, bi- and multivariate statistics were computed, and statistical significance was set at P≤ 0.05. RESULTS The study sample comprised 15 INF patients (53.3% females; 46.7% post-AS-COVID) with a mean age of 42.2 ± 22.7 years (range, 18-85). 13.3% ES and 53.3% IP were contaminated with SARS-CoV-2. However, only IP-contamination between the two cohorts reached statistical significance (P= 0.01; odds ratio, 0.02; 95% confidence interval, 0 to 0.47; Pearson's r= 0.73; post hoc power = 87.4%). Multiple linear regression models refuted the associations between PVS and the other parameters (i.e. age, gender, time to treatment, length of hospital stay, lengths of ES/IP placement). CONCLUSIONS Despite a relative low sample size, our findings suggest PVS via endonasal materials removed from cured COVID-19 patients, especially those healed from MS-COVID. This PVS may trigger re-infection and surgical site infections and/or transmission to other humans, and thereby, requires further investigations.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Nasal fractures and anesthetic applications. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1065843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Epstein S, Ettinger RE. Nasal and Naso-orbito-ethmoid Fractures. Semin Plast Surg 2021; 35:263-268. [PMID: 34819808 DOI: 10.1055/s-0041-1735791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Craniofacial fractures are common among trauma patients. Nasal fractures are the most common craniofacial fracture. Understanding how to evaluate and manage craniofacial fractures is important for the craniofacial trauma consultant. This manuscript describes the appropriate workup and management of nasal and naso-orbito-ethmoid fractures.
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Affiliation(s)
- Sherise Epstein
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Russell E Ettinger
- Division of Plastic and Craniofacial Surgery, Department of Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
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Abstract
This article outlines current methods in the evaluation and management of nasal fractures including clinical workup, imaging, and treatment.
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Affiliation(s)
- Kelly C Landeen
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave S7 South, Nashville, TN 37232, USA
| | - Kyle Kimura
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave S7 South, Nashville, TN 37232, USA
| | - Scott J Stephan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave S7 South, Nashville, TN 37232, USA.
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Bastianpillai J, Khan S, Acharya V, Tanna R, Pal S. How COVID-19 Changed Our Management of Nasal Bone Fractures and Its Impact on Patient Outcomes-A Retrospective Study. EAR, NOSE & THROAT JOURNAL 2020; 101:671-676. [PMID: 33302744 DOI: 10.1177/0145561320981439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Nasal bone fractures are a common presentation to the Ear, Nose and Throat (ENT) surgeon. Simple, closed fractures are assessed and considered for closed manipulation under anesthesia (MUA #nasal bones). Most departments perform this under general anesthesia (GA). Our protocol changed in the face of COVID-19, where procedures were alternatively performed under local anesthesia (LA) in the clinic, to cope with lack of elective theater capacity during the pandemic, while still allowing a nasal fracture service to take place. We present postoperative patient outcomes on breathing and shape, comparing GA versus LA. METHODS Patient records retrospectively analyzed (January 2020-August 2020), and patients undergoing MUA #nasal bones interviewed by telephone after one month. Exclusion criteria were open injuries or depressed nasal bones requiring elevation. Breathing and shape scores were evaluated subjectively using a Likert scale (1 = very unsatisfied, 5 = very satisfied). RESULTS Two hundred five nasal injury referrals were made (21 MUA #nasal bones under GA and 27 under LA). Manipulation under anesthesia #nasal bones significantly improved both breathing satisfaction scores (GA; 2.88 ± 0.24 to 4.06 ± 0.23, P < 0.05; LA; 2.86 ± 0.22 to 3.77 ± 0.27, P < 0.05) and aesthetic scores (GA; 2.00 ± 0.21 to 3.94 ± 0.23, P < 0.05; LA; 1.64 ± 0.19 to 3.59 ± 0.28, P < 0.05) in both GA and LA groups. There was no statistically significant difference between LA and GA in postoperative outcomes. There was a trend toward greater satisfaction for GA, though this was not statistically significant and may be impacted by the rate of cartilaginous deformity in the LA group. Both techniques were well tolerated and most patients would repeat the procedure in hindsight. CONCLUSIONS Local anesthesia could provide a safer, cheaper, and satisfactory alternative for performing MUA #nasal bones in the clinic for selected patients, particularly with reduction of elective theater capacity in the event of further COVID-19 surges. We recommend training junior ENT surgeons to perform this procedure under supervision with adequate protective measures.
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Affiliation(s)
| | - Shaharyar Khan
- ENT Department, Northwick Park Hospital, London, United Kingdom
| | - Vikas Acharya
- ENT Department, Northwick Park Hospital, London, United Kingdom
| | - Ravina Tanna
- ENT Department, Lister Hospital, Stevenage, United Kingdom
| | - Surojit Pal
- ENT Department, Northwick Park Hospital, London, United Kingdom
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Akhondzadeh R, Olapour A, Rashidi M, Elyasinia F. Comparison of Sedation with Dexmedetomidine Alfentanil Versus Ketamine-Alfentanil in Patients Undergoing Closed Reduction of Nasal Fractures. Anesth Pain Med 2020; 10:e102946. [PMID: 33134144 PMCID: PMC7539046 DOI: 10.5812/aapm.102946] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/06/2020] [Accepted: 07/26/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives To compare the sedative effects of dexmedetomidine alfentanil versus ketamine-alfentanil in patients undergoing closed reduction of nasal fractures on the basis of intraoperative hemodynamic changes, satisfaction of patients and surgeons, and the adverse effects. Methods Sixty patients with ASA class 1 or 2 were randomized to either of two groups, a dexmedetomidine alfentanil group (DA group; n = 30) or a ketamine-alfentanil group (KA group; n = 30). Hemodynamic parameters, oxygenation status, adverse events, the satisfaction of patients and surgeons, and postoperative pain scores by visual analog scale (VAS) were recorded at specific time intervals during the trial. Results Systolic blood pressure was significantly lower in the DA group than in the KA group from T1 min to T15 min. The duration of the recovery ward stay was longer in the DA group; however, two groups were similar in terms of total anesthesia time and awakening time. Likewise, two groups were similar in terms of the patient and surgeon’s satisfaction, pain scores, and the occurrence of adverse effects. Conclusions Both sedation methods were safely performed, and dexmedetomidine-alfentanil is as effective as ketamine-alfentanil in patients undergoing short-term operations such as nasal fracture corrections.
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Affiliation(s)
- Reza Akhondzadeh
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Olapour
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahboobe Rashidi
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Fahimeh Elyasinia
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Pediatric-Specific Midfacial Fracture Patterns and Management: Pediatric Versus Adult Patients. J Craniofac Surg 2020; 31:e312-e315. [PMID: 31934970 DOI: 10.1097/scs.0000000000006166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the midfacial fracture patterns and management approaches between pediatric and adult patients. METHODS We retrospectively analyzed 164 pediatric patients (<16 years old) and 564 nongeriatric adult patients (16 to 65 years old) with midfacial fractures at a single institution between 2011 and 2016. The location of the fractures, along with the etiology and management of the midfacial fractures, were compared. RESULTS Significantly greater proportions of pediatric versus adult patients had sports-related injuries (P < 0.001) and sustained nasal fractures (P < 0.001). On the other hand, significantly greater proportions of adult versus pediatric patients were injured in falls, traffic accidents, or assaults (P = 0.004, P < 0.001, and P = 0.002) and sustained maxillary or zygomatic fractures (P = 0.039 and P < 0.001). Bivariate logistic regression analyses revealed that the risks of nasal, maxillary, and zygomatic fractures were significantly related to age status after adjusting for etiology (P < 0.001, P = 0.045, and P < 0.001). In contrast, the risks of hospitalization and surgical treatment were significantly associated with etiology, but not with age status (P = 0.290 and P = 0.847). CONCLUSION These data suggest that the age-related structure and composition of the facial skeleton affect the pediatric-specific fracture patterns independent of the etiology. The comparisons in this study may serve as a guide for the management of pediatric midfacial fractures.
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Lee SJ, Sung TY, Cho CK. Comparison of emergence agitation between succinylcholine and rocuronium-sugammadex in adults following closed reduction of a nasal bone fracture: a prospective randomized controlled trial. BMC Anesthesiol 2019; 19:228. [PMID: 31842841 PMCID: PMC6916043 DOI: 10.1186/s12871-019-0907-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/08/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Sugammadex allows rapid recovery from rocuronium-induced neuromuscular blockade. Succinylcholine is often used for brief surgeries but is associated with myalgia, headache, histamine release, and increased lactate levels. Thus, we hypothesized that succinylcholine may affect emergence agitation (EA) and compared the effects of succinylcholine and rocuronium-sugammadex on EA in patients undergoing closed reduction of a nasal bone fracture under general anesthesia. METHODS Forty-two patients were prospectively enrolled and allocated randomly to the succinylcholine group (group SC) or the rocuronium-sugammadex group (group RS; each n = 21). Neuromuscular block and its reversal were achieved with succinylcholine and normal saline in group SC, whereas rocuronium and sugammadex were administered in group RS. After surgery, the incidence of EA as a primary outcome, the incidence of dangerous EA, and duration of EA as secondary outcomes were compared. RESULTS The incidence of EA was higher in group SC than in group RS (90.5% vs. 47.6%, respectively; relative risk [RR] 4.3; 95% confidence interval [CI] 1.2 to 15.7; P = .006). The incidence of dangerous EA increased in group SC compared to group RS (33.3% vs. 4.8%, respectively; RR 2.1; 95% CI 1.3 to 3.4; P = .045). The duration of agitation was longer in group SC than in group RS [106.5 (65.1) vs. 40.4 (26.0) sec; mean difference 66.1 s; 95% CI 31.0 to 101.1; effect size 1.3; P = .001). CONCLUSION Succinylcholine increases the incidence, severity, and duration of EA compared to rocuronium-sugammadex in patients undergoing closed reduction of a nasal bone fracture. TRIAL REGISTRATION CRiS Registration number KCT0002673. Initial registration date was 31 January 2018 (Retrospectively registered).
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Affiliation(s)
- Seok-Jin Lee
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, 158, Gwangeodong-ro, Seo-gu, Daejeon, 35365, South Korea
| | - Tae-Yun Sung
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, 158, Gwangeodong-ro, Seo-gu, Daejeon, 35365, South Korea.
| | - Choon-Kyu Cho
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, 158, Gwangeodong-ro, Seo-gu, Daejeon, 35365, South Korea
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Bagatin T, Bagatin D, Šakić L, Šakić K. IMPACT OF LOCAL INFILTRATION ANESTHESIA ON POSTOPERATIVE PAIN MANAGEMENT AFTER RHINOPLASTY IN DAY CARE SURGERY. Acta Clin Croat 2019; 58:62-66. [PMID: 31741561 PMCID: PMC6813470 DOI: 10.20471/acc.2019.58.s1.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Use of local infiltration anaesthesia with 2% lidocaine in combination with epinephrine 1/100000 in rhinoplasty and 0.25% levobupivacaine in this research as an adjunct to general anaesthesia is compared analysing the need for postoperative analgesia in rhinoplasty patients. 30 patients received lidocaine combined with epinephrine (LA) and other 30 patients received levobupivacaine (LB). Comparison is done with Visual Analogue Scale in 30 min and 1, 3, 6 h postoperatively. Also 24 h need for analgesic treatment was recorded. In conclusion postoperative analgesia in LB group with general anaesthesia was significantly prolonged (P = 0.038).
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Affiliation(s)
| | - Dinko Bagatin
- 1Department of Maxillofacial, Plastic, Reconstuctive and Aesthetic Surgery at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 2Department of General, Plastic, Reconstuctive and Aesthetic Surgery at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 3Department of Anaesthesiology and Pain therapy at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 4Department of Anaesthesiology, Reanimathology and Intensive medicine University hospital "Sveti Duh", Zagreb, Croatia; 5Faculty of Dental medicine and Health Osijek, Josip Juraj Strossmayer University in Osijek, Osijek, Croatia; 6Catholic University of Croatia, Zagreb, Croatia
| | - Livija Šakić
- 1Department of Maxillofacial, Plastic, Reconstuctive and Aesthetic Surgery at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 2Department of General, Plastic, Reconstuctive and Aesthetic Surgery at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 3Department of Anaesthesiology and Pain therapy at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 4Department of Anaesthesiology, Reanimathology and Intensive medicine University hospital "Sveti Duh", Zagreb, Croatia; 5Faculty of Dental medicine and Health Osijek, Josip Juraj Strossmayer University in Osijek, Osijek, Croatia; 6Catholic University of Croatia, Zagreb, Croatia
| | - Kata Šakić
- 1Department of Maxillofacial, Plastic, Reconstuctive and Aesthetic Surgery at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 2Department of General, Plastic, Reconstuctive and Aesthetic Surgery at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 3Department of Anaesthesiology and Pain therapy at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 4Department of Anaesthesiology, Reanimathology and Intensive medicine University hospital "Sveti Duh", Zagreb, Croatia; 5Faculty of Dental medicine and Health Osijek, Josip Juraj Strossmayer University in Osijek, Osijek, Croatia; 6Catholic University of Croatia, Zagreb, Croatia
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Abstract
This study investigated the use of endonasal infiltrative anesthesia for the management of pain associated with nasal bone fracture reduction. Fifty-two patients with nasal bone fractures were distributed in 2 groups. In the first group, topical endonasal anesthesia and external transcutaneous infiltrative anesthesia were employed. In the second group, endonasal infiltrative anesthesia was also added. Visual analog scale pain scores related to the different steps of the procedure were registered. The addition of endonasal infiltrative anesthesia was associated with a significant decrease (p < .05) in pain during reduction maneuvers (6.71 vs. 4.83) and nasal packing (5.18 vs. 3.46). Addition of endonasal infiltrative anesthesia is an effective method of pain reduction during nasal bone fracture treatment.
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Scawn RL, Allen MJ, Rose GE, Verity DH. Randomised, masked study of local anaesthesia administered prior to external dacryocystorhinostomy under general anaesthesia. Eye (Lond) 2018; 33:374-379. [PMID: 30228368 DOI: 10.1038/s41433-018-0201-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/05/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To determine whether administration of local anaesthetic at the site of skin incision during open lacrimal drainage surgery under general anaesthesia alters the total dosage of anaesthetic drugs required during total intravenous anaesthesia (TIVA), and whether it alters postoperative pain and recovery. STUDY DESIGN Masked comparison of a randomized, two-group interventional study. PATIENTS AND METHODS Patients undergoing unilateral external dacryocystorhinostomy under total intravenous general anaesthesia were recruited from the lacrimal service at Moorfields Eye Hospital between September 2012 and February 2014. The patients were randomised to receive, after induction and stabilisation of general anaesthesia, infiltration of the ipsilateral paranasal tissues with 2.5 ml of 0.5% bupivacaine with 1:100000 epinephrine ("treatment" group), or a sham injection ("control" group); the infiltration was performed about 7 min prior to the skin incision. The infusion rates for propofol and remifentanil were adjusted to maintain a steady intra-operative mean blood pressure of 55-70 mmHg and BIS score of 40-60%. The time taken for extubation of the patient after cessation of TIVA was recorded, and postoperative pain scores (on a Likert scale from 0-10) were taken at regular intervals after extubation. The average intra-operative mean blood pressures, total drug usage, extubation time and pain scores for each of the two groups were compared using two-tail Student's t-testing and Wilcoxon rank sum testing. RESULTS There were 12 patients (7 female; 58%) in the treatment group and 11 (7 female; 64%) in the control group, with similar average age at surgery (59 years treatment, 53 years control; p = 0.38) The average operative time was 45 min in the treatment group (median 42, range 30-55) and 47 min (median 45; range 37-61) in the control group (p = 0.52). The mean dosage of propofol required to maintain satisfactory GA was significantly less in the "treatment" group (89.8 mcg/kg/min) as compared to the "control" group (mean 126 mcg/kg/min) (p = 0.0007). Likewise, remifentanil dosage was significantly less in the "treatment" group (100 ng/kg/min) as compared to controls (259 ng/kg/min) (p = 0.00007). The mean non-invasive blood pressure was consistently lower during surgery in the "treated" group, and showed less intra-operative variation. After surgery, the patients receiving LA had a significantly shorter extubation time (mean time 6.0 min in "treated" group, 12.1 min in "controls"; P < 0.0002) and also significantly lower pain scores at 10, 30, 60, 120 and 180 min after extubation (p < 0.01, p < 0.01, p < 0.01, p < 0.01 and p < 0.05, respectively). CONCLUSIONS Ipsilateral infiltration of local anaesthesia containing epinephrine in the paranasal tissues just prior to open dacryocystorhinostomy under total intravenous anaesthesia is associated with a 28% reduction in mean propofol usage, and a 61% reduction in remifentanil usage. LA usage during GA also produces improved and less variable intra-operative mean blood pressures, a significantly shorter extubation time and significantly lower postoperative pain scores.
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Affiliation(s)
- Richard L Scawn
- Adnexal Service, Moorfields Eye Hospital, London, UK.,Department of Ophthalmology, Stoke Mandeville NHS Trust, Buckinghamshire, UK
| | - Matthew J Allen
- Department of Anesthesia, Moorfields Eye Hospital, London, UK
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18
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Comparison of Postoperative Outcomes Between Monitored Anesthesia Care and General Anesthesia in Closed Reduction of Nasal Fracture. J Craniofac Surg 2018; 29:286-288. [PMID: 29084114 DOI: 10.1097/scs.0000000000004084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Fracture of nasal bone is among the most common facial bone fractures. Reduction of nasal bone fracture is able to be performed under local or general anesthesia. The aim of this study is to compare monitored anesthetic care (MAC) and general anesthesia (GA) based on intraoperative vital signs, and the adverse effects after closed reduction of nasal bone fractures.The authors performed a retrospective study of 45 patients who underwent a closed reduction of nasal bone fracture between January 1, 2016 and December 31, 2016. Patients are divided into an MAC group (n = 17) or GA group (n = 28). A sore throat, postoperative pain scores, nausea, vomiting, hospital stay, operation time, and the result of surgery are compared between the groups. All the patients have interviewed their satisfaction of aesthetic and functional outcome.The operation time and hospital stay were lower in the MAC group. There is no difference in a sore throat, postoperative pain score, and the result of surgery significantly. In the MAC and GA groups, there was no statistically significant difference in the postoperative cosmetic and functional satisfaction scores.Closed reduction of nasal bone fracture using MAC is as safe and efficient as GA. However, MAC anesthesia may not be feasible if airway discomfort due to bleeding is expected, or fracture is severe and multiple manipulations are required. Therefore, MAC is considered to be a good alternative when patients undergoing short-term or small operations do not prefer general anesthesia.
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Zhu J, Liu J, Shen G, Zhong T, Yu X. Comparison of Efficacy Outcomes of Lidocaine Spray, Topical Lidocaine Injection, and Lidocaine General Anesthesia in Nasal Bone Fractures Surgeries: A Randomized, Controlled Trial. Med Sci Monit 2018; 24:4386-4394. [PMID: 29941861 PMCID: PMC6050998 DOI: 10.12659/msm.908468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Lidocaine is widely used as a general and local anesthetic in minor or major surgeries. The objective of the study was to compare postoperative pain relief and adverse events using different forms of lidocaine administration in patients following closed nasal bone reduction surgery. Material/Methods A total of 381 patients with a solitary nasal fracture that could be managed with closed reduction were included in this study and divided into 3 groups of 127 patients in each group. Patients had received 1% lidocaine HCl with epinephrine (LL group), inserted a mesh impregnated with lidocaine spray (TL group), or 1 mg/kg/h lidocaine infusion (GL group) before surgeries. Patients also received morphine when the pain was not controlled. The postoperative pain was assessed at 6 hours and 48 hours after surgery. Postoperative vomiting and nausea were evaluated. Repeated ANOVA/Tukey-Kramer multiple comparisons test was performed at 95% confidence level. Results At 6 hours after surgery, patients in the general lidocaine (GL) group reported decreased postoperative pain compared with those in the topical lidocaine (TL) group (P<0.001, q=6.633) and LL group (P<0.001, q=8.056). The morphine consumption within 48 hours was least in GL group than TL group (P<0.001, q=172.9) and LL group (P<0.001, q=226.42). Lidocaine infusion caused nausea (P<0.001, q=6.742) and vomiting (P<0.001, q=4.306). Conclusions Topical lidocaine anesthesia had the same postoperative pain relief and the least adverse events as local and general lidocaine anesthesia.
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Affiliation(s)
- Jihong Zhu
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Jian Liu
- Department of General Surgery, Wuyi Traditional Chinese Medical Hospital, Jinhua, Zhejiang, China (mainland)
| | - Guoying Shen
- Our-Patient Department, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Taidi Zhong
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Xin Yu
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
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Choi SR, Kim JH, Chae KL, Lee SC, Park SY. Anesthetic considerations during surgical intervention in Woake's syndrome -a case report. Korean J Anesthesiol 2018; 72:265-269. [PMID: 29764007 PMCID: PMC6547234 DOI: 10.4097/kja.d.17.00078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/04/2018] [Indexed: 11/13/2022] Open
Abstract
Background Woake’s syndrome (WS) is a recurrent nasal polyposis, accompanied by broadening of the nose, frontal sinus aplasia, dyscrinia, and bronchiectasis. There has been no previous report on anesthetic management in patients with WS. Case We describe a case involving a 13-year-old male patient with WS who was scheduled for septorhinoplasty for necrotic ethmoiditis. Anesthesia was induced and maintained with propofol and remifentanil using a target-controlled infusion device. The anesthetic considerations of this rare syndrome and the advantages of an intravenous infusion method over local and volatile anesthesia for these patients are discussed. We report on caveats, such as pulmonary dysfunction during the anesthetic management, and nasal structural problems encountered in WS patients. Conclusions Given that conventional inhaled anesthesia reduces ciliary movement and that local anesthesia with sedative has several disadvantages, perioperative control and precautions against respiratory infections by using antibiotics, and preventing cilio-depressant actions, are important for anesthetic management.
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Affiliation(s)
- So Ron Choi
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jeong Ho Kim
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Kyoung Lin Chae
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Seung Cheol Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Sang Yoong Park
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
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Abstract
Nasal fractures are the most frequently fractured facial bone from blunt facial trauma resulting in a significant number of patients seeking treatment. Proper evaluation and treatment in the acute setting can minimize secondary surgeries, lower overall health care costs, and increase patient satisfaction. Nasal fracture management, however, varies widely between surgeons. The open treatment of isolated nasal fractures is a particularly controversial subject. This review seeks to describe the existing literature in isolated nasal fracture management.
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Dougherty WM, Christophel JJ, Park SS. Evidence-Based Medicine in Facial Trauma. Facial Plast Surg Clin North Am 2017; 25:629-643. [PMID: 28941514 DOI: 10.1016/j.fsc.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article provides the reader with a comprehensive review of high-level evidence-based medicine in facial trauma and highlights areas devoid of high-level evidence. The article is organized in the order one might approach a clinical problem: starting with the workup, followed by treatment considerations, operative decisions, and postoperative treatments. Individual injuries are discussed within each section, with an overview of the available high-level clinical evidence. This article not only provides a quick reference for the facial traumatologist, but also allows the reader to identify areas that lack high-level evidence, perhaps motivating future endeavors.
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Affiliation(s)
- William M Dougherty
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - John Jared Christophel
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Stephen S Park
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
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Abstract
Facial fractures are a common source of emergency department consultations for the plastic surgeon. A working understanding of evaluation, assessment, management, and prevention of further injury when dealing with these fractures is vital. This two-part series detailing the management of midface fractures serves as a guide for the appropriate workup and management of the wide variety of fracture patterns that are commonly encountered.
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Affiliation(s)
- Matthew Louis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Nikhil Agrawal
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew Kaufman
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Tuan A Truong
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Alsharif U, Al-Moraissi E, Alabed S. Systemic antibiotic prophylaxis for preventing infectious complications in maxillofacial trauma surgery. Hippokratia 2017. [DOI: 10.1002/14651858.cd012603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ubai Alsharif
- Charite-Universitatsmedizin Berlin; Chariteplatz 1 Berlin Germany 10117
| | - Essam Al-Moraissi
- Thamar University; Department of Oral and Maxillofacial Surgery; Radaa Street Thamar Thamar Yemen
| | - Samer Alabed
- University of Sheffield; Academic Unit of Radiology; Sheffield UK
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25
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Abstract
Osteotomies are critical techniques in rhinoplasty. There are a variety of approaches, trajectories, and tools used with no widely standardized classification or nomenclature. Percutaneous osteotomies are gaining in popularity, and picture framing the nasomaxillary bone is crucial for predictable fracture and reproducible results. This is best accomplished with medial, lateral, and transverse osteotomies. Intermediate osteotomies are used less frequently, but provide more mobility. With a detailed understanding of anatomy and a thorough approach to nasal osteotomies, the contour and function of the bony vault can be reshaped with a successful outcome for both the surgeon and patient.
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Affiliation(s)
- Kyle K VanKoevering
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA
| | - Andrew J Rosko
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA; Center for Facial Cosmetic Surgery, 19900 Haggerty Road, Suite 103, Livonia, MI 48152, USA.
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Al-Moraissi EA, Ellis E. In Reply. J Oral Maxillofac Surg 2016; 74:1106-8. [DOI: 10.1016/j.joms.2016.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 11/30/2022]
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Kelly E. In Regard to Local Versus General Anesthesia for the Management of Nasal Bone Fractures: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2016; 74:1105-6. [PMID: 26917202 DOI: 10.1016/j.joms.2016.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 11/29/2022]
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30
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Abstract
With demands for an evidence-based approach to patient care, the management of facial fractures will come under increasing scrutiny because there is an overall deficiency in higher level clinical evidence. This article reviews the management of facial fractures, focusing on an evidence-based approach. It focuses on select areas of facial trauma in which there is controversy and presents randomized studies and meta-analysis to help define best practice. The article notes the many areas where the evidenced-based literature is weak and looks at the future of evidence-based facial trauma care.
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Affiliation(s)
- Timothy D Doerr
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood, Box 629, Rochester, NY 14642, USA.
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