scholarly journals The Impact of Bilateral Suprazygomatic Maxillary Nerve Blocks on Postoperative Pain Control in Patients Undergoing Orthognathic Surgery

FACE ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 58-65
Author(s):  
Gabriela D. Garcia Nores ◽  
Daniel A. Cuzzone ◽  
Stefanie E. Hush ◽  
Kalyani Pandya ◽  
Adam Stuart ◽  
...  
Keyword(s):  
Pain Control ◽  
Complication Rates ◽  
Block Group ◽  
Nerve Blocks ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Nerve Blockade ◽  
Maxillary Nerve ◽  
Pain Scales ◽  
Le Fort I

Aims: The mainstay of analgesia in orthognathic interventions for maxillary hypoplasia is perioperative opioids, however, the side effect profile is broad with the potential for well-described deleterious effects. The suprazygomatic maxillary nerve block has been previously shown to be effective in decreasing pain associated with palatal surgery. To date, there have been no studies detailing the use of maxillary nerve blocks as an adjunctive pain control measure during correction of maxillary hypoplasia. Consequently, we sought to evaluate the efficacy of intra-operative, ultrasound-guided bilateral suprazygomatic maxillary nerve blockade in decreasing postoperative narcotic consumption in patients undergoing Le Fort I level surgical orthognathic correction of cleft-related maxillary hypoplasia. Methods: Between January and December 2019, patients underdoing suprazygomatic maxillary nerve blockade for orthognathic correction of maxillary hypoplasia via either Le Fort I advancement or distraction were prospectively collected and compared to controls. Patient demographics, narcotic use (represented as morphine milligram equivalents per kg; MME/kg), self-reported pain scales, operative times, length of stay (LOS), and complication rates were compared. Results: Over the 12-month interval, 40 patients met inclusion criteria (n = 19 Block; n = 21 Control). Mean ages were 15.6 and 15.9 years, respectively. The block group demonstrated a significant reduction in postoperative narcotic requirements on POD1 and POD2 when compared to controls (POD1: 0.020 mg/kg vs 0.066 mg/kg, P < .005; POD2: 0.030 mg/kg vs 0.080 mg/kg, P < .016), with a trend toward significance thereafter. Corroboratively, self-reported pain scores in the first 24 hours were significantly decreased in the block compared to control groups with a trend toward significance thereafter (POD1: 1.13 vs 2.72, P < .001; POD2: 1.72 vs 2.56, P < .08; POD3: 1.21 vs 2.07, P < .06). LOS was decreased by an average of 1 day in the block group, operative times were unchanged, and neither group evidenced perioperative complication or return to service within 30 days. Conclusion: Administration of bilateral suprazygomatic maxillary nerve blocks in patients undergoing Le Fort I maxillary osteotomy for correction of cleft-related maxillary deficiency demonstrated a significant reduction in post-operative narcotic requirements, self-reported pain scales, and LOS without increased complications, suggesting its utility as a safe and effective analgesic adjunct in this patient population.

A new Le Fort I internal distraction device in the treatment of severe maxillary hypoplasia

2005 ◽  
Vol 63 (1) ◽  
pp. 148-154 ◽  
Author(s):  
Jaime Gateno ◽  
Eric R. Engel ◽  
John F. Teichgraeber ◽  
Kyoko E. Yamaji ◽  
James J. Xia
Keyword(s):  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Distraction Device ◽  
Le Fort I ◽  
Internal Distraction

Evaluation of Lefort I Osteotomy Line and Pterygomaxillary Junction Region in Patients With Cleft Lip and Palate

2020 ◽  
pp. 105566562096957
Author(s):  
Bahadır Sancar ◽  
Şuayip Burak Duman
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Class Iii ◽  
Class Iii Malocclusion ◽  
Le Fort I Osteotomy ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Osteotomy Line ◽  
Le Fort I ◽  
Pterygomaxillary Junction

Objective: This study aimed to evaluate the Le Fort I osteotomy line and pterygomaxillary junction via cone-beam computed tomography in individuals with cleft lip and palate (CLP). Design: Retrospective study. Patients and Methods: The study included individuals older than 16 years with CLP, who were scheduled for repositioning of the maxilla by Le Fort I osteotomy, and those with class III malocclusion with maxillary hypoplasia, who were scheduled for Le Fort I osteotomy. The measurements made in the area of the cleft of individuals with CLP were compared with both the side with no cleft and those with class III malocclusion with maxillary hypoplasia. A total of 11 measurements were made on the axial section parallel to the Frankfurt Horizontal plane, corresponding to the lower 1/5 of the distance between the infraorbital foramen and the anterior nasal spine. Results: There were significant differences both in the comparisons made between the individuals with CLP and those without CLP in terms of the canal-anterior alveolar crest (G) and sinus-anterior alveolar crest (L) measurements ( P < .05). The mean measurement values showed that the measurement results were higher in individuals with CLP in general. Conclusion: In conclusion, we believe that there might be difficulties both in osteotomy and down fracture stages during Le Fort I osteotomies performed in individuals with CLP.

scholarly journals The Role of Interfascial Plane Blocks in Paediatric Regional Anaesthesia: A Narrative Review of Current Perspectives and Updates

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Sujana Dontukurthy ◽  
Roshanak Mofidi
Keyword(s):  
Pain Control ◽  
Regional Anaesthesia ◽  
Early Mobilization ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Narrative Review ◽  
Complication Rates ◽  
Early Recovery ◽  
Nerve Blocks ◽  
Anaesthesia Practice

Regional anaesthesia has been increasingly used for analgesia in the perioperative period in paediatric anaesthesia for better pain control and improved patient outcomes. Interfascial plane blocks are considered as a subgroup of peripheral nerve blocks. The advent of ultrasound in modern regional anaesthesia practice has led to the evolution of various interfascial plane blocks. The ease of their performance and the low complication rates, compared with neuraxial anaesthesia, have led to their increased use in the perioperative period. Interfascial plane blocks are often incorporated in the multimodal analgesia regimen in the early recovery and ambulation after surgery protocols for various chest wall and abdominal surgeries. This achieves better pain control and decreases the requirements of opioids in the perioperative period, thereby facilitating early mobilization and discharge. This narrative review focuses on the relevant anatomic considerations, technique for the performance of each block along with its current applications and limitations, and includes a review of the current literature on various interfascial plane blocks in paediatric regional anaesthesia.

Etiology of Cleft Lip Lower Lip Deformity: Use of an Objective Analysis to Measure Severity

2019 ◽  
Vol 56 (10) ◽  
pp. 1333-1339 ◽  
Author(s):  
Mirte Langeveld ◽  
Richard A. Bruun ◽  
Maarten J. Koudstaal ◽  
Bonnie L. Padwa
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Case ◽  
Lower Lip ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Le Fort I ◽  
Control Study

Objective: Measure lower lip thickness and eversion in patients with cleft lip and palate (CLP) and maxillary hypoplasia. The specific aims were to (1) compare lower lip thickness/eversion in patients with CLP to noncleft controls with maxillary hypoplasia, (2) determine differences between patients with unilateral CLP (UCLP) and bilateral CLP (BCLP), and (3) document changes in the lower lip that occur with Le Fort I advancement. Design: Retrospective case–control study. Setting: Tertiary care center. Patients/Participants: Patients with available pre- and postoperative CT scans and 2D lateral photographs who had a Le Fort I advancement between 2009 and 2017. There were 32 patients with CLP (17 females; mean age 17.7 ± 1.9 years) and 33 noncleft controls (21 females; mean age 18.8 ± 2.6 years). Main Outcome Measures: Lower lip thickness and eversion. Results: Patients with CLP and maxillary hypoplasia have a significantly thicker lower lip ( P = .019) and outward rotation of the vermilion border ( P = .003) compared to noncleft controls. The lower lip was significantly thicker in patients with BCLP than in those with UCLP ( P = .035). Lower lip thickness and rotation did not change after maxillary advancement. Conclusions: Patients with CLP and maxillary hypoplasia have a thicker and more everted lower lip than noncleft controls. Patients with BCLP have a significantly thicker lower lip than those with UCLP. Strain of the lower lip musculature appears to be an important contributor to the development of the cleft lip lower lip deformity.

Lateral Incisor Agenesis Predicts Maxillary Hypoplasia and Le Fort I Advancement Surgery in Cleft Patients

2015 ◽  
Vol 135 (1) ◽  
pp. 142e-148e ◽  
Author(s):  
Li Han Lai ◽  
Brian K. Hui ◽  
Phuong D. Nguyen ◽  
Kristen S. Yee ◽  
Martin G. Martz ◽  
...  
Keyword(s):  
Lateral Incisor ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Lateral Incisor Agenesis ◽  
Le Fort I

Maxillary Hypoplasia in the Cleft Patient: Contribution of Dental Agenesis to Le Fort I Advancement Surgery

2014 ◽  
Vol 72 (9) ◽  
pp. e56-e57
Author(s):  
B.K. Hui ◽  
L.H. Lai ◽  
P.D. Nguyen ◽  
K.S. Yee ◽  
M.G. Martz ◽  
...  
Keyword(s):  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Le Fort I

Morphologic and Management Characteristics of Individuals with Unilateral Cleft Lip and Palate Who Required Maxillary Advancement

2008 ◽  
Vol 45 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Snehlata Oberoi ◽  
Radhika Chigurupati ◽  
Karin Vargervik
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Control Group ◽  
Missing Teeth ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Time Points ◽  
Team Care ◽  
Maxillary Advancement ◽  
Le Fort I

Objective: To delineate factors that may contribute to maxillary hypoplasia requiring maxillary advancement surgery in individuals with nonsyndromic unilateral cleft lip and palate (UCLP). Methods: This retrospective, longitudinal study used lateral cephalometric radiographs and chart reviews of 16 nonsyndromic UCLP individuals who underwent Le Fort I maxillary advancement and 16 controls matched for cleft type, age, and gender. Cephalometric measurements were made at three time points (T1, T2, and T3): mean ages of 10.7, 13.3, and 15.8 years for the Le Fort group and 10.11, 12.9, and 15.7 years, respectively, for the control group. Information regarding team care, timing and number of surgical procedures, and number of congenitally missing teeth were determined from clinical records. Results: The Le Fort group had significant maxillary hypoplasia at all time points compared to the UCLP controls, indicated by midface length measurements, ANB and Wit's analysis ( p < .001). The Le Fort group had twice the number of palatal surgical procedures and number of missing teeth in the maxillary arch as compared with the cleft controls. Most of the control group had consistent team care, while most of the surgical group did not. Conclusions: Maxillary hypoplasia that will require a Le Fort I advancement can be determined as early as age 10. Multiple missing maxillary teeth, secondary palate procedures including pharyngeal flaps, and inconsistent team care with delayed orthodontic intervention are contributing factors to maxillary underdevelopment.

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