The Comparison of Duration Endotracheal Tube Insertion Using Aerosol Box And without Aerosol Box in Elective Surgery Patients in the Covid-19 Pandemic

Introduction. The aerosol box can reduce the risk of droplet and aerosol transmission from the patient to the operator when performing intubation, but in practice, an aerosol box makes the glottis visualization less evident, and the operator moves less space with less space the aerosol box. This study aimed to compare ETT duration using an aerosol box and without an aerosol box using a video laryngoscope. Methods: This study was a clinical trial with a post-test-only control design. The study was carried out from February 2021 to May 2021 at the Central Operating Theater of dr. Mohammad Hoesin General Hospital Palembang. The sample in this study was all patients who underwent elective surgery under general anesthesia using intubation at the Central Surgical Installation of dr. Mohammad Hoesin Palembang. After the data is collected, it is analyzed using the SPSS 22.0 program with the appropriate test. Results. There were no differences in subject characteristics (age, sex, BMI, Mallampati score, TMD, Cormack Lehane, limited mouth opening, short neck, limited mouth movement) between the group using the aerosol box and the group without the aerosol box. The duration of intubation without an aerosol box is 30.67 + 2.63 seconds, and using an aerosol box is 44.53 + 2.89 seconds. There was a significant difference between the two groups in the duration of patient intubation (p < 0.001). However, there was no significant difference in complications in the two groups (p >0.05). Conclusion. The duration of the endotracheal tube insertion using an aerosol box is more extended than without an aerosol box in elective surgery patients.

MANDIBULAR DEVIATION IN UNILATERAL CHEWING HABITS

ntroduction: The mandibular movement pattern was used to evaluate the presence of a dysfunction. Impaired TMJ function is called temporomandibular disorder (TMD). One of the causes that are often associated with TMD is a bad habit of chewing one side. This habit is often done without realizing it, causing an imbalance in the distribution of the chewing load and can result in deviation or displacement. The occurrence of TMD can be characterized by limited mouth opening of less than 40 mm. Objective: This study aims to determine the presence of abnormalities in the pattern of mandibular movement in the bad habit of chewing on one side. Methods: The research method used is descriptive observational research with saturated sampling technique with a sample of 25 students of the Faculty of Dentistry, Mahasaraswati University Denpasar, class of 2017. Data collection was carried out by observing through videos of mandibular movement patterns. Results and conclusions: The results showed the pattern of mandibular movement with the habit of chewing on one side, in men who deviated 28%, in women 32%, while in men who did not deviate 12% and in women as much as 28%

Airway Challenges in Sanjad-Sakati Syndrome (SSS): A Case Report and Review of Literature

Sanjad-Sakati Syndrome (SSS) is a rare syndrome, discovered in Saudi Arabia in 1988. This syndrome is characterized by congenital hypoparathyroidism, severe growth retardation, dysmorphic features, mild to severe mental retardation as well as recurrent chest infections. We presented an eight-year-girl with SSS, with severe growth retardation, mental retardation, resolution of recent chest infection together with a history of bronchial asthma, dysmorphic features, limited mouth opening, micrognathia as well as high susceptibility to difficult intubation. The objective of this case report is to present the successful anaesthetic management of a rare genetic endocrinal syndrome.

Pathological fracture of the jaw due to osteomyelitis after a third molar extraction

The osteomyelitis is an inflammatory process in bone tissue caused by an infection, commonly related to anaerobic pathogens, frequently Staphylococcus aureus and Streptococcus sp. Several causes have been related such as dentoalveolar infection, trauma, radiation and genetic condition, but it is not common after surgery for third molar extractions, especially in healthy patients. The symptoms of chronic osteomyelitis usually include signs and symptoms such as pain, edema, suppuration, areas of bone sequestration, and limited mouth opening. Among the complications associated with this condition, pathological fracture may occur due to local bone fragility. This paper aimed to report a rare case of pathological mandible fracture due to osteomyelitis after third molar extraction in a healthy male patient treated by a surgical procedure. The procedure consisted of decortication and resection of the sclerotic bone followed by reduce and fixation of mandibular fracture with one 2.4 reconstructive plate and one 2.0 plate with standard screws.

Distribution of Oral Submucous Fibrosis Cases and Malignant Transformation Rate among Bhutanese Patients Treated at Jigme Dorji Wangchuck National Referral Hospital, Bhutan

BACKGROUND: Oral Submucous Fibrosis (OSMF) is a chronic, insidious, scarring disease of the mouth often involving the palate, oro-pharynx, pharynx, esophagus, tongue and the buccal mucosa which leads to ulceration, blanching and ultimately limited mouth opening. The aim of the study is to describe the age, gender and district-wise distribution of oral submucous fibrosis cases and to assess the malignant transformation rate among the patients with oral submucous fibrosis who were treated at Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.MATERIALS AND METHOD: This is a descriptive retrospective study. The patients were clinically diagnosed by examining their mouth and by measuring their mouth opening (Inter-incisal height). Patients who had less than 3 fingers mouth opening and diagnosed as Oral submucous fibrosis (OSMF) during these three-year period from 2018 to 2020 were considered for the study.RESULTS: There were 278 cases in total. Thimphu district had the maximum number of cases followed by Wangduephodrang and Samtse. Gasa and Haa districts had the minimum cases. More males were affected than females. The malignant transformation rate among these patients was 4.3%.CONCLUSION: Thimphu district had the highest proportion of OSMF cases and was almost equally distributed among genders. Over 90% of the patients reported improvement without surgery while the malignancy transformation rate was 4.3%. The study recommends conducting screening in districts with high burden of OSMF cases for early diagnosis and treatment.

The importance of videolaryngoscopy in maxillofacial practice associated with restricted mouth opening in traumatized patients

Orotracheal intubation is considered the most delicate maneuver performed by anesthesiologists, and failure to manage the airways is one of the main causes of possible complications that can be catastrophic during its performance, thus requiring good team planning. Anatomical and / or physiological characteristics, such as limited mouth opening, a condition often found in patients suffering from fractures of the zygomatic arch or who have some abnormality in the temporomandibular joint (TMJ), can characterize a difficult airway, which demands attention greatest of the professional. Therefore, in order to overcome the obstacles that may occur during a difficult or unexpected intubation, new tools have been used, such as videolaryngoscopy in which an intubation device containing miniature video cameras is used in order to allow the operator has an indirect view of the glottis to increase success rates and decrease intubation time. The aim of the present study is to report a clinical case of a trauma victim, with limited mouth opening, who underwent intubation with the aid of a video laryngoscope after failed attempts at conventional intubation.

Non-invasive treatment modalities of limited mouth opening due to diseases and internal disorders of the temporomandibular joint

Magnetic resonance imaging is widely used in the presence of such patient complaints as clicking, locking and pain in the temporomandibular joint. The different problems in the treatment of temporomandibular joint pathology, which is accompanied by limited mouth opening, requires certain recommendations for magnetic resonance imaging, supported by current classifications. The purpose of the study: to substantiate the need for the use of an individual mandibular fixator, made before magnetic resonance imaging in the open mouth position to systematization of the treatment outcomes. Materials and methods. On the basis of clinical examination and objectification of the temporomandibular joint status by magnetic resonance imaging the results of treatment of diseases and internal disorders of the temporomandibular joint, which can be obtained by a dentist-gnathologist using non-invasive methods, was analyzed. To obtain images after treatment of the temporomandibular joint an individual mandibular fixator was used, which provided the possibility of evidencebased determination of the articular head position in the open mouth state. To systematize the analysis results of magnetic resonance imaging of the temporomandibular joint, the most convenient classification was chosen. Results. From a clinical sight, the gnathological treatment of temporomandibular joint dislocation without reposition is considered effective if the distance between the incisors, at maximum mouth opening, is 41–50 mm, the articular head is located at the apex of articular tubercle, and in the questioning and isometric tests the patient complaints are absent. Conclusions. The most effective non-invasive treatment of limited mouth opening is possibly with early ambulation, i.e. from three to seven months after onset. Key words: temporomandibular joint, gnathologist, magnetic resonance imaging.

Temporomandibular joint pain and associated magnetic resonance findings: a retrospective study with a control group

Background To better understand and evaluate clinical usefulness of magnetic resonance imaging (MRI) in diagnosis and treatment of temporomandibular disorders (TMD), parameters for the evaluation are useful. Purpose To assess a clinically suitable staging system for evaluation of MRI of the temporomandibular joint (TMJ) and correlate the findings with age and some clinical symptoms of the TMJ. Material and Methods Retrospective analysis of 79 consecutive patients with clinical temporomandibular disorder or diagnosed inflammatory arthritis. Twenty-six healthy volunteers were included as controls. Existing data included TMJ pain, limited mouth opening (<30 mm) and corresponding MRI evaluations of the TMJs. Results The patients with clinical TMD complaints had statistically significantly more anterior disc displacement (ADD), disc deformation, caput flattening, surface destructions, osteophytes, and caput edema diagnosed by MRI compared to the controls. Among the arthritis patients, ADD, effusion, caput flattening, surface destructions, osteophytes, and caput edema were significantly more prevalent compared to the healthy volunteers. In the control group, disc deformation and presence of osteophytes significantly increased with age, and a borderline significance was found for ADD and surface destructions on the condylar head. No statistically significant associations were found between investigated clinical and MRI parameters. Conclusion This study presents a clinically suitable staging system for comparable MRI findings in the TMJs. Our results indicate that some findings are due to age-related degenerative changes rather than pathological changes. Results also show that clinical findings such as pain and limited mouth opening may not be related to changes diagnosed by MRI.