No abstract

THE VALUE OF periodontal dressings after periodontal surgery has been questioned. This study further evaluated chlorhexidine as a possible alternative. A group of nine patients requiring comparable bilateral inverse bevel flap procedures underwent preoperative oral hygiene instruction and scaling. Immediately before surgery and up to 3 months postoperatively, clinical records of plaque index, pocket depths and sulcus bleeding index were made. Records were taken of patients' postoperative discomfort and preferences. During the 1st postoperative week either a 0.2% chlorhexidine gluconate or a 1% saline mouthrinse was prescribed. Plaque accumulation and sulcus bleeding were significantly reduced on the sides treated with chlorhexidine. Significant reductions in pocket depths were recorded for both groups but there were not differences between treatments. Less postoperative discomfort was experienced with chlorhexidine, although the difference was not significant. Five patients preferred chlorhexidine, one saline, and three had no preferences. These and previous results suggest that a periodontal dressing is unnecessary or even undesirable after the inverse bevel flap procedure, and may be usefully replaced by a suitable antiplaque agent.

No abstract

A consecutive series of 48 adult patients with a chronic subdural hematoma is reported. These patients were treated according to a protocol consisting of a sequence of conventional surgical procedures ranging from simple burr-hole drainage to craniotomy and subdural membranectomy. Seven patients (15%) continued to demonstrate severe neurological dysfunction, or suffered acute neurological deterioration after completion of this protocol. However, after undergoing excision of the cranial vault overlying the hematoma site, six of these seven patients demonstrated a significant clinical improvement. Based on analysis of these seven cases, the authors suggest that craniectomy be considered in those patients who suffer a symptomatic reaccumulation of subdural fluid following craniotomy and membranectomy, or who demonstrate further neurological deterioration as a result of cerebral swelling subjacent to the hematoma site. However, this procedure probably has no efficacy once extensive cerebral infarction has occurred.

A group of 15 patients requiring comparable bilateral internal bevelled flap procedures took part in a study to compare the clinical results achieved when a dressing or chlorhexidine mouthwash was used during the first postoperative week. Initial preoperative conditions were comparable. At the end of the first postoperative week, significantly more plaque accumulated and the sulcus bleeding index was significantly higher on the dressing treated side. At 1 month and 3 months postoperatively the sulcus bleeding indices were below preoperative levels for both treated sides with no significant differences between the sides. A significant and comparable reduction in pocket depths occurred following the two postoperative treatments. Subjectively recorded pain scores demonstrated that more pain was experienced on the dressing treated side, particularly during the first 4 postoperative days. More patients preferred the mouthwash as a postoperative treatment.