Clinico-Pathological Characteristics, Management, and Outcome of Benign Intraosseous Maxillary Tumors in Adolescents: A Prospective Study

Abstract

that nasal congestion with respiratory difficulty is 1 of the worst symptoms, which were most difficult to tolerate after bimaxillary orthognathic surgery including Le Fort I osteotomy. 7 Second, naso-tracheal intubation is usually required for the orthognathic surgery, which causes mucosal swelling inside nasal airway due to damage or irritation to the nasal mucosa. Furthermore, patients with intermaxillary fixation immediate after the surgery have difficulty in oral breathing.Regarding to treatment, conservative managements such as rest, oxygen therapy, and pain control with analgesia are preferred. Supplying oxygen will increase the diffusion pressure of nitrogen in the subcutaneous tissue and mediastinum. If resolving the pneumomediastinum is fail, mediastinotomy should be performed making incision in the supraclavicular fossa posterior to the sternocleidomastoid muscle and in the suprasternal notch. In our cases, case 1, 2, and 4 patients with treated with high oxygenation but case 3 patient were treated with both oxygenation and suprasternal notch incision.In conclusion, we reported 4 cases of subcutaneous emphysema with or without pneumomediastinum after orthognathic surgery. It can be occurred by cervical fascia injury or alveolar ruptures. To preventing the pneumomediastinum after the orthognathic surgery, traumatic naso-tracheal intubation, excessive positive pressure ventilation, intermaxillary fixation immediate after the surgery and increase of intra-alveolar pressure of the patients should be avoided. Plain chest radiography is useful tool for initial diagnosis of pneumomediastinum, however chest CT describes exact extent of lesion. Conservative management with pain control and oxygenation can be done first and mediastinotomy also performed if resolving the air is failed.

Bilateral Inverted and Impacted Mandibular Third Molars: A Rare Case Report

“…Piezosurgery is a kind of osteotomy in which ultrasonic micro-vibrations are used to perform green bone slicing [28]. Ultrasonic vibrations grant a specific and depicted slicing activity, leading to a higher level of accuracy and protection and substantially less tissue injury than the utilization of typically used burs [29][30][31][32]. This makes the piezoelectric device useful for application in critical areas, including the posterior mandible, where the osteotomy is required in close proximity of nerves and blood vessels.…”