Journal of dental anesthesia and pain medicine最新文献

{"title":"Adrenaline dilution in dental local anesthetic: a preliminary study to prevent coring in cartridges.","authors":"Takutoshi Inoue, Toru Yamamoto","doi":"10.17245/jdapm.2024.24.6.415","DOIUrl":"10.17245/jdapm.2024.24.6.415","url":null,"abstract":"<p><p>Many patients with underlying medical conditions are treated with local anesthetics in dental clinics. Dental local anesthetic cartridges contain the vasoconstrictor adrenaline, which can affect the cardiovascular system. For this reason, the adrenaline in the cartridge (2% lidocaine + 1:80,000 adrenaline) is sometimes diluted in order to avoid hemodynamic changes in these patients. However, at the same time, considerations have to be made for coring. Coring is a process in which a piece of rubber is scraped off when a needle is inserted into a rubber stopper, and the rubber is mixed with the drug solution. Particles generated during the coring process contaminate local anesthetic solutions. In this study, we closely observed the puncture site of a 33G dental needle inside a cartridge to investigate a safe dilution method that considers coring. The puncture site was located within 1.50 ± 0.08 mm (mean ± SD) of the diameter from the center of the rubber stopper of the cartridge head. Punctures were made with a 0.75-mm outer diameter metal needle outside the 1.50-mm diameter range from the center of the rubber stopper to reduce the overlap between puncture sites and minimize the risk of coring. After discarding half of the cartridge, 2% lidocaine without adrenaline was injected by piercing the end of the rubber stopper at the cartridge head with a 22-27G metal needle (outer diameter approximately 0.4-0.7 mm). This method minimizes the risk of rubber displacement and coring while ensuring a safe and effective dilution process. Providing a safer method for adrenaline dilution reduces the risk of coring and contamination in dental anesthetic cartridges.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 6","pages":"415-420"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of vasoconstriction by dexmedetomidine in the mandible of rat.","authors":"Hikaru Sato, Shota Abe, Kimiharu Ambe, Shinya Yamazaki, Hiroyoshi Kawaai","doi":"10.17245/jdapm.2024.24.6.375","DOIUrl":"10.17245/jdapm.2024.24.6.375","url":null,"abstract":"<p><strong>Background: </strong>In recent years, dexmedetomidine (DEX) has been proposed as a useful vasoconstrictor for local anesthesia because it is less effective in circulation than clonidine of antihypertensive drugs. In addition, DEX is expected to act as a vasoconstrictor during local anesthesia. However, histomorphometric studies demonstrating that DEX exerts vasoconstrictive effects are lacking. This study aimed to clarify whether DEX exerts a histomorphologically vasoconstrictive effect on blood vessels in the mandible of rats.</p><p><strong>Methods: </strong>A total of 12 male Wistar rats were used. General anesthesia was induced and maintained using sevoflurane. Normal saline (0.2 ml) was injected on the left side of the jaw (DEX (-) effect site) and 0.2 ml normal saline containing 12.5 µg/ml DEX was injected on the right side of the jaw (DEX (+) effect site). The puncture point was located on the mesial side of the first molar, 1 mm away from the gingival sulcus. Following decalcification, the specimens were paraffinized and sagittally sliced into 20 µm-thick sections, followed by staining with anti-α smooth muscle actin antibody. The intravascular lumen area was measured in the oral mucosa, periodontal ligament, mandibular bone above the root apex, mandibular bone below the root apex, and dental pulp. The unpaired t-test was used for statistical analysis, and a P value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Compared to the DEX (-) effect site, the intravascular lumen area in the oral mucosa and periodontal ligament of the DEX (+) effect site was significantly decreased. No significant difference was observed in the intravascular lumen area between the DEX (-) and DEX (-) effect sites in the mandibular bone above and below the root apex and dental pulp.</p><p><strong>Conclusion: </strong>A direct vasoconstrictive effect of DEX was not observed in the intravascular lumen of the mandibular bone above and below the root apex and dental pulp; however, it was observed in the oral mucosa and periodontal ligament.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 6","pages":"375-383"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the effect of essential oil aromatherapy on anxiety and pain during administration of local anesthesia in children: a randomized clinical trial.","authors":"Aarti Yadav, Sandeep A Bailwad, Akash Bhatnagar, Medha Roy","doi":"10.17245/jdapm.2024.24.6.395","DOIUrl":"10.17245/jdapm.2024.24.6.395","url":null,"abstract":"<p><strong>Background: </strong>The key to a child's treatment success in a pediatric dental setting is to control discomfort and anxiety. The proposed method supports the execution of a non-aversive behavior management scheme. This study aimed to evaluate the effects of essential oil aromatherapy on anxiety and pain associated with the administration of local anesthesia (LA) in children.</p><p><strong>Methods: </strong>This study included 176 children (87 girls and 89 boys) aged 6-9 years, who were randomly divided into two groups. Group 1 received aromatherapy with essential oil using a nebulizer for 2 min with a 10-min induction period before the administration of LA. Group 2 (control group) was managed using non-pharmacological behavioral techniques. Baseline anxiety levels were recorded for all children before the intervention. LA was administered according to a standard protocol. Postprocedural pain and anxiety were assessed using the Wong-Baker Faces Pain Rating Scale (WBFPRS); Visual Analog Scale (VAS); Sound, Eye, Motor (SEM) scale; and Modified Child Dental Anxiety Scale (MCDAS)(f). Data were analyzed using SPSS version 21.0.</p><p><strong>Results: </strong>The Mann-Whitney U test revealed a statistically significant difference in anxiety MCDAS(f) scores between the groups at both baseline (P = 0.022) and post-procedure (P = 0.001). The Wilcoxon signed-rank test also indicated a statistically significant change in anxiety scores within each group from baseline to post-procedure (P = 0.001). Furthermore, VAS, analyzed using the Mann-Whitney U test, demonstrated a significant difference between the groups (P = 0.001). Pain scores measured using WBFPRS and SEM scales were significantly lower in the aromatherapy group, as determined using the chi-square test.</p><p><strong>Conclusion: </strong>Prior use of essential oil aromatherapy can effectively reduce anxiety and pain in children during the administration of LA.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 6","pages":"395-406"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the effect of premedication on the success of inferior alveolar nerve block in tobacco chewing patients with symptomatic irreversible pulpitis: a randomized control trial.","authors":"Sanjeev Kumar Singh, Simith Yadav, Amit Kumar, Harmurti Singh, Hena Rahman, Madan Mohan Niranjan, Manika Jindal Mittel, Mohit Wadhawan","doi":"10.17245/jdapm.2024.24.5.351","DOIUrl":"https://doi.org/10.17245/jdapm.2024.24.5.351","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate and compare the efficacy of oral premedication with ibuprofen on the anesthetic efficacy of inferior alveolar nerve block (IANB) using 2% lignocaine and 1:100000 epinephrine in tobacco-chewing (TC) and non-tobacco-chewing (NTC) patients with symptomatic irreversible pulpitis (SIP) during nonsurgical endodontic intervention (NEI).</p><p><strong>Methods: </strong>This multicenter, prospective, double-blind, two-arm parallel-group randomized controlled trial involving 160 patients was conducted for a period of 9 months. The patients were classified into the study (TC patients) and control (NTC patients) groups, which were subdivided into two subgroups 1 hour before the procedure based on oral premedication with tab ibuprofen 600 mg. Nicotine dependence was assessed using the Modified Fagerstrom Tolerance Nicotine Scale. Patients were administered an IANB injection of 2% lignocaine containing epinephrine 1:100000 after premedication. Pulpal anesthesia before NEI was confirmed using electric pulp testing and cold spraying. Patients rated their pain on the 10-point visual analog scale (VAS) during NEI thrice at the dentin, pulp, and instrumentation levels. No pain at each level indicated the success of anesthesia.</p><p><strong>Results: </strong>The success and failure rates did not differ between the premedication and non-premedication subgroups in the TC or NTC groups (P > 0.05). However, the success rate was higher in the premedication subgroup of the NTC group (52.5%) than in the TC group (45%). Most patients with premedication experienced failure at the instrumentation level, whereas patients in the non-premedication group experienced pain at the dentin level. Failure rates of IANB did not differ significantly at different levels between the groups (P > 0.05). The mean VAS scores differed significantly at the dentin level in both groups, with lower values in the premedication group (P < 0.05).</p><p><strong>Conclusions: </strong>The efficacy of ibuprofen premedication with IANB during NEI did not differ significantly between the TC and NTC patients with SIP. The effect of premedication was more significant in the NTC group than in the TC group. A causal relationship between nicotine consumption and the success of premedication could not be established, and further studies are required to validate the results of the present study.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 5","pages":"351-360"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11471341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesic efficiency of dexketoprofen trometamol in third molar surgery: a systematic review and meta-analysis.","authors":"Bishwa Prakash Bhattarai, Diane Isabel Selvido, Dinesh Rokaya","doi":"10.17245/jdapm.2024.24.5.305","DOIUrl":"https://doi.org/10.17245/jdapm.2024.24.5.305","url":null,"abstract":"<p><p>This study aims to compare the analgesic efficacy of dexketoprofen trometamol (DT) with other analgesic drugs for pain relief after third molar surgery. The PubMed, Scopus, and Web of Science databases were searched to identify randomized controlled trials comparing DT with other analgesics for third molar surgery. The outcome measures were the sum of pain intensity differences (SPID), total pain relief (TOTPAR) at the 6^th and 8^th postoperative hours, time to rescue medication, and tolerability. In total, four studies met our inclusion criteria. A total of 660 third molar surgeries were performed: 365 in the DT group and 295 in the active control group. Compared to other analgesics, DT produced significantly better pain relief at the 6^th postoperative hour: SPID (MD, 0.33; P = 0.01) and TOTPAR (MD, 0.41; P = 0.02). However, there were no statistically significant differences in the efficiency of pain relief at the 8^th postoperative hour, time to rescue medication, or tolerability. Overall, a 25 mg dose produced the best results for pain relief. In conclusion, DT (25 mg) is a viable alternative to contemporary analgesics for pain relief after third molar surgery, particularly during the early postoperative period.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 5","pages":"305-318"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11471343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective comparison of articaine buccal infiltration and lidocaine intraosseous anesthesia in carious mandibular molars.","authors":"Damin Park, Bokyung Shin, Ji-Young Yoon","doi":"10.17245/jdapm.2024.24.5.319","DOIUrl":"10.17245/jdapm.2024.24.5.319","url":null,"abstract":"<p><strong>Background: </strong>It is vital to identify more efficient anesthesia techniques for the restorative or endodontic treatment of mandibular molars. Both articaine buccal infiltration anesthesia (ABI) and lidocaine inferior alveolar nerve block anesthesia (LIANB) may not provide profound anesthesia, necessitating supplementary anesthesia. This study aimed to investigate whether lidocaine intraosseous lidocaine intraosseous anesthesia (LIO) is more suitable than ABI as primary anesthesia for caries treatment of mandibular molars.</p><p><strong>Methods: </strong>This study retrospectively analyzed patients treated for advanced caries according to the International Caries Detection and Assessment System (ICDAS) 5 and 6. The study involved 48 patients, split evenly between those receiving ABI and LIO, and examined the anesthesia success rate, pain during anesthesia, onset time, duration, and post-anesthesia lower lip numbness using Chi-square and Independent T-tests.</p><p><strong>Results: </strong>In the ABI group, 17 patients (70.8%) did not require additional anesthesia, whereas all 24 patients (100%) in the LIO group did not require additional anesthesia (P < 0.001). ABI was associated with significantly higher pain during anesthesia, slower onset time, and longer duration of anesthesia than LIO. There was no significant difference in post-anesthesia lower lip numbness between the two methods.</p><p><strong>Conclusion: </strong>Intraosseous anesthesia using lidocaine is more effective for treating severe caries in the mandibular molars because of its higher success rate, decreased pain during anesthesia, faster onset, and shorter recovery time.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 5","pages":"319-328"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11471345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Photobiomodulation by soft laser irradiation with and without ibuprofen improves success rate of inferior alveolar nerve block using 2% lignocaine with adrenaline in symptomatic irreversible pulpitis of mandibular molar teeth: a double-blind, randomized placebo-controlled trial.","authors":"Shahnaz, Sweta Rastogi, Vivek Aggarwal, Sanjay Miglani","doi":"10.17245/jdapm.2024.24.5.341","DOIUrl":"https://doi.org/10.17245/jdapm.2024.24.5.341","url":null,"abstract":"<p><strong>Background: </strong>Achieving successful pain control and adequate anesthesia through an inferior alveolar nerve block for endodontic treatment in cases with symptomatic irreversible pulpitis (SIP) is difficult, especially in mandibular molars. This study was designed to compare the effect of oral medication with ibuprofen and soft laser therapy on inferior alveolar nerve block during endodontic treatment.</p><p><strong>Methods: </strong>The trial comprised 180 patients (45 each group) with SIP. Four groups of patients were created: group 1 received 400 mg of ibuprofen; group 2 received soft laser irradiation; group 3 received a combination of soft laser and ibuprofen 400 mg; and group 4 received a placebo 1 h prior to local anesthesia. Patients recorded their pain scores on the Heft-Parker visual analog scale (VAS) before the start of intervention, 15 min after anesthesia, during access cavity preparation, and ultimately during root canal instrumentation. Each patient also rated their level of discomfort on a VAS. Every stage with no or minimal discomfort was deemed successful. The chi-square, Kruskal-Wallis, and one-way analysis of variance tests were used to evaluate the data.</p><p><strong>Results: </strong>The best success rate was achieved for soft laser ibuprofen combination, ibuprofen and soft laser groups reported similar success results, and control group recorded the least pain scores. The mean pain scores were lowest for group 3 and highest for group 4 (P < 0.001). Ibuprofen and soft laser combination was significantly better than control group (P < 0.001). There was no significant difference between ibuprofen and laser groups (P = 0.24).</p><p><strong>Conclusion: </strong>For teeth with irreversible pulpitis, preoperative ibuprofen treatment combined with soft laser irradiation greatly improved the success rates of inferior alveolar nerve block anesthesia.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 5","pages":"341-350"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11471344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eye movement desensitization and reprocessing therapy as an adjunct to pain management during dental extraction in children - a randomized control trial.","authors":"Apoorva Rathore, Namita Kalra, Rishi Tyagi, Amit Khatri, Shruti Srivastava, Deepak Khandelwal","doi":"10.17245/jdapm.2024.24.5.329","DOIUrl":"https://doi.org/10.17245/jdapm.2024.24.5.329","url":null,"abstract":"<p><strong>Background: </strong>Dental treatment is challenging for children experiencing pain and anxiety. Effective administration of local anesthesia (LA) is crucial for most pediatric dentistry treatments. Eye Movement Desensitization and Reprocessing (EMDR) therapy has emerged primarily to manage post-traumatic stress disorder (PTSD) and a wide variety of anxiety- and pain-related conditions. However, the use of this therapy to manage pain in pediatric dentistry has not yet been reported. This study aimed to assess the trends in pain in pediatric dental patients with and without EMDR therapy during LA and extraction. The need for analgesic consumption within 24 h post extraction and the overall dental experience were also evaluated.</p><p><strong>Methods: </strong>Sixty children aged 8-12 years participated in a randomized controlled clinical trial with the goal of extracting the primary mandibular first or second molar on the right or left side and were stratified into: group I: EMDR therapy; group II: Tender Love and Care. Pain was measured at three different time intervals. An unpaired t-test was performed for intergroup comparison of continuous data, and the repeated measures ANOVA was applied for intergroup comparison between the groups.</p><p><strong>Results: </strong>Pain was significantly lower in group I (pain after topical LA gel application, P = 0.229; pain after LA administration, P = 0.036; pain after extraction, P < 0.001). The need for analgesic consumption was lower in this group (P = 0.072), and the overall dental experience was rated better (P < 0.0001).</p><p><strong>Conclusion: </strong>Research has shown that EMDR therapy effectively reduces pain in children, making it a recommended practice for pediatric dentists trained in this technique.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 5","pages":"329-340"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11471346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mirror-image tooth pain referred from superficial masseter muscle - a case report.","authors":"Anuvindha Js, Jonna M Immaculate, Jitendra Chawla, Saindhya Tora Sonowal, Cheranjeevi Jayam, Samarjit Dey","doi":"10.17245/jdapm.2024.24.5.367","DOIUrl":"https://doi.org/10.17245/jdapm.2024.24.5.367","url":null,"abstract":"<p><p>Toothaches are the main reason patients seek dental care, but not all pain in the orofacial region originates from the teeth. Some toothaches may stem from musculoskeletal, neuropathic, or neurovascular issues. Additionally, certain toothaches may not be tooth-related, but rather, referred from nearby orofacial structures, where the site and source of pain differ. In referred pain, the pain typically travels to the site from an ipsilateral source in the orofacial region. However, when the site and source of pain are on different parts of the body, but the pain is referred in a predictable manner, it is termed mirror-image pain. This case report illustrates mirror-image pain originating in the right mandibular tooth, referred from the contralateral superficial masseter muscle. A comprehensive history, thorough head and neck evaluation, an understanding of anatomy, and the utilization of diagnostic trigger-point injections were instrumental in reaching the correct diagnosis and the management of this non-odontogenic toothache, thus avoiding unnecessary dental interventions for managing the pain site.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 5","pages":"367-374"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11471347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cuff tear of endotracheal tube induced by a palatal orthodontic device during nasotracheal intubation: a case report.","authors":"Kyung Nam Park, Seung-Hwa Ryoo, Kwang-Suk Seo, Hyun Jeong Kim, Myong-Hwan Karm","doi":"10.17245/jdapm.2024.24.5.361","DOIUrl":"https://doi.org/10.17245/jdapm.2024.24.5.361","url":null,"abstract":"<p><p>Orthognathic surgery often requires intraoral orthodontic appliances that are fixed directly to the bone, which can complicate nasotracheal intubation if the devices protrude into the nasal cavity. This case report describes a 19-year-old man scheduled for elective orthognathic surgery who experienced recurrent cuff tears of the endotracheal tube during nasotracheal intubation due to protruding orthodontic screws in the palate. Despite initial attempts at nasotracheal intubation through the left nostril, the cuff of the 7.0 mm internal diameter (ID) Ring, Adair & Elwyn (RAE) tube repeatedly ruptured, with identical rupture patterns observed. Facial CT revealed that the orthodontic screws had protruded into both nasal cavities with significant visibility in the sagittal, coronal, and transverse views. Fiberoptic examination of the left nasal passage identified a firm protrusion below the inferior turbinate, corresponding to the location of the screw, which likely caused the cuff tears. Intubation was successfully performed via the right nostril during the fiberoptic examination. This case highlights the critical importance of evaluating intraoral corrective devices using comprehensive craniofacial imaging before anesthesia induction, as well as conducting fiberoptic examinations during intubation to avoid complications and ensure patient safety.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 5","pages":"361-366"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11471342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}