MDent, Faculty of Health Sciences, University of the Witwatersrand, 2009 / INTRODUCTION Clinical audits of maxillofacial and oral surgery units in the United Kingdom have shown significant changes in the workloads of staff, in the social and demographic profiles of the patients, in the types of procedures performed and in the use of local or general anesthesia. This data allows the planning of a better service, of monitoring the increasing workload and the suitability of the procedures being performed for the training of registrars. AIMS AND OBJECTIVE The objective of this investigation were to carry out a clinical audit in the maxillofacial and oral surgery unit at CH Baragwanath Hospital for a six month period in 1987 and in 2007 and to compare this data in order to determine changing trends. MATERIALS AND METHODS A clinical audit for the periods 1 January to 30 June 1987 and 2007 was undertaken. The audit was based on a review of the surgical procedures register which records all surgical procedures carried out in the unit. The following information was extracted from the procedures register for the two time periods and statistically compared; numbers of patients, age, gender, race of patient, local or general anaesthesia, diagnosis, duration of operation and procedure performed. RESULTS. There were no significant changes in the demographic profiles of the patients treated except that in the second time period the sample contained 15 whites and 5 Indians. A decrease in trauma related diagnoses and an increase in presentation for wisdom teeth removal was found. There was also a significant shift from the use of general to local anaesthesia. There were no significant differences in the types of procedures performed although clearly there was a shift from trauma related surgery to surgery for removal of wisdom teeth. The range of operative procedures was inadequate for the training of registrars as virtually no exposure to implant related surgery nor to orthognathic surgery occurred in the unit. DISCUSSION This is the first audit of its kind to be performed in South Africa and very few similar audits have been performed internationally. While the data shows a distinct trend away from trauma related surgery, this was still the major activity in both the first and the second time periods. The change from predominantly general to local anaesthesia is partly the result of a critical shortage of anaesthesiologists in the public service in South Africa. CONCLUSION We recommend that: The scope of the data collected be expanded to include information on numbers of staff, waiting lists, work done in the Out-Patients Department (OPD) or on patients admitted by other specialties, referrals, length of hospital stay and cancellations and no-shows. A computerized audit system be introduced based on models in the UK. Clinical staff will have to take responsibility for capturing the data. Units should determine benchmark standards against which they can monitor their own performance.

Thesis (doctoral)--Mun̈chen, 1934.

Thesis (M.S.)--University of Michigan, 1932.

Thesis (doctoral)--Mun̈chen, 1934.

The purpose of this study was to validate a set of predictor variables which identify perspective orthognathic surgical patients who may be poor surgical risks. The predictive qualities of four MMPI scales, two Bloom Sentence Completion scales, and seven Dental Inventory scales were used to identify presurgical, orthognathic patients who were likely to express postsurgical dissatisfaction.All variables were considered jointly to assess their significance in predicting surgical satisfaction versus dissatisfaction. Subsequently, a minimal set of predictors, which accounted for a significant proportion of the criterion variance, were derived by using factor analysis.A nonrandomized, pretest-posttest design with a one-way, multivariate analysis of variance yielding a Hotelling T square statistic was used. A discriminate analysis of variance was used as a follow-up to the Hotelling T square to note those variables which caused the differences between the means.This study was conducted at a large military teaching and research hospital in Southwest Texas. Patients used in this study were identified during routine dental examinations or were referred by their dentists. Eighty-nine subjects participated in the research project. All subjects were between the ages of 15 and 50 with a mean age of 23.7. They were all volunteers and received their surgery in the same hospital by the current staff of oral surgeons. All subjects were informed that the psychological evaluation was an integral part of the oral surgery evaluation.Upon admission to the hospital the patient received the scheduled surgery and underwent 8 weeks of routine postoperative care. Prior to being discharged from the hospital the patient was readministered the MMPI, Bloom Sentence Completion, and the Dental Inventory. The 8-week period was chosen for postoperative testing because patients were medically cleared to resume normal functioning at that time.A statistically significant difference between the four MMPI scores on the results of the orthognathic surgery variable was evident when comparing satisfied versus dissatisfied patients (F = 3.020, P 0.028). Additionally, there was a multilinear relationship among the presurgical test and the level of postsurgical satisfaction.Factor analysis rendered a minimal set of predictor variables which proved practical in identifying satisfied from dissatisfied patients.Considering the limitations of the study and the above-mentioned results, it can be concluded that a minimal set of predictor variables could be effective in helping surgeons screen out those patients who have the potential of being poor surgery risks.

Made available in DSpace on 2014-06-11T19:23:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-11Bitstream added on 2014-06-13T18:17:18Z : No. of bitstreams: 1 jardim_ecg_me_araca.pdf: 229259 bytes, checksum: 15c9095c65db3dcdffe47d437cca73fa (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / As cirurgias ortognáticas são procedimentos executados com frequência e complicações como lesões arteriovenosas ou mesmo pelo tempo cirúrgico, podem ocasionar hipovolemia. A necessidade de reposição do volume sanguíneo por meio da infusão de soluções cristalóides, colóides ou até a transfusão de sangue é sempre considerada. Assim, propôs-se neste estudo quantificar a perda sanguínea, bem como avaliar a necessidade da transfusão sanguínea em 19 pacientes submetidos à expansão rápida de maxila assistida cirurgicamente. Foram avaliados os valores de pressão arterial média, tempo de procedimento cirúrgico, gênero, perda volêmica intra-operatória e classificação ASA. Pode-se concluir que a hipovolemia e a requisição de transfusão de sangue nestas cirurgias foram pequenas, entretanto, os profissionais devem sempre estar atentos quanto ao tempo cirúrgico e ao aprimoramento da técnica cirúrgica / Orthognathic surgeries are procedures performed at a frequency quite considerable and now, at the expense of complexity with regard to the complications inherent in the technique, such as arteriovenous injuries or even the time of surgery, can cause a severe hypovolemia. The need for replacement of blood by infusion of crystalloid solutions, colloids or by blood transfusion is always considered. Thus, we proposed this study to quantify the blood loss, and assess the need for blood transfusion in 19 patients undergoing to surgical assisted rapid maxillary expansion. The values of mean arterial pressure, duration of surgery, gender, ASA classification and volume loss. It can be concluded that hypovolemia and the request for blood transfusion in these surgeries were small, however, professionals should always be alert as to the time of surgical procedure and the development of a meticulous surgical technique

Orientador: Elio Hitoshi Shinohara / Banca: Jéssica Lemos Gulinelli / Banca: Roberta Okamoto / Resumo: As cirurgias ortognáticas são procedimentos executados com frequência e complicações como lesões arteriovenosas ou mesmo pelo tempo cirúrgico, podem ocasionar hipovolemia. A necessidade de reposição do volume sanguíneo por meio da infusão de soluções cristalóides, colóides ou até a transfusão de sangue é sempre considerada. Assim, propôs-se neste estudo quantificar a perda sanguínea, bem como avaliar a necessidade da transfusão sanguínea em 19 pacientes submetidos à expansão rápida de maxila assistida cirurgicamente. Foram avaliados os valores de pressão arterial média, tempo de procedimento cirúrgico, gênero, perda volêmica intra-operatória e classificação ASA. Pode-se concluir que a hipovolemia e a requisição de transfusão de sangue nestas cirurgias foram pequenas, entretanto, os profissionais devem sempre estar atentos quanto ao tempo cirúrgico e ao aprimoramento da técnica cirúrgica / Abstract: Orthognathic surgeries are procedures performed at a frequency quite considerable and now, at the expense of complexity with regard to the complications inherent in the technique, such as arteriovenous injuries or even the time of surgery, can cause a severe hypovolemia. The need for replacement of blood by infusion of crystalloid solutions, colloids or by blood transfusion is always considered. Thus, we proposed this study to quantify the blood loss, and assess the need for blood transfusion in 19 patients undergoing to surgical assisted rapid maxillary expansion. The values of mean arterial pressure, duration of surgery, gender, ASA classification and volume loss. It can be concluded that hypovolemia and the request for blood transfusion in these surgeries were small, however, professionals should always be alert as to the time of surgical procedure and the development of a meticulous surgical technique / Mestre

published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

Orientador: Luis Augusto Passeri / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-14T01:52:16Z (GMT). No. of bitstreams: 1 Tavares_RodrygoNunes_D.pdf: 4607826 bytes, checksum: cb601fd849daad83c1b34a9b58376d44 (MD5) Previous issue date: 2009 / Resumo: O presente estudo avaliou as alterações em tecido mole associadas com avanço total de maxila em uma população brasileira por meio de radiografias cefalométricas. Vinte seis pacientes foram submetidos a tratamento orto-cirúrgico, com a utilização de fixação interna rígida. Nenhum dos pacientes realizou qualquer tipo de procedimento associado ou combinado, tais como osteotomia mandibular ou mentoplastia. Foram utilizadas telerradiografias, em norma lateral, pré-operatória e pós-operatória com intervalo mínimo de 6 meses. Os pacientes foram submetidos a avanços de maxila que variaram de 2 a 9 mm, com movimento no sentido vertical não maior que 3 mm. Foram analisados deslocamentos horizontais e verticais em pontos de tecido ósseo e do tecido mole. Proporções entre as mudanças do tecido ósseo e o tecido mole, assim como as análises de correlação significativas, foram calculadas. Os resultados demonstraram várias correlações significativas. A resposta do tecido mole ao avanço da maxila pareceu ser previsível: (1) o lábio superior acompanhou o movimento do incisivo central superior no plano horizontal, com o ponto labrale superius acompanhando em 65,2% e stomion superius, em 50,1%; (2) o ponto A foi relacionado com três pontos do tecido mole, subnasale, labrale superius e stomion superius, por 60,2%, 58,2% e 58,1%, respectivamente / Abstract: The present study evaluated the soft tissue changes associated with total maxillary advancement in a brazilian population through cephalometric radiographs. Twentysix patients were submitted to presurgical orthodontic maxillary surgery stabilized with a rigid fixation. None of them were submitted to any other adjunctive procedure, such as mandibular osteotomy or genioplasty. Presurgical and late postsurgical radiographs taken apart with a minimum of 6 months interval had been used. All the patients were submitted to advancement of the maxilla between 2 and 9,5 mm, with no more than 3 mm of vertical displacement. The horizontal and vertical displacement of skeletal and soft tissue profile points were analyzed. Soft-tissue change to hard tissue change ratios, as well as correlations analyses, were calculated. The results demonstrated many statistical significant correlations. The soft tissue response to maxillary advancement appeared to be predictable: (1) the upper lip followed the movement of maxillary central incisor in the horizontal plane, with the point labrale superius following by 65.2% and stomion superius, 50.1%; (2) the point A was related to three points at the soft tissue, subnasale, labrale superius and stomion superius, by 60.2%, 58.2% and 58.1%, respectively / Doutorado / Cirurgia e Traumatologia Buco-Maxilo-Faciais / Doutor em Clínica Odontológica