1/3. Anaesthetic management of two paediatric patients with Hecht-Beals syndrome.We undertook the anaesthetic management of two children with Hecht-Beals syndrome for orthopaedic surgery under general anaesthesia. Both patients had arachnodactyly, kyphoscoliosis, and multiple congenital joint contractures, but limited mandible excursion was not obvious preoperatively in either, although mental retardation made it difficult for them to cooperate with mouth examination. They had no apparent difficulties with their mouths in daily activities. The anaesthesia records of one patient showed that intubation had been difficult in an earlier procedure. The other patient also had a history of difficult intubation, with slight tearing of the corners of her mouth during an intubation procedure. During slow induction of general anaesthesia with sevoflurane, face mask ventilation was easily performed. We attempted to visualize the larynx under anaesthesia with muscle relaxation, but we were unsuccessful because of the limited mouth opening. After several trials, blind oral intubations were fortunately successful in both patients. There were no postoperative problems with the airway.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Infratemporal and submasseteric infection following extraction of a non-infected maxillary third molar.A case is described where an otherwise fit young female patient developed a large submasseteric abscess following the uneventful extraction of a non-infected maxillary third molar under local anaesthesia with intravenous sedation. This report highlights the difficulty of clinical diagnosis especially in the early stages of the infection. This case also demonstrates the imaging modalities used to confirm the diagnosis. It is likely that the infection in this case arose in an infratemporal fossa haematoma resulting from reactionary haemorrhage. Careful injection of local anaesthetic with aspiration may prevent this complication arising. This is the first reported case of a submasseteric abscess associated with the extraction of a clinically non-infected maxillary third molar.- - - - - - - - - - ranking = 0.25keywords = anaesthesia (Clic here for more details about this article) |
3/3. Inverse activity of masticatory muscles with and without trismus: a brainstem syndrome.Clinical and EMG findings in 10 cases of intrinsic brainstem lesions are reported with paradoxical activity of jaw closing muscles during jaw opening, with and without trismus. In five cases with trigeminal anaesthesia, the inverse activity of jaw closers is interpreted as a manifestation of disturbance in the central programming of mastication in the motor trigeminal area of the brainstem. Stretch reflex mechanisms and disinhibition of the trigeminal motor neurones play no part in the origin of inverse activity. The distinct brainstem syndrome can only be detected by EMG and the special clinical features.- - - - - - - - - - ranking = 0.25keywords = anaesthesia (Clic here for more details about this article) |