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Biomedical subjects

N H Luyk

Publications and source records attributed to N H Luyk.

At least 19 recordsLinked to original sources
PubMed1994

Patient-controlled sedation using midazolam.

Midazolam was given for sedation as an initial bolus, followed by either a continuous infusion or a patient controlled infusion during third molar extractions. The results showed that there were no significant changes in blood pressure, pulse rate or oxygen saturation during the procedure. Both methods gave good amnesia to events at the start, (100%), as well as to events during, (70% and 75%), and at the end, (61% and 70%), of surgery. There was high acceptance of both methods of sedation (93% and 98% respectively). There was no patient preference for either method of sedation, nor was the operator able to distinguish between the two methods. Hence it is concluded that patient controlled infusion and continuous infusion of midazolam are both satisfactory methods of sedation for patients undergoing surgery under local anaesthesia.

Adolescent↗
PubMed1994

Effect of flumazenil on the recovery from intravenous midazolam.

Psychomotor recovery characteristics were studied in young, healthy patients undergoing intravenous sedation using midazolam for the extraction of third molars. There were significant changes to Choice Reaction Time and Critical Flicker Fusion Threshold noted half an hour after the administration of midazolam (P < 0.001). The administration of the benzodiazepine antagonist flumazenil significantly improved the Choice Reaction Times, but failed to reverse changes in Critical Flicker Fusion Threshold up to 120 minutes later. However, the use of flumazenil assured that no post-operative changes in oxygen saturation occurred in any of the patients.

Adolescent↗
PubMed1993

A potential role for costo-chondral grafting in adults with mandibular condylar destruction secondary to rheumatoid arthritis--a case report.

Little attention has been directed towards reconstruction of the mandibular condyles in adult patients with rheumatoid arthritis, other than with allogenic implants which are now known to cause serious complications. There is a relatively high incidence of condylar erosion and breakdown in rheumatoid arthritis, often leading to anterior open bite and retrognathia. Costochondral grafting does not appear to have been considered as a logical option for reconstruction, despite its high success rate in many other situations. A case is described of rapid bilateral condylar destruction occurring in a young woman with rheumatoid arthritis, leading to anterior open bite. Reconstruction was undertaken using bilateral costochondral grafts, giving an excellent clinical result which has been maintained over the follow-up period of two-and-a-half years. Radiologically complete healing of severe glenoid fossa erosion has taken place.

Adult↗
PubMed1993

The safe practice of intravenous sedation in dentistry.

All clinicians who administer intravenous sedation should undergo appropriate training according to recognised guidelines. Such guidelines are now established in New Zealand through the joint endeavours of the New Zealand Dental Association, Royal Australasian College of Dental Surgeons, and the Australian and New Zealand College of Anaesthetists. It is essential that there be acceptable staff training and experience, that physical facilities and arrangements for emergency care are adequate, and that parameters for patient selection are adhered to. Adequate knowledge of pharmacology and the therapeutic indications for specific sedative drugs is necessary, and sedation procedures must be undertaken with appropriate monitoring. There are significant medico-legal aspects to this area of dental practice and these should be well recognised by all practitioners.

Adolescent↗
PubMed1993

Local anesthesia during surgery: when is the best time to give it?

Patients undergoing third molar extractions while under general anesthesia were given local anesthesia either before (group 1) or after (group 2) surgery. The medication intake and pain scores were studied for 7 days but showed no difference between the two groups. It is suggested that timing of local anesthesia alone may not prevent or reduce the postoperative pain experience.

Adult↗
PubMed1992

Temporalis muscle as a disc replacement in the temporomandibular joint of sheep.

Temporalis muscle flaps were evaluated in sheep. Flaps placed following discectomy were examined at 2, 4, 12, and 24 weeks. Histologic evaluation showed avascular necrosis and subsequent displacement and loss of tissue from the joint resulting in close contact between the condyle and fossa. Muscle flaps placed lateral to the joint in operative controls were examined at 4, 12, and 24 weeks. This muscle remained viable while undergoing fibrous replacement. Although the surface layers of the condyle and fossa were initially lost, the tissues were reformed with time. This experiment showed that in the sheep, temporalis muscle does not withstand functional loading within the joint. However, despite the lack of interpositional material, the condyle and fossa can remodel.

Animals↗
PubMed1992

Bolus dose with continuous infusion of midazolam as sedation for outpatient surgery.

This double-blind, randomised, cross-over trial in 41 patients for 3rd molar surgery compared the safety, amnesic properties and psychomotor recovery between a bolus injection of midazolam and a bolus injection followed by continuous infusion of midazolam. The latter showed good safety and better amnesia to events during the procedure, but prolonged the recovery time.

Adolescent↗
PubMed1992

Control of vertical dimension during maxillary orthognathic surgery. A clinical trial comparing internal and external fixed reference points.

The accuracy of vertical control during maxillary orthognathic surgery was assessed in 45 patients, comparing the use of traditional internal measurements across the osteotomy lines (15 subjects) with measurements between the incisor teeth and an external reference point consisting of a bone screw placed at nasion (two groups of 15 subjects each). Although use of a fixed external reference point can significantly decrease positioning error (p < 0.001), considerable care is required during application of rigid fixation to maintain the correct vertical dimension.

Bone Plates↗
PubMed1992

Fractures of the mandible: role of the general dentist.

Mandibular fractures are the second most common facial fracture, the majority being the result of interpersonal violence, road traffic accidents, or sports injuries. Although most of these patients attend a hospital, it is not uncommon for patients with these injuries to present first to the general dentist, perhaps complaining of a loose tooth or abnormal bite. A careful history should be taken from the patient in order to identify the possibility of other injuries. Mandibular fractures are rarely life-threatening, although airway difficulties can arise. A systematic approach to diagnosis is essential if fractures are not to be missed, including radiological assessment in two planes at right angles. The initial treatment consists of airway management, control of fracture segments, and pharmacologic management. Most fractures have been traditionally managed by the use of intermaxillary fixation; however, increasing use is being made of open reduction and internal fixation techniques. Occasionally, general dentists are involved in the post-operative care of the patient following definitive management.

General Practice, Dental↗
PubMed1992

Zygomatic bone fractures complicated by retrobulbar haemorrhage.

The two patients described in this report demonstrate retrobulbar haemorrhage as a complication of zygomatic bone fracture. Successful treatment of this rare but very serious complication involves urgent consultation with an ophthalmology service, and immediate medical and surgical management. It is extremely important to check the vision of patients with zygomatic bone fracture, before and after surgery, and consideration should be given to obtaining an ophthalmology opinion for all fractures involving the orbit. A simple examination, which every dentist should be able to perform, should include inspection of the eye, a test of visual acuity, testing eye movements, testing visual fields, reaction of the pupils, and an examination for proptosis.

Adult↗
PubMed1992

Oxygen saturation during intravenous sedation using midazolam.

Intravenous sedation with midazolam was given to young, fit, adult patients undergoing third molar surgery; oxygen saturation (SpO2) was continuously measured during the surgery and for 30 minutes after the surgery. There were some instances of a brief fall in the oxygen saturation, during the surgery and in the immediate period following surgery. It is suggested that it may be necessary to observe and selectively monitor some patients in the immediate post-surgical period as well as during the period of operation. Although not addressed by this investigation, this would be particularly true of medically compromised patients and the elderly.

Adult↗
PubMed1991

Facial pain and muscle atrophy secondary to an intracranial tumour.

Orofacial pain rarely arises from a distant site. It is unusual for orofacial pain to be associated with wasting of the facial musculature and diminished sensation. This case report describes a patient who presented with temporomandibular joint pain dysfunction syndrome which was initially successfully managed with splint therapy. She re-presented later with unilateral wasting of the muscles of mastication, facial pain and diminished sensation ipsilaterally. An intracranial meningioma was diagnosed following an extensive series of investigations.

Adult↗
PubMed1991

The diagnosis and initial management of the fractured mandible.

Mandibular fractures are the second most common facial fracture. The usual causes are interpersonal violence and motor vehicle accidents (MVA). Nearly all cases present to an emergency department for initial management. They are rarely life-threatening injuries and must assume low priority in the initial assessment and management of the severely traumatized patient. Following any resuscitation and exclusion of other significant injuries, a clinical and radiologic diagnosis of the facial injuries should be undertaken including assessment of the fractured mandible. Initial therapy should be directed at temporary immobilization and pharmacologic treatment, followed by referral for appropriate definitive care.

Dental Occlusion↗
PubMed1991

Efficacy of oral midazolam prior to intravenous sedation for the removal of third molars.

The combination of oral and intravenous sedation has not been well investigated and this study examined the combination's effect on amnesia, anxiety, cardiovascular stability and recovery in a double blind, cross-over, placebo controlled trial. Patients were given 7.5 mg oral midazolam or placebo 1 h prior to intravenous midazolam and surgery. This investigation demonstrated significant anxiolysis, amnesia and patient preference for oral midazolam compared to placebo. There was no significant effect on cardiovascular stability, the intravenous dose of midazolam used or post-operative recovery. Low dose oral midazolam prior to intravenous sedation may be beneficial in very anxious patients, particularly if surgery is delayed.

Administration, Oral↗
PubMed1990

Aetiology and diagnosis of clinically evident jaw trismus.

Trismus is a common problem presenting to the dental practitioner. It is usually of a benign nature; however a number of types can have serious implications. This review outlines the aetiology and diagnosis of clinically evident jaw trismus.

Humans↗