Background: Perineurally adding dexamethasone to local anesthetics could enable postoperative analgesia. Our aim was to investigate the efficacy of 4 mg dexamethasone and 0.5% ropivacaine on the prolonged duration of mandibular anesthesia for postoperative analgesia during third molar surgery. Materials and method: The patients of both sexes, and in the age range of 17 to 50 yrs of age, received the Gow-Gates anesthesia. Group I received 4 mL of plain 0.5% ropivacaine, with perineurally added 1 mL/4 mg of dexamethasone; group II received 4 mL of plain 0.5% ropivacaine with perineurally added 1 mL of 0.9% saline; group III received 4 mL of plain 0.5 bupivacaine with perineurally added 1 mL of 0.9% saline. The prime anesthesia outcome was the duration of conduction anesthesia (DCA); the secondary outcome was the duration of analgesia (DAN) and analgesia before analgesic intake. Results: In 45 randomly selected subjects (mean age 27.06 ± 8.20), DCA was statistically longest in group I (n = 15) (592.50 ± 161.75 min, p = 0.001), collated with groups II (n = 15) and III (n = 15) (307.40 ± 84.71 and 367.07 ± 170.52 min, respectively). DAN was significantly the longest in group I (mean: 654.9 ± 198.4 min, p = 0.001), compared with group II (345.4 ± 88.0 min) and group III (413.7 ± 152.3 min), with insignificant adverse reactions. One-third of the operated patients absented from the use of analgesics. Conclusion: A amount 0.5% ropivacaine with dexamethasone usefully served as an analgesic with a success rate of 93.4% of the given anesthesia.

Differentiation of true from mimicking Eagle’s syndrome based on conventional radiography is difficult; however, cone beam computed tomography (CBCT) images can contribute to proper diagnosis of mimicking Eagle’s syndrome. The aim was to study radiological images of a 37-year old female patient (patient #1), with chronic cervicofacial pain who underwent radiological diagnosis with a conventional panoramic machine; another 75-year old male patient (patient #2), with chronic oropharyngeal pain, underwent a radiological diagnosis with the CBCT machine, with a field of a view of 16 × 12 cm. Exposure factors were 120 kVp, 7 mA, with a 20 s exposure time of acquisition. The results show a panoramic image (patient #1) with a pathologically elongated styloid process 46 mm of length, which was surgically removed, releasing the patient from further pain episodes. CBCT acquisition (patient #2) showed an impacted left maxillary canine in the edentulous maxilla and a peculiar elongation of both stylohyoid complexes as impressive, “collar-like”, bilateral, elongated, multiple segmented, calcified stylohyoid complexes, without pressure on the vital neurovascular neck structures, mimicking true Eagle’s syndrome. The impacted maxillary canine was surgically extracted with a subsequent resolution of pain episodes and the cessation of neurological complaints. The conclusions suggest that the use of CBCT images can contribute to differentiating mimicking from true Eagle’s syndrome, which has been rarely reported in the literature.

Introduction: Mylohyoid mandibular anesthesia is not a standard and independent primary anesthesia for performing surgery on mandibular teeth. Objective: The objective was to examine the success of achieved mylohyoid anesthesia for mandibular molar surgery, by injecting an anesthetic that could penetrate the bone in the lingual region of the mandible, using the technique for modified mylohyoid mandibular anesthesia. Materials and methods: In the pilot study, 10 patients were divided into 2 equal groups (of 5 patients each), of both sexes and aged 18-75, who required mandibular anesthesia owing to mandibular molar surgery. In group I, 3.5 ml of 4% articaine with 1:100000 adrenaline, and the addition of 0.5 ml/4 mg of dexamethasone, was injected into the sublingual region of the corner of the mandible using a modified mylohyoid approach; in group II, 4 ml of 2% lidocaine with 1:100000 adrenaline was injected into the region of the mandibular foramen using the approach for standard mandibular conduction direct anesthesia. A visual analogue scale (VAS) was used for the subjective assessment of the pain during surgery in patients, the recorded duration of the realized mandibular anesthesia, as well as the total effectiveness of the achieved anesthesia, expressed in percentages. Results: A successful intervention was achieved in all patients, with different VAS scores, but within the values indicating successful anesthesia (group I: 17.40±11.10mm; group II: 12.80±4.55mm). A longer duration of anesthesia was achieved in the first group-205.2 min (3h 25 min), compared to the second group-182 min (3h 2 min). Conclusion: Mylohyoid mandibular anesthesia with 4% articaine and with adrenaline and dexamethasone could be applied as primary anesthesia for the purpose of successfully achieving standard mandibular anesthesia.

Patients who are on anticoagulant or antiaggregant therapy are not only at risk of prolonged bleeding after minor surgical interventions, but are also at risk of worsening the condition of the underlying disease due to the preoperative discontinuation of anticoagulant or antiplatelet therapy. In outpatient surgery, the conditions for monitoring patients who are at high risk of bleeding are not satisfactory. Today, there are new kinds of anticoagulants that exert their effect in different ways and different times. Taking into account that a certain number of patients use dual and even triple anticoagulant therapy, preoperative and postoperative protocols for the care of such patients should be clearly defined.

BACKGROUND:The Halstead inferior alveolar nerve block (IANB) is the standard local anesthetic method for mandibular dental procedures, but it can fail due to anatomic variations. A modified mylohyoid anesthesia (MMA) block can be used as a supplemental injection technique for the surrounding tissues. Therefore, this study included patients undergoing mandibular molar surgery and aimed to compare outcomes following a modified mylohyoid nerve block with 4% articaine with epinephrine and dexamethasone, 4% articaine with epinephrine, and 2% lidocaine with epinephrine. MATERIAL AND METHODS:Sixty patients were equally allocated into 3 groups (n=20). Group 1 received 4% articaine with epinephrine plus dexamethasone via modified mylohyoid anesthesia (MMA). Group 2 received MMA with 4% articaine and epinephrine alone. Group 3 (control) received 2% lidocaine with epinephrine using Halstead’s inferior alveolar nerve block. Pain intensity was assessed using a visual analog scale (VAS). Secondary outcomes included quality of anesthesia score (QAS) and duration of anesthesia (DOA). RESULTS:Groups were comparable in age (P=0.958). Median VAS scores were 3.5, 5.5, and 8 mm for Groups 1, 2, and 3, respectively, with no significant differences (P=0.232). Median QAS was 2 in all groups (P=0.168). Mean DOA was 189.2, 216.5, and 219 min, respectively. CONCLUSIONS:MMA demonstrated clinical outcomes comparable to the conventional inferior alveolar nerve block, although no statistically significant differences were observed among groups.