Frederic Lauwers

Background Double-jaw surgeries are known to be painful and to require opioids. Maxillary (V2) and mandibular (V3) nerves block could provide adequate pain management with minimal opioid-related side effects. Our main objective was to evaluate the analgesic effect of bilateral ultrasound-guided V2 and V3 combined nerves block in patients undergoing double-jaw orthognathic surgery. Methods In this single-blind, randomized control study, 50 patients were prospectively allocated to either bilateral ultrasound-guided V2 and V3 combined nerves block or intraoral infiltration of local anesthetic. Primary outcome was the cumulative oral morphine equivalent (OME) consumption assessed at postoperative day 1. Secondary outcomes were cumulative OME consumption and pain scores in recovery room and at postoperative day 2, intraoperative anesthetic consumption, and opioid-related side effects. Preoperative anxiety was investigated by the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Results Compared with infiltration, ultrasound-guided regional anesthesia reduced cumulative OME consumption on day 1 (45.7±37.6 mg vs 25.5±19.8 mg, respectively, mean difference of −20.1 (95% CI −37.4 to −2.9) mg, p=0.023) and day 2 (64.5±60 mg vs 35.8±30.2 mg, respectively, mean difference of −28.7 (95% CI −55.9 to −1.43) mg, p=0.040). Interestingly, worst pain score and cumulative OME consumptions on day 2 were positively correlated with the APAIS (Pearson’s correlation coefficient of 0.42 (p=0.003) and 0.39 (p=0.006), respectively). Conclusion Bilateral ultrasound-guided V2 and V3 combined nerves block reduces postoperative opioid consumption by about 50% in patients undergoing double-jaw surgery. Trial registration number NCT05351151.

Purpose This study assesses the anatomical features of the cutaneous fibular perforators and perforasomes of fibular free flap to determine the clinical implications therein. Methods This anatomical study was performed with 16 fresh cadavers after selective arterial injections of inked serum. The numbers of perforators, diameter, location of the perforasome center, perforator course, the distance between perforator origin and tibiofibular division, and the perforasome area were all documented. Results Thirty-one lower legs were dissected. Eighty-eight cutaneous perforators were found, averaging 2.8 per leg (1–4). The mean diameter was 1.7 mm and decreased from proximal to distal (p < 0.001). The centers of the perforasomes were aligned on an oblique projection from proximal to distal and anterior to posterior. Seventeen perforators (19%) were musculocutaneous, all in the proximal half of the leg, whereas 71 perforators were septocutaneous (81%), including 18 in the proximal half of the leg. Six of the uppermost perforators originated from the fibular artery less than 10 mm from the tibiofibular division. The mean area perforasome was 37.2 cm² (7.9–106 cm²) and decreased from proximal to distal (p < 0.01). Conclusion Distal and proximal fibular flap perforasomes sported different features. Large skin paddles supplied by large and often intramuscular perforators were found in the proximal half of the leg. Distal skin paddles were smaller, more posterior, and featured septocutaneous perforators. These factors should be considered in the skin paddle choice during the fibular free flap harvest.

Introduction: Squamous cell carcinoma of the oral cavity is the most common cause of mandibular defect. The functional and aesthetic impacts of this surgery must be considered. The number of mandibular resections depends on the TNM classification of the tumor. Mandibular reconstruction by a fibula free flap has become the gold standard. Unfortunately, not all mandibular resections are rehabilitated. The purpose of this study is to evaluate oral rehabilitation after mandibular resection in patients with squamous cell carcinoma. Materials and methods: A retrospective study was conducted to evaluate oral rehabilitations according to the type of surgical resection and reconstruction. The secondary evaluation criteria were type of rehabilitation, implant success rate, post-radiotherapy delay, rehabilitation success rate, and causes of non-rehabilitation. Results: The study included 157 patients with mandibular resection. Of the patients, 26.7 percent received oral rehabilitation. All rehabilitation with implants was functional. The main causes of non-rehabilitation were death or recurrences related to the progression of the disease, postoperative anatomical difficulties, and cost of oral rehabilitation. Conclusion: Oral rehabilitation after mandibular resection surgery is insufficient. A rehabilitation unit including a maxillofacial surgeon, oral surgeon, and dentist is essential. Implementation of the unit should be considered as soon as possible. The cost of rehabilitation should not be a limiting factor.

Purpose: To compare the accuracy of distal suprascapular nerve (dSSN) blockade performed with the use of ultrasound‐guided regional anesthesia (USRA) versus with a landmark‐based approach (LBA). A secondary aim was to describe the anatomic features of the sensory branches of the dSSN. Methods: USRA and LBA were performed in 15 shoulders each from 15 cadavers (total of 30 shoulders). Then, 10 mL of methylene blue‒infused ropivacaine 0.75% was injected into the dSSN. Simultaneously, 2.5 mL of red latex solution was injected to identify the position of the needle tip. The division and distribution of the sensory branches originating from the SSN were described. Results: The tip of the needle was identified at 1.3 cm (range, 0‐5.2 cm) and 1.5 cm (range, 0‐4.5 cm) with USRA and the LBA, respectively ( P = .90). Staining diffused past the origin of the most proximal sensory branch in 27 cases. The most proximal sensory branch arose 2.5 cm from the suprascapular notch. Among the 3 failures that occurred in the USRA group, the sensory branches also failed to be marked. All 30 dSSNs gave off 3 sensory branches, which innervated the posterior glenohumeral capsule, the subacromial bursa, and the coracoclavicular and acromioclavicular ligaments. Conclusions: An LBA is as reliable and accurate as US guidance for anesthetic blockade of the dSSN. Marking of the suprascapular nerve must be proximal to the suprascapular notch to involve the 3 sensory branches in the anesthetic blockade. Clinical Relevance: The present study demonstrates that a landmark‐based approach to anesthetic blockade of the distal suprascapular nerve is accurate and can be performed by orthopaedic surgeons lacking experience in ultrasound‐guided anesthetic techniques.