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We audited the recovery characteristics of 51 patients who had undergone orthognathic maxillofacial surgery at a single center. Patients whose anesthesia had been maintained with intravenous propofol and remifentanil (n  =  21) had significantly higher pain scores during the first 4 hours after surgery than those whose anesthesia was maintained with volatile inhalational agents and longer-acting opioids (n  =  30) (P  =  .016). There was a nonsignificant trend towards shorter recovery times in the former group, while there were no differences in early postoperative opioid usage, hemodynamic parameters, or postoperative nausea and vomiting . Given that our data were collected retrospectively and without the ability to control for potential confounders, we interpret the results with caution. Notwithstanding these limitations, we believe this is the first report comparing the effects of different opioid-based anesthetic regimens on early recovery from orthognathic surgery, and we believe this report may be used as the starting point for a controlled study.

Objective: To investigate trends in oral surgery in England and Wales 1991-2000., Methods: Oral surgery procedure data were derived from Dental Practice Board and Department of Health Hospital Episode Statistics., Results: There was a 6% increase in minor oral surgery (MOS) procedures, including ordinary extractions, extractions of special difficulty, apicectomies and third molar removals, carried out in the General Dental Services (GDS) but the number of third molars removed fell by 32% after 1997. General anaesthetics (GA) administered in the GDS fell by 77% and the number of sedations rose 54% after 1998. There was concentration of minor oral surgery in practices: in the year 2000, 88% of practitioners carried out less than five third molar removals. In the Hospital Dental Service (HDS) there was a 98% increase in day surgery, and a 53% decrease in ordinary admissions for minor oral surgery. HDS waiting times remained constant over the ten year period., Conclusions: The principal trends were substantial decreases in apicectomies, third molar removals after 1997 and GAs after 1998; increases in extractions of special difficulty and concentration of MOS in the GODS. Numbers of ordinary extractions did not change. In the HDS there was a large shift from in-patient to daycase provision which has facilitated expansion of maxillofacial surgery. This is an important example of NHS reconfiguration. Perhaps the most important implication of these changes concerns the place of MOS in vocational training.