Prophylactic measures during oral surgery in patients with Moyamoya

摘要

IntroductionMoyamoya disease is an uncommon cerebrovascular condition in Western populations; therefore, it is not well known. Patients with Moyamoya require preventative measures when undergoing oral surgery.PRESENTATION OF CASE: A 15-year-old girl with Moyamoya disease was referred to our department of Oral and Maxillofacial Surgery for removal of a lateral incisor and four impacted wisdom teeth. An empathic approach, a low-stress environment, conscious sedation and adequate local anesthesia were provided during surgery. The procedure was uneventful.DiscussionIn patients with Moyamoya, it is imperative not to cause a variations in cerebral blood flow (eg by hyperventilation), since this might lead to ischemic attacks or cerebral hemorrhage with detrimental consequences. Maintenance of blood pressure is achieved by providing a tranquile environment and adequate patient information. Furthermore, the use of conscious sedation is advised. Use of adequate local anesthetic is important. Regardless of the concentration of epinephrine, there is no significant impact of the local anesthetic on blood pressure, as long as the maximum dose is not surpassed. Anti-platelet therapy can be continued safely without a significant increase in post-operative bleeding. There are no indications for antibiotic profylaxis in patients with this disease.ConclusionOral surgery in patients with Moyamoya can be performed safely. Local anesthesia and post-operative analgesia should be adequate to prevent complications during and after surgery. The use of intravenous sedation in a low-stress environment is advised.