EB - two case reports

Resident’s Name: Joanne Lewis Date: March 5, 2010

Article title: Epidermolysis bullosa: dental and anesthetic management of two cases

Author(s): J. Tim Wright, DDS, MS

Journal: Oral Surgery, February 1984, Volume 57, Number 2

Type of Article: case report

Main Purpose: to present the dental and anesthetic management of two severely affected EB patients.

Overview: Two siblings were diagnosed as having recessive epidermolysis bullosa atrophicans-gravis Herlitz; severe enamel hypoplasia with typical cutaneous, esophageal, and ocular lesions was seen in both cases. Both children required dental rehabilitation under general anesthesia. Special care was taken in the surgical management of the cases to prevent nosocomial infections or minor tissue trauma that might precipitate the formation of bullae. The special precautions were:

- synthetic sheepskin bedding was used on all carts, beds, and the operating table.

- patient’s arm was wrapped in guaze before placement of the blood pressure cuff.

- orotracheal intubation was used; the tubing, laryngoscope blade, and perioral area was lubricated with 1%hydrocortisone cream.

- moist guaze packs were place on one side of the orotracheal tube.

- prior to extubation, the anesthesiologist used an endoscope to check for bullae.

Dental treatment consisted of stainless steel crown and extractions.

Key points/Summary: Patients with EB often require early and extensive dental treatment – this dental treatment is most safely accomplished in the operating room using special precautions.

Assessment of article: interesting.