J Dent Anesth Pain Med.  2015 Sep;15(3):173-179.

Full mouth rehabilitation of a patient with Sturge-Weber syndrome using a mixture of general and sedative anesthesia

• Doh RM
• Yu TM
• Park W
• Kim S

Abstract

Issues related to the control of seizures and bleeding, as well as behavioral management due to mental retardation, render dental treatment less accessible or impossible for patients with Sturge-Weber syndrome (SWS). A 41-year-old man with SWS visited a dental clinic for rehabilitation of missing dentition. A bilateral port-wine facial nevus and intraoral hemangiomatous swollen lesion of the left maxillary and mandibular gingivae, mucosa, and lips were noted. The patient exhibited extreme anxiety immediately after injection of a local anesthetic and required various dental treatments to be performed over multiple visits. Therefore, full-mouth rehabilitation over two visits with general anesthesia and two visits with target-controlled intravenous infusion of a sedative anesthesia were planned. Despite concerns regarding seizure control, bleeding control, and airway management, no specific complications occurred during the treatments, and the patient was satisfied with the results.

Keyword

Dental care for the disabled; General anesthesia; Mouth rehabilitation; Sedation; Sturge-Weber syndrome

MeSH Terms

Adult
Airway Management
Anesthesia*
Anesthesia, General
Anxiety
Dental Clinics
Dentition
Gingiva
Hemorrhage
Humans
Infusions, Intravenous
Intellectual Disability
Lip
Mouth Rehabilitation*
Mouth*
Mucous Membrane
Nevus
Rehabilitation
Seizures
Sturge-Weber Syndrome*

Figure

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  Fig. 1 (A) Extraoral photograph showing a marked facial nevus, (B-F) Intraoral photographs obtained during the patient's first visit. The arrows indicate the hemangioma in the gingiva.

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  Fig. 2 Panoramic radiograph and intraoral radiographs obtained during the patient's first visit revealing missing dentition and advanced dental caries.

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  Fig. 3 Bronchoscopic view of the larynx. A swollen epiglottis (black arrows) was noted.

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  Fig. 4 Extraoral (A) and intraoral (B-F) photographs obtained at the 1-week follow-up.

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  Fig. 5 Panoramic radiograph obtained at the 1-week follow-up.

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  Fig. 6 Intraoral photographs with provisional dentures showing marked insufficiency of the buccal vestibules for denture support (black arrows).

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