title: Impalement oral injury: Ultrasonic scalpel is the best tool to cut off a toothbrush.
abstract: OBJECTIVE
  Penetrating injuries to the oral cavity involving a toothbrush are relatively common among children. Sometimes general anesthesia is recommended. Although the handle prevents adequate mask ventilation in the induction of anesthesia, it is unknown what is the best tool to cut it preventing complications. The aim of this study was to evaluate the optimal tool to cut off the toothbrush handle.
  
  
  METHODS
  Six anesthesiologists participated in this study. We attached a triaxial acceleration sensor to the tip of the toothbrush to virtually measure force toward the wound. Each participant cut off the handle of the toothbrush using 3 tools: Gluck rib shears (GRS: cutting horizonal); Sklar Coryllos rib shears (SCRS: cutting vertical); and an ultrasonic scalpel (USS). Acceleration and time required to cut the toothbrush were measured. Each anesthesiologist evaluated the usability of each tool on a 5-point scale.
  
  
  RESULTS
  The USS showed the longest mean time (GRS, 1.78 ± 1.01 s; SCRS, 7.30 ± 4.58 s; USS, 28.13 ± 13.41 s), lowest 3-dimensional acceleration (GRS, 2.15 ± 0.69 G; SCRS, 2.13 ± 0.57 G; USS, 1.01 ± 1.07 G), and highest mean score for usability.
  
  
  CONCLUSIONS
  The USS appeared preferable to rib shears for cutting off toothbrush handles, even though it takes longer.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Miyashita
authors.forename: Keiko
authors.initials: K
authors.lastname: Toki
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Takaki
authors.forename: Takahisa
authors.initials: T
authors.lastname: Goto
mesh_terms: D006801:Humans; D009055:Mouth / Q000601:surgery*; D013997:Time Factors; D014099:Toothbrushing; D014465:Ultrasonics; D014950:Wounds, Penetrating / Q000601:surgery*
keywords: Impalement oral injury; anesthesia induction; rib shear; ultrasonic scalpel