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Introduction: Paracetamol is an optimal non-opioid analgesic and holds considerable advantages over NSAIDs in managing post-operative pain. Literature to date doesn't provide substantial documentation of it's efficacy and safety in major oral and maxillofacial surgeries. The study is designed to compare the effectiveness of intravenous paracetamol with diclofenac sodium for controlling post-operative pain and edema in major oral and maxillofacial surgeries. Method: The double-blind randomised prospective study includes 140 healthy patients with ASA grades I and II. Patients were divided into Group A (1gm paracetamol) and B (75 mg diclofenac sodium), 70 patients each, undergoing similar surgical procedures. VAS and VRS were assessed for pain and thread method for measuring swelling. Mouth opening in space infections was measured with calliper and scale. Results: Independent samples t-test and chi-square test showed longer pain-free interval, more interval between first and second dose, lesser number of doses required in Group A than Group B (p-value < 0.05). Independent samples t-test and Mann-Whitney test showed faster resolution of swelling in Group A (p-value < 0.05). Independent samples t-test showed lesser time taken for resolution of trismus in space infections in Group A (p-value < 0.05). Discussion: Paracetamol 1 g was found to be an effective analgesic with less adverse effects. It is superior non-opioid analgesic in reducing the intensity of post-operative pain and swelling, also requires less number of doses than diclofenac sodium in major surgeries. Patients treated with paracetamol had better quality of life during post-operative period.

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INTRODUCTION: We report a case of post COVID-19 Sino-orbital Mucormycosis infection caused by Rhizopus oryzae and its management. PRESENTATION OF CASE: The patient was diagnosed with COVID-19 and treated according to the persisting protocols. Following recovery, on the 18th day, the patient developed chemosis and pain in the left eye. A diagnosis of mucormycosis was established after Magnetic Resonance Imaging (MRI) and Functional Endoscopic Sinus Surgery (FESS). Initially, conservative management with intravenous (IV) Fluconazole & Amphotericin B was done and later on with surgical debridement. The patient recovered with minimal residual deformity. DISCUSSION: Mucormycosis generally develops secondary to immunosuppression or debilitating diseases. In Head and Neck cases, the mold usually gains entry through the respiratory tract involving the nose and sinuses, with possible further progression into the orbital and intracranial structures. Hence, an early diagnosis and intervention is required for a good prognosis, decreasing the morbidity. This can be achieved on the basis of clinical picture and direct smears. CONCLUSION: Research needs to be carried out in COVID-19 patients for better prevention and management of opportunistic infections in order to reduce its incidence and morbidity. Prophylactic treatment protocols need to be established, along with rational use of corticosteroids.

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Presurgical nasoalveolar molding (PNAM) is a key step in the early management of cleft babies. It involves making an impression of the alveolar segments and the lip elements, after which an appliance is fabricated and activated to achieve optimal alveolar and nasal positions for a superior surgical result. These appliances are fabricated and activated in babies as young as 10 days, and the molding is ideally carried on till the baby is ready for the primary lip repair. This article outlines in detail a digital method of fabricating the PNAM appliance using a combination of intraoral scans, computer-assisted digital software, and computer-assisted machining, facilitated by milling machines. This process obviates impression making and the subsequent laboratory procedures.

Asunto(s)

Labio Leporino/cirugía , Fisura del Paladar/cirugía , Procedimientos de Cirugía Plástica , Proceso Alveolar , Humanos , Lactante , Nariz , Cuidados Preoperatorios

RESUMEN

INTRODUCTION: Intramuscular lipoma are benign mesenchymal soft tissue neoplasm of mature adipocytes that arises within the muscle. Oral intramuscular lipoma are more commonly seen on tongue. Lobular capillary hemangioma (LCH) on the other hand are common benign vascular neoplasms which are often confused with pyogenic granuloma. PRESENTATION OF CASE: In this paper we present a rare case of co-existence of oral intramuscular lipoma with LCH. A 65 year old male complains of swelling on the left chin region from past 4-5 years. On complete intraoral examination another mass was noted on ventral surface of tongue. After performing USG and FNAC of the swelling in the chin region, an excisional biopsy was done and was sent for histopathological examination which showed thin connective tissue septa separating lobules of mature adipocytes. Histopathological examination of tongue mass revealed a benign tumor composed of blood vessels comprising of small capillary sized vascular channels. After a follow-up of 1 year patient showed no signs of recurrence. DISCUSSION: According to the literature recurrences are seen in case of intramuscular lipoma due to difficulty in total excision of the lesion. Immunohistochemistry plays a crucial role in distinguishing LCH from pyogenic granuloma. Intraoral LCH should be properly excised after understanding the vascularity of the lesion. CONCLUSION: In literature, the co-existence of intraoral lipoma with other lesions have been encountered hence for a surgeon a complete examination of oral cavity plays a crucial role to rule out such co-existence.

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INTRODUCTION: Local anesthetics are generally much less effective when administered in inflamed tissues. PURPOSE: This study was conducted to validate the addition of sodium bicarbonate in local anesthetics to increase its effectiveness as local infiltrations in teeth associated with periapical infections. METHODS: Two hundred subjects requiring extraction of maxillary teeth with periapical infections were enrolled. These subjects were divided in two groups of 100 subjects each. One group received local infiltration with 2 % lignocaine and 1:80,000 adrenaline, and the other group received local infiltration with sodium bicarbonate as an adjunct to the above mentioned local anesthetic solution. All extractions were performed using a consistent intra-alveolar technique by a single operator. Both the patient and the operator were blinded to the contents of local anesthetic solution. Data related to the onset of action of local anesthesia, pain experienced by the patient while undergoing extraction on two scales-"the visual analog scale and the verbal response scale", and any requirement of repeated injections during the procedure was recorded. RESULTS: Clinical and statistical data confirmed that the addition of sodium bicarbonate in local anesthetics did increase the efficacy of local anesthesia in inflamed tissues. CONCLUSION: It has been observed in this study that the action of sodium bicarbonate in local anesthetics increases the pH levels of these solutions, thus possibly making them more effective in an acidic environment.

Asunto(s)

Adyuvantes Anestésicos/administración & dosificación , Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Enfermedades Periapicales/fisiopatología , Bicarbonato de Sodio/administración & dosificación , Fístula Dental/complicaciones , Método Doble Ciego , Epinefrina/administración & dosificación , Humanos , Concentración de Iones de Hidrógeno , Inyecciones , Lidocaína/administración & dosificación , Maxilar/cirugía , Dimensión del Dolor/métodos , Extracción Dental/métodos , Odontalgia/complicaciones , Vasoconstrictores/administración & dosificación

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The healing process after any surgical intervention has always posed a challenge for the surgeons. In spite of the advances in wound closure techniques and devices, there is a crucial need for newer methods of enhancing the healing process to achieve optimal outcomes. Fibrin adhesives and platelet concentrates have proven useful in various treatment modalities in the fields of microvascular and plastic surgery. This case report shows its unique use in the field of maxillofacial and cutaneous surgery. It shows an innovative technique of enhancement of skin wound healing by local application of platelet-rich fibrin.

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Intraoral dermoid and epidermoid cysts are rare and account for less than 0.01% of all the cysts in the oral cavity. A large majority of the same arise in the floor of the mouth and infrequently in other sites. These cysts often remain asymptomatic for years until they reach a size that interferes with mastication, speech and rarely, breathing. However, they also can become acutely symptomatic if they are secondarily infected. We would like to report a case of a rare epidermoid cyst in the buccal mucosa with its differential diagnosis and a review of literature.

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BACKGROUND: Foreign bodies embedded deep in facial tissues presents a challenge to maxillofacial surgeons. Approximately one third of all foreign bodies are missed during initial examination. After facial trauma foreign bodies like grit particles, wooden pieces, thorns, pebbles, glass particles may get embedded into deeper facial tissues which are detected only accidently either with the help of radiographs or at a later stage when patient presents with some signs & symptoms like pain, pus discharge, sinus formation etc. Trauma to maxillofacial region especially after road traffic accidents is one of major cause of embedment of foreign body, but many of these cases go unnoticed. This article contains 3 cases of foreign bodies embedded in facial tissues. CONCLUSION: Proper initial examination of facial lacerations with thorough debridement is very essential for finding embedded foreign bodies. Foreign bodies embedded in deeper tissues are missed by surgeon eyes, so whenever in doubt radiographs must be advised to rule out presence of foreign bodies.

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The aim of this study was to review the pattern and prevalence of maxillofacial fractures occurring in rural children, at Rural Dental College and Hospital, Loni, Central Maharashtra, India. A retrospective analysis of patient records and radiographs was conducted during the 5 year period between January 2005 and December 2010. Data were identified and analysed based on age group, gender and anatomic site. During the 5 year period, 156 patients with 163 maxillofacial fractures were reviewed, males formed 70 % and females formed 30 % of studied population with the peak incidence rate occurring in 10-12-year old age group. The most common fracture site in maxilla was dentoalveolar component (70 %) and in mandible common fracture site was condyle (40.9 %). Of the fractures, 43 % were from accidental fall, 24.3 % from assaults, 16 % from road traffic accidents, 13.5 % from sporting injuries and 3.2 % from other causes such as animal injuries. Our results exhibit that accidental falls were the leading cause of maxillofacial fractures, and males were three times more affected than females. There is variation of incidence and pattern of maxillofacial injuries from region to region.

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Aim of the study was to find out the number of miniplates used by Indian Oral and Maxillofacial Surgeons for parasymphysis fractures. A survey was done among Oral and Maxillofacial Surgeons of India at the 34th annual meeting of Association of Oral and Maxillofacial Surgeons of India. Four questions were given to each individual to find out their opinion regarding use of miniplates in parasymphysis fractures. Eighty-eight per cent of Indian surgeons were in favour of using intra-operative or post-operative intermaxillary fixation. Thirty-eight per cent responded in favour of using single miniplate for parasymphysis fracture instead of using two miniplates. Fifty-four per cent maxillofacial surgeons use various modifications depending on different conditions. Forty-two per cent of maxillofacial surgeons accepted that lower arch bar can be used as a tension band. Use of miniplates for the treatment of parasymphysis fracture varies from centre to centre and from surgeon to surgeon. Though miniplates are best used following Champy's principle, still many surgeons use single miniplate. Arch bars placed for intermaxillary fixation can be used as a tension band, again eliminating the need for upper plate.

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The use of buccal fat pad as a graft for intraoral defects is an uncommonly reported procedure but, it has been frequently used for closure of oro-antral and oro-nasal communications. Buccal fat pad was used to reconstruct 3 medium sized defects due to tumoral resection and oro-antral communication. It was used as an unlined pedicled graft. Three cases are discussed along with anatomical aspect of the buccal fat pad. The findings support the view that the buccal fat pad is versatile, logical, convenient, and reliable method for the reconstruction of oral defects up to 4-5 cm in diameter and it healed within 4-5 weeks.

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Multiple supernumerary teeth are very rare, accounting for less than 1% of cases. They are commonly associated with syndromes like Gardner's syndrome and cleidocranial dysostosis and cleft lip and palate. Non-syndromic multiple supernumerary teeth have a predilection to occur in the mandibular premolar region. Orthokeratinized odontogenic cyst (OOC) is a relatively uncommon developmental cyst comprising about 10% of the cases that had been previously implied as odontogenic keratocysts. More than half of the cases of OOC are associated with impacted tooth; but not a single case of OOC associated with supernumerary teeth is reported. Hence, the purpose of this article is to report the first case of multiple supernumerary mandibular premolars associated with OOC in a 35-year-old male and to review the literature associated with multiple bilateral supernumerary mandibular premolars.

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Carcinoma ex pleomorphic adenoma (CXPA), as a group, constitutes 12% of malignant salivary gland tumors. We present a case of CXPA of the buccal mucosa in a 17-year-old patient. The buccal mass was of a size of 3.0 cm located in the right cheek. Pleomorphic adenoma was the provisional diagnosis. The tumor was excised under local anesthesia. Histopathological evaluation revealed a pre-existing pleomorphic adenoma. However, on magnification, certain areas showed islands of dysplastic epithelial cells' invading the fibrous capsule and CXPA was diagnosed. The patient was recalled and secondary surgery of the site performed. No tumor tissue could be detected in the secondary resection specimen. There is no sign of recurrence since 2 years.

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The technique of approximating tissues resulting in minimal amount of scar usually requires skillful suturing techniques by the surgeons, especially in cleft lip repair. Increased awareness and demand for aesthetic surgical correction with quality in tissue closure has led to the invention of new materials and techniques. Amcrylate (iso amyl 2-cyanoacrylate) is retrospectively evaluated as tissue glue in cleft lip repair, and the results are compared with skin closure by 6-0 Prolene. A retrospective analysis of 60 patients with unilateral or bilateral cleft lip repair was carried out to compare the results of skin closure with Amcrylate and 6-0 Prolene. Patients were randomly divided into 2 groups, each group containing 30, and the study was designed to evaluate the quality of scars after the use of Amcrylate tissue adhesive to close the skin during cleft lip repair and its advantages over sutures (6-0 Prolene). Both groups were analyzed for the time taken for skin closure, resultant scar, parental satisfaction, and complications, and the results were found to be statistically significant for the Amcrylate group. Amcrylate, when used as tissue glue for skin closure in cleft lip repair, definitely has an edge over conventional suturing techniques.

Asunto(s)

Cianoacrilatos/uso terapéutico , Adhesivos Tisulares/uso terapéutico , Técnicas de Cierre de Heridas , Preescolar , Cicatriz/clasificación , Cicatriz/prevención & control , Labio Leporino/cirugía , Procedimientos Quirúrgicos Dermatologicos , Estética , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Satisfacción Personal , Polipropilenos , Complicaciones Posoperatorias , Estudios Retrospectivos , Dehiscencia de la Herida Operatoria/etiología , Infección de la Herida Quirúrgica/etiología , Técnicas de Sutura , Suturas , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

INTRODUCTION: Fracture of the mandible occurs more frequently and the surgical anatomy of the mandible and adjacent structures is extremely important in understanding the pattern of fracture, the displacement of fractured fragments, and factors necessary for uncomplicated healing. In the field of dentistry, surface electromyography, electrokinesiography, and more recently, TMJ sound analysis have been particularly important developments. Previous electromyographic studies involving anterior temporalis and superficial masseter have been conducted in mandibular condylar fractures and in orthognathic and cosmetic procedures of the jaws. MATERIALS AND METHODS: This experimental study was undertaken to measure the electrical activity of the anterior temporalis and superficial masseter muscles in mandibular angle fracture cases (n = 6) and the changes in the electrical activity over a period of 6 months. RESULTS: The study shows that muscle activity increases significantly over a period of time but never matches the muscle activity of the normal subjects of same sex and age in a follow-up of 6 months post-trauma. DISCUSSION: Electrodiagnostic testing is a potentially valuable tool for the management of patients who have suffered craniomaxillofacial trauma. Electromyography is being employed in clinical practice, and allows the inclusion of quantitative data on the qualitative aspects of a diagnosis. These data are often of significant importance in the correct management of therapy and patient follow-up, particularly if the subject is at risk of developing a different and/or more serious disease.

Asunto(s)

Electromiografía , Fracturas Mandibulares/fisiopatología , Músculo Masetero/fisiopatología , Procesamiento de Señales Asistido por Computador , Músculo Temporal/fisiopatología , Adulto , Fuerza de la Mordida , Femenino , Estudios de Seguimiento , Fijación de Fractura/métodos , Fijación Interna de Fracturas/métodos , Curación de Fractura/fisiología , Humanos , Masculino , Masticación/fisiología , Persona de Mediana Edad , Proyectos Piloto , Valores de Referencia

RESUMEN

Dentigerous cyst is the most commonly occurring odontogenic cyst after radicular cyst and accounts for 15% of all true cysts in the jaws. The cyst is more common in mandible than in maxilla. The dentigerous cyst is commonly associated with impacted mandibular third molars. In maxilla, the incidence is rare. Dentigerous cyst in maxillary sinus in association with an impacted third molar is an uncommon entity. We present a case of dentigerous cyst associated with an impacted third molar, completely obliterating the maxillary sinus in a 28-year-old female.

Asunto(s)

Quiste Dentígero/complicaciones , Enfermedades Maxilares/complicaciones , Sinusitis Maxilar/etiología , Tercer Molar/patología , Diente Impactado/complicaciones , Adulto , Asimetría Facial/etiología , Femenino , Estudios de Seguimiento , Humanos

RESUMEN

BACKGROUND: Complete management of extraconal ocular tumors may require the joint efforts of a maxillofacial surgeon to provide access and an ophthalmic surgeon to completely excise the lesion. Pleomorphic adenoma is the most common benign tumor of the lacrimal glands, representing around 12% of the lacrimal fossa lesions. They may however undergo malignant changes. Carcinoma ex pleomorphic adenoma (CXPA), a type of malignant mixed tumor of the lacrimal gland has been rarely reported. CASE REPORT: We report a case of CXPA of the lacrimal gland in a 35-year-old male. He was managed by a modified lateral orbitotomy access osteotomy with complete removal of the lesion and showed postoperative uneventful recovery. DISCUSSION: Accurate clinical diagnosis of a neoplasm in the orbital cavity is important for correct therapeutic management. This paper emphasises on the comprehensive management of these lesions with a special emphasis on diagnosis and surgical technique.

Asunto(s)

Adenocarcinoma/diagnóstico , Adenocarcinoma/cirugía , Adenoma Pleomórfico/diagnóstico , Adenoma Pleomórfico/cirugía , Conducta Cooperativa , Neoplasias del Ojo/diagnóstico , Neoplasias del Ojo/cirugía , Comunicación Interdisciplinaria , Enfermedades del Aparato Lagrimal/diagnóstico , Enfermedades del Aparato Lagrimal/cirugía , Órbita/cirugía , Osteotomía/métodos , Enfermedades Raras/diagnóstico , Enfermedades Raras/cirugía , Adenocarcinoma/patología , Adenoma Pleomórfico/patología , Adulto , Transformación Celular Neoplásica/patología , Diagnóstico Diferencial , Neoplasias del Ojo/patología , Estudios de Seguimiento , Humanos , Interpretación de Imagen Asistida por Computador , Enfermedades del Aparato Lagrimal/patología , Masculino , Invasividad Neoplásica , Órbita/patología , Enfermedades Raras/patología , Tomografía Computarizada por Rayos X

RESUMEN

BACKGROUND: The posterior superior alveolar (PSA) nerve block is commonly used in dentistry for treatment of the maxillary molars. Although this procedure is associated with many complications, ocular complications have been rarely reported. CASE REPORT: This report details an iatrogenic paresis of the abducent nerve and partial palsy of the oculomotor nerve leading to diplopia, strabismus and ptosis following a PSA nerve block and extraction of maxillary right second molar. The patient was treated symptomatically, and the recovery was uneventful. Relevant anatomical pathways with review of literature are discussed. DISCUSSION: Although rare, the dentist should be aware of these complications to avoid being perplexed by this unexpected circumstance, thus adversely affecting the doctor-patient trust.

Asunto(s)

Enfermedades del Nervio Abducens/inducido químicamente , Anestésicos Locales/efectos adversos , Blefaroptosis/inducido químicamente , Diplopía/inducido químicamente , Nervio Maxilar/efectos de los fármacos , Bloqueo Nervioso/efectos adversos , Parálisis/inducido químicamente , Anestésicos Locales/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Enfermedad Iatrogénica , Lidocaína/administración & dosificación , Lidocaína/efectos adversos , Persona de Mediana Edad , Diente Molar/cirugía , Enfermedades del Nervio Oculomotor/inducido químicamente , Estrabismo/inducido químicamente , Extracción Dental/métodos

RESUMEN

Osteosarcomas are malignant neoplasms of the bone which commonly affect the long bones. The involvement of the jaws are rarely noticed. These neoplasms often shows a typical clinical behaviour as well as varied radiological appearances. Similarly, their histological growth pattern can be quite diverse. Confirmation of the final diagnosis of an osteosarcoma often requires a histopathological examination of the multiple biopsy specimens and vigorous discussion amongst the experts. All these clinical features, radiographic appearances and histological diagnostic difficulties were encountered in a case of osteosarcoma of the mandible in a 29-year old female.