Maxillofacial fractures in Pondicherry, India: An eight-year single centre retrospective study.

Background: The purpose of the present study was to analyze the etiology, incidence, pattern, and treatment modalities of patients with maxillofacial fractures treated at the Department of Dentistry of a medical college in Pondicherry during the period between June 2011 and June 2019. Materials and Methods: A retrospective epidemiological study of 277 patients treated for maxillofacial fractures between June 2011 and June 2019 was performed. Data regarding age, gender, etiology, site of the fracture, time of injury, presence of associated injuries, treatment modalities, and complications were recorded. Results: A total of 491 maxillofacial fractures were seen in 277 patients. These were 261 males (94.2%) and 16 females (5.8%) with a male to female ratio of 16.3:1. Most of the patients 79.8% were in the age group of 11 to 40 years. Most common cause of injury was Road Traffic Collisions (RTCs; 62.1%), followed by fall (20.2%), assault (14.4%) and others (3.3%). Fractures of the mandible (52.3%) and zygomatic complex (18.9%) were the most common maxillofacial fractures reported in our study. 196 patients sustained associated injuries with a prevalence of soft tissue injury (61.2%). Majority of fractures were treated with open reduction and internal fixation (ORIF; 71.9%) of patients followed by closed reduction (17.7%) and observation only (10.4%). Postoperative complications were presented in 16.8% of the patients in the study. Conclusion: RTC is the commonest cause of maxillofacial injury with a male predominance in our study. Mandibular and zygomatic complex fractures were the most common. ORIF remains the preferred method of treatment.s.

Submental intubation in maxillofacial surgery: a prospective study.

We designed a prospective study with the objective to evaluate the efficacy, indications and our experience of submental intubation in different types of maxillofacial surgeries. From May 2008 to August 2010, 23 patients with different conditions were intubated by submental route of tracheal intubation and patients were evaluated on different parameters during and after surgery to find its efficacy, indications and utilization in maxillofacial surgeries. All the patients were managed well with this technique of intubation with no significant difference in intubation and extubation time. We did not face any uneventful complication. There was only one reported complication that is rupture of the bulb of cuffed flexometallic tube but was managed well by changing tube. We found skull base access surgery as a new indication for submental intubation. The submental route for endotracheal intubation may be utilized as an alternative to blind nasal intubation or tracheostomy in the surgical management of patients involving complex maxillofacial surgeries. We hypothesized that the submental intubation should not be used where long term ventilation support is needed. We did a technique modification to deliver the endotracheal tube out from the submental region to avoid pilot cuff damage. Our study proposes that skull base access surgery is a safe and potential indication for submental intubation. In our experience submental intubation is a simple, secure and effective procedure for operative airway control in major maxillofacial surgeries.

Periapical actinomycosis.

Actinomycosis is a rare chronic infection caused by species of Actinomyces and characterised by abscess formation, tissue fibrosis, suppurative lesions and fistulas with purulent discharge containing sulphur granules. Owing to its multiform manners of presentation and non-specificity from its clinical features, it has been considered as a challenging diagnosis. Periapical actinomycosis is one of the rarest forms of actinomycosis occurring in the maxillofacial region. In its occurrence it presents in the form of persistent and recurrent draining fistula in the periapical region. We report a case of periapical actinomycosis occurred in endodontically treated teeth and accidentally found to be actinomycosis during histopatological examination. An insight towards the portal of entry of the organisms into the periapical region is also discussed. The practice of sending even a tiny bit of tissues to histopathology obtained from periapical surgery will very well demonstrate this disease and help in rapid resolution through appropriate antibiotic therapy.

Microflora in maxillofacial infections--a changing scenario?

PURPOSE: Advances in isolation and culturing techniques have brought the role of anaerobic bacteria-causing maxillofacial infections to the fore. Recent literature also favors the role of anaerobes in maxillofacial infections. A prospective clinical and microbiological study was designed to check the validity of such claims. PATIENTS AND METHODS: This study included 88 patients who fulfilled the inclusion criteria. Pus was obtained by aspirating the involved spaces and culture and sensitivity tests were performed to determine the microbes involved and their sensitivity to various antibiotics. RESULTS: Upon isolating the various organisms causing infection, it was found that 68.2% were aerobes, 13.6% were mixed infections, and 9.1% were anaerobes. Streptococcus and Peptostreptococcus species were the most common among aerobes and anaerobes, respectively. On determining sensitivity to penicillin, 81.3% were sensitive and 18.8% were resistant. Coagulase-negative Staphylococcus and Staphylococcus aureus were predominantly resistant to penicillin. CONCLUSION: Analysis of the results indicated no change in microflora-causing infections in the maxillofacial region and penicillin remains the drug of choice in treating these infections.

Antibiotic prophylaxis in third molar surgery.

AIMS AND OBJECTIVES: To evaluate the role of prophylactic antibiotics, if any, in the removal of mandibular impacted third molars. PATIENTS AND METHODS: A total of 89 patients were randomly allocated in 3 groups (group 1, placebo; group 2, amoxicillin 1 g orally 1 h before surgery; and group 3, metronidazole 800 mg orally 1 h before surgery). RESULTS: Of the 89 patients, 5 had surgical wound infection (3 [10.33%] in group 1, 2 [6.45%] in group 2, and none [0%] in group 3), leading to an overall infection rate of 5.61%. There was no statistically significant difference found in surgical wound infection between the groups. CONCLUSIONS: Our study failed to show any advantage in the routine use of prophylactic antibiotics because we found no statistically significant difference between the groups.

Prophylactic antibiotics in maxillofacial fractures: a requisite?

The role of prophylactic antibiotics to prevent surgical wound infection (SWI) in the management of maxillofacial fractures is controversial. We carried out a retrospective study in 67 patients with 114 maxillofacial fractures, of which 9 patients each were in group 1 (no antibiotic) and group 3 (cefotaxime) and 49 in group 2 (penicillin). We had an overall SWI rate of 16.66%, of which 3 of group 1 (33.33%), 12 of group 2 (24.48%), and 2 of group 3 (22.22%) constituted the SWIs. Statistical analysis showed no significant difference between the infection rates. A strong positive correlation was found between infection rate and the delay in treatment, and a similar correlation was found in the use of catgut and SWI. Our study suggests that prophylactic antibiotic therapy may not alter the incidence of surgical wound infection.

Poliomyelitis causing TMJ ankylosis?--report of two intriguing cases.

INTRODUCTION: Temporomandibular joint (TMJ) ankylosis is one of the common diseases which affect the TMJ especially in children. We are reporting two rare cases of TMJ ankylosis which occurred along with poliomyelitis and which are not reported in literature so far. DISCUSSION: In this article, we discussed about the most probable causes which resulted in TMJ ankylosis in these patients.

Peculiar presentation of bilateral temporalis muscle hypertrophy--report of a case and review of literature.

PURPOSE: Temporal hypertrophy is a rare clinical entity, especially the bilateral variety, whereas masseteric hypertrophy is a commonly occurring disorder. Very few bilateral cases are reported in literature. We are reporting a case with bilateral temporalis muscle hypertrophy with peculiar symptoms which is not reported so far in literature.