Evaluating Morphology of the Pterygomaxillary Junction and Its Association With the Orbit in Different Facial Skeletal Relationships.

PURPOSE: The etiology for blindness after Le Fort I osteotomy is poorly understood. The authors propose that a study of the morphology and anatomical relationship of the pterygomaxillary junction to orbital vital structures may be crucial for understanding the possible etiology. MATERIALS AND METHODS: This retrospective observational study involved analysis of data procured from computed tomography scans of individuals who were categorized into 4 groups based on their skeletal characteristics: skeletal Class I, II, and III and cleft lip and palate (CLP). The outcome variables included i) the height, width, and thickness of the pterygomaxillary junction (PTMJ) which represent its morphology and ii) distance of the PTMJ to the superior orbital fissure and optic canal, to demonstrate its proximity to orbital vital structures. Primary outcome measures were to i) compare variance of the outcome variables across groups, ii) determine association between PTMJ morphology and its proximity to the orbit, and iii) determine association between skeletal morphology and the outcome variables. Data were analyzed using descriptive and inferential statistics to study variance and association. RESULTS: Forty patients (80 sides) were divided into 4 groups. The CLP group demonstrated maximum height and thickness of the PTMJ, whereas the Class II group demonstrated the minimum (P < .001 and P = .001, respectively). The CLP group demonstrated the closest proximity of the PTMJ to orbital vital structures (P < .001), with Class II being the farthest (P < .001). There was a weak positive correlation between the PTMJ height and its thickness and width, whereas a moderate negative correlation was seen between the PTMJ height and its distance from the optic canal and superior orbital fissures (P < .001). CONCLUSIONS: Morphology of the PTMJ varies with facial skeletal relationship and also influences the relationship of the PTMJ with the orbital vital structures. This may be critical in understanding the pathophysiology of blindness after Le Fort I osteotomies.

Mandibular fracture scoring system: for prediction of complications.

INTRODUCTION: Mandibular fractures are one of the most commonly encountered injuries in trauma clinics. Although several widely accepted classification systems exist, these are mostly region specific, differ in the classification criteria used, and are sometimes only correlated with specific treatment modalities, thereby making it impossible to uniformly and comprehensively document facial fracture patterns. In this study, we developed a modified scoring system for mandibular fractures and analyzed the relationship between scoring of fractures that were treated and the incidence of complications after surgical treatment. MATERIALS AND METHODS: To evaluate the suitability of the proposed scoring system, a prospective study on a series of 116 patients was performed. All the fractures were classified using the proposed scoring system. The scoring was based on clinical and radiological evaluation of each fracture. Patients were followed up postoperatively for presence of complications. RESULTS: A good correlation between the proposed scoring system and the incidence of complications was detected. DISCUSSION: This scoring system for mandibular fractures facilitates an objective and standardized assessment of the degree of severity of a fracture, thereby allowing for systematic evaluation of facial fracture outcomes, including assessment of complications. However, it is our understanding that a multicenter study should be performed before the effectiveness of the proposed classification can be clearly stated.

Role of Arthrocentesis in the Management of Acute Closed Lock of TM Joint: A Pilot study.

The following study was conducted in Meenakshi Ammal Dental College on 32 patients. The objective of our study was to assess the efficacy of arthrocentesis for the management of acute closed lock of TMJ. All patients presented with a history of sudden and persistent difficulty in mouth opening and associated TMJ pain. A total of 27 female and 5 male patients were treated using arthrocentesis and lavage under local anesthesia. Patients were assessed for pain and jaw function using visual analogue scales, VAS I (Fig. 4b), VAS II (Fig. 4c), respectively and mouth opening MMO (Fig. 4a) for a period of 6 months. Our results showed satisfactory relief in pain and improved mouth opening in 30 patients. The results proved that arthrocentesis is a very useful technique for treatment of acute closed lock of TMJ. However to arrive at a definitive conclusion a long term evaluation is required.

Microbiology of the white coat in a dental operatory.

BACKGROUND: It remains important to have a thorough knowledge of the micro-flora harboring the white coats of doctors to minimize cross-contamination and improve patient safety by reducing the risk of nosocomial infections. This study presents the microbiological analysis of the white coats in clinical departments of a dental college and hospital. MATERIALS AND METHODS: The swabs for the study were taken from the white coats of undergraduate students posted in various clinical departments, interns, and the post-graduate students. The microbial contamination was studied by observing and recording the colony morphology on the culture plates, Gram's staining with light microscopic screening of the slides, and the biochemical characterization of the isolates using standard microbiology protocols. RESULTS: Microbiological analysis of swabs taken from the white coats in the dental operatory showed that 100% coats had bacterial contamination. Out of 30 swabs collected, 46 cultures were obtained. 50% cultures showed Gram-positive cocci, making it the major microbial group contaminating the white coats in the dental operatory. CONCLUSION: The presented study highlights the fact that the white coats are a potential source of cross infection. The results of this study mandate a strict audit process and protocols to be set in place for preventing cross-contamination from the white coats in a dental operatory.

Orofacial granulomatosis: a clinicopathologic correlation.

Orofacial granulomatosis is an uncommon disorder, but has been increasingly recognized in the past decade. It causes significant morbidity in the patient including oral ulcerations, enlargement of soft tissues which are often persistent and painful. This necessitates early medical intervention. We report one such case of a female patient who presented with a persistent upper lip enlargement. She had visited multiple general dental practitioners and general physicians but was undiagnosed. Ultrasonography proved an adjunctive tool in diagnosis. She was treated with a combination of topical and intra-lesional steroids. A 1-year follow-up did not show any evidence of recurrence.