Trigeminocardiac reflex during maxillary third molar extraction: Our experience.

Trigeminocardiac reflex (TCR) is a cascade of physiological response secondary to the stimulation of any of the sensory divisions of the trigeminal nerve, which is the largest cranial nerve and provides sensory supply to the face, scalp, mucosa of the nose, and mouth. This response usually presents as a triad including bradycardia, apnea, and gastric motility changes. On the another side, transient loss of consciousness or vasovagal syncope, a well-known phenomenon in dentomaxillofacial surgery with its pathophysiology fully elucidated, is thought to be mediated by TCR and sometimes termed as dentocardiac reflex. Thus, it is imperative to know about TCR and its association with routine dental and maxillofacial surgery procedures. It can potentially happen during any minor or major oral surgical procedures ranging from simple third molar extractions, soft tissue surgeries, root canal treatments, or management of maxillofacial fractures. This paper presents two case reports demonstrating TCR which presented during maxillary third molar extraction and author(s) own experience in managing the same.

Efficacy of Microplates versus Miniplates in the Management of Maxillofacial Fractures.

INTRODUCTION: Increased facial trauma has led to advances in techniques of internal fixation, improvements in plating system, refinements in exposure of facial skeleton fueling the rapid use of internal fixation for the management of facial fractures. Evaluating 40 patients with confirmed midfacial (Le Fort I and II) and mandibular fractures, this study presents the efficacy of microplate in comparison with miniplate in terms of load bearing capacity, stability at the fracture site and postoperative palpability. OBJECTIVES: To evaluate the efficacy of microplates in comparison with miniplates in maxillofacial trauma. MATERIALS AND METHODS: Study sample consists 40 subjects, 20 each in two groups clinically and radiographically diagnosed with Group 1 (maxillary) and Group 2 (mandibular fractures) which were subdivided into 10 each treated with miniplate and microplate respectively. Postoperatively, stability of fracture, bite force, need for postop MMF, pain, infection, wound dehiscence, mouth opening, occlusion and palpability was noted. All cases have been evaluated clinically for various parameters for minimum of 3 months to assess any postoperative complications. RESULTS: We found microplates are stable enough and have adequate load bearing capacity. Due to close adaptability and less hardware, postoperative palpability is less but larger sample study with long term follow up is necessary to conclude its efficacy in load bearing fracture sites.

Enchondroma of the Mandibular Body: An Occult Entity.

Cartilaginous tumors are commonly encountered tumors that can involve almost any bone and very rarely found in the maxillofacial region. These tumors may have varied presentations ranging from a simple enchondroma to a high-grade osteo or chondrosarcoma. Owing to their membranous development they are reported to occur usually in the cartilage bearing areas of the jaws like condylar process of the mandible. This article is intended to present a rarest of rare case of enchondroma of the mandibular body which to the best knowledge of authors', is not reported in the literature so far.

Cuddling Teeth: A New Terminology.

Literature is replete with information on the diverse patterns exhibited by impacted teeth and a clinical scenario in which >1 impacted teeth appears in close proximity is documented very rarely. Occasionally, molars are found to be impacted in interesting patterns which were described previously as "rosette teeth" or "kissing molars". This article intends to introduce a new term, namely, "cuddling teeth" to broadly describe the clinical presentations where 2 or >2 impacted teeth are found in close approximation.

Three-Dimensional Miniplate: For the Management of Mandibular Parasymphysis Fractures.

BACKGROUND: Recently, oral and maxillofacial surgeons are favoring three-dimensional (3D) miniplates to treat mandibular fractures. AIMS: The aim of the study is to evaluate the efficacy of 3D-miniplates over standard miniplates in the management of mandibular parasymphysis fracture. MATERIALS AND METHODS: Forty patients with mandibular parasymphysis fractures were divided into two groups of 20 patients each. Group I patients underwent osteosynthesis of mandibular fracture by noncompression, unicortical, and stainless steel 3D miniplates, and Group II patients underwent osteosynthesis by noncompression, unicortical, and stainless steel Champy's miniplates. All the patients were followed up 6 months' postoperatively, evaluating occlusion, mobility of fracture segment, pain, wound dehiscence, neurological deficit, and infection. STATISTICAL ANALYSIS USED: The data were analyzed by SPSS for windows (version 17) statistical package (SPSS Inc., Chicago, IL, USA). Chi-square test was carried out to determine the statistical difference between the groups. RESULTS: Mobility of the fractured site was evaluated postoperatively after 2 weeks, and it was found that mobility was absent in all the cases of Group I and 36 (80%) cases in Group II. There was significant difference in the mean visual analog scale scores among the Group I and II when compared from preoperative to 4-week follow-up. In Group II, two patients showed wound dehiscence. After 2 weeks, infection was seen in two patients of Group II. CONCLUSION: 3D plates in mandibular parasymphysis fractures give dimensional stability and carry low morbidity and infection rates.

Protocol for Antibiotic Administration in Mandibular Trauma: A Prospective Clinical Trial.

PURPOSE: The purpose of this study is to determine the necessity and/or effectiveness of antibiotics in cases with maxillofacial trauma and emphasise the administration of antibiotics in maxillofacial fractures indicated for open reduction and rigid internal fixation (ORIF). MATERIALS AND METHODS: This study is a single blind, prospective, randomized clinical trial composed of subjects who presented with non-comminuted, linear fractures of the mandible and were treated by ORIF via an intraoral approach. One hundred and forty-four subjects (2011-2015) who belonged to the above entities were randomly categorized into 2 groups of 72 each, on lottery method. Patients in Group A were administered a 5 day course of antibiotic (1 day IV antibiotics followed by 4 days oral) while patients in Group B received a 1 day course of IV antibiotic (1 dose post op). Both the groups were followed up on the 1st day, 3rd day, 1st week, 1st month, 3rd month post operatively and were evaluated for pain, swelling, infection, fever, spontaneous wound dehiscence, purulent discharge and any other adverse effects. RESULTS: Post operative infection when measured clinically and radiographically was comparatively higher in Group B. Out of 72 patients in both the groups, 5 patients each in Group A and Group B reported with wound dehiscence, 9 patients in both groups developed pyrexia. CONCLUSION: Though the post operative infection was slightly more in Group B compared to Group A, 1 day antibiotic regimen was found to be equally effective when compared to 5 day regimen and helps in reducing the after effects, superinfection and antibiotic resistance. It has better patient compliance and is cost effective.

Quest for an Ideal Route of Intubation for Oral and Maxillofacial Surgical Manoeuvres.

PURPOSE: The optimal route of intubation that may be planned for different oral and maxillofacial surgical manoeuvres. MATERIALS AND METHODS: A study was performed on patients who underwent nasal, oral or submental route of intubation for elective oral and maxillofacial surgery under general anaesthesia. The study variables were the anaesthetic and surgeon factors that should be taken into consideration before intubation and during surgery, and also algorithms for uneventful surgical procedures. The outcome variables were influence of the 'route of intubation' on 'surgical technique' and vice versa. Overall results were compiled, tabulated and analysed using SPSS version 14.0. RESULTS: The study sample comprised of 634 patients. It was found that 35 % (204) nasal, 7.5 % (4) oral and 0 % submental route of intubation had statistically significant influence on oral and maxillofacial surgical procedures and vice versa (p < 0.001). CONCLUSION: This present study concluded that the surgical access and visibility was immensely improved by following the anaesthetic and surgeon factors in conjunction with algorithms described for uneventful oral and maxillofacial surgical procedures. Further, this has also substantially minimized the influence of the 'route of intubation' on 'surgical technique' and vice versa.

Salivary gland tumors: a diagnostic dilemma!

Salivary gland tumors generate considerable interest because of their heterogeneous and variable histology, grade of malignancy, and clinical behavior. Fine needle aspiration cytology (FNAC) is considered the first diagnostic modality for salivary neoplasms due to its ready availability and ease of performance. However it cannot always be relied upon in isolation, and should be used in conjunction with other investigations like incisional biopsy. We present two cases, which highlight the drawbacks of relying on FNAC alone, which resulted in misdiagnosis of adenoid cystic carcinoma as pleomorphic adenoma.