Analysis of Effect of Melatonin on Postoperative Sensory Nerve Recovery Following Open Reduction and Internal Fixation of Anterior Mandible Fractures: A Prospective Randomized Control Trial.

Purpose: Open reduction and internal fixation (ORIF) of the anterior mandibular fractures are commonly associated with mental nerve paraesthesia. This study evaluates the efficacy of melatonin on postoperative sensory functional recovery and pain following surgical treatment of anterior mandibular fractures. Methods: Forty patients were randomly allocated to two groups: Group I-melatonin, and Group II-control group. Postoperative neurosensory recovery was evaluated both subjectively and objectively at 1-week, 1-month, and 3-month intervals. The pain was assessed during the immediate postoperative period, postoperative days 1, 2, 3, and 7 using a visual analog scale. Statistical significance was set at P value < 0.05. Results: The statistically significant difference was noticed in both subjective and objective recovery of sensory nerve function at 1-month follow-up. All patients in the melatonin group showed complete recovery of nerve function as compared to the control group where 10% of patients showed limited recovery. Conclusion: Neurosensory recovery following ORIF of mandibular fractures was better in the melatonin group as compared to the control group and therefore the perioperative administration of 10 mg. Melatonin can be recommended for quicker and better nerve recovery in the anterior mandibular fractures requiring close manipulation of the mental nerve during treatment.

Facial Asymmetry-Demystifying the Entity.

Introduction/Background: Perfect facial symmetry has always been considered a hallmark of beauty, but, is almost elusive in nature. However, clinically evident skeletal facial asymmetry on the other hand is quite common, which can result from congenital deformities, developmental abnormalities, secondary to maxillofacial trauma and it is an entity maxillofacial surgeons deal with on a regular basis. Surgical correction of facial asymmetry is challenging, as it not only involves the correction of the skeletal asymmetry for an aesthetic outcome, but, also the improvement of the soft tissue drape and dental occlusal harmony. This results in rehabilitation of functional components of orofacial complex like speech, deglutition and phonation. Objective: With this paper, we intend to throw a light on this challenging aspect of maxillofacial surgery, along with giving the next generation of maxillofacial surgeons a direction to explore the topic further. Conclusion: Meticulous evaluation and diagnosis of the patient's problems with latest diagnostic methods like 3-dimensional imaging and surgical treatment with orthognathic surgery, gap arthroplasty or distraction osteogenesis, utilizing cutting edge 3-D virtual planning will result in better outcomes.This review will collate the information available in the literature, along with the authors' recommendations for better planning and execution of this challenging puzzle of facial asymmetry.

Pre-emptive analgesia efficacy of piroxicam versus tramadol in oral surgery.

Background: This double-blind randomized controlled trial (RCT) was conducted to evaluate the pre-emptive analgesia and anti-inflammatory efficacy of piroxicam compared with tramadol in patients undergoing oral surgery. Methods: Seventy-eight patients who required extraction of impacted mandibular third molars were randomized into three treatment groups of 26 patients each: group I received 100 mg of tramadol, group II received 20 mg of piroxicam, and group III received a placebo. Drugs were administered intramuscularly 30 min prior to the extraction procedure. Results: Pain intensity, time to first analgesic administration, total analgesic consumption, facial edema, and trismus were the outcomes of interest. The group receiving 20 mg of piroxicam showed significantly lower pain intensity, increased time to first analgesic, and reduced edema from preoperative to postoperative day seven than those in the tramadol and placebo groups. Conclusion: The findings of this study showed that piroxicam had significant pain relief efficacy after third molar surgery compared with that in tramadol.

Relationship between fracture of mandibular condyle and absence of unerupted mandibular third molar-a retrospective study.

PURPOSE: The purpose of the present study was to find, if there exists, a co-relation between presence of unerupted mandibular third molar and fracture of mandibular condyle. METHODS: A retrospective, multicenter study was done collecting the data of all mandibular condyle fractures treated from November 2006 till August 2015. Data was collected from the patient's records and radiographs for the following information: age, sex, etiology of fracture, presence and state of lower third molars, and associated fracture. The results were subjected to statistical analysis. RESULTS: Out of 180 patients of condylar fracture, unerupted third molars were present in 35 (19.44 %) cases compared to 145 (80.55 %) cases of condylar fracture where the unerupted third molars were not present. The difference was statistically significant (p < 0.05). In the unerupted third molar present group, isolated bilateral condylar fracture was seen in 4 (11.4 %) cases, bilateral condylar fracture associated with other mandibular fractures in 9 (25.7 %) cases, isolated unilateral condylar fracture in 0 (0.0 %) cases, and unilateral condylar fracture associated with other mandibular fractures in 17 (48.5 %) cases and condylar fracture associated with mid face fractures in 5 (14.2 %) cases. In the unerupted third molar absent group, isolated bilateral condylar fracture was seen in 5 (3.4 %) cases, bilateral condylar fracture associated with other mandibular fractures in 30 (20.6 %) cases, isolated unilateral condylar fracture in 24 (16.5 %) cases, unilateral condylar fracture associated with other mandibular fractures in 73 (50.34 %) cases, and condylar fracture associated with mid face fractures in 13(8.96 %) cases. The difference between the groups was statistically significant (p = 0.032). CONCLUSION: This study suggests that the fractures of mandibular condylar region have a significantly higher incidence in patients without an unerupted mandibular third molar.

Analysis of patterns and treatment strategies for mandibular condyle fractures: review of 175 condyle fractures with review of literature.

This study aims to evaluate incidence, patterns and epidemiology of mandibular condylar fractures (MCF) to propose a treatment strategy for managing MCF and analyze the factors which influence the outcome. One hundred and seventy-five MCF's were evaluated over a four year period and their pattern was recorded in terms of displacement, level of fracture, age of incidence and dental occlusion. Of the 2,718 facial bone fractures, MCF incidence was the third most common at 18.39 %. Of 175 MCF 58.8 % were unilateral and 41.12 % were bilateral. 67 % of bilateral fractures and 43.8 % of unilateral fractures were associated with midline symphysis and contralateral parasymphysis fractures respectively. Most of the MCF was seen in the age group of above 16 years and 50 % of them were at subcondylar level (below the neck of the condyle). Majority of MCF sustained due to inter personal violence were undisplaced (72.7 %) and contrary to this majority of MCF sustained during road traffic accident were displaced. 62.9 % of total fractures required open reduction and rigid fixation and 37.1 % were managed with closed reduction. 80 % of MCF managed with closed reduction were in the age group of below 16 years. From this study it can be concluded that the treatment algorithm proposed for managing MCF is reliable and easy to adopt. We observed that absolute indication for open reduction of MCF is inability to achieve satisfactory occlusion by closed method and absolute contraindication for open reduction is condylar head fracture irrespective of the age of the patient.

Ipsilateral, isolated amaurosis after inferior alveolar nerve block: report of two rare cases.

BACKGROUND: Local anesthetics are utilized all over the world for performing painless dental procedures. Usually, the administration of local anesthetic is an uncomplicated process that passes off uneventfully. Complications, when seen, are not usually serious. However, blindness is an alarming complication both for the patient and for the dentist. Amaurosis can occur with both maxillary and mandibular nerve blocks. Amaurosis is usually associated with other ocular complications like ptosis, diplopia, and periorbital blanching. CASE REPORT: We report two rare cases of transient isolated amaurosis. Both the instances of amaurosis were seen after inferior alveolar nerve blocks. The condition was transient and resolved without any active intervention. DISCUSSION: Though permanent amaurosis has been reported, it is usually transient in nature. Various causes have been proposed like intravascular injection, sympathetic impulse generation, and embolism. The etiology in the present case was believed to be intravascular injection.

Cephalometric norms for Central Indian population using Burstone and Legan analysis.

BACKGROUND: Lateral cephalometric standards of normal Central Indian adults having class I occlusion and acceptable facial profile were studied using the Burstone and Legan comprehensive cephalometric analyses that are specific for orthognathic surgery. AIM: To study normal dentofacial patterns of adult population belonging to Central India. MATERIALS AND METHODS: Cephalometric radiographs of 76 Central Indian adults (38 males and 38 females) having class I occlusion with acceptable facial profile were analyzed, and the mean values of their hard and soft tissue measurements were compared with those of Caucasian adults as reported in the literature. RESULTS: The Central Indian males demonstratedgreater anterior cranial base length and ramal length and a reduced chin depth. The inclination of the upper and lower incisors was also greater. The females demonstrated greater posterior cranial base length, increased upper anterior and posterior facial heights, and an increased maxillary length. Both mandibular body and ramal lengths were increased and there was greater mandibular protrusion and a reduced chin depth. The lower incisors were found to be proclinated. CONCLUSION: This study reveals that some of the cephalometric parameters in the Central Indian population are significantly different than that of the Caucasian population, especially in the females.

A Case of Thrombocytopenia due to Odontogenic Infection.

Thrombocytopenia in surgical patients is a potentially serious condition,faced by surgeons. A close relationship between sepsis and thrombocytopenia has been suggested. Thrombocytopenia has even been suggested to be indicative of an acute infection. Platelet count in a septicemic patient may also serve as a prognostic tool. There are many reports of thrombocy-topenia due to septicemia in the literature but the occurrence of thrombocytopenia in maxillofacial infections is rare. Thrombocytopenia in a patient with odontogenic infection presents unique diagnostic and management challenges. A case report of an adult male patient with odontogenic infection, who developed life-threatening thrombocytopenia, is presented.