Piezo-osteotomy in orthognathic surgery: A comparative clinical study.

Background: After the clinical introduction of ultrasound scalpel in recent years, piezosurgery has become competitive with conventional instruments in orthognathic procedures to reduce the operative and postoperative complications reported to occur in association with these surgeries. Aims: The aim of this prospective clinical study was to compare intraoperative and postoperative outcomes of both piezoelectric device and the traditional bur technique in orthognathic surgery. Intraoperative bleeding time, operative time, postoperative swelling, and neurological impairment were evaluated. Materials and Methods: In this study, a split-mouth technique was applied on ten patients requiring orthognathic surgery. To make the osteotomy cuts, on the one side, piezo-osteotome was used, and on the other side, conventional osteotomy bur was used. Results: Duration of osteotomy was found to be greater with piezo osteotomy compared to bur osteotomy. Mild bleeding was observed with piezosurgery. Postoperative swelling was greater on the side of piezosurgery compared to the bur side. Altered neurosensory activity was found to be equal on the 1st day postoperatively, but the piezo side recovered faster compared to the bur side in the 1st month after surgery. Conclusion: Piezoelectric device offers better advantages over the conventional bur in orthognathic surgery and hence can be considered an alternative to the bur in some orthognathic procedures.

Partial superficial parotidectomy for pleomorphic adenoma of the parotid gland.

Pleomorphic adenoma, otherwise called as benign mixed tumour, is the most common salivary gland tumour which accounts for 60% of all benign salivary gland tumours. The clinical, radiological and histopathological presentations are varied. The tumour occurs in diverse anatomical sites and can consist of epithelial and mesenchymal components. In this case report, the patient reported with an asymptomatic swelling on the face. CT scan with contrast was advised. The clinical, roentgenographic findings and Fine Needle Aspiration Cytology were indicative of pleomorphic adenoma of the parotid gland. Treatment included partial superficial parotidectomy under general anaesthesia using the modified Blair's incision. The facial nerve was not involved. Part of the gland along with the tumour was resected completely superficial to the facial nerve with a margin of normal tissue all around. Histopathologic examination of tissue specimen confirmed the lesion as pleomorphic adenoma. The patient was asymptomatic at 6-month follow-up.

The Retromandibular Transparotid Approach for Reduction and Internal Fixation of Mandibular Condylar Fractures.

INTRODUCTION: The retromandibular transparotid approach is most useful for condylar and subcondylar fractures and provides the best access to the joint and ascending ramus. The study aims at evaluating the ease of access and outcomes encountered on using the retromandibular transparotid approach to access the fracture site for the open reduction and internal fixation (ORIF) of condylar and sub-condylar fractures. MATERIALS AND METHODS: An observational clinical study was carried out among 10 patients with unilateral and bilateral condylar fracture requiring ORIF. Maximal interincisal mouth opening, facial swelling, occlusal discrepancy, facial nerve injury, scar formation, and acceptability and complications including wound dehiscence, infection, and sialocele/salivary fistula were assessed and measured preoperatively and postoperatively. RESULTS: There was a notable improvement in mouth opening and facial nerve weakness. Postoperative intermaxillary fixation was done with selective patients who had a discrepancy in their occlusion. Preoperatively, swelling was present in four patients (40%) out of 10 patients studied. There was no incidence of sialocele/salivary fistula in any of the cases studied. CONCLUSION: Retromandibular transparotid incision is technique sensitive and thorough knowledge about the retromandibular area is must for good results and minimal morbidity. The cosmetic results are good in this approach, as well as the facial nerve injury were less in this without any permanent damages.

Bisphosphonate-Induced Osteonecrosis of the Jaws (BIONJ).

INTRODUCTION: The risk of osteonecrosis of the jaw is greater for patients receiving intravenous bisphosphonates for cancer than for patients receiving oral bisphosphonates for osteoporosis or Paget's disease. MATERIALS AND METHODS: This article provides a review of the treatment of Bisphosphonate induced osteonecrosis of jaws. CONCLUSION: Bisphonates associated jaw necrosis and its relation to dentisitry and maxillofacial surgery has become common now a days. Proper diagnosis and treatment may help the patients health getting worsen.

Orthopantomography and Cone-Beam Computed Tomography for the Relation of Inferior Alveolar Nerve to the Impacted Mandibular Third Molars.

CONTEXT: Relation of inferior alveolar nerve to the impacted mandibular third molars (IMTMs). AIMS: The aim of this study was to assess the reliability of seven specific radiographic signs of mandibular third molar root that are observed on orthopantomography (OPG) and to predict the proximity and the absence of corticalization between the mandibular canal and IMTM root on cone-beam computed tomography (CBCT) images. SETTINGS AND DESIGN: The present study was conducted in the Department of Oral and Maxillofacial Surgery, Raja Rajeswari Dental College and Hospital. SUBJECTS AND METHODS: Data set of 30 panoramic images was retrieved between the year of 2015 and 2016 indicated for extraction of lower third molars. The sample consisted of 30 individuals, who underwent preoperative radiographic evaluation before the extraction of impacted mandibular third molars (IMTM). Patients aged above 18 years with any of the seven specific signs observed on the panoramic radiograph which includes darkening, deflection, narrowing of roots, bifid root apex, diversion, narrowing of canal and interruption in the white line of the canal were included in the study. If any of the above mentioned seven specific sign were present, the patient was subjected to CBCT. On the CBCT images, the canal was traced in three planes. The acquired images were assessed for the presence or absence of corticalization. STATISTICAL ANALYSIS USED: Descriptive and inferential statistical analyses were used. Proportions were compared using the Chi-square test and Student's t-test. RESULTS: Among the 4 subjects, diagnosed with an absence of corticalization, patients with isolated darkening of root P = 0.001 and patients with isolated interruption in white line P = 0.69. Patients with darkening of root in association with interruption in white lines on OPG showed the absence of corticalization on CBCT findings P = 0.001, respectively. CONCLUSIONS: This study showed the poor reliability of radiographic signs seen on OPG on predicting the proximity of third mandibular root with mandibular canal related to CBCT finding. Four were diagnosed with the absence of corticalization in CBCT findings.

True median palatal cyst; a rare case report.

Median palatal cyst is rare nonodontogenic lesion as it represents only 7.14% of all jaw cysts. Also called mid palatal cyst has raised controversy about pathogenesis of such fissural cysts. Specific diagnostic criteria have been described for true median palatal cyst after it has been excluded from WHO classification. The purpose of this paper is to report a rare case of true median palatal cyst satisfying these criteria and discuss current controversy about these cysts.

Histopathological Evaluation of Dental Follicle Associated with Radiographically Normal Impacted Mandibular Third Molars.

INTRODUCTION: Removal of impacted mandibular third molar is a common procedure performed in oral surgery. Indications for removal of the third molar have generated much discussion in dentistry. The presence of pericoronal pathosis is generally accepted reason for the extraction of impacted mandibular third molars. Radiographic pathology is usually defined as a pericoronal radiolucency measuring about 2.5 mm or larger in any dimension. PURPOSE: This study aims to evaluate the histopathologic changes in radiographically normal dental follicles associated with impacted mandibular third molars. METHODS: After extraction of 50 impacted mandibular third molars, dental follicle associated with extracted teeth was placed in 10% formalin solution. Histopathologic examination was done. The type of pathological changes was recorded based on histopathological reports. Patients' gender, age, and radiographic parameters were recorded. RESULTS: Cystic changes were found in 24% of radiographically normal impacted mandibular third molars. Significant cystic changes were observed in position A vertically impacted lower third molars (ILTMs). Male predominance for cystic change was seen with a male-female ratio of 2:1. CONCLUSION: The result of the present study shows that radiographic analysis may not be reliable technique for the diagnosis of cystic changes in ILTM. The presence of cystic changes can be found even in radiographically normal impacted mandibular third molars. Hence, we recommend that impacted mandibular third molars should be removed and histopathological analysis should be conducted on all surgically extracted dental follicles.

Unusual Case of Acquired Capillary Hemangioma of the Eyelid in an Adult.

Acquired capillary hemangioma of the eyelid is very uncommon in adults. To our knowledge, only eight such cases have been reported in the literature till date. We report the case of a 25-year-old female with acquired capillary hemangioma of the left lower eyelid treated by cutting diathermy followed by reconstruction of the cutaneous and cartilaginous defect. This patient had a history of a similar lesion in the left malar region treated 5 years back. This case is being presented to highlight the occurrence of such lesions in an adult and to discuss the dilemmas in the diagnosis and management.

Treatment of Mandibular Fractures Using Intermaxillary Fixation and Vacuum Forming Splints: A Comparative Study.

OBJECTIVE: The study was done to compare the clinical efficacy of vacuum formed splints and arch bar in treating minimally displaced mandibular fractures. METHOD: Forty patients were included in two groups. Group 1 was treated with custom made splints and group 2 with conventional arch bar. Patients were recalled on 3rd, 7th, 14th day and on the day of removal of the appliance. Periodontal status, stability of appliance and chair side time were evaluated. RESULTS: The mean chair side time taken by vacuum formed splint was 18.05 min and conventional arch bar fixation was 68.25 min. 8.3 % of patients with vacuum formed splints had poor oral hygiene in comparison with 25 % of patients with conventional arch bar. 70 % of patients with vacuum formed splints and 60 % of the patients with conventional arch bars were comfortable in mastication during treatment. CONCLUSION: Vacuum formed splints has better advantages over arch bar with respect to chair side time, periodontal health, patient's compliance of maintaining oral hygiene, mastication and speech. Vacuum formed splints avoid needle stick injuries. So, they can be used for intermaxillary fixation in minimally displaced mandibular fractures.

Treatment algorithm for ameloblastoma.

Ameloblastoma is the second most common benign odontogenic tumour (Shafer et al. 2006) which constitutes 1-3% of all cysts and tumours of jaw, with locally aggressive behaviour, high recurrence rate, and a malignant potential (Chaine et al. 2009). Various treatment algorithms for ameloblastoma have been reported; however, a universally accepted approach remains unsettled and controversial (Chaine et al. 2009). The treatment algorithm to be chosen depends on size (Escande et al. 2009 and Sampson and Pogrel 1999), anatomical location (Feinberg and Steinberg 1996), histologic variant (Philipsen and Reichart 1998), and anatomical involvement (Jackson et al. 1996). In this paper various such treatment modalities which include enucleation and peripheral osteotomy, partial maxillectomy, segmental resection and reconstruction done with fibula graft, and radical resection and reconstruction done with rib graft and their recurrence rate are reviewed with study of five cases.

Efficacy of lignocaine with clonidine and adrenaline in minor oral surgical procedure.

Use of vasoconstrictors in local anaesthesia is well known. The study was done on 30 patients who underwent removal of bilateral impacted third molars. The aim of the study was to compare the efficacy of lignocaine with clonidine and lignocaine with adrenaline in respect to onset, duration of anaesthesia, and postoperative analgesia along with hemodynamic stability (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate in intraoral nerve block. The patients were randomly selected of both sexes (male and female) between the age group of 18-40 years. Patients received 2 mL of 2% lignocaine with adrenaline (12.5 µg/mL) on one side and 2 mL of 2% lignocaine with clonidine (15 µg/mL) on the other side at two different appointments. 2 millilitres of drug was administered in both the test group and the control group. Statistically there was significant decrease in intraoperative and postoperative systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate in the lignocaine with clonidine group. The efficacy of clonidine based on visual analog scale was similar to adrenaline. No significant operative complications were observed.