Interventions for the Management of Mandibular Coronoid Process Fractures: A Systematic Review.

Background: The fracture of the coronoid process of mandible is one of the rarest fractures seen and the paucity of literature on the topic reflects the same. Despite the low incidence rate, the complications maybe grave which is why proper management is important. The treatment is controversial also because of the absence of standardized treatment protocol. This systematic review aims to compare the outcome of various treatment modalities available. Methods: Registered under PROSPERO: CRD42020200700. Systematic research was conducted across databases like PubMed, Google Scholar, Pro Quest, Wiley Online. All clinical studies done till January 2021 which included participants above 14 years of age were included. Case reports, case series and studies not mentioning the treatment plan were excluded. The studies were shortlisted by the authors based on the eligibility criteria. Risk of bias was assessed using the MINORS tool and JBI checklist. Results: A total of five studies were included. Four were retrospective studies and one was a retrospective case-controlled study. Two studies reported high, two moderate and one low risk of bias. Various treatment modalities were reported for the management of coronoid process fractures including conservative management, ORIF and coronoidectomy. Most authors preferred conservative management in asymptomatic cases and surgical management in symptomatic cases. Discussion: No randomized control trials were found on the topic. Majority of the articles were case reports. Conservative management was preferred in minimally displaced fractures of coronoid process. However, in presence of displaced coronoid process fractures causing impediment of mandibular function surgical management is preferred.

Assessment of primary stability of the implant placed in prepared infected extraction sockets.

BACKGROUND: Dental conditions like periodontal, periapical pathologies and failed endodontically treated teeth are one of the commonest reasons for tooth removal. These conditions also contraindicate replacement of such teeth with immediate implant procedures. AIM: This study aimed to evaluate the clinical and radiological fate of immediately placed dental implants in debrided infected dentoalveolar sockets. MATERIALS AND METHODS: A total of 24 implants were immediately placed into prepared infected sockets. The pathology at the receptacle sockets included subacute periodontal infection, perio-endo infection, chronic periapical infection, periodontal cyst and traumatic infected teeth. The treatment protocol emphasized on meticulous debridement of the infected sockets under pre- and post-surgical antibiotic therapy. Follow up of at least 24 months was done to evaluate the survival of implants. RESULTS: At the end of follow up time period of 24 months, all 24 implants were stable with no signs of clinical mobility and infection. However, on radiological examination, crestal bone loss was observed during the osseointegration periods which settled at the level of first thread. CONCLUSION: Survival of immediately placed implants in infected sockets is predictable and depends on the meticulous debridement of dentoalveolar sockets along with adequate pre- and post-operative antibiotic coverage.

Prospective study of treatment outcomes with lag screw versus Herbert screw fixation in mandibular fractures.

The principle of axial compression for better adaptation of fracture segments, with the advantage of increased stability and early function, is a promising means of avoiding the bulky rigid plates used previously. This study was done to compare the treatment outcomes between Herbert screw and lag screw fixation in mandibular fractures. Thirty patients with oblique displaced or undisplaced mandibular fractures requiring open reduction and internal fixation with rigid screw fixation, under general anaesthesia, were included. Herbert screws were used in 15 patients (group 1) and lag screws were used in the other 15 patients (group 2). Patients were followed up at 1 week, 6 weeks, 3 months, and 6 months for postoperative occlusion, inter-fragmentary mobility, pain, nerve sensation, and isodensity values on panoramic radiographs. Postoperative occlusion, inter-fragmentary mobility, pain, and nerve sensation were similar in the two groups. Group 1 patients attained isodensity values similar to the final follow-up value much faster than group 2 patients (P<0.05). This study strongly suggests that the use of Herbert screws results in significantly faster healing as compared to lag screws, in terms of achieving higher isodensity values faster.

Simple Technique Overcoming a Persistent Problem in Cleft Palate Repair.

PURPOSE: Cleft palate repair mandates use of a mouth gag and Dingmans moth gag is the most commonly used for the same; but the use of Dingmans mouth gag may have the demerit of the suture getting tethered at various places of the instrument during cleft palate closure particularly in the hands of the beginner surgeon. METHOD: This article discusses about a simple technique of using a rubber dam sheet to cover the frame of the mouth gag. CONCLUSION: The technique discussed in this article is simple, cost effective method to overcome the potential disadvantage of suture adherence during repair of palatal tissue. The technique also has the potential to reduce the total operative time which needs a further study to validate the same.

Mandibular coronoid fractures, how rare?

BACKGROUND: To study the rarity of mandibular coronoid process fractures and treatment strategies based on the displacement of these fractures. MATERIALS AND METHODS: A retrospective study of 11 cases of coronoid process fractures among 307 treated cases from 2008 to 2013 was conducted. Six patients were treated conservatively and 5 underwent ORIF with associated fractures. A statistical analysis of the data obtained after subjective and objective evaluation was done. RESULTS: The incidence of coronoid process fractures was 3.58% of all mandibular fractures analyzed. There was no statistically significant difference found between two treatment modalities, but differences in maximum interincisal opening (MIO) and pain in the postoperative period were significant. CONCLUSION: We recommend that linear coronoid fractures with minimal displacement can be managed with conservative treatment. For patients with significant displacement of coronoid process, limited mouth opening or concomitant mid-face or lower-face fractures, rigid internal fixation is recommended.

Pentoxifylline in patients with oral submucous fibrosis-a randomized clinical trial.

BACKGROUND AND AIM: As far as research regarding any disease is concerned, each and every aspect poses a challenge. One such entity that poses a challenge in our arena is oral submucous fibrosis (OSF) as no effective treatment is available for this progressively disabling condition with high malignant potential. Hence the present study was undertaken with the aim to determine the use of pentoxifylline (PTX) on the clinical and histopathologic course of OSF. METHOD: Thirty clinically confirmed OSF patients were categorized randomly into group I and group II. In group I, drug PTX was administered as an adjunct along with other conventional therapies. Group II patients were advised conventional therapies only. Pre- and post-treatment biopsies were obtained for the following parameters:Micro-vascular density (MVD),Area percentage of blood vessels,Severity of fibrosis, andInflammatory components. RESULTS:  On comparing MVD in groups I and II there was no significant difference in pre- and post-treatment.On comparing the average area percentage occupied by blood vessels, significant difference was seen in pre- and post-treatment biopsies in group I.On assessment of mouth opening and tongue protrusion, there was no significant improvement in either of the groups individually or in comparison. But when burning sensation of mucosa was assessed, pre- and post-treatment, both groups showed quite significant improvement individually. CONCLUSION: Use of pentoxifylline seemed to be questionable, and taking into consideration the long administration time, its use is not recommended for the treatment of OSF patients.

Assessment of changing patterns of Le fort fracture lines using computed tomography scan: an observational study.

OBJECTIVES: To assess the changing mid-face fracture patterns using a computed tomography scan. METHODOLOGY: Fifty patients with mid-face trauma requiring open reduction and fixation were studied using 1.6 mm axial, sagittal, coronal and 3D images. Images were evaluated clinically, intra-operatively and finally were compared with standard Le Fort lines. Results. The male population dominated the female at a ratio of 11.5:1. The majority of the mid-face fractures were seen in the age group of 21-30 years. Road traffic accident (78%) was the major etiological factor followed by work-related accidents (12%) and assaults (10%). The CT scan analysis included categorizing the patients into three groups: (1) Fracture patterns resembling Le Fort lines (24%); (2) Fracture patterns partially resembling Le Fort lines (56%); and (3) Fracture patterns that do not resemble Le Fort lines (20%). CONCLUSION: With the change in the velocity of wounding object, there is a change in the mid-face fracture patterns. The majority of the cases present as a variant of classical Le Fort fractures. Computed tomography is a valuable diagnostic tool in assessing the fractures of the mid-face. 2D images are more sensitive than 3D images. However, both the images are required in delivery of an optimal treatment plan.

Anterior Segmental Distraction Osteogenesis in the Hypoplastic Cleft Maxilla: Report of five cases.

Orthognathic surgery and distraction osteogenesis play a prime role in the correction of maxillary hypoplasia in patients with cleft lip and palate (CLP). Advancement of the anterior maxilla alone without interfering with the velopharyngeal sphincter may be advantageous in cleft patients, who more commonly have speech deficits and dental crowding. We present a case series of anterior maxillary segmental distraction for maxillary hypoplasia in 5 CLP patients with a one-year follow-up. A custom-made tooth-borne distraction device with a hyrax screw positioned anteroposteriorly was used. The evaluation comprised of hard and soft tissue analysis and speech assessment. A stable occlusion with positive overjet and correction of dental-crowding without extraction was achieved at one year post-distraction. Facial profile and lip support improved. There was no deterioration in speech.

Mandibular ramus fractures: a rarity.

AIM: To determine the incidence of mandibular ramus fractures in KLE's PK Hospital and to analyze the outcome of open reduction and internal fixation of these fractures. MATERIALS AND METHODS: Using a retrospective study design, records of all trauma patients who reported to the Department of Oral and Maxillofacial Surgery, KLE's PK Hospital Belgaum, between the years January 2006 to October 2011 was obtained from the medical records office. The data variables that were analyzed were the name, age, sex, cause of injury, pretreatment occlusion, treatment given, period of MMF and post-treatment occlusion. RESULTS: Total number of mandibular fracture cases was 298. Ramus fractures were 10 in number which accounted for 3.3% of fractures. The age range of these 10 patients was seen to be between 20 to 80 years with the average age being 35.6 years. Of these 10 patients, 9 were male and 1 was female and 7 patients were treated by open reduction and internal fixation and the remaining 3 by closed reduction. The average period of MMF was 3 days for the patients who underwent open reduction and internal fixation. There was improvement in occlusion in all 10 patients post-treatment and there was no complication reported in any of the cases. CONCLUSION: Ramus fractures accounted for 3.3% of all mandibular fractures. Open reduction and internal fixation of ramus fractures ensures adequate functional and anatomic reduction. CLINICAL SIGNIFICANCE: This study makes an attempt to throw a light on the increasing incidence of ramus fractures and a successful management of these fractures by open reduction and internal fixation. How to cite this article: Kale TP, Kotrashetti SM, Louis A, Lingaraj JB, Sarvesh BU. Mandibular Ramus Fractures: A Rarity. J Contemp Dent Pract 2013;14(1):39-42. Source of support: Nil Conflict of interest: None declared.

Efficacy of buprenorphine added 2 % lignocaine 1:80000 in postoperative analgesia after minor oral surgery.

PURPOSE: Recent studies have demonstrated that opioid analgesia cannot be exclusively attributed to effects within central nervous system. Peripheral opioid receptors exist that can be activated by locally applied opioid agonists which mediate analgesic effects that are particularly prominent in painful inflammatory conditions. Patients who present themselves with conditions requiring minor surgery in the maxillo-facial region usually have associated ongoing inflammatory process. The aim of our study was to apply the concept of peripheral opioid analgesia in minor oral surgery and evaluate its effectiveness in managing postoperative pain. The present study was designed to evaluate the efficacy of buprenorphine added lignocaine 2 % in providing postoperative analgesia after minor oral surgery. MATERIALS AND METHODS: Hundred consenting adult patients who were scheduled to undergo various minor oral surgeries were enrolled in this double blinded study. Patients were randomly assigned into one of the two groups based on whether they received buprenorphine added 2 % lignocaine 1:80000 (Group I) or (Group II) lignocaine 2 % with adrenaline 1:80000 alone. Visual analog scale method was used for evaluation of the postoperative analgesia. RESULTS: The duration of analgesia in Group I was found to be 36 ± 1.5 h and the average consumption of NSAIDs was found to be 1.86 as compared to Group II mean value of 4.4 (P < 0.0001). CONCLUSION: Addition of small amounts of buprenorphine to 30 ml lignocaine with adrenaline 1:80000 for minor oral surgery results in significant improvement in postoperative analgesia up to 36 h and markedly reduces the need for excessive analgesic intake. Thus reducing the adverse effects associated with excessive use of NSAIDs.

Portfolio: a comprehensive method of assessment for postgraduates in oral and maxillofacial surgery.

Post graduate learning and assessment is an important responsibility of an academic oral and maxillofacial surgeon. The current method of assessment for post graduate training include formative evaluation in the form of seminars, case presentations, log books and infrequently conducted end of year theory exams. End of the course theory and practical examination is a summative evaluation which awards the degree to the student based on grades obtained. Oral and maxillofacial surgery is mainly a skill based specialty and deliberate practice enhances skill. But the traditional system of assessment of post graduates emphasizes their performance on the summative exam which fails to evaluate the integral picture of the student throughout the course. Emphasis on competency and holistic growth of the post graduate student during training in recent years has lead to research and evaluation of assessment methods to quantify students' progress during training. Portfolio method of assessment has been proposed as a potentially functional method for post graduate evaluation. It is defined as a collection of papers and other forms of evidence that learning has taken place. It allows the collation and integration of evidence on competence and performance from different sources to gain a comprehensive picture of everyday practice. The benefits of portfolio assessment in health professions education are twofold: it's potential to assess performance and its potential to assess outcomes, such as attitudes and professionalism that are difficult to assess using traditional instruments. This paper is an endeavor for the development of portfolio method of assessment for post graduate student in oral and maxillofacial surgery.

A comparative study of closed versus open reduction and internal fixation (using retromandibular approach) in the management of subcondylar fracture.

OBJECTIVE: The aim of this study was to evaluate the clinical and radiologic outcomes of open reduction and internal fixation compared with closed reduction approach for fractures occurring at the subcondylar level. STUDY DESIGN: Twenty-two patients with subcondylar fractures were included in the study; 12 patients were treated by closed reduction and 10 patients underent open reduction and rigid internal fixation, with follow-up at 3 and 6 months. Selection of patients for open and closed procedures was done on a random basis. RESULTS AND CONCLUSIONS: The results showed that open reduction and internal fixation of displaced subcondylar fractures showed better results clinically as well as radiographically compared with similar fractures treated by closed reduction.

Effectiveness of Hemcon Dental Dressing versus Conventional Method of Haemostasis in 40 Patients on Oral Antiplatelet Drugs.

OBJECTIVES: The purpose of the study was to evaluate the effectiveness of the HemCon Dental Dressing (HDD) in controlling post extraction bleeding and to ascertain its role in healing of extraction wounds, as compared to control. METHODS: The 40 participants in the study were all receiving oral antiplatelet therapy (OAT). A total of 80 extractions were conducted without altering the patients' drug therapy. The extraction sites were divided into 2 groups: one group received a HDD, and the control group where the conventional method of pressure pack with sterile gauze under biting pressure (followed by suturing if required) was used to achieve haemostasis. RESULTS: All HemCon treated sites achieved haemostasis sooner (mean = 53 seconds) than the control sites (mean = 918 seconds) which was statistically significant (P <0.001). Postoperative pain in the HDD group (1.74) was also significantly lower than in the control group (5.26) (P <0.001). Approximately 72.5% of HDD-treated sites showed significantly better postoperative healing when compared to the control site (P <0.001). CONCLUSION: HDD proved to be an excellent haemostatic agent that significantly shortened the bleeding time following dental extraction in patients on OAT. Additionally, HDD offered significantly improved post-operative healing of the extraction socket and less postoperative pain.

A comparitive clinical study between self tapping and drill free screws as a source of rigid orthodontic anchorage.

BACKGROUND AND OBJECTIVES: Self-tapping miniscrews are commonly being used as a temporary anchorage device for orthodontic purpose. A prerequisite for the insertion of these screws is the preparation of a pilot hole, which is time consuming and may result in damage to nerves, tooth root, drill bit breakage and thermal necrosis of bone. On the other hand the design of drill-free screws enables them to be inserted without drilling. The aim of this prospective study was to compare the stability and clinical response of the soft tissue around the self tapping and drill free screws when used for orthodontic anchorage for en mass retraction of maxillary anterior teeth. MATERIALS AND METHODS: The study sample consisted of 20 patients requiring retraction of maxillary anterior teeth. The screws were placed in the alveolar bone between maxillary 2nd premolar and 1st molar bilaterally at the junction of attached gingiva and moveable mucosa. Pilot hole was drilled on the side which was selected for insertion of the self tapping screw under copious irrigation, after which it was inserted. Drill free screw was inserted on the contralateral side without predrilling. All screws were immediately loaded with 150-200 gm of retraction force. Patients were recalled for regular follow up for a period of 6 months. If the screws became mobile or showed any signs of inflammation during the course of the study, they were considered to be a failure. RESULTS: After a period of 6 months an overall success rate of 77.5% was noted. Four self tapping and five drill-free screws failed during the study. There was no statistically significant difference between the two types of screws with respect to success/failure. Mobility was found to be the major cause for the failure. CONCLUSION: Both self-tapping and the drill-free screws are effective anchorage units. But the latter have an edge over the conventional self-tapping screws because of decrease in operative time, little bone debris, less thermal damage, lower morbidity, and minimal patient discomfort as predrilling is not required, thus they can be used as a viable alternative. But self-tapping screws are still recommended for areas with high bone density and thick cortical bone.

Comparative evaluation of dento-alveolar distraction and periodontal distraction assisted rapid retraction of the maxillary canine: a pilot study.

Distraction osteogenesis is a biological process of new bone formation between the surfaces of the bone segments that are gradually separated by incremental traction. A recent innovative use of distraction osteogenesis in orthodontic tooth movement is to move individual tooth segments rapidly thus reducing orthodontic treatment time. Six patients, comprising two groups, were compared using two different surgical techniques: dento-alveolar distraction and periodontal distraction to bring about rapid canine retraction using an indigenously designed intra-oral distractor. The aim was to assess and evaluate the best approach to reduce the overall orthodontic treatment time by means of distraction osteogenesis. The patients were assessed at regular intervals with intra-oral periapical radiographs and lateral cephalograms for gauging the time required for retraction, canine tipping, anchorage loss and external root resorption. Dento-alveolar distraction was superior to periodontal distraction in all areas of assessment.

Transport dentoalveolar distraction osteogenesis-assisted rapid orthodontic canine retraction.

OBJECTIVE: A recent innovative use of distraction osteogenesis technique in the field of orthodontic tooth movement is the application of the principle of distraction to move individual tooth segments rapidly, thus reducing orthodontic treatment time. STUDY DESIGN: Twelve maxillary canine teeth were rapidly retracted using the concept of dentoalveolar distraction osteogenesis. They were evaluated for the time required to complete the retraction, canine tipping, anchorage loss, and root resorption using intraoral radiographs and lateral cephalograms. The vitality of the canine was also evaluated using an electric pulp tester. RESULTS: Canines can be rapidly retracted by dentoalveolar distraction, and subsequently the total orthodontic treatment time can be reduced as described in this technique. The time taken is 12.5 +/- 0.50 days with a minimal amount of tipping and acceptable amount of anchorage loss. All the teeth were vital with no evidence of root resorption. CONCLUSION: The concept of distraction osteogenesis for rapid orthodontic tooth movement is thought to be promising and feasible for clinical practice.

A comparative study between transbuccal and extra-oral approaches in treatment of mandibular fractures.

BACKGROUND AND OBJECTIVES: Mandibular angle fractures continue to be a common type of facial injury. The objectives in treatment are to effect rapid healing by anatomic reduction and fixation and to restore function and appearance with minimal disability and complications. Traditionally, when open techniques are utilised, the extra-oral approach is performed through a skin incision concealed in the submandibular crease. However, patients develop unsightly scars and there is a risk of injury to the marginal mandibular nerve. In comparison, the trans-oral approach, performed through an oral mucosal incision, results in minimal external scarring or injury to the marginal mandibular nerve and allows direct visualisation and confirmation of the desired occlusion during the placement of the miniplates. The basic aim of the study was to provide a treatment for the mandibular fractures which results in minimal scarring and fulfills all the functional needs of the patient. STUDY DESIGN: Patients coming to KLES PK Hospital and MRC with mandibular angle fractures requiring open reduction and internal fixation admitted under OMFS were taken for the study. The sample size of the study was 15. In one group, the patients were treated by extra-oral approach and the other group by transbuccal approach. In patients treated by transbuccal approach, special armamentarium consisting of trocar, cannula, and cheek retractor were used; and in both the groups, semirigid fixation was done using two miniplates with around a distance of 1cm. RESULTS: Total of 15 patients were treated, 10 with transbuccal approach and 5 with submandibular approach. It has been found that both techniques fulfill the functional requirements of the patients. Patients treated with submandibular approach developed obvious unsightly scars, whereas transbuccal approach results in minimal scarring. CONCLUSION: The results associated with clinical observations suggest that transbuccal approach is a superior and less time consuming approach than extraoral approach, but it requires special instruments, lots of skill by the operating surgeon in using the armamentarium, and a skilled assistant.

Necrotizing cervical fasciitis: a case report and review of literature.

Necrotizing cervical fasciitis is a rare, fulminating infection causing extensive necrosis of the subcutaneous tissue and fascial planes with resultant skin gangrene. To reduce the morbitity and mortality from this condition, it requires early recognition and aggressive surgical debridment with appropriate antibiotic therapy. The origin is generally odontogenic and presents more often in immunocompromised patients. This article presents a case with typical clinical features and appropriate management of this condition. An review of literature was carried out for microbiology, pathogenesis, clinical features, diagnosis, management and prognosis of this condition.

Arthrocentesis for the treatment of internal derangement of the temporomandibular joint.

OBJECTIVE: The study aims to evaluate the efficacy of arthrocentesis in the treatment of internal derangement of the temporomandibular joint (TMJ). STUDY DESIGN: Thirty patients with TMJ internal derangement underwent arthrocentesis using saline. Pain using visual analog scale, maximum mouth opening, joint noises and mandible deviation were documented pre-operatively and post-operatively. Patients were followed for 1 year. Statistical analysis of pain was done by Wilcoxon signed Rank's test and dysfunction by students paired t test. RESULTS: The mean pre-operative pain was 4.8 ± 2.65 and post-operatively at 1 year was 0.27 ± 0.45 with an average decrease of 4.72 (P = 0.000). The mean maximal mouth opening pre-operatively was 29.8 ± 2.35 mm and post-operatively 41.9 ± 2.48 mm at 1 year. The mean increase in the mouth opening was 12.1 ± 3.0 mm (P = 0.000). CONCLUSION: Arthrocentesis is simple, minimally invasive procedure with less risk of complications and significant benefits in patients with TMJ internal derangement.

Liquid nitrogen cryotherapy in the management of oral lesions: a retrospective clinical study.

UNLABELLED: BACKGROUND #ENTITYSTARTX00026; OBJECTIVES: The purpose of this study was to evaluate effectiveness and convenience of cryosurgical procedure, to assess the events during postoperative healing and to find out the incidence of recurrence MATERIALS AND METHODS: This study was conducted in the Department of Oral and Maxillofacial Surgery, KLESVK Institute of Dental Sciences, Belgaum. The 40 patients selected for the study were divided into 2 groups of 20 patients each irrespective of age and sex. Group I 20 patients with Pre-Malignant Lesions Group II 20 patients with Oral Mucous Cyst RESULTS: It was observed that all the 20 patients of mucocele were cured without any complication and recurrence, but in 20 patients of leukoplakia 5 patients had recurrence which was directly attributed to their persisting habits. CONCLUSION: We state that this modality of treatment is promising with good results and has certain advantage over other modalities of treatment.