Comparison of Autologous Blood Injection and Dextrose Prolotherapy in the Treatment of Chronic Recurrent Temporomandibular Dislocation: A Randomized Clinical Trial.

Introduction: Prolotherapy is a minimally invasive technique that aims to functionally restore or repair the soft and hard tissues of the TMJ by injecting a stimulant. The present study was conducted to compare the effectiveness of dextrose and autologous blood injection (ABI) as prolotherapy agents in the treatment of patients with chronic recurrent TMJ dislocation (CRTD). Materials and Method: Thirty-two patients were divided into two groups-ABI and dextrose (n = 16 each). The superior joint space was located by means of cantho-tragal line and lavage. Delivery of prolotherapy agent was performed by single-needle technique. An elastic bandage was applied for a week and rehabilitation was initiated three weeks after the treatment. Pain level, joint hypermobility, maximal mouth opening, and frequency of dislocations were recorded at various follow-up intervals up to one year post-treatment. Results: No significant difference (p > 0.05) was seen for the values between both groups at all time intervals in the pain level. At the 6-month and annual follow-ups, the mouth opening of the patients treated with ABI was significantly lower (p < 0.01) as compared to those treated with dextrose. The patients treated with ABI therapy exhibited fewer dislocations (p < 0.05) within the following year. Conclusion: Prolotherapy is a relatively noninvasive, safer, and effective treatment modality with a high success rate for patients with CRTD. Both, ABI and dextrose, proved effective in reducing the pain and joint hypermobility associated with CTRDs within a week. ABI proved to be more efficient in reducing the mouth opening and limiting the dislocation of TMJ as compared to dextrose therapy.

Vertical Ridge Augmentation Using Distraction Osteogenesis Versus Autogenous Bone Grafting: A Systematic Review and Meta-Analysis.

Aim: The aim of this systematic review was to systematically assess the papers comparing the surgical techniques of Alveolar Distraction Osteogenesis(ADO) and Autogenous Bone grafting (ABG) for Vertical Ridge Augmentation in terms of bone gain, bone resorption and incidences of complications. Metholodology: The review was registered on PROSPERO with the ID : CRD42021237671. A broad electronic survey was conducted in the PubMed, Scopus, Web of Science, Cochrane Library, and Virtual Health Library databases of all studies published till 08/03/2022. Four studies fulfilled the criteria to carry out a meta-analysis a in which a total of 58 patients underwent ADO and 43 patients for ABG. A total of 133 implants were placed in the ABG group and 124 in the ADO group. Statistical Analysis: DerSimonian-Laird estimator of variance was used for Random effect meta-analysis. The estimates of an intervention were expressed as the odds ratio (OR) and standard mean difference (SMD) in millimeters. Results: There was statistically significant difference in terms of bone height gain with SMD of - 0.78 (95% 0.04-1.55) in ABG. Bone resorption and complications were statistically insignificant with SMD of 0.52 (95% - 1.59 to 0.56) and OR 0.55 (95% 0.18-1.70), respectively.PROSPERO Registration ID: CRD42021237671.

Pre-adjusted Three-Dimensional Plate Employing Printing versus Conventional Plate in the Management of Mandibular Fractures - A Comparative Study.

Introduction: The aim of this study was to compare the efficacy of pre-adjusted three-dimensional (3D) plating system employing 3D printing with conventional 3D plating in the management of mandibular fractures. Materials and Methods: A randomised, clinical trial was conducted where the study sample (n = 20) was divided into two groups. In Group 1, 3D plate and in Group 2, pre-bent 3D plate was fixed to the fracture site. The parameters assessed were number of bends required for adaptation, duration of fixation, pain, occlusal stability, reduction in lingual splaying and post-operative complications. Results: Statistically significant difference was seen for the number of bends required (P = 0.000, P < 0.01) and duration of fracture fixation (P = 0.001, P < 0.01). There was statistically significant difference between the values of pain during the adaptation of 3D plate (P = 0.033, P < 0.05). Discussion: The application of pre-adjusted 3D plate is superior to conventional 3D plating in terms of reducing number of bends, duration of fixation and pain during adaptation.

An In Vitro Evaluation of a Novel Design Z Plate for Fixation of Mandibular Symphysis and Parasymphysis Fractures-A Finite Element Analysis.

Aim: Surgical management of mandibular symphysis and parasymphysis fractures has evolved from rigid fixation to semi-rigid fixation with miniplate osteosynthesis. Various miniplate systems have been developed in recent years including three-dimensional miniplate, microplates and bioresorbable plate, and their advantages and disadvantages have been compared and studied. To overcome the shortcomings of 3D plating system such as difficulty in adaptation and fixation in fractures involving the mental nerve, a novel Z plate has been designed by our institute. Material and Methodology: An in vitro study was performed to evaluate the biomechanical behaviour of the newly designed Z plate with 3D plate and two-miniplate system using finite element analysis. Results: Our study showed total structural deformation of 0.17 mm and 0.31 mm of newly designed Z plate after canine loading and molar loading, respectively. The equivalent von Mises force for plate after canine loading had shown the following results-Z plate showed values of 121.3 MPa and 58.40 MPa after molar loading. Conclusion: Our study concluded that the Z plate produces lowest stresses, lesser total structural deformation, superior stability and support in comparison with the 3D plate and two-miniplate system.

Survival of Dental Implants on Irradiated Jaws: A Systematic Review and Meta-analysis.

Objectives: Dental implants play a significant role in functional rehabilitation of the oral cavity after debilitating jaw surgeries for oral cavity cancers followed by radiotherapy. Design: The meta-analysis was done using Preferred Reporting Items for Systematic Review (PRISMA) guidelines published from January 1947 till August 2020. Twenty three articles consisting of 1246 participants with 4838 implants were included in our analysis. Results: The mean age of the included participants was 51.4 years. 2186 and 1685 implants were placed on irradiated and non-irradiated jaws and showed a success rate of 82.47% and 89.37% respectively. Correspondingly, publication bias of p value = 0.2129 and p-value = 0.6525 was found by Egger's and Begg's test respectively for pooled data of 16 studies. The implant success rate of 70.4% on maxillary bone and 94.5% were observed on mandibular bone. Timing of implant placement and its influence on survival rate have resulted in a 75.5% survival rate of dental implants when placed primarily in comparison with 87.7% on delayed placement. The waiting interval of 14 months in delayed implant placement has shown better results. Conclusion: Presence of radiotherapy does not play a significant role in the success rate of dental implants in oral cavity cancers. However, delayed implant placement may have a better chance of survival. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-022-01686-6.

'Temporomandibular joint hematoma nerve block'-a new technique in management of mandibular condylar fractures.

PURPOSE: Management of mandibular condylar fracture has invited a great deal of controversy in maxillofacial trauma care. In the orthopaedic literature, surgeons have exhaustively described the use of a 'hematoma block' technique during closed reduction (CR) of the ankle or other long bone fractures. Post-traumatic ankylosis of the temporomandibular joint (TMJ) is due to development and progression of the intra-articular hematoma. We improvised their technique for use during CR of mandibular condylar fractures. The desirable effects which can be achieved with our proposed 'novel TMJ hematoma nerve block' technique are evacuating the accumulated hematoma, blocking auriculotemporal and masseteric nerves which in turn causes relaxation of the lateral pterygoid muscle, all in all, favouring accurate anatomical reduction of the fracture. METHOD: Thirteen patients with isolated unilateral condylar fractures were subjected to our new technique. The parameters assessed were the amount of hematoma evacuated, pain in TMJ region during reduction and postoperative anatomic reduction on cone beam computed tomography (CBCT). RESULTS: All the patients showed a significant reduction in pain and lowered post-reduction angulation between the proximal condylar and distal ramal segments. CONCLUSION: Our technique is minimally invasive, safe, simple to perform, yielding excellent anatomic reduction of the fracture fragments.

Role of Superficial Cervical Plexus Nerve Block as an Adjuvant to Local Anesthesia in the Maxillofacial Surgical Practice.

PURPOSE: Infiltration techniques are used as an adjuvant to regional anesthesia. In this study, we evaluated the efficacy of the superficial cervical plexus nerve block, as an alternative to local infiltration techniques; in the management of mandibular fractures and peri-mandibular space infections. METHODS: A prospective randomized controlled trial was conducted on 24 patients having either mandibular fractures or peri-mandibular space infections; and were scheduled for surgery under regional anesthesia (eg, inferior alveolar nerve block, long buccal nerve block). The control group involved delivering a combination of regional anesthesia along with local infiltration. The experimental group received regional anesthesia with a superficial cervical plexus nerve block. The following parameters were studied: pain, onset and duration of anesthesia, time interval until first analgesic request, pulse rate and blood pressure [at different time intervals]. RESULTS: Intergroup comparison was done using unpaired t-test. Intragroup comparison was done using repeated measures ANOVA (for >2 observations), followed by a post hoc test. The superficial cervical plexus nerve block group showed highly statistically significant (P < .01) improvement in terms of intra-operative pain at 30 minutes, duration of anesthesia, intraoperative anesthetic requirement, time interval until first analgesic request and intraoperative diastolic blood pressure at 10 minutes. CONCLUSION: It can be concluded that the combination of a regional anesthesia technique with a superficial cervical plexus nerve block is an alternative and safe technique for patients undergoing surgery for mandible fractures and perimandibular space infections, with clear advantages over local infiltration.

Combined endoscopic and intra-oral approach for chronic maxillary sinusitis of dental origin-a prospective clinical study.

AIMS AND OBJECTIVES: The traditional Caldwell-Luc approach for maxillary diseases has been criticized for its shortcomings such as removal of a large amount of bone, numbness of the teeth, flap dehiscence, and recurrent sinusitis. On account of its minimal invasiveness and physiological approach, functional endoscopic sinus surgery (FESS) has come to replace the Caldwell-Luc approach for the treatment of chronic rhinosinusitis. Chronic maxillary sinusitis of dental origin (CMSDO) is a less common variant on the chronic rhinosinusitis spectrum whose treatment involves simultaneous management of both the diseased maxillary sinus and the dental source of infection. Thus, this study was undertaken to assess the efficacy of FESS when combined with an intra-oral approach for the treatment of CMSDO. MATERIAL AND METHODS: Eighteen patients with CMSDO in the age group of 18-50 years were treated with a combined endoscopic and intra-oral approach (buccal advancement flap with/without buccal fat pad) in this study. The patients were followed up for a total duration of 18 months. The primary outcome measurements were the SNOT-22 Quality of Life questionnaire and the Lund and Mackay CT Scan Scoring Criteria. The Friedman test was used to assess improvement in the above variables and the level of significance was set at 0.05. OBSERVATIONS AND RESULTS: There was a statistically significant reduction (p < 0.05) in both the above parameters at all post-operative intervals. Two patients presented with epistaxis (immediate post-operative phase) and synechiae (second week follow-up interval). Both complications were successfully resolved. Two patients showed recurrence at the 6th-month interval for which they underwent revision surgery successfully. Overall, results were maintained even at the 18th month follow-up interval. CONCLUSION: The endoscopic approach appears to be a reliable, minimally invasive technique associated with less morbidity and stable long-term results. Thus, a multi-disciplinary approach between maxillofacial surgeons and otolaryngologists is essential in the treatment of CMSDO.

The Pterygoid Hamulus Syndrome - An Important Differential in Orofacial Pain.

The purpose of this review was to document cases of pterygoid hamulus (PH) syndrome and to describe the various etiology, differential diagnosis, and management strategies so far reported in literature. Here, we also present two case reports of PH syndrome. A comprehensive search in PubMed/Medline database was done using MeSH terms such as "Pterygoid Hamulus," "Pterygoid Hamulus Syndrome," and "Hamular Bursitis" using various Boolean operators such as "AND" and "OR". Till date, 31 cases of this entity including the present cases have been found. Conservative management was followed in the earlier reported cases; however, most cases were treated by surgical resection.

Expansile radiolucent lesion of the Temporomandibular Joint-A diagnostic enigma.

Radiolucent lesions of Temporomandibular Joint (TMJ) represent a diagnostic challenge and a treatment conundrum. Biopsy of the lesions is technically difficult owing to their complex anatomy. The Differential Diagnosis (DD) includes a wide array of lesions including Simple Bone Cyst, Ameloblastoma, Central Giant Cell Granuloma, Hemangioma, Osteoblastoma, Osteochondroma, Chondroblastoma, Chondrosarcoma, Neurofibroma and metastatic malignant lesions though none has a specific predilection for TMJ. Here we present a case report of a large expansile radiolucent lesion of right TMJ in a 22 year old male patient with difficulties involved in diagnosis and management. Though cystic lesion of TMJ is uncommon it is incumbent on the Maxillofacial Surgeon for an early diagnosis and prompt management.

A working paradigm for managing mandibular fractures under regional anesthesia.

OBJECTIVES: Isolated mandibular fractures contribute to approximately 45% of maxillofacial traumas. Improper management of mandibular fractures can cause myriad potential complications and can lead to serious functional and aesthetic sequelae. The objective of the study is to design a stepwise approach for managing isolated mandibular fractures using open reduction and internal fixation (ORIF) with regional anesthesia on outpatient basis. MATERIALS AND METHODS: Patients with isolated mandibular fractures presenting to the department of maxillofacial surgery were selected for ORIF under regional anesthesia based on occlusion, age, socioeconomic status, general condition, habits, and allied medical ailments. Standard preoperative, intraoperative, and postoperative protocols were followed. All patients were followed up for a minimum of 4 weeks up to a maximum of 1 year. RESULTS: Of 23 patients who received regional anesthesia, all but one had good postoperative functional occlusion. One patient was hypersensitive and had difficulty tolerating the procedure. Two patients developed an extraoral draining sinus, one of whom was managed with local curettage, while the other required hardware removal. One patient, who was a chronic alcoholic, returned 1 week after treatment with deranged fracture segments after he fell while intoxicated. CONCLUSION: With proper case selection following a stepwise protocol, the majority of mandibular fractures requiring ORIF can be managed with regional anesthesia and yield minimal to no complications.

Dentinogenic ghost cell tumor.

Dentinogenic ghost cell tumor (DGCT) is a rare, odontogenic neoplasm which is considered to be a solid variant of calcifying odontogenic cyst (COC) with locally aggressive behavior. It accounts for only 2-14% of all COCs. To the best of our knowledge, only 88 cases of DGCT have been reported in the literature from 1968 to 2014. Herewith, we report a case of DGCT in a 68-year-old male patient with clinical presentation as a soft tissue growth over alveolar ridge and histopathologically characterized by ameloblastomatous epithelium, abundance of eosinophilic material and ghost cells.