Comparison of two incisions for open reduction and internal fixation of mandibular body fractures: A randomised controlled clinical trial evaluating the surgical outcome.

PURPOSE: The purpose of the study is to compare the surgical access and post-operative outcome of two intra-oral incisions used for approaching a mandibular body fracture. METHODS: This clinical trial involved 60 patients with mandibular body fractures who were randomly allocated to control and study groups. The fractures were approached using the routine vestibular incision in the control group and crevicular incision with vertical release in the study group. The effects of incision design on the post-surgical outcome variables like swelling, trismus, paresthesia, wound healing and gingival recession were statistically analysed with non-parametric tests by using SPSS 22.0 software. Comparison of continuous variables between the groups and time points was done using Mann Whitney test and Friedman test respectively. Chi-square test was used to compare proportions between groups. Dunn's test with Bonferroni correction was used for pair wise comparisons. RESULTS: The study group demonstrated favourable surgical outcome in the immediate postoperative phase as compared to the control group. The difference in mouth opening, swelling and neurosensory impairment between the two groups was found to be statistically significant (p < 0.05). CONCLUSION: Crevicular incision was found to be an ideal alternative to vestibular incision in achieving surgical access and fixation of mandibular body fractures with reduction in postoperative patient discomfort and better surgical outcome.

Is the Vazirani-Akinosi Nerve Block a Better Technique Than the Conventional Inferior Alveolar Nerve Block for Beginners?

PURPOSE: This study was performed to compare the efficacy and comfort of the inferior alveolar nerve (IAN) block and the Vazirani-Akinosi (VA) nerve block when administered by dental trainees. MATERIALS AND METHODS: In this prospective, randomized controlled trial, patients requiring extraction of mandibular teeth received either the conventional IAN block (IAN group) or VA nerve block (VA group). Objective parameters evaluated included ease of locating landmarks, incidence of positive aspiration, and failure rate. Patient comfort during injection was assessed with a visual analog scale. Statistical analysis was performed with the unpaired t test and Fisher exact test. RESULTS: One hundred patients were included in each group. Landmarks were easier to locate in the VA group. The incidence of positive aspiration was higher in the IAN group (0.08%) than in the VA group (0.01%, P < .05). The incidence of failed blocks was higher in the IAN group than in the VA group. Patients appeared to experience less pain with the VA injection than with the IAN injection. CONCLUSIONS: This study showed that the dental trainees found the VA technique more straightforward to perform. It had a higher success rate and lower incidence of positive aspiration and was more comfortable for patients than the conventional IAN block.