Comparing the Efficacy of Postoperative Antibiotic Regimens in the Treatment of Maxillofacial Fractures: A Prospective Study.

AIM: The present study was designed to investigate the difference in the effectiveness of a 3 day postoperative course and a single perioperative dose of antibiotics on the incidence of postoperative infection in the management of maxillofacial trauma patients. MATERIALS AND METHODS: About 183 maxillofacial trauma patients requiring open reduction and internal fixation (ORIF) under general anesthesia were divided based on the type of fracture sustained, i.e., mandibular fractures, Le Fort fractures, and zygomaticomaxillary complex fractures. Patients from each fracture type were randomized into two groups, A and B. All patients were administered amoxicillin/clavulanate 1.2 grams intravenously 8 hours from the time of admission till the patient was taken up for surgery. Once the patients were taken up for surgery, a perioperative dose was administered. No antibiotics beyond this point were given to patients in Group A. Patients in Group B were administered the same antibiotic for 3 postoperative days additionally. Outcomes in terms of purulent discharge from the surgical site, an abscess or any other sign of infection, and wound dehiscence requiring reopening of the surgical site were considered. Patients were reviewed at 1 week, 2 weeks, 1 month, 2 months, and 3 months. RESULTS: No statistically significant difference was found between the two groups across all three fracture types in terms of postoperative outcomes. However, increased numbers of complications were noted in the patients treated with an intra-oral approach in each fracture type irrespective of group. All complications were managed with local measures. CONCLUSION: A single perioperative dose of antibiotics is effective in minimizing postoperative complications following ORIF of maxillofacial fractures and there is no significant benefit in prolonging the course of antibiotics postoperatively with the need for further studies to be conducted considering comminuted, complex fractures and old fractures. CLINICAL SIGNIFICANCE: In maxillofacial trauma, fractures frequently communicate with contaminated indigenous flora on the skin surface, oral cavities, or sinus cavities. Surgery is frequently performed using an approach across a contaminated area, even in closed fractures. Postoperative infections can be significantly decreased by using antibiotics in surgical procedures to treat facial fractures.

Randomized Study on Postoperative Intra-alveolar Betadine Irrigation Versus Chlorhexidine Irrigation on the Incidence of Occurrence of Alveolar Osteitis After Mandibular Third Molar Surgery.

Purpose: To compare the effectiveness of two different antiseptic solutions for irrigation of the extraction socket and the incidence of occurrence of dry socket in the sample population in Bhubaneswar, Odisha. Patients and Methods: A prospective and randomized study among the patients reporting to the department of oral and maxillofacial surgery for surgical removal of impacted mandibular third molars under local anesthesia was done in a group of 100 patients meeting the inclusion and exclusion criteria. Two different intervention groups (groups A and B) were allocated which comprised irrigation of the extraction sockets continuously up to 7 postoperative days with chlorhexidine (hexidine 0.2% ICPA) and povidone iodine (Betadine® mouthwash 1%), respectively. Pain, edema, trismus, alveolar osteitis, infection, wound dehiscence and food debris impaction were the various outcome variables. Results: A total of 100 patients participated in this study, while there was a loss in the follow-up of 5 patients. Pain scores, edema and the incidence of occurrence of alveolar osteitis were significantly reduced in group A (p < 0.05). The effect on trismus was statistically insignificant. Pain scores had reduced significantly on the 7th-day follow-up in group A as compared to group B (p < 0.05). Conclusion: Chlorhexidine is therefore a good option for irrigation of the surgical site. There is also a decrease in incidence of occurrence of AO with chlorhexidine irrigation than with that of povidone iodine irrigation. Hence, chlorhexidine can be preferred over betadine for the routine preparation and irrigation of the surgical site.

Use of Elastomeric Separators in Maxillofacial Fracture Reduction.

BACKGROUND: Management of maxilla and mandibular fractures are based on the principles of reduction, fixation and immobilization of the fracture segments. PURPOSE: One of the processes of reduction is to apply continuous and gradual elastic traction by placing elastics from the upper and lower arch bars in a definite manner and direction as per the fracture line. Orthodontic elastic separators are versatile, and the major advantage is the higher traction forces as compared to conventional elastics. METHODS: Prestretched separator elastics were guided over the arch bar or fixed orthodontic appliances to provide desired traction. RESULTS: Orthodontic elastic separators are therefore versatile, and the major advantage is the higher traction forces as compared to conventional elastics. They provide an edge over the use of wires as they tend to break off by work hardening. CONCLUSION: Therefore, we have adapted orthodontic separators and have used them in place of conventional elastics for the last 10 years with appreciable results after taking informed consent from the patients.

Preoperative Anatomic Evaluation of the Relationship Between Inferior Alveolar Nerve Canal and Impacted Mandibular Third Molar in a Population of Bhubaneswar, Odisha, Using CBCT: A Hospital-Based Study.

PURPOSE: To evaluate the correlation between the position of inferior alveolar nerve canal and the angulation of impacted mandibular third molars using cone beam computed tomography (CBCT) in a hospital-based study in the state of Odisha, India. MATERIALS AND METHODOLOGY: Three hundred cases of impacted third molars in 200 patients (154 males; 46 females) were included in the study, for whom an initial periapical or panoramic radiograph had revealed that the mandibular canal and the lower third molars were in close proximity. A CBCT scan of each patient was carried out to assess how the canal position influenced the class and position of impaction, angulation of impaction and bone contact. RESULTS: Class II position B impactions were found in 78.37% cases where the position of ID canal was approximate to the lingual plate and inferior to third molar (73.75%). The results were statistically significant (p = 0.00). 80% of the ID canals showed bone contact. Of these 73.75% ID canals showed lingual bone contact. Mesioangular impactions were most common in mandible and significantly associated with lingual and inferior positioning of the canal. CONCLUSIONS: The study mostly exhibited patients having mesioangular class II position B third molar impactions of the mandible. The position of the canal has a significant influence on the type of impaction and the bone contact.

An analysis of approach toward oral and maxillofacial surgery: A survey of 1800 health-care specialists, students, and general people in Odisha, India.

AIM: The aim of the study is to assess the perception of oral and maxillofacial surgery (OMFS) by health-care professionals, students, and general public in the state of Odisha, India. MATERIALS AND METHODS: A questionnaire form was formatted that listed ten clinical situations and given by hand to 1800 individuals, divided into six groups: Group I - general medical practitioners; Group II - specialties of dentistry; Group III - general dental practitioners; Group IV - medical students; Group V - dental students; and Group VI - general public, each comprising 300 individuals. Respondents were asked to indicate who they would expect to treat them if they had one of the specified conditions listed in the questionnaire. We present the results and current awareness levels of this simple questionnaire and in due course educate and inform the society about the treatment OMFS provides. RESULTS: Most of the respondents in Groups II, III, and V agreed that specific conditions listed in the questionnaire were within the domain of OMFS, but such response was not seen in Groups I, IV, and VI (P < 0.05). An overall awareness level of OMFS was found to be 50.8%. CONCLUSION: The liability and responsibility of creating and improving the awareness and perception of our specialty lies on oral and maxillofacial surgeon. Unified efforts at individual as well as global level will help achieve this goal.

A rare nonsyndromic case of adenomatoid odontogenic tumor associated with multiple impacted supernumerary teeth.

Adenomatoid odontogenic tumour (AOT) is a rare benign odontogenic tumour characterized by a progressively slow growing pattern and symptomless behavior. The differential diagnosis between AOT and other odontogenic tumours, such as ameloblastoma, should be well conducted in order to avoid extensive ablative surgery. The present case report is of a 27 year old female who reported with a chief complaint of mild intermittent pain and a swelling which was gradually increasing in size, on the left mid-facial region since 6 months. Radiographic Investigations revealed a round uni-locular radiolucent image of an intra-osseous lesion with a well defined border in the left maxilla. The tumor was encapsulated and was attached with 2 impacted supernumerary teeth which were fused and shaped as maxillary premolars. The images also showed multiple impacted supernumerary teeth in the maxilla and mandible. The clinical and radiographic diagnostic hypothesis of Adenomatoid odontogenic cyst and a differential diagnosis of Dentigerous Cyst was given. Surgical enucleation of the lesion was done under General Anaethesia. The histological sections were consistent with AOT.

Evaluation of Donor Site Morbidity Associated with Iliac Crest Bone Harvest in Oral and Maxillofacial, Reconstructive Surgery.

INTRODUCTION: Iliac crest is the most common donor site for autogenous bone grafting as cortical bone, cancellous bone or combination of both can be harvested in abundance depending upon the need. Ilium provides highest concentration of osteo-component cells and greater quality of bone with less morbidity. AIM: The study was conducted to evaluate the donor site morbidity associated with autogenous iliac crest bone grafting for reconstruction in maxillofacial surgery. MATERIALS AND METHODS: Around 12 patients, who had undergone iliac crest bone harvesting for various maxillofacial and reconstructive surgical procedures like cleft alveolus repair, malar augmentation, mandibular reconstruction following tumour resection and cyst enucleation and other surgical procedures performed in the Department of Oral and Maxillofacial Surgery, over a span of two years. The donor site was evaluated for the following factors: pain, neuropraxia, abnormal gait and scar evaluation. RESULTS: None of the 12 patients had intraoperative complications like haemorrhage, damage to the muscles/ligaments, fracture of the ilium and damage to the acetabular fossa/femur head. Any major postoperative complications were also not recorded. Minor postoperative complications like pain, contour defect, walking difficulty were present, which gradually got resolved by the time of discharge. CONCLUSION: Anterior iliac crest provides an adequate harvest of cancellous, corticocancellous or bicortical grafts for reconstruction of various osseous defects in the maxillofacial region with least morbidity and should be considered as a major reservoir of bone for bony reconstructive procedures.

Orthognathic Surgery: A Review of Articles Published in 2014-2015.

OBJECTIVES: We did a retrospective study and reviewed some of the orthognathic surgery related papers that were published between January 2014 and December 2015 in a leading International Maxillofacial Surgery Journal. It was conducted to ascertain the trends of articles being published. METHOD: A total of around 57 articles were reviewed, of which most of the full length articles were on post operative outcomes and obstructive sleep apnoea. RESULTS: Bulk of the studies were retrospective, and less interest was shown onto experimental researches. CONCLUSION: A thorough review and analysis thus gives an impression that there is a high requirement of well designed clinical studies.

A review of temporomandibular joint-related papers published between 2014-2015.

We conducted a retrospective study and reviewed the temporomandibular joint (TMJ)-related papers published in a leading international journal, Journal of Oral and Maxillofacial Surgery, between January 2014 and December 2015. The study was conducted to ascertain and compare the trends of articles being published in the years 2014 and 2015. A total of 28 articles were reviewed, of which most of the full-length articles were on clinical management and outcomes and the role of radiology. The bulk of the studies were prospective, and less interest was shown in experimental research. A thorough review and analysis thus gives the impression that there is a great need for well-designed clinical studies on TMJ.