Efficacy and Reliability of Single Tooth Anesthesia (STA) for Surgical Removal of Impacted Wisdom Teeth: A Comparative Study.

Introduction: Single tooth anesthesia via intra-ligamentary injections has long been used to provide localized pain control with minimal discomfort while avoiding undesirable effects like lip numbness, mainly in pediatric population with definite success. In this study, we aimed to assess the efficacy of single tooth anesthesia (STA) via intra-ligamentary injections using WAND® STA in the surgical removal of impacted third molar. Methodology: Sixty patients were randomly divided into two groups of 30 each where Group I (study group) received local anesthesia via STA system with 4% articaine and Group II (control group) received conventional injection, that is, inferior alveolar nerve block, (IANB) with 4% articaine. Assessment of the effectiveness of the anesthesia was made by noting the onset of action, failure of anesthesia, intra-operative pain and necessity for additional injection. Additional effects such as lip numbness were also noted. Patients were evaluated for pain and discomfort after 24 h. Results: The difference between the mean time for onset of action for STA injections and conventional block and the mean difference in the onset of action between both groups was 2.2 (± 0.25) minutes which was statistically significant (p < 0.05). Statistically significant difference in VAS score was noted only during tooth elevation with Group I reporting higher VAS score than Group II. Additional blocks were indicated in 6.7% for lingual block and 50% for long buccal nerve block in Group I and repetition of long buccal nerve block was indicated in 23.3% patients in group II. Postoperative pain and trismus was found to be higher in Group II. Conclusion: In spite of some limits in the extent of anesthesia achieved, WAND® STA was seen to be able to achieve adequate anesthesia for surgical removal of impacted third molar and is a viable alternative, particularly in patients where blocks are contraindicated due to systemic conditions. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-023-02017-z.

Guided Full Mouth Implant Rehabilitation in Atrophic Alveolar Ridges Using TTPHIL ALL TILT® Protocol: A Case Report With Three Years Follow-Up.

Computer-assisted implant planning has become a key diagnostic and therapeutic tool in modern dentistry. This case report emphasizes the possibilities in modern implantology combining virtual implant planning, guided surgery with surgical templates, and immediate function. A 75-year-old female presented with maxillary and mandibular dentures and wanted fixed replacement in minimal appointments. Diagnosis, decision-making, and treatment approaches were based on clinical findings and detailed virtual three-dimensional implant planning. Guided implant placement of six implants in each arch using Tall and Tilted Pin Hole Immediate Loading Technique (TTPHIL ALL TILT®), and immediate loading with a provisional fixed dental prosthesis (FDP) was performed fulfilling patient's functional and esthetic demands in a minimally invasive manner. The final computer-assisted design/computer-assisted manufacturing (CAD/CAM) FDP with a titanium framework and ceramic layering was delivered after six months. At the three-year recall, the implant-supported FDP was free of any complications. Uneventful osseointegration of the dental implants and a healthy peri-implant mucosa were observed. Computer-assisted TTPHIL ALL TILT® technique including three-dimensional virtual implant planning, guided surgery, and CAD/CAM fabrication of provisional and final reconstructions allowed for a concise treatment workflow with favorable esthetic and functional outcomes in this maxillary and mandibular full-mouth case without the need of multiple surgeries in a short treatment time.

Cholesterol granuloma of the maxillary sinus in association with a dental implant-A case report.

BACKGROUND: Cholesterol granuloma is typically a benign granulomatous growth seen mostly in the mastoid process and the petrous temporal bone. Although cholesterol granuloma in maxillary sinus was first reported in the scientific literature in 1978, the occurrence is very rare and it is usually clinically and radiographically manifested ambiguously as maxillary sinusitis. PURPOSE: The presence of cholesterol granuloma in the maxillary sinus in association with a dental pathology or prosthesis has been scarcely known. In this case report, we present a case of cholesterol granuloma in the maxillary sinus of a middle-aged male who had previously undergone dental implant placement in relation to that anatomical location. MATERIALS AND METHODS: A 64-year-old man reported to the Dental OP with a chief complaint of oral malodor, swelling, and tenderness over the right middle third of the face for the past 3 months. A cone beam computed tomography scan showed a well-defined radio-opaque lesion along with sclerosis and thinning of bone within the right maxillary antrum in relation to the dental implant placed in the 16 regions. The left maxillary sinus appeared normal. The Caldwell-Luc procedure was performed and a solitary soft lesion with yellowish-gray contents was evident within the right maxillary sinus. Histopathological examination revealed cholesterol clefts surrounded by foreign body giant cell reaction and granulation tissue formation, along with the presence of old and recent hemorrhage. A final diagnosis of cholesterol granuloma was made based on the histopathological examination report. CONCLUSION: Based on the evidence available in the present case, we hypothesize that the localized trauma and hemorrhage initiated by implant placement in this particular anatomical location could have plausibly resulted in the occurrence of cholesterol granuloma in our patient.

Correlation of transverse mandibular dimension with naso-pharyngeal and oro-pharyngeal airway using computed tomographic analysis - A retrospective observational study.

PURPOSE: The aim of the study was to investigate changes in the naso-pharyngeal and oro-pharyngeal airway with varying degrees of mandibular flare. METHODS: The investigators implemented a retrospective, observational study including CT data from patients fitting the inclusion criteria. Linear and angular measurements were used to assess the flare and transverse dimension of the mandible, while standard reference planes were used for assessment of airway dimensions. The primary outcome measures were to correlate and quantify the naso-pharyngeal and oro-pharyngeal volumes with mandibular flare. Secondary outcome measures were to study the intra-variable correlation. Significance level was fixed at 5% (α = 0.05). RESULTS: The sample included CT data from 30 individuals with apparently normal craniofacial skeleton (53% males and 46.7% female with a mean age of 29.53 years). Both nasopharyngeal and oropharyngeal volumes demonstrated moderate positive correlations with inter-condylar width (p = 0.020 and p = 0.038) and inter-condylar angles (p = 0.041 and p = 0.005) respectively. Linear regression modelling demonstrated that for every millimetre increase of the Inter-condylar width, the naso-pharyngeal and oro-pharyngeal airway volume increased by 0.423 cm3 (p = 0.020) and 0.381 cm3 (p = 0.038) respectively, and every degree increase of inter-condylar angle produced an increase the nasopharyngeal and oropharyngeal volumes by 0.376cm3 (p = 0.041) and 0.496cm3 (p = 0.005) respectively. CONCLUSION: Parameters of mandibular flare demonstrate statistically significant correlation to pharyngeal airway volume, which may be a relevant predictor to evaluate airway in patients undergoing corrective skeletal surgery.

COVID-19 and Cleft and Craniofacial Surgery in Indian Scenario.

The coronavirus disease (COVID-19) had created the new normal approach towards the management of all maxillofacial problems as it is highly contagious and causing a threat to the health care professionals. The surgical management of patients with cleft and craniofacial deformities has caused lots of anxiety among patients and doctors in the recent COVID era as some essential treatment will be required for cleft babies from day one. Safety and protection for cleft children and parents must be the priority while dealing with this non-emergency disease. This article will highlight the important steps of management of the cleft and craniofacial cases during this pandemic by adhering to the protocols. It also throws light towards the strategies in revoking the cleft surgical management at least till this infection subsides.

Evaluating Morphology of the Pterygomaxillary Junction and Its Association With the Orbit in Different Facial Skeletal Relationships.

PURPOSE: The etiology for blindness after Le Fort I osteotomy is poorly understood. The authors propose that a study of the morphology and anatomical relationship of the pterygomaxillary junction to orbital vital structures may be crucial for understanding the possible etiology. MATERIALS AND METHODS: This retrospective observational study involved analysis of data procured from computed tomography scans of individuals who were categorized into 4 groups based on their skeletal characteristics: skeletal Class I, II, and III and cleft lip and palate (CLP). The outcome variables included i) the height, width, and thickness of the pterygomaxillary junction (PTMJ) which represent its morphology and ii) distance of the PTMJ to the superior orbital fissure and optic canal, to demonstrate its proximity to orbital vital structures. Primary outcome measures were to i) compare variance of the outcome variables across groups, ii) determine association between PTMJ morphology and its proximity to the orbit, and iii) determine association between skeletal morphology and the outcome variables. Data were analyzed using descriptive and inferential statistics to study variance and association. RESULTS: Forty patients (80 sides) were divided into 4 groups. The CLP group demonstrated maximum height and thickness of the PTMJ, whereas the Class II group demonstrated the minimum (P < .001 and P = .001, respectively). The CLP group demonstrated the closest proximity of the PTMJ to orbital vital structures (P < .001), with Class II being the farthest (P < .001). There was a weak positive correlation between the PTMJ height and its thickness and width, whereas a moderate negative correlation was seen between the PTMJ height and its distance from the optic canal and superior orbital fissures (P < .001). CONCLUSIONS: Morphology of the PTMJ varies with facial skeletal relationship and also influences the relationship of the PTMJ with the orbital vital structures. This may be critical in understanding the pathophysiology of blindness after Le Fort I osteotomies.

The Anatomical Basis for Plate Fixation in BSSO to Minimize Condylar Torquing: A Comparative CT Study of Mandibular Advancement and Setback.

INTRODUCTION: Condylar displacement after bilateral sagittal-split osteotomy (BSSO) occur in the sagittal plane as clockwise/counter-clockwise rotation of the ramus, in the coronal plane as medial/lateral inclination, or in the axial plane as medial/lateral condylar torquing. The purpose of this prospective CT study was to evaluate the role of plate fixation in minimizing condylar torquing or rotational changes in the axial plane. MATERIALS AND METHODS: This prospective study was carried out on 26 patients, 13 of whom underwent advancement BSSO and 13 setback BSSO, without maxillary LeFort I osteotomies. All mandibular movements were symmetrical. Fixation of the osteotomized segments was achieved with a single 4-hole plate and monocortical screws. In case of mandibular setbacks, a straight plate was used, whereas an inset-bent plate was used for advancements. Computed tomography scans were obtained preoperatively and postoperatively to measure condylar rotation or torqueing in the axial plane. An increase in condylar angle on axial slices was considered as lateral condylar torquing, whereas a decrease was considered as medial condylar torquing. RESULTS: A mean medial condylar torquing of 0.2° was noted postoperatively in case of setbacks (p > 0.05 not significant). This suggested minimal condylar torquing, indicating that the proximal and distal segments maintained contact at the anterior vertical osteotomy fixed with a straight plate. In case of advancements, a mean lateral condylar torquing of 2.2° was noted postoperatively (p < 0.005, highly significant). This suggested that the proximal segment flare at the anterior vertical osteotomy site was maintained by inset-bent plate fixation. CONCLUSION: The gaps between the proximal and distal segments created by mandibular advancement and setback should be maintained. An attempt to close these gaps, especially in mandibular advancement, will result in an unfavourable axial condylar torque. Consequently, the areas of bony contact between the proximal and distal osteotomy sites created by mandibular advancement and setback should be maintained as well.

Correction to: Comparative Aesthetic Evaluation of Lip Reconstruction Using Abbe's Flap in Secondary Cleft Lip Deformities: A Retrospective Study.

[This corrects the article DOI: 10.1007/s12663-019-01279-w.].

Utility of Chitra-HASi Granules in Cystic Defects of the Maxillofacial Region: A Pilot Study.

BACKGROUND: Cystic defects that are critical sized or larger require bone replacement strategies. However, due to inherent disadvantages of the various types of grafts, none of the available materials are best suited for these defects. Among the alloplastic materials, hydroxyapatite (HA)-based grafts are the most popular, due to their osteoconductive nature and resemblance to mineral bone. The aim of the study was to assess the utility of the novel material "Chitra-HASi" as a bone substitute in the maxillofacial region. MATERIALS AND METHODS: In a single-arm, prospective study, patients with radicular and dentigerous cysts were included and the minimum defect size was standardized at 20 × 20 mm or above. The Chitra-HASi material was developed by a wet precipitation technique and adopted for use following multiple in vitro and in vivo studies, confirming its safety and biocompatibility profile. All cysts underwent enucleation, followed by peripheral ostectomy and apicectomy of the teeth involved. The HASi graft was packed inside the cystic defect in a granular form and covered with a mucoperiosteal flap. Panoramic radiographs were taken preoperatively and at 3, 6, and 12 months postoperatively. RESULTS: Twenty-three patients were included in the study, of which only 10 patients could be followed up for 12 months after graft placement. The mean preoperative bone density was found to be 14.9% ± 4.97 (standard deviation), whereas the postoperative 3-month, 6-month, and 12-month densities had a mean difference of -11.3%, -22.9%, and -37.3%, respectively, and the differences were statistically significant. Minor complications such as sinus formation (n = 7) and extrusion of granules (n = 4) were noted, which were managed conservatively. Only two patients required graft removal secondary to infection, leading to a persistent sinus tract. CONCLUSION: The results of the study suggest that Chitra-HASi granules show potential as an alternative to other bone substitutes. The addition of silica to the porous HA material offers superior strength characteristics and needs long-term evaluation to assess its stability in large cystic defects.

Comparative Aesthetic Evaluation of Lip Reconstruction Using Abbe's Flap in Secondary Cleft Lip Deformities: A Retrospective Study.

AIM: To objectively evaluate the surgical outcome of deformed cleft lip treated by Abbe's flap using Digimizer image analysis software. METHODS: Fifteen Abbe's flap (AF) reconstruction cases with satisfactory photographic records were acquired in Digimizer image analysis software. Anthropometric landmarks were marked on the lip. Bilateral lip lengths, height and width were measured preoperatively and postoperatively after AF reconstruction for comparison. RESULTS: It was observed that by AF reconstruction, we could increase vermillion lip length and Cupid's bow width, hence providing adequate bulk to the middle of the lip. In addition to it, in some cases we could achieve the acceptable anatomy of the centre of the Cupid's bow with which it was sometimes disturbed during primary cheiloplasty. Lip length and lip height became proportionately equal bilaterally, leading to adequate lip symmetry in all cases. CONCLUSION: Computer-assisted anthropometric analysis of photographs using Digimizer image analysis software (MedCalc Software, Belgium) demonstrates that AF lip reconstruction technique produces aesthetic lip consistently.

Distraction Osteogenesis Versus Orthognathic Surgery: Demystifying Differences in Concepts, Techniques and Outcomes.

INTRODUCTION: The popularity and interest evoked by orthognathic surgery and distraction osteogenesis are undisputed in the field of oral and maxillofacial surgery. However, questions regarding the individual identities of either of them with clarity in their concepts, techniques and outcomes have remained unanswered. The aim of this review is to shed light on these questions. METHODS: This review is structured as a narrative review of thirty years of literature available in the specialities of orthognathic surgery and distraction osteogenesis. CONCLUSION: The authors present a review of existing literature combined with contrasting experience gained over the years in providing an overview of the merits and demerits of the two surgical techniques which will aid the clinician in justifying the use of one technique over the other.

Does Sphenopalatine Ganglion Block Improve Pain Control and Intraoperative Hemodynamics in Children Undergoing Palatoplasty? A Randomized Controlled Trial.

PURPOSE: Children undergoing cleft palate repair have pain, dysphagia, and wound irritation in the immediate postoperative phase that may compromise surgical outcomes. This trial evaluates the efficacy of the sphenopalatine ganglion block (SPGB) in optimizing intraoperative hemodynamics and postoperative analgesia in children undergoing primary palatoplasty. MATERIALS AND METHODS: The study was designed as a prospective, double-blind, randomized controlled trial comparing the use of SPGB with general anesthesia (GA) (study group) versus the use of only GA (control group). Routine preoperative documentation included type of cleft, patient weight, hemoglobin (Hb%), packed cell volume (PCV), blood pressure, and echocardiogram. Intraoperative monitoring included heart rate, blood pressure, and surgical field assessment. Postoperatively, the pain score, pain-free duration, and need for rescue analgesics were recorded. Postsurgical changes in Hb% and PCV values were assessed. Data analysis of collected variables was performed using SPSS software (version 16; IBM, Armonk, NY). Quantitative data were assessed for normality using the Shapiro-Wilk test and analyzed using the independent-sample t test, and the Fisher exact test was used for comparison of the binary variable (gender). The outcome variables were compared between the study and control groups after adjustment for confounding variables. P < .05 was considered statistically significant. RESULTS: We randomized 100 patients undergoing primary palatoplasty under GA into the control group (n = 49) and study group (SPGB) (n = 51). Three patients were excluded from the control group because of changes in intraoperative anesthetic protocol. The results showed statistically significant differences in the postsurgical pain-free duration (19.46 minutes vs 87.59 minutes) and mean blood loss (105.5 mL vs 62 mL) in favor of the study group. Surgical field and postoperative reduction of Hb% and PCV were also significantly favorable for the study group. CONCLUSIONS: SPGB is a potent pre-emptive technique offering excellent perioperative analgesia, hemodynamic stability, and a clear surgical field.

Simultaneous Occurrence of a Midline Sublingual Dermoid Cyst with Respiratory Epithelium and Submental Dermoid Cyst in a Paediatric Patient: A Case Report and Review of Literature.

AIM: To present the case of a simultaneously occuring sublingual dermoid cyst with respiratory epthelium and a submental dermoid cyst, and also to review literatures on the same. METHODS: A complete examination, radiograph, MRI and excision biopsy of both lesions were carried out and diagnosis was arrived at histopathologically. RESULTS: The histopathology of the submental swelling revealed orthokeratinized stratified squamous epithelium with underlying connective tissue consisting of dense irregularly arranged collagen fibres with fibroblasts along with chronic inflammatory cell infiltrate of lymphocytes and plasma cells. There was presence of sebaceous glands and sebum. Sublingual swelling showed non-keratinized stratified squamous epithelium with a fibrovascular connective tissue. Areas of pseudostratified ciliated columnar epithelium were also evident in some areas. Presence of sebaceous glands also seen. Based on these findings a confirmatory diagnosis of sublingual dermoid cyst with respiratory epithelium and submental dermoid cyst was made. CONCLUSION: This report throws light on midline lesions of the oral cavity and hopes to add this rare case into the current differential diagnosis of the same.

Mid-Face Degloving: An Alternate Approach to Extended Osteotomies of the Midface.

Extended osteotomies for mid-face advancement require generous exposure of the anterior maxilla, nasal bones, infraorbital rims, orbital floor, zygoma, and the anterior third of the zygomatic arches. This cannot be obtained with an exclusive transoral approach. Hence, the surgeon is usually compelled to utilize supplemental cutaneous incisions that are a compromise on the purpose behind a cosmetic surgery. In order to alleviate the need for such compromise, the authors advocate the mid face degloving approach for extended osteotomies at Lefort II and Lefort III levels. Mid face degloving involves a combination of circumvestibular incision, with inter cartilaginous and transfixation components from a nasal incision. The authors have utilized this technique for 9 patients and documented favorable results. The purpose of this paper is to focus the utility of this approach in orthognathic surgery and promote this as a viable alternative to traditional approaches in surgery of the mid face because of the absence of external scars.

Distraction osteogenesis in complex facial asymmetry corrections.

This article highlights the authors' experience in the management of facial asymmetries with the use of distraction osteogenesis. It is a narrative based on the clinical experience at the Meenakshi Cleft & Craniofacial Center at Chennai.

Reconstruction of Nasal Cleft Deformities Using Expanded Forehead Flaps: A Case Series.

INTRODUCTION: Reconstruction of the nasal clefts is a challenging task considering the nasal anatomic complexity and their possible association with craniofacial defects. The reconstruction of these defects needs extensive amounts of soft tissue that warrant the use of forehead flaps. Often presence of cranial defects and low hairline compromise the amount of tissue available for reconstruction warrenting tissue expansion. AIM: To evaluate the efficacy of tissue expansion in reconstruction of congenital nasal clefts. SUBJECTS AND METHODS: 9 patients with congenital nasal clefts involving multiple sub units were taken up for nasal reconstruction with expanded forehead flaps. The average amount of expansion needed was 200 ml. The reconstruction was performed in 3 stages. RESULTS: Expanded forehead flaps proved to be best modality for reconstruction providing the skin cover needed for ala, columella and dorsum with minimal scarring at the donor site. CONCLUSION: Expansion of the forehead flap is a viable option for multiple sub unit reconstruction in congenital nasal cleft deformities.

A Modified Kole's Osteotomy for Correction of Anterior Open Bite and Macrogenia in a Cleft Patient.

We present a modified technique to close anterior open bite as well as to correct anterior and vertical macrogenia without sacrificing the lowermost symphyseal segment, in comparison with conventional Kole's osteotomy, which can alter the symmetric bone architecture of the chin and jeopardize the blood supply of the sandwich segments.