Autogenous bone chip interspersed in PRF and PRP as an augmentative bio material in autogenous tooth transplant - A case report.

INTRODUCTION: Autotransplantation technique involves extraction of tooth from the recipient site and donor tooth without damage, placing and stabilizing donor tooth within same individual. The use of autogenous bone combined with platelet rich fibrin (PRF) and platelet rich plasma (PRP) seems to be favorable to achieve stable alveolar bone. Thus we provide an innovative adjuvant method for enhancing bone formation using PRF and inter-radicular bone with PRP as autogenous graft. PRESENTATION OF CASE: A 26 year old healthy female individual reported university teaching hospital to outpatient department of oral and maxillofacial surgery, with complain of decayed tooth. On clinical and radiographic examination it was diagnosed was chronic irreversible pulpitis with to left maxillary first molar. Looking at clinical profile, age and health status an autogenous tooth transplant was advised. DISCUSSION: Periodontal ligament, interradicular bone autografts, PRF and PRP has potential to induce formation of alveolar bone and is recommended in cases of atrophy of alveolar process. CONCLUSION: The solution mentioned can be hypothesized to improve - quantity and quality of bone formed, reduce the chances of ankylosis of the tooth, bone loss, sinus perforation.

Various Treatment Modalities in COVID-19 Associated Facial Mucormycosis and the Need for its Surgical Management: A Systematic Review.

Introduction: Mucormycosis emerged as a wildfire in post-covid-19 infected patients. Most frequently involved sites of mucormycosis are rhino-orbital, rhino-sinusal and rhino-orbito-cerebral. The hallmark sign of mucormycosis is tissue necrosis, which is often a late sign. The fatality rate of mucormycosis is 46% globally. Despite early aggressive combined surgical and medical therapy, the prognosis of mucormycosis is poor. Methods: We searched the electronic database of PubMed, web of science, Embase, Scopus and Google Scholar from Jan 2020 until December 2021 using keywords. We retrieved all the granular details of original research articles, case reports/series of patients with rhino-orbito-cerebral mucormycosis (ROCM), and COVID-19 reported worldwide. Subsequently, we analyzed the patient characteristics, associated comorbidities, location of mucormycosis, treatment given and its outcome in people with COVID-19. (Prospero registration-CRD42021256830, June 4, 2021). Results: Overall, 544 rhino-orbito-cerebral mucormycosis patients were included in our review with a history of Covid-19 infection. Out of which 410 patients had diabetes mellitus which has proven to be major contributing immunocompromised disease. Other diseases like hypertension, chronic kidney diseases, hypothyroidism, etc., were also attributed as an immunocompromised disease causing increased number of covid associated mucormycosis cases. We found out that total number of patients alive after taking only antifungal drug treatment were 25 in number, whereas total number of patients alive when antifungal drugs were combined with surgical intervention were 428 which was significantly higher. Conclusion: Our systematic review concluded that surgical debridement should be performed whenever feasible in parallel to antifungal treatment in order to reduce the mortality rate of COVID-19 associated rhino-orbito-cerebral mucormycosis patients.

Role of distraction osteogenesis and flip genioplasty to correct sleep apnea and aesthetics in long standing TMJ ankylosis - A case report.

INTRODUCTION AND IMPORTANCE: Temporomandibular joint (TMJ) ankylosis triad includes TMJ ankylosis, micrognathia, and obstructive sleep apnea (OSA) which is common in long-standing cases of TMJ ankylosis. Unilateral long-standing cases of TMJ ankylosis also result in a severe discrepancy in the midline of the chin. CASE PRESENTATION: A young adult female presented with restricted mouth opening and daylight sleepiness. Her AHI was mild and there was excessive facial disfigurement. Right-side TMJ ankylosis was diagnosed with compromised posterior airway space and Ramal height was also short on the affected side. Chin has severely deviated to the affected side. CLINICAL DISCUSSION: Treatment protocols for TMJ ankylosis are different for different case scenarios. A proper protocol derivation is a must looking into the clinical and radiographical examination of the patient. As mentioned in previous literature, anti-Kaban's protocol has been shown to provide good results. A genioplasty improves the chin midline deviation. CONCLUSION: A careful assessment and a proper treatment plan should be selected for the management and early relief of the symptoms of the patient. Thorough knowledge and update should be available to the operating surgeon to choose the correct treatment plan for the management of a triad patient.

Comparative evaluation of salivary alpha amylase level for assessment of stress during third molar surgery with and without piano music and co-relation with pain catastrophizing scale: an in vivo study.

OBJECTIVES: Preoperative nervousness and anxiety are frequently encountered by individuals who undergo extractions of impacted wisdom teeth. The aim of the present study is to evaluate salivary alpha amylase (sAA) level in patients for assessment of stress during third molar surgery while listening to piano music and to determine its co-relation with pain catastrophizing scale (PCS). MATERIALS AND METHODS: Seven patients (four males and three females) indicated for surgical extraction of bilaterally impacted mandibular third molars were included. Pre-surgical patient assessments were completed, and three samples of saliva were collected during surgery-one at baseline, one 30 minutes after commencement of surgery, and one after suturing. Assessment was performed on both sides separately with and without piano music, and the samples were assessed for sAA level and correlated with the patient's self-reported PCS. RESULTS: Statistically significant results were obtained in patients who underwent surgical extraction while listening to piano music (P=0.046). The correlation of sAA level with PCS was not significant. CONCLUSION: Music demonstrated a beneficial effect on lowering the levels of stress and anxiety that a patient exhibits during any surgical procedure, and sAA can be a useful biomarker for similar assessments.

Evaluation of Presurgical Serum Cortisol Level in Patients Undergoing Major Maxillofacial Surgery.

BACKGROUND: Stress is an integral part of life. Anxiety levels may increase when it comes to being treated surgically due to road traffic accidents causing facial trauma, other pathologies or burns. The stress that is caused during a surgical procedure as well as during the treatment in debilitated patients or traumatic conditions is bound to cause disturbance in the metabolic and physiologic levels of cortisol. Therefore, a study was carried out to determine the cortisol levels just prior to surgery on the day of operation to quantify the stress levels and also aid in any preanesthetic medication changes for the patient undergoing maxillofacial surgery. AIM: To evaluate and compare pre-surgical serum cortisol levels in patients undergoing major maxillofacial surgery under general anaesthesia. OBJECTIVE: To evaluate the serum cortisol level of patient 3 days prior to surgery, on the day of surgery and to compare and evaluate the difference seen in both the obtained values. METHODS: A prospective, randomized, in- vivo study was carried out in the Department of Oral and Maxillofacial Surgery at a teaching dental hospital. A total of 32 patients were included in this study. Inclusion and Exculsion criteria was made along with pre-opertive assessment of the patient, informed consent was obtained from all patients involved in the study. Patient blood sample, at 8 am three days prior to surgery and on the day of surgery and sent for laboratory investigations. RESULT: Participants in this clinical study underwent treatment of various ailments like facial trauma, and miscellaneous pathologies like Dentigerous Cyst, Oral submucosa fibrosis, Osteomyelitis, Benign Tumor and Orthognathic surgery. The anxiety of the patients were assessed by serum cortisol level preoperatively and on the day of operation. A total of 32 patients, 26 male and 06 female were included in the study. There was statistically highly significant difference seen between the mean values obtained three days prior to surgery and on the day of surgery. CONCLUSION: We have concluded from this study that the serum cortisol level shows significant increase on the day of surgery. A future study can focus on association between increased levels of serum cortisol and postoperative wound healing where patients can be divided into two groups one receiving pre-operative stress reduction protocol and other not receiving the same.

The use of Velscope to assess cellular changes occuring in oral premalignancy.

OBJECTIVES: To improve visualization of suspicious lesions of the oral mucosa and to assess the accuracy of Velscope in assessing cellular changes occurring in oral premalignancy for early diagnosis. MATERIALS AND METHODS: In this prospective, randomized in-vivo clinical study a total of 250 patients who gave history of chewing tobacco were screened. The selection of the site of biopsy was taken based on the area of loss of fluorescence identified by the Velscope within the lesion. Routine blood investigations were done. A biopsy was performed to confirm the findings of clinical examination. The data was collected and analysed. RESULTS: Among 200 patients only 110 underwent incisional biopsy. Of these only 89 patients showed neoplastic changes. Of the control biopsies, none of them showed any dysplastic changes. Out of 106 who exhibited speckling under autofluorescence, only 89 showed dysplastic changes whereas only 17 showed no dysplastic changes. Out of these 17 specimens, the histopathological diagnosis of 5 was coated tongue, 3 were pigmented lesions, 3 were geographic tongue and 2 were mucositis. Of the remaining 4, the histopathological diagnosis of 1 was oral submucous fibrosis, 1 was lichen planus and 2 were frictional keratosis. CONCLUSION: False positive findings are possible in presence of highly inflamed tissues, and it is possible that use of Velscope alone may result in failure to detect regions of dysplasia, but it has its use definitely to improve clinical decision making about the nature of oral lesions and aids in decisions to biopsy regions of concern. Use of the scope has allowed practitioners to identify the best region for biopsy. It is much better to occasionally sample tissue that turns out to be benign than to fail to diagnose dysplastic or malignant lesions. However, poor specificity is a major limitation for using it as a screening tool.

Comparing intra-oral wound healing after alveoloplasty using silk sutures and n-butyl-2-cyanoacrylate.

OBJECTIVES: The need for proper wound closure is of paramount importance after any intra-oral surgery. Various wound closure techniques have been described in literature using traditional non-absorbable suture materials. These include like synthetic absorbable sutures, surgical staples and tissue adhesives. Cyanoacrylates are among the most commonly used biocompatible tissue adhesives. To evaluate and compare intraoral wound healing using 3-0 silk sutures and n-butyl-2-cyanoacrylate after alveoloplasty. MATERIALS AND METHODS: A total of 20 patients requiring bilateral alveoloplasty in the same arch (upper or lower) were included in this study. Patients with any pre-existing pathology or systemic disease were excluded. After alveoloplasty was performed, the wound was closed using 3-0 braided silk sutures on one side, and using n-butyl-2-cyanoacrylate bio adhesive on the other side. Patients were evaluated based on the following parameters: time required to achieve wound closure; the incidence of immediate and postoperative hemostasis; the time to the use of the first rescue medication; the side where pain first arises; and the side where wound healing begins first. RESULTS: Compared to 3-0 silk sutures, cyanoacrylate demonstrated better hemostatic properties, reduced operative time, reduced postoperative pain and better wound healing. CONCLUSION: These data suggest that cyanoacrylate glue is an adequate alternative to conventional sutures to close the surgical wound after alveoloplasty, and better than are 3-0 silk sutures.

An in vivo study comparing efficacy of 0.25% and 0.5% bupivacaine in infraorbital nerve block for postoperative analgesia.

BACKGROUND: Pain is an unpleasant sensation ranging from mild localized discomfort to agony and is one of the most commonly experienced symptoms in oral surgery. Usually, local anesthetic agents and analgesics are used for pain control in oral surgical procedures. Local anesthetic agents including lignocaine and bupivacaine are routinely used in varying concentrations. The present study was designed to evaluate and compare the efficacy of 0.25% and 0.5% bupivacaine for postoperative analgesia in infraorbital nerve block. METHODS: Forty-one patients undergoing bilateral maxillary orthodontic extraction received 0.5% bupivacaine (n = 41) on one side and 0.25% bupivacaine (n = 41) on the other side at an interval of 7 d. The parameters evaluated for both the bupivacaine concentrations were onset of action, pain during procedure (visual analog scale score [VAS]), and duration of action. The results were noted, tabulated, and analyzed using the Wilcoxon signed rank test. RESULTS: The onset of action of 0.5% bupivacaine was quicker than that of 0.25% bupivacaine, but the difference was not statistically significant (P = 0.306). No significant difference was found between the solutions for VAS scores (P = 0.221) scores and duration of action (P = 0.662). CONCLUSION: There was no significant difference between 0.25% bupivacaine and 0.5% bupivacaine in terms of onset of action, pain during procedure, and duration of action. The use of 0.25% bupivacaine is recommended.

Effect of Formalin Fixation on Surgical Margins in Patients With Oral Squamous Cell Carcinoma.

PURPOSE: Formalin fixation causes shrinkage of surgical margins, which can result in the underestimation of tumor-free margins. The purpose of this study was to show the effect of formalin fixation on surgical margins. Another aim of this study was to evaluate surgical margin shrinkage after fixation of oral squamous cell carcinoma (OSCC) specimens of the gingivobuccal sulcus (GBS). MATERIALS AND METHODS: This was a cross-sectional study. The study sample consisted of OSCC specimens of the GBS after composite resection. The primary predictor variable was the length of the linear margin at various locations (anterior, posterior, medial, and lateral). The primary outcome variable was the percentage of change in each respective margin (anterior, posterior, medial, and lateral) after fixation in 10% formalin for 24 hours. Other variables were age, gender, use of smokeless tobacco, smoking status, and tumor staging. The difference between pre-fixation and post-fixation data was calculated using paired t test. RESULTS: The sample consisted of 15 patients (7 men and 8 women; age range, 55 to 65 yr) diagnosed with OSCC of the GBS. Shrinkage of surgical margins (decrease) occurred after fixation compared with margins before fixation. The average surgical margin shrinkages were 18.7% anteriorly, 14.9% posteriorly, 23.6% medially, and 23.9% laterally. This shrinkage was statistically significant (P < .001). CONCLUSION: Formalin fixation causes considerable shrinkage of surgical margins. This phenomenon should be considered by the pathologist before providing the final histopathology report.

Comparative Evaluation of Immediate Post-Operative Sequelae after Surgical Removal of Impacted Mandibular Third Molar with or without Tube Drain - Split-Mouth Study.

INTRODUCTION: Third molar surgery is one of the most common surgical procedures performed in general dentistry. Post-operative variables such as pain, swelling and trismus are major concerns after impacted mandibular third molar surgery. Use of passive tube drain is supposed to help reduce these immediate post-operative sequelae. The current study was designed to compare the effect of tube drain on immediate post-operative sequelae following impacted mandibular third molar surgery. AIM: To compare the post-operative sequelae after surgical removal of impacted mandibular third molar surgery with or without tube drain. MATERIALS AND METHODS: Thirty patients with bilateral impacted mandibular third molars were divided into two groups: Test (with tube drain) and control (without tube drain) group. In the test group, a tube drain was inserted through the releasing incision, and kept in place for three days. The control group was left without a tube drain. The post-operative variables like, pain, swelling, and trismus were calculated after 24 hours, 72 hours, 7 days, and 15 days in both the groups and analyzed statistically using chi-square and t-test analysis. RESULTS: The test group showed lesser swelling as compared to control group, with the swelling variable showing statistically significant difference at post-operative day 3 and 7 (p≤ 0.05) in both groups. There were no statistically significant differences in pain and trismus variables in both the groups. CONCLUSION: The use of tube drain helps to control swelling following impacted mandibular third molar surgery. However, it does not have much effect on pain or trismus.

Applications of coronoid process as a bone graft in maxillofacial surgery.

The coronoid process can be easily harvested as a donor bone by an intraoral approach during many maxillofacial surgery procedures. The purpose of this study was to evaluate the utility of autogenous coronoid process bone grafts for maxillofacial reconstructive surgery. Twelve patients, who underwent coronoid process grafts for reconstruction of maxillofacial deformities due to trauma, alveolar atrophy, or temporomandibular joint ankylosis, were included in the study. There were 3 orbital defects after extended maxillectomy, 1 blowout fracture of the orbit, 2 cases of reconstruction after temporomandibular joint ankylosis surgery, 1 case of additional chin augmentation following horizontal flip genioplasty, 1 defect of anterior wall of maxilla due to trauma, 2 mandibular defects, and 2 cases of bone augmentation for implants.We recommend the use of coronoid process of the mandible as a source for autogenous bone graft as it can provide sufficient bone in quantity and quality for selected maxillofacial reconstructions.

A simple method to control bleeding by stationary paper clips as an alternate to raney clips during coronal incisions.

The value of coronal incisions in maxillofacial surgery has been well documented. The incision provides excellent access to the upper facial skeleton aiding in adequate access, good anatomic reduction of fractures and hidden scar. The associated bleeding with raising a bicoronal flap is a matter of concern to beginner surgeons. This often prevents the regular use of this approach. Textbooks have recommended the use of Raney clips but these are not available routinely in India and are expensive. We have utilized simple stationary paper clips, autoclaved and used for surgery. This not only provide haemostasis but also aids in holding the flap during dissection. This technique would be of great help to young surgeons and in developing countries where economics plays a major role in surgery.

Juvenile psammomatoid ossifying fibroma: a review.

In WHO classification of odontogenic tumors (2005), juvenile ossifying fibroma (JOF) is divided into juvenile psammomatoid ossifying fibroma (JPOF) and juvenile trabecular ossifying fibroma (JTOF). JPOF has been distinguished because of its location, clinical behavior, and age of occurrence. It is generally seen in younger age group and the most common site is paranasal sinuses, orbits, and fronto-ethmoidal complex. Radiologically, the internal structure can be radiolucent, mixed, or radiopaque, depending on the degree of calcification and extent of the cystic changes. Histologically, it is characterized by a densely cellular fibrous stroma interspersed with numerous psammoma bodies. The treatment is "en bloc" surgical excision while in case of intracranial extension, tumor removal may need a combination of neurosurgical and transfacial approach. Malignant transformation and metastasis has not been reported but recurrence is common. The purpose of this narrative review article is to discuss the various aspects of JPOF reported in the English medical literature.

Transmylohyoid/Submental intubation: review, analysis, and refinements.

Successful outcome in any surgery is dependent on unobstructed access. Management of patients with polytrauma of the face or those undergoing multiple/complex facial osteotomies has always been a challenge, not only to maxillofacial surgeons but also to the anesthetists, as both specialists fight for the same anatomic territory. Hernandez in 1986 published the first article on the submental route for endotracheal intubation. He developed this technique to avoid tracheotomy particularly in maxillofacial trauma where short-term maxillomandibular fixation was required.Since our first report in 1992, we have successfully avoided tracheostomy in 400 patients, by using this technique of transmylohyoid intubation. Experience of 20 years is put forward with critical analysis of problems and complications along with certain suggestions and refinements.

Application of 2.0 mm Titanium Plates in Rigid Internal Fixation of Mandibular Angle Fractures.

PURPOSE: The present study aimed to evaluate the efficacy and stability of 2.0 mm Titanium plates in treatment of mandibular angle fractures. MATERIALS AND METHODS: A randomized, prospective study was carried out on 17 patients treated by ORIF with 2.0 mm titanium plates. Operative handling of the plate and clinical stability were qualitatively analyzed. RESULTS: The 2.0 mm plate showed good intra-operative handling and adequate clinical stability with follow up of 6 months showing good soft tissue healing. CONCLUSION: A single 2.0 mm titanium plate provides easy handling and adequate occlusal stability in the post-operative phase as compared to the traditional 2.5 mm plate without post-operative MMF. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12663-010-0128-2) contains supplementary material, which is available to authorized users.