Post-traumatic Actinomycotic Oro-antral Fistula Closure with Three-dimensional Stereolithographic Modeling and Patient-Specific Titanium Implant.

We report an interesting case of a post-traumatic actinomycotic oro-antral fistula of the left posterior maxilla, that was not salvageable via local flaps due to the size of the defect and was managed with the patient-specific titanium implant, fabricated by three-dimensional stereolithographic model planning followed by primary closure.

Quantitative Prediction of Change in Chin Position in Le Fort I Impaction.

BACKGROUND: Vertical maxillary excess, a dentofacial deformity present in a large proportion of population impute an increased lower facial height due to increased maxillary height. This results in a clockwise rotation in the mandible, and the chin advances posteriorly and inferiorly. Le Fort I superior repositioning of the maxilla begets movement of pogonion point anteriorly and cranially. Cephalometric analysis helps to access change in position of chin following Le Fort I impaction. In our study, from this analysis a formula was defined to perceive the exact amount of this change in chin position along the vertical and sagittal plane as a result of autorotation. MATERIALS AND METHODS: This experimental study assessed 45 patients with vertical maxillary excess over a period of 2 years and 6 months (January 2016-May 2018) in Government Medical College Hospital, Kottayam, Kerala, India. The planned procedure was Le Fort I superior impaction for correction of vertical maxillary excess. Pre-operative cephalograph was taken initially. Post-operative cephalograph after 3 months was then compared with initial pre-operative cephalograph to assess the change in position of the pogonion and menton. RESULTS: Forty-five participants were studied. The multiple regression model was applied to predict the changes in the chin (dependent factor) according to the vertical change in the maxilla (predictive factor). For every 1 mm change in the maxilla vertically, the chin was estimated to move 0.59 vertically. For a standard deviation increase of 1 in the position of the maxilla, the chin moved superiorly by 0.744 of the standard deviation. For every 1 mm of vertical change in the maxilla, the chin could be expected to move 0.22 mm horizontally. For a standard deviation increase of 1 in the maxillary position, the chin advanced by 0.273 of the standard deviation. CONCLUSION: This study draws to a conclusive finding that the movement of maxilla in the superior direction has an effect on the repositioning of the chin in the anterior and cranial directions. This has led to a formulation that 1 mm of superior impaction of maxilla results in 0.6 mm of vertical and 0.2 mm of sagittal movement of chin. This might help to have a glance of future chin position and aid in deciding the need for mandibular surgery.

Institutional microbial analysis of odontogenic infections and their empirical antibiotic sensitivity.

Most purulent orofacial infections are of odontogenic origin. It is well established that odontogenic infections are polymicrobial in nature. Empiric antibiotics were administered before the culture and sensitivity test results were obtained and specific antibiotics were administered based on the culture and sensitivity test results. But resistance was a challenging problem all throughout along with development of more virulent strains of microorganisms which were more infectious and resistant to many known antibiotics. OBJECTIVE: To identify the causative aerobic and anaerobic micro-organisms responsible for orofacial infections and to evaluate the resistance against empirical antibiotics used in the treatment of space infections. METHOD: 142 patients with head and neck fascial space infections of odontogenic origin were randomly taken, the pus samples and aspirates were collected aseptically from patients for aerobic and anaerobic microbiological study. RESULTS: In this study the most common aerobic organism isolated was streptococcus viridians (34.49%), most common anaerobe was peptostreptococci, (61.11%) and the most common mixed organism was streptococcus with peptostreptococci (30%). Amoxicillin was the most commonly used empirical drug in all cases and showed highest resistance (96.55%) for all the organisms. But linezolid (100%) was sensitive to all the aerobic, anaerobic and mixed group of organisms. Metronidazole (100%) turned out to be sensitive to the entire anaerobic group. Clindamycin (100%) appeared sensitive to the entire aerobic group. CONCLUSION: Knowledge about the pathologic flora involved in head and neck infection in a locality and their sensitivity and resistance to commonly used antibiotics will help the clinician in administering appropriate antibiotics.

Comparison of clinical outcomes of treatment of dysfunction of the temporomandibular joint between conventional and ultrasound-guided arthrocentesis.

Patients with disorders of the temporomandibular joint (TMJ) who do not respond to non-operative treatment may require invasive procedures such as arthrocentesis and arthroscopy. We divided 80 patients with dysfunction of the TMJ into two groups: a control group who were treated by conventional arthrocentesis, and an experimental group who were treated by ultrasound-guided arthrocentesis. Both groups were monitored three days, one week, and one month postoperatively and the clinical outcomes compared. The experimental group had a significant reduction in the degree of pain in the immediate postoperative period (p=0.015). However, ultrasound-guided arthrocentesis showed no significant improvement in symptoms overall compared with conventional arthrocentesis. Both techniques seem to be effective in the management of dysfunction of the TMJ.

Neurosensory evaluation of inferior alveolar nerve after bilateral sagittal split ramus osteotomy of mandible.

Mandibular skeletal deformities are mostly corrected by Sagittal Split Ramus Osteotomy. One of the main complications of Bilateral Sagittal Split Ramus Osteotomy is impairement of sensory function of Inferior Alveolar Nerve. OBJECTIVES: To evaluate the occurrence of neurosensory disturbance by comparing the subjective and objective assessment of neurosensory responses after bilateral sagittal split ramus osteotomy.To assess the progress of recovery from the first post operative day till six months. To explain the factors causing neurosensory disturbances. METHOD: A series of 24 patients with clinically and radiographically diagnosed mandibular skeletal deformity were treated with Bilateral Sagittal Split Ramus Osteotomy. For evaluation of the neurosensory responses, the parameters consist of subjective and objective test in order to compare the subjective and objective assessment. RESULTS: On the first post operative day neurosensory disturbances were seen in all the patients. Recovery of sensation was seen in all the patients at the end of this study. CONCLUSION: The incidence of functional nerve disturbances is acceptable, since the progression towards recovery is inevitable. Prolonged neurosensory disturbance is greatly related to the degree of manipulation of the inferior alveolar nerve.

Extent and outcome of self-medication by patients reporting to a private skin clinic in Dar es Salaam, Tanzania.

A total of 350 patients (203 females and147 males) attending Meise private skin clinic in Dar es Salaam were interviewed to elicit information on various aspects of self-medication including skin conditions for which self medication is commonly used, type and source of medication, the appropriateness for the medication and the outcome of self-medication. Thirty percent of the patients could not ascertain the type of medication they used. The drugs commonly used for self-medication were anti-fungals (42%), antibiotics (25%), steroid containing drugs (10%), analgesics (44%), antihistamines 6(%) and others (13 %). Most of the drugs were obtained from community pharmacies (40%), other sources were relatives and friends (18%), other health facilities (17%), those stored at home as left-overs from unfinished doses (15%) and from traditional healers (10 %). More than 82% of those who practiced self-medication were judged to have used improper drugs for the presenting skin condition. In about half of the patients (54%) who practiced self-medication the skin condition became worse. Fourteen percent of the patients benefited, while 32% of the drugs used did not have significant effect on the presenting condition of the patients. These findings suggest that self-medication for the treatment of skin conditions is a common practice among patients in Dar es Salaam. A significant proportion of these patients does not benefit from such practice and yet they can easily get a variety of tropical medicinal preparations without a professionally authorised prescription. It is therefore recommended to disseminate health education messages to patients and health care providers, including pharmacists, to address the need for a thorough dermatological assessment of patients by qualified professionals before embarking on treatment of skin diseases.