Intraoral Cellular Schwannoma Involving Maxillary Gingiva: A Rare Case Report.

Oral schwannomas (OSs) are uncommon benign nerve sheath tumors accounting for 1% of all schwannomas and may arise from either soft tissue or bone. Cellular schwannoma is a rare histological variant of schwannoma which is characterized by increased cellularity. The most common intraoral site of occurrence is the tongue followed by the floor of the mouth and palate. Here, we are reporting a rare case of intraoral cellular schwannoma involving both facial and palatal gingiva of the right maxilla in a young Indian male patient.

Distraction Osteogenesis as a reliable method in management of Obstructive Sleep Apnoea (OSA) secondary to TMJ Ankylosis: A Case Report.

Obstructive sleep apnoea (OSA) is identified as repetitive and intermittent upper airway collapse or narrowing during sleep. Skeletal advancement through maxillomandibular surgery remains the most effective surgical treatment for OSA but is radical with certain relapse rate. Distraction Osteogenesis of mandible is a single-jaw surgical treatment alternative to bi-jaw surgeries having lesser complications. This case report describes successful management of a 46-year-old patient who reported with a chief complain of obstruction in breathing while sleeping since one year. Obstructive Sleep Apnoea (OSA) secondary to a retrognathic mandible was the final diagnosis, which was successfully treated by Distraction Osteogenesis (DO) of the mandible. The case showed enhancement in airway by 13mm and marked forward movement of Point-B (SNB increased by 6 degrees). The Epworth Sleepiness Scale value decreased from 19mm to 8 mm indicating substantial increase in the airway with stable results after 18 months of follow-up (elimination of symptoms and subsequent sound sleep). Distraction osteogenesis is an effective and reliable method to treat obstructive sleep apnoea secondary to retrognathic mandible.

A Rare Case of Malignant Fibrous Histiocytoma Mimicking Benign Tumour in Maxillofacial Region.

Sarcomas are malignancies arising from mesenchymal (nonepithelial) tissue and are broadly classified into sarcomas of soft tissue and bone. Soft tissue sarcomas of the head and neck are rare; they comprise < 1% of head and neck cancers and < 10% of all soft tissue sarcomas (Chang et al. in Otolaryngol Head Neck Surg 151:976-983, 2014). There have been few large series, and most have included embryonal rhabdomyosarcomas which are different from other sarcomas and are both radio- and chemosensitive (Eelesl et al. in Br J Cancer 68:201-207, 1993). Malignant soft tissue tumours differ from benign ones in that they are rapidly growing, and invade adjacent tissues and vital structures, and distant metastases through haematogenous or lymphatic routes (Sinha in Cancer Ther Oncol Int J 10(3):1-3, 2018). Benign tumours are well encapsulated and do not infiltrate the adjacent structures both clinically and radiographically. In the following case report, a male patient represented with a soft tissue movable swelling in left cheek; though it shows clinical and radiographic characteristics of benign soft tissue lesion, indeed histopathological presentation was suggestive of undifferentiated pleomorphic sarcoma. This gives us insight into how a malignant lesion can mimic benign lesion and subsequent changes in treatment and follow-up strategy.

Comparative Evaluation of the Intranasal Spray Formulation of Midazolam and Dexmedetomidine in Patients Undergoing Surgical Removal of Impacted Mandibular Third Molars: A Split Mouth Prospective Study.

PURPOSE: The purpose of this prospective randomized single blinded split mouth study was to conduct a comparative evaluation of the efficacy of intranasal atomised spray formulation of Dexmedetomidine with Midazolam in patients undergoing surgical removal of bilaterally impacted mandibular third molars. METHODS: This prospective study was conducted in twenty volunteers. Each volunteer underwent the surgical removal of an impacted mandibular third molar at two separate appointments at an interval of two weeks. The first third molar surgery was conducted using either intranasal Midazolam (Group M) or intranasal Dexmedetomidine (Group D). At the second appointment the surgical procedure was performed using the sedative agent not used at the first appointment. The primary testing outcome variables were Plasma oxygen saturation (SpO2), pulse and blood pressure and Modified Observer's Assessment of Alertness/Sedation (OAA/S) scale. These were recorded at predetermined intervals starting 10 min before the administration of local anaesthesia and continued up to 10 min after completion of the procedure. In addition surgeon's opinion regarding the patient cooperation, event amnesia, post operative nausea & vomiting were obtained. RESULTS: The sample composed of twenty patients (M = 9 and F = 11). There was statistically no significant difference between Group M and Group D with respect to mean SpO2. Minor differences were however noted at 20 and 30 min after sedation. There was no significant difference between the groups with respect to mean pulse rate, blood pressure, OAA/S, event amnesia, post operative nausea and vomiting and patient cooperation. CONCLUSION: We conclude that Midazolam and Dexmedetomidine are equivalent and can be used in minor oral surgery with minimal complications. These drugs can be used intranasally using nasal atomization device in routine outpatient basis in otherwise normal healthy but anxious patients. All procedures must however be performed in the presence of an anaesthesiologist and with ready availability of emergency drugs and equipment.

Comparative Evaluation of C-Reactive Protein and WBC Count in Fascial Space Infections of Odontogenic Origin.

PURPOSE: To assess efficacy of C-reactive protein levels as monitoring tools for patients with fascial space infections of odontogenic origin. MATERIAL AND METHOD: A randomized prospective study was conducted on 20 patients suffering from fascial space infection of odontogenic origin, in the department of Oral and Maxillofacial Surgery Bharati Vidyapeeth dental college and hospital, Pune, Patients between 18 and 60 years of age of both the sexes were selected. All patients were treated and observed by the same surgeon. Patient's venous blood sample was collected pre-operatively and on 2nd and 5th post-operative days for evaluation of WBC count and C-reactive protein (CRP). All patients were encouraged for strict follow-up protocol. RESULT: Where the results of WBC count and CRP when compared it was seen that the mean values of WBC were normal in 15 cases and abnormal in 5 cases on day 0, day 2 and day 5; whereas the mean values of CRP were abnormal on day 0 and day 2 and were within normal limit on day 5 in all cases. CONCLUSION: The findings of this prospective analysis indicate that White blood cells and C-reactive protein are effective markers for determining severity of infection, efficacy of treatment regime for patients with fascial space infections of odontogenic origin. Thus the markers also help in making treatment of patients with fascial space infections of odontogenic origin more cost effective and they also help protecting patients from side effects of excess drugs usage. Thus we conclude that CRP should be incorporated as monitoring tools for managing patients with fascial space infections of odontogenic origin.

Cone Beam Computed Tomography Heralding New Vistas in Appropriate Diagnosis and Efficient Management of Incidentally Found Impacted Mesiodens.

As dentistry continues to go "digital," the field has seen a phenomenal increase in the use of digital imaging in dental practice. Complex impacted mesiodens present potential treatment complications and sometimes possible patient morbidity. Objectives of diagnostic imaging are to aid in diagnosis, decision making, and enhance treatment outcomes. As cases become more complex, sophisticated multiplane imaging methods allowing for a three-dimensional view are more likely to meet these objectives as opposed to traditional two-dimensional radiography. The clinical report elucidates with the help of an illustrative patient how cone beam computed tomography imaging can assist the surgeon during surgical treatment planning, risk assessment, and treatment outcomes of impacted mesiodens.

Peripheral neurectomy: minimally invasive surgical modality for trigeminal neuralgia in Indian population: a retrospective analysis of 20 cases.

OBJECTIVE: To evaluate the efficacy of peripheral neurectomy in 20 cases of trigeminal neuralgia as minimally invasive surgical treatment modality. MATERIALS AND METHODS: Twenty (12 males and 8 females) patients with trigeminal neuralgia aged between 35 and 68 years (mean 48 years), who had undergone peripheral neurectomy, were retrospectively analyzed for relief of pain, complications, recurrence of pain, and any additional procedure required to treat recurrence, in a follow-up period of 36 months postoperatively. RESULTS: There was no significant intra-operative and post-operative complications. There was recurrence of pain in two patients (10 %) in 24 and 28 months post-operative follow-up respectively, whereas, rest of the 18 patients were symptom free during 36 months follow-up. CONCLUSION: Peripheral neurectomy is one of the minimally invasive and expeditious forms of surgical modality for the treatment of trigeminal neuralgia. This treatment option is cost effective and provides long term relief from neuralgic pain.

Evaluation of 2.0-mm Titanium Three-Dimensional Curved Angle Strut Plate in the Fixation of Mandibular Angle Fractures-A Prospective Clinical and Radiological Analysis.

The aim of the study was to evaluate the efficacy and complication rate with use of 2.0-mm titanium three-dimensional (3D) curved angle strut plate for mandibular angle fractures. Twenty cases requiring internal fixation of the mandibular angle by 2.0-mm titanium 3D curved angle strut plates were evaluated. Postoperative clinical and radiological analyses were done on 1st, 2nd, 4th, and 6th weeks, which included wound healing, transmitted movements, difficulty in function and occlusion, and neurosensory changes, if any. Reasonable level of success in terms of immediate jaw function was noted in all cases. Transient inferior alveolar nerve dysfunction was observed in three cases, which recovered gradually in 2 months, and surgical site infection was observed in two cases, which resolved with appropriate course of antibiotics and wound care. Fixation of mandibular angle fractures with a 2.0-mm titanium 3D curved angle strut plate is predictable, expeditious, and has less complication rate.

Is post-operative antibiotic therapy justified for surgical removal of mandibular third molar? A comparative study.

Surgical removal of impacted mandibular third molar (SRIMTM) is the most common procedure performed in oral and maxillofacial surgery. In the literature, many complications associated with lower third molar removal are described such as pain, swelling, trismus, infection, inflammation, and nerve damage. Antibiotics are routinely used either pre-operatively or post-operatively to reduce the chances of surgical site infection (SSI). However routine use of antibiotics for SRIMTM is still controversial. For antibiotics to be effective in reducing post-operative infective complications, the time of administration is very important. Adequate serum concentration of antibiotic must be achieved prior to the procedure. In a developing country like India, antibiotics are routinely prescribed post-operatively. The current study is designed to evaluate the efficacy of post-operative prophylactic antibiotic in SRIMTM.

Transosseous fixation of pediatric displaced mandibular fractures with polyglactin resorbable suture--a simplified technique.

Management of pediatric mandibular fractures presents a unique challenge to surgeons in terms of its numerous variations compared to adults. Both conservative and open methods have been advocated with their obvious limitations and complications. However, conservative modalities may not be possible in grossly displaced fractures, which necessitate the open method of fixation. We present a novel and simplified technique of transosseous fixation of displaced pediatric mandibular fractures with polyglactin resorbable suture, which provides adequate stability without any interference with tooth buds and which is easy to master.

Numbness over the distribution of trigeminal nerve--trigeminal trophic syndrome or viral neuritis: a diagnostic dilemma!

Numbness and ulceration of the face, particularly erosion of ala of the nose, sometimes occur after sensory denervation in the territory of the divisions of the trigeminal nerve. The incidence is uncertain and usually follows surgical treatments for trigeminal neuralgia. Such condition is known as trigeminal trophic syndrome (TTS), although some authors believe it to be a special form of dermatitis artefacta. Trigeminal trophic syndrome most commonly affects adults, after iatrogenic, vascular, viral, or neoplastic damage to the trigeminal nerve. We present a rare case of TTS in a 32-year-old woman who was referred to us with progressive numbness in the right upper and lower lip region.

Efficacy of single dose azithromycin as prophylactic antibiotic in surgical removal of mandibular third molars: a clinical study.

OBJECTIVE: To evaluate the efficacy of single dose Azithromycin as prophylactic antibiotic in surgical removal of mandibular third molar. MATERIALS AND METHODS: The study was carried out as an open clinical trial on fifty (23 males & 27 females) patients chosen from the ones referred to our Oral & Maxillofacial Surgery Department for surgical removal of mandibular third molar (SRMTM). Pre-surgical evaluation of pain, swelling, lymphadenopathy, fever and purulent discharge from the surgical site were made. All patients were administered oral Azithromycin 500mg, 1 hour prior to the procedure. The patients were followed up clinically for a minimum period of 10 days post operatively. Evaluation for pyrexia, purulent discharge from surgical site, persistent pain &/or swelling & lymphadenopathy was done on 1st, 3rd, 7th and 10th postoperative day to determine SSI (surgical site infection). All patients received same set of post-operative medications (Tab. Diclofenac sodium (50mg) TID, Tab. Ranitidine 150 mg BID for 5 days) and set of instructions. RESULTS: Surgical site infection was seen in only one patient (2%) out of the total fifty patients included in the study when oral Azithromycin was administered one hour prior to surgical removal of mandibular third molar. CONCLUSION: Our study suggests that, giving antibiotics pre-operatively 1 hour before the SRMTM is beneficial to reduce/avoid SSI. The surgeon must consider all potential factors that may contribute to the post-operative complication and decide whether the benefits of antibiotic therapy outweigh its risks.

Comparative evaluation of the resin bonded arch bar versus conventional erich arch bar for intermaxillary fixation.

PURPOSE: Application of Erich arch bar with the help of circumdental wires for intermaxillary fixation is most widely accepted method for mandibular fractures. However, circumdental wires causes injury to periodontium. There is always fear of inadvertent injury by wire ends and chances of serotransmission of blood born viruses to the operator thus, we want to use the safest method of intermaxillary fixation avoiding use of circumdental wires. METHODS AND RESULT: We modified arch bar and bonded it to the dental arches by light cure composite resin and intermaxillary fixation was done without circumdental wires. Comparative study against conventional Erich arch bar fixation and evaluation concerning the oral hygiene, stability and safety of operator was made among 20 patients in two groups. CONCLUSION: As per our observation and result, resin bonded arch bar is easy to apply, causes less periodontal injury, and its application minimizes threat of percutaneous injury to operator.