Is Paracetamol Better than Diclofenac Sodium in Management of Postoperative Pain and Edema Following Major Maxillofacial Surgeries?

Introduction: Paracetamol is an optimal non-opioid analgesic and holds considerable advantages over NSAIDs in managing post-operative pain. Literature to date doesn't provide substantial documentation of it's efficacy and safety in major oral and maxillofacial surgeries. The study is designed to compare the effectiveness of intravenous paracetamol with diclofenac sodium for controlling post-operative pain and edema in major oral and maxillofacial surgeries. Method: The double-blind randomised prospective study includes 140 healthy patients with ASA grades I and II. Patients were divided into Group A (1gm paracetamol) and B (75 mg diclofenac sodium), 70 patients each, undergoing similar surgical procedures. VAS and VRS were assessed for pain and thread method for measuring swelling. Mouth opening in space infections was measured with calliper and scale. Results: Independent samples t-test and chi-square test showed longer pain-free interval, more interval between first and second dose, lesser number of doses required in Group A than Group B (p-value < 0.05). Independent samples t-test and Mann-Whitney test showed faster resolution of swelling in Group A (p-value < 0.05). Independent samples t-test showed lesser time taken for resolution of trismus in space infections in Group A (p-value < 0.05). Discussion: Paracetamol 1 g was found to be an effective analgesic with less adverse effects. It is superior non-opioid analgesic in reducing the intensity of post-operative pain and swelling, also requires less number of doses than diclofenac sodium in major surgeries. Patients treated with paracetamol had better quality of life during post-operative period.

Non-Surgical Ciliated Cyst of the Maxilla - An Unconventional Variant.

The term surgical ciliated cyst of the maxilla is a designation for cysts of the maxillary sinus conventionally associated with surgery and trauma. Surgical ciliated cysts with a noncontributory history of surgery or trauma can pose a diagnostic challenge. We report an interesting case of ciliated cyst of the maxilla in a 54-year-old male patient. The present case provides a plausible explanation for the occurrence of ciliated cyst of the maxilla lacking history of surgery or trauma.

Simultaneous bilateral ranula in an edentulous patient. Rare presentation with a brief review of the literature.

A ranula is a large mucocele located in the floor of the mouth. Ranulas is usually a mucous extravasation phenomenon due to injury to sublingual salivary gland. unilateral presentation has been reported in many cases but bilateral presentation and that too in an edentulous patient is quite uncommon. This is a case report of bilateral ranula in an edentulous patient and its management along with a brief review of pertinent literature.

A rare case report of mucinous cystadenoma with immunohistochemical analysis and review of literature.

Cystadenomas are rare salivary gland tumours characterised by prominent epithelium-lined papillary projections into the cystic spaces. A 37 year-old female, presented with a swelling on the right side of the hard palate. Clinically, the swelling was soft, fluctuant, sessile and non-tender measuring 2.5 × 2 cm in diameter. Excisional biopsy was performed. The histopathological and immunohistochemical features were characteristic of mucinous cystadenoma. There has been no recurrence over a 2-year follow up period. The article highlights its clinical, histopathological, immunohistochemical features and differential diagnosis along with review of literature. Cystadenoma of the palate is rare, papillary variety being more common than mucinous with very few cases reported in literature.

Combating inadequate anesthesia in periapical infections, with sodium bicarbonate: a clinical double blind study.

INTRODUCTION: Local anesthetics are generally much less effective when administered in inflamed tissues. PURPOSE: This study was conducted to validate the addition of sodium bicarbonate in local anesthetics to increase its effectiveness as local infiltrations in teeth associated with periapical infections. METHODS: Two hundred subjects requiring extraction of maxillary teeth with periapical infections were enrolled. These subjects were divided in two groups of 100 subjects each. One group received local infiltration with 2 % lignocaine and 1:80,000 adrenaline, and the other group received local infiltration with sodium bicarbonate as an adjunct to the above mentioned local anesthetic solution. All extractions were performed using a consistent intra-alveolar technique by a single operator. Both the patient and the operator were blinded to the contents of local anesthetic solution. Data related to the onset of action of local anesthesia, pain experienced by the patient while undergoing extraction on two scales-"the visual analog scale and the verbal response scale", and any requirement of repeated injections during the procedure was recorded. RESULTS: Clinical and statistical data confirmed that the addition of sodium bicarbonate in local anesthetics did increase the efficacy of local anesthesia in inflamed tissues. CONCLUSION: It has been observed in this study that the action of sodium bicarbonate in local anesthetics increases the pH levels of these solutions, thus possibly making them more effective in an acidic environment.

Pattern of mandibular third molar impaction in the Indian population: a retrospective clinico-radiographic survey.

OBJECTIVE: The objective of this study was to study incidence of type of impaction of mandibular third molars in the Indian population. STUDY DESIGN: Data of 1200 patients examined during a 5-year period were reviewed, which included status of mandibular third molar for inclination, emergence in oral cavity, and prevalence of caries. Radiographically, angulation of tooth, level of occlusal surface of third molar with respect to second molar, relationship between ascending ramus of mandible and distal surface of third molar, and proximity to inferior alveolar nerve were studied. RESULTS: Of 1200 patient data reviewed, 620 (51.77%) were of men and 580 (48.3%) were women in the age group of 20 to 40 years (26.3 years). Mesioangular impaction was most prevalent followed by distoangular. A strong statistical significance was found between gender and ramus relationship. Fifty percent of cases showed proximity to the inferior alveolar nerve, which was more frequent in males (58.3%). CONCLUSION: Our study highlights mesioangular impaction as the most frequently encountered angulation in impacted teeth.

PSA block for maxillary molar's anesthesia - an obsolete technique?

BACKGROUND: Routine use of posterior superior alveolar (PSA) nerve block or maxillary infiltration for the removal of maxillary molars has been validated. OBJECTIVE: The present study was undertaken to determine the relative contribution of posterior superior alveolar (PSA) block in cases of anesthesia required for maxillary molars. STUDY DESIGN: One hundred patients requiring removal of maxillary second and third molars were enrolled. These patients were divided into 2 groups. One group received infiltration for anesthesia and other group received PSA nerve block using lignocaine with vasoconstrictor. All extractions were performed using a consistent technique of intraalveolar extraction. Data relating to the pain during extraction obtained on a visual analog scale and a verbal response scale, requirement of repeated injection for anesthesia, efficacy of these injections in localized infections, and requirement of rescue analgesics 3 hours after extraction. RESULTS: Statistical data confirmed clinical equivalence between infiltration and PSA nerve block. CONCLUSIONS: Considering the difficulty in mastering the technique of PSA nerve block, and the possibility of more complications associated with it (compared with infiltration); it may not be necessary for anesthesia of maxillary molars.

Bilateral dentigerous cyst in a non-syndromic patient: Report of an unusual case with review of the literature.

Dentigerous cysts are the most common developmental cysts of the jaws, most frequently associated with impacted mandibular third molar teeth and impacted canines. Bilateral dentigerous cysts are rare and occur typically in association with a developmental syndrome. The occurrence of bilateral dentigerous cysts is rare and, to date, only 21 cases have been reported in literature till 2009. Here, we report a case of bilateral dentigerous cysts in maxillae of non-syndromic 10-year-old patient with brief review of literature.

Efficacy of double gloving technique in major and minor oral surgical procedures: A prospective study.

BACKGROUND: A prospective analysis was carried out over a 1-year period to assess gloves used during 100 major and 100 minor oral surgical procedures to test for efficacy of double gloving in oral surgical procedures. PURPOSE: The purpose of this study was to assess the efficacy of double gloving technique in preventing cross infection in both major and minor oral surgical procedures. MATERIALS AND METHODS: Gloves used during 100 major and 100 minor oral surgical procedures were analyzed to check for glove perforations and skin punctures. 100 sterile gloves were tested as control. STATISTICAL ANALYSIS USED: Chi-square test was used to determine whether there was any difference between the expected and observed values in various categories. RESULTS: A higher number of glove perforations was seen in minor oral surgical procedures compared with major surgeries, dominant hand compared with the nondominant, outer gloves compared with the inner, in procedures which took a longer duration of time to complete, in procedures involving wiring and in the index finger followed by the thumb and the palm. CONCLUSION: Double gloving technique using sterile gloves can be used as an effective means of infection control for all major and minor surgical procedures, especially high-risk procedures involving patients who maybe suffering from or carriers of blood-borne infections.

Complications of exodontia: a retrospective study.

PURPOSE: The purpose of this study was to analyze the incidence of various complications following routine exodontia performed using fixed protocols. MATERIALS AND METHODS: A total of 22,330 extractions carried out in 14,975 patients, aged between 14 and 82 years, who reported to the Department of Oral and Maxillofacial Surgery at Padmashree Dr. D. Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, were evaluated for various complications. RESULTS: The most common complications encountered were tooth fracture, trismus, fracture of cortical plates and dry socket. Wound dehiscence, postoperative pain and hemorrhage were encountered less frequently. Luxation of adjacent teeth, fracture of maxillary tuberosity, and displacement of tooth into adjacent tissue spaces were rare complications. CONCLUSION: The practice of exodontia inevitably results in complications from time to time. It is imperative for the clinician to recognize impending complications and manage them accordingly.