Application of mouth gag and temporomandibular joint pain and trismus in tonsillectomy.

OBJECTIVE: To determine the effect of duration of application of mouth gag on Temporomandibular (TM) joint pain and trismus after tonsillectomy. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of ENT and Head and Neck Surgery, Combined Military Hospital, Nowshera, from February to July 2012. METHODOLOGY: A total of 40 patients undergoing tonsillectomy, in mouth opening prior to surgery was measured as inter incisor distance in cms. A stop watch was used to calculate the time of application of mouth gag. Mouth opening was again measured 06 hours after the surgery. Difference between the two readings was considered as trismus score and categorized as mild (1 cm), moderate (2 cm) and severe (3 cm). Patient was asked to score pain on a visual analogue scale (0 - 9). Score 0 was categorized as no pain; 1 - 3 as mild pain; 4 - 6 as moderate pain; 7 - 9 as severe pain. Spearman's rank correlation was used for finding correlation between time of mouth gag application and study outcome (pain and trismus). RESULTS: Trismus as observed by difference in inter incisor distance was mild in 11 patients; moderate in 15 patients and severe in 14 patients 06 hours after the surgery. Eleven (27.5%) had mild pain over temporomandibular joint, 15 (37.5%) had moderate and 14 (35%) had severe pain 06 hours after the surgery. Direct relationship was observed between duration of application of mouth gag with postoperative pain and trismus. Significant strong correlation was observed between length of mouth opening to severity of pain and trismus (rs = 0.738; p < 0.001). CONCLUSION: Duration of mouth gag application should be reduced to cause less TM joint pain and trismus in early postoperative period in tonsillectomy.

Duration of nasal packs in the management of epistaxis.

OBJECTIVE: To compare the efficacy of nasal packs for 12 and 24 hours in the management of epistaxis. STUDY DESIGN: Quasi experimental study. PLACE AND DURATION OF STUDY: Combined Military Hospital, Nowshera and Heavy Industries Taxilla Hospital, from October 2012 to April 2013. METHODOLOGY: A total of 60 patients presenting with epistaxis were selected and were divided into two groups of 30 patients each. Patients in both the groups were managed by nasal packs. In group-A packs were removed after 12 hours while in group-B after 24 hours. Symptoms of headache, lacrimation and recurrence of bleeding were recorded. SPSS 20 was used for data analysis and p-value less than 0.01 was considered significant. RESULTS: There was significant difference for headache between removal of nasal packs after 12 hours and 24 hours (p < 0.001). There was significant difference for excessive lacrimation at 12 and 24 hours (p = 0.001). No significant difference was observed for recurrence of bleed when nasal packs were removed at 12 and 24 hours (p = 0.317). CONCLUSION: Duration in removal of nasal packs after 12 or 24 hours made a difference in the management of epistaxis. Symptoms of headache and excessive lacrimation were significantly higher when nasal packs were removed after 24 hours. It is recommended that patient could be managed with lesser duration of packs after episode of epistaxis to avoid inconvenience.