Efficacy of Fentanyl Transdermal Patch in Impacted Mandibular Third Molar Surgery-A Comparative Study.

Introduction: Removal of mandibular third molars surgically is one of the most frequently performed oral surgical procedures which are often accompanied with post-operative pain, swelling and trismus. Despite general progress in pain management, moderate to severe acute post-operative pain after removal of lower third molars remains a problem. Fentanyl is an extremely effective drug in the treatment of severe chronic pain such as cancer pain and post-operative pains which acts by increasing patient's tolerance to pain. Fentanyl Transdermal System (FTS) is a rectangular transdermal patch which contains high concentration of fentanyl, a potent short-acting Schedule II opiate. In this study the efficacy of transdermal fentanyl for management of post-operative pain after impacted mandibular 3rd molar surgery is evaluated. Methods: 20 patients within the age group of 18-40 years with asymptomatic impacted mandibular third molars were equally divided into 2 groups as group A & group B which underwent surgery in Local Anaesthesia. In every patient one side belonged to group A and other side belonged to group B. 50 µg FTS was applied in group A while placebo patch was applied in group B. Results: Patients in group A performed significantly better than group B in terms of mean pain intensity scores assessed by VAS and VRS along with minimum need of post-operative rescue analgesics. Conclusion: It was found that FTS resulted in significantly better pain relief, longer pain-free intervals, and lesser post-operative analgesic consumption.

Simplified Method for Reduction of Displaced Condylar Head Fracture Using a Monocortical Screw.

Background: Condylar head fractures is difficult to treat because of medial displacement caused by muscle pull and limited access to visualize the proximal segment and secure them back to anatomic position. A novel technique is proposed to overcome the difficulties and ease the task of a surgeon. Purpose: The main goal in Open reduction and internal fixation is to achieve anatomical position and establish occlusion, a task possible only after securing the segment back into place. Over decades, many authors have described various techniques to ease the task yet surgeons are forced to treat cases using closed technique which adds limitation to the rehabilitation of stomatognathic system for a prolonged time. Methods and Materials: Self holding screw driver, 1.5x10mm monocortical screws and drill bit. Using any preauricular access incision, dissection is proceeded anteromedially and the medial segment is identified. A drill hole is made with 1.2 mm diameter drill with counter using periosteal retractor, monocortical screw fixed and segment secured using a self-holding driver and lateralized after increasing the joint space thus achieving the original retromandibular height. Results: The treatment outcomes are better achieved with ease to surgeon and with minimal armamentarium without any special needs per se. Conclusion: The technique proposed is novel and can help achieve desired outcomes even in hands of budding surgeon with minimal time and efforts invested.

Orbital and Intracranial Emphysema Causing Orbital Compartment Syndrome: A Rare Case Report and Literature Review.

A case of 50-year-old male who presented with orbital compartment syndrome as a sequela of mid facial trauma, and literature review. Orbital compartment syndrome (OCS) is one of the potentially sight threatening emergencies encountered in clinical practice. Acute rise in pressure within the confined orbital cavity compromises the blood flow to retina and optic nerve leading to irreparable vision loss. Air entrapped in the orbital cavity leading to orbital compartment syndrome has been rarely reported. A brief literature search for the term orbital emphysema in PubMed yielded 352 articles out of which 280 articles were identified after screening for appropriate titles and case reports. A total of 138 patients were reported in the literature with severe orbital emphysema. Acute orbital compartment syndrome needs to be recognized and addressed on an emergency basis to achieve decompression so as to prevent an irreversible vison loss. Watchful eyes, an accurate diagnosis and timely surgical intervention could potentially reverse permanent damage to the optic nerve.

Glossopharyngeal Neuralgia, An Usually Overlooked Diagnosis: A Prospective Single Center Observation Study.

Glossopharyngeal Neuralgia is often difficult to diagnose in view of its symptoms that overlap with many other regional causes. This subset of patients commonly visits otolaryngologists, dentists, oncologists only to be referred to the other and finally to the psychiatrist when the diagnosis is overlooked. We hereby present a prospective observation study of 26 cases of Glossopharyngeal neuralgia. In our observation we found a prevalence of 0.2% for glossopharyngeal neuralgia in our patients with facial pain, however amongst the neuropathic pain the GPN was more prevalent with about 35% of all the cases. Amongst the cases diagnosed with GPN we had 73.1% female predilection as compared to only 26.9% male. 53.8% of cases had left sided and 46.2% on the right sided making it non-significant in sidewise predilection.

Use of Orthopaedic Impactor to Assist the Fine Reduction of Rotated Zygomaticomaxillary Complex Fractures.

Anatomic reduction of Zygomaticomaxillary complex (ZMC) fractures is quite challenging and technically demanding. Various methods and instruments are mentioned in the literature to achieve the same. However, a precise anatomic reduction is still a difficult task. We propose the use of a simple orthopaedic impactor in reducing laterally rotated ZMC fractures.

Duplication of the internal jugular vein: a rare presentation during neck dissection.

The anatomical variations of the internal jugular vein (IJV) is a well-documented phenomenon which may depend on the course of drainage, fenestration in the vein, bifid formation, variations in the tributaries and so on. However, a true duplication of the IJV is a rare entity on its own and is seldom reported in the literature. We report a case of true duplication of IJV which is an incidental discovery during the course of neck dissection.

Rhytidectomy approach for treatment of zygomatic arch fractures.

Comminuted zygomatic arch fractures are a challenge to manage without complete exposure owing to their instability. The presence of facial nerve branches near the bone often means that these fractures are often treated by closed methods or left untreated. The disadvantages of such comminuted fracture left untreated cannot be overemphasised. Hence, there is a need of a surgical approach for exposure and fixation of such fractures without limitation of facial nerve injury. We propose and report a case of malunited comminuted fracture of zygomatic arch using facelift approach.

Use of a Heister mouth gag as an aid to reduction in open treatment of condylar fracture.

INTRODUCTION: The management of condylar fractures remains controversial. Open treatment of condylar fractures is a routine treatment in cases of displaced or dislocated condylar and subcondylar fractures. TECHNICAL NOTE: Because of the pull of the lateral pterygoid muscle, the condylar fragment is usually located anterior and medial to the mandible. Distraction of the mandible in an inferior direction simplifies proper reduction. Various distraction devices have been described in literature. We describe a technique of using the Heister mouth gag at the surgical site to aid in reduction of displaced dislocated condylar fractures.

Glossopharyngeal Nerve Block: The Premolar Approach.

This is a technical note describing hard tissue landmarks to simplify the intraoral glossopharyngeal nerve block. Our literature review revealed no specific mention of the same procedure in documented data.

Bifurcation of external jugular vein: an anatomical variation during neck dissection.

BACKGROUND: The pattern of venous drainage of head and neck involves single external jugular vein bilaterally. METHODS AND RESULTS: We report a case of bifurcation of the external jugular vein observed during a neck dissection procedure. CONCLUSIONS: Anatomical variations in drainage pattern of superficial veins of the head and neck are important for head and neck surgeries including for anastomosis during free tissue transfer for head and neck reconstruction.

Hemangiopericytoma/Solitary Fibrous Tumor of the Buccal Mucosa.

Hemangiopericytomas (HPCs)/Solitary fibrous tumor are rare neoplasms of vascular origin that occur in head-and-neck region. These tumors arise from capillary pericytes and are difficult to distinguish from other tumors of vascular origin. HPC, initially described by Stout and Murray in 1942, usually occur in the fifth decade of life and account for 3%-5% of all soft-tissue sarcomas and 1% of all vascular tumors. The tumors usually occur in limbs, pelvis, or head-and-neck region; 15%-30% of all HPCs occur in head and neck. We report a case of HPC located in the right buccal area of a 60-year-old man.

Screw and Wire Technique for Condylar Fracture Reduction.

In case of displaced condylar fractures, ideal reduction during open reduction and internal fixation poses a challenge to the surgeon. This article describes a simple technique to aid reduction with the use of a screw and wire during open treatment.

Transnasal Stabilization in Naso-orbito-ethmoid Fractures: The Easy Way!

Effective management of naso orbito ethmoidal fractures involves both functional and esthetic correction. While functional correction is routinely achieved, in our experience, most secondary deformities resulted from inadequate nasal bridge projection. We hereby suggest a simple technique to stabilize the nasal bridge after mild overcorrection thereby improving the esthetic outcome in naso orbito ethmoidal fractures.

Lower Face Asymmetry: Can We Distract the Mandibular Lower Border?

Orthognathic surgery and alloplastic grafting are the main stay in management in hemifacial microsomia. Distraction osteogenesis is used to increase the ramus and corpus length in the management, but here we have described a technique to increase the height of the body of the mandible using the principles of basal osteotomy and distraction osteogenesis.

Transoral removal of peripheral osteoma at sigmoid notch of the mandible.

Osteoma is a benign osteogenic slow-growing tumor. Though mandible is involved more often than the maxilla only one other case of osteoma sigmoid notch has been mentioned in the English literature till date. Cosmesis and function are the main reasons that dictate the removal of the osteomas, so we preferred to use an intra oral approach to better prevent the scar and achieve good patient acceptance.

Use of mono cortical screws as an aid to zygomatic complex fracture reduction.

INTRODUCTION: Zygomatic complex fractures by virtue of its anatomic area poses a great challenge in reduction of the fracture. Uses of various methods have been mentioned in English literature. METHOD: A new technique describing the use of reduction screw with a self-holding screwdriver in reduction of the zygomatic complex fracture. CONCLUSION: We found the method to be simple and effective and recommend its application in daily practice.