"Can Perioperative Intravenous Lidocaine Decrease Postoperative Pain After Oral and Maxillofacial Surgeries?": A Randomized Clinical Trial.

Purpose: To determine the efficacy of perioperative intravenous lidocaine in decreasing postoperative pain after oral and maxillofacial surgeries. Methods: Forty patients undergoing various oral and maxillofacial surgeries under general anesthesia were recruited in this prospective, randomized, double blinded controlled trial. Lidocaine group received Lidocaine 2.0%, whereas the control group received Normal saline 0.9% infusion. Pain intensity, sedation, vitals and side effects were assessed at 2 h, 4 h, 6 h, 12 h and 24 h postoperatively. Results: Twenty patients were assigned to each group. There were no significant differences between the groups for the study variables at baseline. The median Numeric Rating Scale (NRS) pain scores were higher in normal saline group than lidocaine group at 2 h, 4 h and 6 h and same at 12and 24 h; however, the differences were not statistically significant. Mean (± SD) analgesic consumed in lidocaine group was 47.37 (± 42.80) mg and 69.47(± 36.13) mg in saline group, which was not significant either. Similarly, no statically significant difference was observed for sedation and vitals at all the time intervals. Conclusion: Perioperative infusion of low dose lidocaine does not have significant effect on reduction in postoperative pain intensity and analgesic consumption, in patients undergoing oral and maxillofacial surgeries. Trail registered at clinicaltrials.gov (NCT03479320).

Effectiveness of pre-injection use of cryoanesthesia as compared to topical anesthetic gel in reducing pain perception during palatal injections: a randomized controlled trial.

Background: Palatal injections are often painful. We aimed to compare topical ice and 20% benzocaine gel for pre-injection anesthesia before greater palatine nerve block (GPNB) injections. Methods: A randomized split-mouth clinical trial was conducted among patients aged 15-60-years needing bilateral GPNB injections. A total of 120 palatal sites from 60 patients were randomly allocated to Group A (topical ice) or Group B (20% benzocaine gel). Pain was evaluated using sound, eye, motor (SEM), and the visual analog scale (VAS) in both groups. Inferential analysis was performed using the Mann-Whitney U test. Results: The mean age of the participants was 20.5 ± 3.9 years. The median VAS score for group A was 11 (Q1 - Q3: 5.25 - 21.75), which was slightly higher than the 10 (Q1 - Q3: 4.0 - 26.75) reported in group B. However, the difference was not statistically significant (P = 0.955). The median SEM score for group A and group B was 3.5 (Q1 - Q3: 3.0 - 4.0) and 4.0 (Q1 - Q3: 3.0 - 4.0), respectively, which was statistically insignificant (P = 0.869). Conclusion: Using ice as a form of topical anesthetic for achieving pre-injection anesthesia before GPNB was as effective as 20% benzocaine gel.

Maxillofacial Injuries in an Eastern Nepal Tertiary Hospital.

BACKGROUND: Maxillofacial injury is a major health problem, and injury patterns vary in different societies. The purpose of the present study was to evaluate the pattern of maxillofacial injuries presenting to BPKIHS. METHODS: Patients with age >15 years presenting with maxillofacial injuries from May, 2019 to April, 2020 were included in this cross-sectional descriptive study. Demographic profile, etiology, delay in presentation, pattern of soft tissue/ bony/ dental injuries, treatment modality were recorded and analyzed using Microsoft excel. RESULTS: Within one year study period 190 patients with age group >15 years presented with facial injuries. There were 164 male (86.32%) and 26 female (13.68 %) patients (M:F=6.3: 1) with mean age of 34.96 years. Road Traffic Accident (RTA) (61.58%) was the most common etiology. Majority of the patients reported to hospital within 2-6 hrs of injury. Other associated injuries was present in 36.32 % of patients with orthopedic injury (60.87%) being common. Soft tissue injuries were seen in 80.53% patients, of which 49.02% were associated with facial fractures. Mandible fractures were seen in 56.19% of hard tissue injuries, of which 40.68% had multiple fractures followed by 28.81% with parasymphysis fracture. Within 37.14% patients with midface fractures, zygoma fracture (33.33%) was the commonest. Intervention was done in 80.95 % patients, with ORIF (72.38 %) being the commonest. Dentoalveolar injuries was seen in 22.63 % patients, of which 48.19% were associated with facial fractures. CONCLUSIONS: Our observations show that motor vehicle accidents were the most frequent cause of maxillofacial injury.

Intra-operative application of ultrasonography (USG) for reduction of zygomatic arch fracture.

Zygomatic arch fractures are the most common facial fractures or second in frequency after the nasal fractures. The high incidence of zygomatic fractures probably relates to its prominent position in the facial skeleton; hence, it is frequently exposed to fractures. This case report presents an left-sided isolated zygomatic arch fracture after subjected to routine investigations and radiographs like submentovertex and CT scans. The patient was operated under general anesthesia for the reduction of zygomatic arch by Gille's temporal approach with the use of Ultrasound intra-operatively. Recommendation for the use of ultrasonography in the identification of zygomatic arch fractures intra-operatively operatively.

Tension orbit secondary to a carious primary molar-A case report.

Though rare, a pediatric dentist should have background knowledge of this kind of presentation which can greatly affect their patient's quality of life and leave them with a significant deficit at a very young age.

A Comparative Study of the Effect of Sutureless Versus Multiple Sutures Technique on Complications following Third Molar Surgery in Nepalese Subpopulation.

OBJECTIVE: To compare the effect of sutureless versus multiple sutures technique on postoperative variables such as pain, swelling, and trismus after surgical removal of the third molar in Nepalese subpopulation. Materials and Methods. Forty-eight patients were equally grouped into multiple sutures (group 1) and sutureless (group 2) groups using a computer-generated random table. The same operator performed all the surgical procedures. Postoperative variables such as pain, swelling, and trismus were measured by a single concealed observer using a 10 cm Numerical Rating Scale (NRS), flexible plastic measuring tape, and vernier caliper preoperatively and on 1st, 2nd, and 7th postoperative days. RESULTS: This study showed significantly more swelling measured from the gonion to lateral canthus in group 1 than in group 2 on all postoperative periods (P < 0.05). The mean NRS score was significantly higher in group 1 on the 1st postoperative day (P < 0.05). The mean NRS score was significantly higher in group 1 on the 1st postoperative day (. CONCLUSION: Our results support the use of sutureless technique after third molar surgery to minimize postoperative morbidity and the overall operative time and reduce the cost within the Nepalese subpopulation.

Practice of Oral and Maxillofacial Surgery in Nepal: Its Scope and Influencing Factor.

OBJECTIVES: Oral and maxillofacial surgery is a relatively newer and growing specialty of dentistry in Nepal whose scope is not yet estimated. The objective of this study was to estimate the scope and the factors influencing the scope of oral and maxillofacial surgery in Nepal. STUDY DESIGN: In this cross-sectional study, all the oral and maxillofacial surgeons who were registered in the Nepalese Association of Oral and Maxillofacial Surgeons (NAOMS) were included (purposive sampling). The structured questionnaires were distributed to them, the collected data were entered in Microsoft excel 2010, and variables were analyzed using descriptive statistics (percentage) by SPSS 16.0. RESULTS: Out of 46 questionnaires distributed, 35 were responded and returned (response rate = 76%). Majority of participants (77.1%) were in 30-39 years of age group. Male to female ratio was 4 : 1. More than half (68.6%) of the participants had practice experience of <5 years, and none had practice experience of >20 years. The ratio of the surgeons practiced in Medical/Dental Teaching Hospital to those in Government Hospital was 3 : 1. Sixteen (45.7%) participants practiced in Capital Valley and none in Far-Western Development Region. Traumatology was practiced by thirty-four (97.1%) participants although only twenty-three (65.7%) participants had primary interest in it. Each of oncology, orthognathic surgery, implantology, and cleft lip/palate surgery was performed by <8% of the participants. Common factors influencing the practice were inadequate training (71.4%) and insufficient facilities/infrastructures (45.7%). CONCLUSION: The scope of oral and maxillofacial surgery is limited in Nepal, and oncology, implantology, cleft lip/palate, and orthognathic surgery have received little attention.

Dentigerous Cystic Changes in the Follicles Associated with Radiographically Normal Impacted Mandibular Third Molars.

OBJECTIVE: To assess the incidence of dentigerous cystic changes in the follicles of radiographically normal impacted mandibular third molars. METHODS: One hundred and thirteen follicles obtained after surgical removal of impacted mandibular third molars with radiolucency of less than 2.5 mm in the radiograph were sent for histopathologic evaluation to evaluate pathologic changes. RESULTS: The incidence of dentigerous cystic changes observed was 15.9%, that is, 18 out of 113 patients (51 males and 62 females), with the maximum incidence of cystic changes seen in the follicular space size of 0.5 mm. The mean age of the patients included was 27.8 ± 8.1. The most common indication for extraction among the patients in this study was recurrent pericoronitis (95%). There were no statistically significant differences in occurrence of cystic changes based on age, gender, angulation, relation to ramus, depth, side of impaction, and follicle size (P > 0.05). CONCLUSION: Dental follicles obtained from surgically removed impacted mandibular third molars should be submitted for histopathologic examination irrespective of the radiographic size of the follicle.

Animal Inflicted Maxillofacial Injuries: Treatment Modalities and Our Experience.

INTRODUCTION: Animal inflicted injuries to the face and neck are becoming much more common as people lavish affection on pets. Injuries caused by animal attacks to the face can cause complex injuries to soft and hard tissues, presented as perforations, lacerations, crushes, avulsion or fractures. An uncountable number of bacteria and virus can be found in such injuries, with a potential pathological effect to humans, regarding infections. Although the infection rate is low due to excellent blood supply to face, the injuries have disfiguring effect with possible psychological repercussion to the patients. The treatment of animal inflicted injuries must address the soft tissue defect, neurovascular injuries, and bone injuries as well as prevention of post treatment infection. Primary wound repair is the treatment of choice for most clinically uninfected bite wound where as delayed closure should be reserved for wounds at high risk of infection or already infected wounds and tissue defect may require local flap or micro-vascular re-implantations. MATERIAL AND METHODS: In this article, we have elicited up to date considerations regarding the management of animal inflicted injuries to the face based on literature search and exemplified by multiple case reports. CONCLUSION: For bite injuries on face, immediate primary wound repair after meticulous wound debridement and irrigation with sufficient volume added by antibiotic prophylaxis gives good cosmetic results with minimum risk of infection. Depending upon type of attack and age of victims, psychiatric or social counseling may also be required.

Frazier Metallic Suction Tube: An Adjunct in Irrigation of Deep Fascial Spaces.

Once incision and drainage of fascial space abscess is performed, irrigation of deep spaces with saline and antibiotic solution should be done daily for effective elimination or reduction of infection. Various advocated aids for irrigation into deeper areas are: small pediatric nasogastric feeding tubes, French catheter, polyethylene irrigation tubes and scalp vein infusion set. All these aids have major inherent disadvantages like, they tend to kink inside the deep spaces limiting the reach of irrigating solution into deeper spaces, are not readily available in dental departments and have to be discarded after every use. Overcoming these disadvantages, a simple yet an effective method is proposed here-use of a Frazier suction tube.