Single-Puncture Versus Double-Puncture Technique Arthrocentesis in the Treatment of Internal Derangement of TM Joint-A Comparative Clinical Study.

Introduction: Tempormandibular Joint (TMJ) Disorders require early diagnosis with a prompt and effective treatment. Arthrocentesis has been found to be a valuable treatment aid for patients with early stage internal derangement of temporomandibular joints. The use of this procedure has been well documented in literature and had been performed for decades. Arthrocentesis under local anaesthesia can be performed in two different techniques i.e Single puncture and Double puncture techniques. Aims and Objectives: Our study was done to show the effectiveness of each of these techniques in aiding the patient as well as time taken to perform this procedure. Our study compares the two techniques to allow us to draw a proper conclusion on which can be put to use for better and less traumatic treatment of these patients. Materials and Method: For this study 50 patients with Internal Derangement, group A was 25 patients that were treated with Arthrocentesis of 200 ml RL using OnePrick TMJ Arthrocentesis System with Single Puncture technique and group B consisted of 25 patients who were treated with Arthrocentesis of 200 ml RL using Double Puncture technique. Result: We found a significant increase in maximal mouth opening in patients undergoing arthrocentesis regardless of the technique. Comparison of mean duration of surgery performed among different groups were assessed using sample T test. Mean duration of technique A is around 17.18 minutes whereas for technique B is 20.90 minutes. The mean difference for two techniques performed is -3.722 with P value of 0.001. In technique A 24% of subjects needed additional lavage whereas in techniques B it is 20 %. On an average, total of 22 % of subjects needed additional lavage for better results. The resultant p value is around 0.733. Discussion: The traditional double puncture technique involves the insertion of two needles into the upper joint space. Difficulties in accurate triangulation, positioning of the needle, and frequent intraoperative needle dislocations lead to longer operating times and are often encountered with the double puncture technique. On comparing the two arthrocentesis techniques in terms of easiness to operator a study done showed the group treated with single needle techniques found it easier than the double needle technique. The difference between groups was significant. The mean difference for two techniques performed was seen to be above three minutes in our study which was statistically significant. Conclusion: Single needle technique is advantageous in the fact that it takes a shorter duration to perform, is less invasive and easier for the operator to complete successfully.

Efficacy of Arthrocentesis and Anterior Repositioning Splints in Treatment of Internal Derangement of TMJ: A Prospective Clinical Study.

The aim of this study is to assess the efficacy of double puncture arthrocentesis and anterior repositioning splints in the treatment of internal derangement of temporomandibular joint. 35 patients with mean age of 36.6 years ± 10.2 years diagnosed with unilateral TMD who fell into Wilkes stage 2 and disc displacement with reduction with intermittent locking described by RDC/TMD were treated with Nitzan's double puncture arthrocentesis and were given a anterior repositioning hard splint. The parameters following parameters were assessed at intervals of 1 week, 2 weeks, 1 month, 3 months and 6 months: pain, maximum inter-incisal mouth opening, Joint noise/click. Statistically significant (p < 0.001) improvements were seen at all recorded intervals in all observed parameters. Simultaneous arthrocentesis and anterior repositioning splint therapy is effective in alleviating pain and improving mouth opening without discomfort in patients with unilateral painful TMD showing disc displacement with reduction with intermittent locking.

Chronic Protracted Dislocation of Temporomandibular Joint in a Trauma Patient - A Case Report.

Rationale: Chronic protracted temporomandibular joint (TMJ) dislocation refers to a condition that persists for more than one month without reduction. Patient Concerns: A 47-year-old male patient first presented to the Department of Maxillofacial Surgery complaining of the inability to close his mouth for nine months. Diagnosis: Chronic protracted dislocation of the temporomandibular joint. Treatment: An initial conservative approach was attempted to reduce the condyle, which was unsuccessful. As literature suggests, open-joint surgery with eminectomy and condylectomy of bilateral joints was performed. Outcomes and Take-away Lessons: A stagewise treatment is essential for such cases of long-standing TMJ dislocations. A conservative approach is first attempted followed by surgery if the conservative approach is unsuccessful. Postsurgery physiotherapy is essential for a better prognosis.

Temporomandibular Joint Replacement Using Stock Alloplastic Graft in the Treatment of Ankylosis: A Case Report.

INTRODUCTION: This paper aims to assess the suitability and effectiveness of temporomandibular joint replacement (TMJR) devices to treat a case of re-ankylosis and association of tuberculosis (TB) with reduced mouth opening. Traditional protocols for the treatment of temporomandibular joint (TMJ) ankylosis have preferred autologous grafts for reconstruction. Usage of TMJR devices have been reserved for very specific conditions. CASE DESCRIPTION: We present a case of a patient previously treated for ankylosis using a sternoclavicular graft, who came with a chief complaint of progressive decrease in mouth opening. She also gave a history of pulmonary TB a year back. Investigations revealed no active TB. Images and clinical presentation were consistent with bilateral ankylosis. The treatment plan consisted of resection of ankylotic mass on the left side and removal of the failed graft and reconstruction with Biomet stock TMJR prosthesis on the left side. DISCUSSION: Stock device has proven to be reliable option in planned TMJR procedures. Osteoarticular TB should be ruled out in patients with a history and features of TB. CONCLUSION: Stock TMJR devices are an effective and viable option for the treatment of re-ankylosis. This ensures almost immediate possibility of physiotherapy and long-term results including maintenance of mouth opening and function. Osteoarticular TB can cause trismus and painful joints which may be misdiagnosed. Any patient with reduced mouth opening with a history of TB should be investigated for possible extrapulmonary TB.

Comparison between an Operating Surgical Microscope and High Magnification Surgical Loupes in Microvascular Reconstruction of Head and Neck Defects in a Tertiary Healthcare Centre.

Introduction and Objective: Microvascular free tissue transfers have become an important method of reconstruction following head & neck oncological resection. The objective of this study was to evaluate the efficacy of surgical loupes against surgical operating microscope, which is the gold standard for microvascular anastomosis and also to explore the possibility of surgical loupes as an essential cost-effective armamentarium in head and neck reconstruction. Materials and Methods: This prospective randomized study included 40 patients diagnosed with head and neck malignancies, requiring microvascular free flap reconstruction. A total of 20 patients who underwent free flap reconstruction following oncologic/maxillofacial defects using high magnification surgical loupes & the other 20 patients were subjected to reconstruction under an operating surgical microscope. The efficacy was assessed based on the following parameters. 1. Total operating time taken for completing anastomosis. 2. Overall fatigue. 3. Free flap failure rate. Results: The microscope group took an overall mean time of 34.26 min considering its limited degree of freedom in adjusting intraoperatively whereas the loupes group had a shorter mean anastomosis time 33.29 min considering its ease of operator adjustability. Overall, fatigue was compared using Mann-Whitney Test and found to be statistically significant with P value of 0.17, the loupe group was found to be better with mean score of 6.90 in 21 patients than microscope with mean score of 6.21in 19 patients. Flap survival rate in the loupe group had two cases of venous obstruction at 24 h follow-up and microscope group had 1 case of venous.obstruction. Conclusion: The success with loupe only free tissue transfer can be attributable considering expertise with the microscope and the loupes can be a cost-effective alternative to microscope.

Role of the Maxillofacial Surgeon in Identifying the Correlation Between Facial Bone Fractures and Traumatic Brain Injury - A Prospective Study.

Introduction: Maxillofacial trauma accounts for a high percentage of patients reporting to the emergency medicine department and being admitted in the hospital. The purpose of this study was to form a direct association between maxillofacial fractures and traumatic brain injury (TBI). Methods: Ninety patients with maxillofacial fractures that reported to/were referred to the Department of Oral and Maxillofacial Surgery were observed for features indicative of TBI based on clinical presentation and radiological interpretations. Parameters such as loss of consciousness, vomiting, dizziness, headache, seizures and the requirement for intubation, cerebrospinal fluid rhinorrhoea and otorrhoea were also assessed. Appropriate radiographs for the diagnosis of the fracture were taken followed by a computed tomography (CT) scan when indicated in accordance to the Canadian CT Head Rule. These scans were then assessed for contusion, extradural haemorrhage, subdural haemorrhage, subarachnoid haemorrhage, pneumocephalus and cranial bone fracture. Results: A total of 90 patients were evaluated, of which 91.1% were males and 8.9% were females. Association between the occurrence of head injury and different maxillofacial bone fractures using the Chi-square test showed a statistical significance of <0.001 in patients with naso-orbito-ethmoid as well as frontal bone fractures. There was a clear association between fractures present in the upper as well as the middle third of the face and traumatic head injury (P ≤ 0.001). Discussion: Patients with the frontal bone and zygomatic bone fractures have a high prevalence of TBI. Patients with the upper and middle third of the face injury are more prone to traumatic head injury and importance should be given to patients with the same and prevent poor prognosis.

Assessment of Postoperative Bleeding after Dental Extractions in Patients Who Are On Antiplatelet Therapy: A Prospective Study.

INTRODUCTION: Patients with ischemic heart disease are placed on antiplatelet therapy (APT). This study allows a definite protocol to be set which will allow us the make the right judgment when it comes to extractions in patients on APT. MATERIALS AND METHODS: For this study, 100 patients were taken up for dental extraction after obtaining a thorough case history. Bleeding time was assessed preoperatively for all the patients and patients with normal bleeding time were taken up for surgery under local anesthesia. Local haemostatic measures were employed after the extraction. Patients were monitored for first 30 minutes at the clinic and a telephonic review of all the patients was done at 24 h-48 h interval after the procedure. If there was an active ooze from the surgical site at any point, haemostatic measures with local haemostatic agents were carried out. RESULTS: In patients with mono antiplatelet therapy, bleeding was noted in 16 patients after the 1 h time interval and was absent after 24h-48 h time intervals. The q = 32 and the P < 0.001, making it statistically significant. Regarding patients on dual APT, bleeding was noted in ten patients after 1 h, and in one patient after 24 h with no patients presenting with bleeding at the 48 h time interval. The q = 16.545 and P < 0.001, making it statistically significant. DISCUSSION: The benefits of continuing APT for patients who require dental extraction outweighs the risks of postoperative bleeding. CONCLUSION: Antiplatelets are used for the prevention of myocardial infarction, ischemic stroke, and vascular death among patients who are at high risk of these events. Antiplatelets have minimal impact on the amount and duration of bleeding following routine dental extractions.

Bilateral Atypical Facial Pain Caused by Eagle's Syndrome.

Recurrent throat pain, "foreign body" sensation, difficulty in swallowing, or vague facial pain is many times caused by the presence of an elongated styloid process. Many times, this condition is misdiagnosed and the patient is treated for facial neuralgia. But once Eagle's syndrome is confirmed by clinical and radiological examination, the treatment is always surgical resection. The approach maybe intraoral or extraoral. In this paper, we present a case of Eagle's syndrome caused by bilateral elongation of the styloid process and where surgical resection of the same gave instant permanent relief for the patient.