The efficacy of Punica granatum extract gel in the treatment of symptomatic oral lichen planus in an Indian population: A clinical study.

INTRODUCTION: The autoimmune disorder, oral lichen planus (OLP), primarily affects oral mucous membranes. Current drug treatments are only palliative and have serious side effects. Pomegranate has been used as a potential herbal remedy for the treatment of OLP. MATERIALS AND METHODS: The study consisted of a sample size of 30 individuals who were diagnosed with symptomatic OLP based on both clinical and histological evidence and were equally assigned to Group A (4% topical Punica granatum seed extract gel, which has been customized for this particular study purpose only) and Group B (0.1% topical steroid). All patients were evaluated for the outcome criteria of pain, burning sensation, and lesion size. RESULTS: In the present study, results were highly statistically significant (P = 0.001) in intragroup observation for both Group A and Group B from baseline to the end of 30 days of follow-up for all three parameters. There was no statistically significant difference between groups for each week of follow-up. CONCLUSION: P. granatum has been used in very few studies, but this is one of the few where a gel made from P. granatum seed extract is used as an oral gel. In conclusion, it can be said that topical P. granatum extract gel is as good as topical corticosteroids at getting rid of the signs and symptoms of OLP, so it can be used as an alternative treatment.

Anatomical Variants of Condylar Process, Coronoid Process, and Sigmoid Notch in a Maharashtrian Population: A Radiographic Study.

Background The cornerstone of an individual's singularity is identification. Digital orthopantomography (OPG) helps to illustrate the varying condylar process, coronoid processes, and sigmoid notch found within a population to facilitate individual recognition. This study aims to assess the various shapes of the condylar process, coronoid process, and sigmoid notch found using OPG in a sample population of an Indian city. Methodology This retrospective, cross-sectional study was conducted using 1,000 good-quality digital OPG scans to evaluate the different shapes. The scans were evaluated by two experienced oral radiologists and tabulated for statistical analysis. Results The current investigation revealed varied morphological forms of the three entities, with the round shape being the most frequently observed condylar process, coronoid process, and sigmoid notch. Comparisons across sides and between sexes revealed differences in all three variables which were found to be statistically significant. We discovered a crooked finger condyle (58.56% on the left side and 41.44% on the right side), a beak-shaped coronoid process (50.0% on the left side and 50.0% on the right side), and a V-shaped sigmoid notch (41.35% on the left side and 58.65% on the right side) in this study. This is a unique finding not reported by other studies. Conclusions Analyzing the shape of the condylar process, coronoid process, and sigmoid notch found on an OPG scan can help with gender identification in forensic odontology and anthropology as these anatomical features show strong sexual dimorphism.

Efficacy of Sodium Bicarbonate-Buffered Local Anesthetic Solution in Cases Requiring Bilateral Maxillary Premolar Orthodontic Extraction: A Comparative Split-Mouth Study.

Aims and objectives This study was carried out to evaluate the efficacy of 8.4% sodium bicarbonate-buffered local anesthetic solution and conventional local anesthetic in patients requiring bilateral maxillary orthodontic extractions in terms of pain on injection, onset of action, and duration of action. Methods 102 patients requiring bilateral maxillary orthodontic extractions were included in the study. Buffered local anesthetic was administered on one side while conventional local anesthesia (LA) was administered on the other side. Pain on injection was measured using a visual analogue scale, while onset of action was measured by probing the buccal mucosa after 30 seconds of administration and duration of action was measured by the time after which the patient experienced pain or took a rescue analgesic. The data was statistically analyzed to determine the significance. Results The pain during injection was found to be lesser at sites where buffered local anesthetic was administered (mean visual analogue scale (VAS) score = 2.4) as compared to conventional local anesthetic (mean VAS score = 3.9). The onset of action was faster with buffered local anesthetic (mean value = 62.3 seconds) as compared to conventional local anesthetic (mean value = 157.16 seconds). Lastly, the duration of action was found to be longer for buffered local anesthetic group (mean value = 225.65 minutes) as compared to conventional local anesthetic (mean value = 187 minutes). Conclusion 8.4% sodium bicarbonate-buffered local anesthetic was found to be more efficient than conventional local anesthetic in terms of reduction in pain on injection as well as faster onset and longer duration of action.

Comparative Evaluation of Intranasal Butorphanol and Oral Diclofenac Sodium for Analgesia After Surgical Removal of Impacted Mandibular Third Molars: Split-Mouth Prospective Controlled Clinical Study.

AIM: The study intended to compare the analgesic effect and patient satisfaction of intranasal butorphanol with oral diclofenac sodium after surgical removal of impacted mandibular third molars. MATERIALS AND METHODS: This split-mouth prospective controlled clinical study included 50 patients with bilateral symmetrically impacted mandibular third molars with the same difficulty on the Pederson Index. All patients had two appointments of surgery. In the first, the molar on one side was surgically removed and depending upon the chit selected by the patient, either intranasal butorphanol or oral diclofenac sodium was prescribed postoperatively for pain relief. Two weeks later, the impacted mandibular third molar on the other side was surgically removed and if butorphanol was selected for the first side, then oral diclofenac sodium was prescribed for the other side and vice versa. Pain relief was recorded on the Facial Visual Analogue Scale at 1, 2, 3, 4 and 5 h postoperatively and on postoperative day 1 and 2 at the same time for both the drugs. RESULTS: Intensity of pain was less with intranasal butorphanol as compared to oral diclofenac sodium at all the time intervals and especially in the 1st postoperative hour. Overall acceptance (88%) to butorphanol nasal formulation was statistically similar to diclofenac sodium tablets. CONCLUSION: Intranasal butorphanol at the very acceptable 1 mg dose after the surgical removal of impacted mandibular third molars provides a profound degree of analgesia. It is a well-tolerated drug with a high acceptance rate if administered correctly.

Ameloblastic Fibroma Mimicking Dentigerous Cyst: A Diagnostic Dilemma.

Ameloblastic fibroma is a rare, slow-growing odontogenic mixed tumor with neoplastic epithelial and ectomesenchymal tissue, which does not show inductive changes to form enamel and dentin. It is frequently found in the first two decades of life. It is often confused with ameloblastoma and dentigerous cyst due to the presence of an impacted tooth and can be distinguished histologically. Ameloblastic fibroma can be differentiated from ameloblastoma by the presence of myxoid appearance of connective tissue. A case of an 11-year-old female with a slow-growing swelling on the left side of mandible in the molar ramus region has been presented which was diagnosed as ameloblastic fibroma postenucleation.

Dentinogenic ghost cell tumor: Tumor in the garb of a cyst!

The dentinogenic ghost cell tumor (DGCT) is a relatively uncommon locally invasive neoplasm that mimics several inflammatory/reactive lesions of the gingiva or odontogenic cysts. The confirmatory diagnosis of this rare lesion can only be made with histopathological examination. Routine staining reveals features of a "mixed" tumor as ghost cells with calcification, dysplastic dentin and islands of epithelium in rosette pattern in mature connective tissue are visible. The case report describes an asymptomatic growth in the maxillary gingiva of a young patient that was incidentally diagnosed as a DGCT after biopsy. Malignant transformation of this lesion to its more aggressive counterpart, odontogenic ghost cell carcinoma has been described, and hence, regular follow-up of diagnosed cases is imperative. The purpose of the paper is to report a case that adds to the literature and this will consequently help to diagnose and understand the biological behavior of these lesions better.

Actinomycosis which Impersonates Malignancy.

Actinomycosis is a suppurative and often chronic bacterial infection most commonly caused by Actinomyces israelii. Actinomycotic infections may mimic more common oral diseases or present in a similar way to malignant disease. Treatment of actinomycosis involves surgical removal of the infected tissue and appropriate antibiotic therapy to eliminate the infection. Rarely seen in day-to-day dental practice, actinomycosis of the oral cavity is a highly significant condition due to its aggressive and locally destructive nature. We report a case of actinomycosis leading to extensive destruction and sequestration of the maxillary bone and deviation of the nasal septum, affecting a patient who complained of an unhealed extraction socket, chronic halitosis, and exposure of the bone with gingival recession crossing the midline.

Management of Chronic Recurrent Dislocation of Temporomandibular Joint Using 'U' Shaped Graft: A New Restrictive Technique.

BACKGROUND: Numerous procedures have been described for the treatment of chronic recurrent dislocation of the temporo-mandibular joint (TMJ), either in the form of enhancement or restriction of the condylar movement, with their obvious merits and demerits. MATERIALS AND METHOD: We present a new technique of using U shaped iliac bone graft to restrict the condylar movement and its advantages over the conventional techniques.We have used this technique successfully in 8 cases where Dautrey's procedure had failed with follow up period of 2 years. RESULTS: No patient complained of recurrent dislocation postoperatively. CONCLUSION: This a very simple and effective technique where other procedures have failed.

Efficacy of Ketamine as an Adjunct to Local Anesthesia in the Surgical Removal of Impacted Mandibular Third Molars - A Split Mouth Prospective Controlled Clinical Study.

INTRODUCTION: The removal of impacted teeth is one of the most common procedures performed by oral and maxillofacial surgeons. Reduction of discomfort post-operatively and efficient local anesthesia are imperative for success in surgical practice. At sub-anesthetic doses, ketamine has a noticeable analgesic action, which can be used to supplement local anesthesia with minimal side effects. AIM: To assess the efficacy of low-dose ketamine as an adjunct to local anesthesia in the management of pain, swelling and trismus after surgical removal of impacted mandibular third molars. MATERIALS AND METHODS: Twenty five patients with bilaterally symmetrical impacted mandibular third molars requiring surgical removal under local anesthesia were selected for the controlled clinical study. The third molar sites of all patients enrolled in the trial were randomly assigned into 2 groups: Local Anesthesia (Lignocaine) Alone [LAA] and Local Anesthesia plus ketamine [LAK]. 5ml of local anesthetic (Lignocaine Hydrochloride 2% with epinephrine 1:100,000) was injected in the 'LAA' group while the 'LAK' group received 5ml of local anesthetic plus 0.2mg/kg ketamine. Patients were blinded to the solution used and the operator recorded the group (LAA or LAK) and the respective site (Right or Left) for analysis. Bilaterally symmetrical impacted mandibular molars were removed at an interval of 15 days. RESULTS: Facial swelling on post-operative days was significantly lower in the LAK group than in the LAA group (p<0.05). The pain scores on the VAS were significantly higher in the LAA group than in the LAK group (p<0.05). CONCLUSION: The role of ketamine in low doses as an analgesic and anti-inflammatory is evident in our study. The combination of a local anesthetic and sub-anesthetic doses of ketamine injected for surgical removal of impacted third molars provides good local anesthesia while alleviating post-operative sequelae for the patient by providing a degree of post-operative analgesia with less swelling.

Kapetansky-Juri Technique to Correct the Whistlers Lip in the Multiple Operated Cleft Patient.

PURPOSE: One of the common sequels of a cleft lip repair may be "whistling lip deformity" but other deformities are also seen particularly in failed or multiple resurgery cases. This retrospective study was carried out to evaluate the usefulness of "Kapetansky-Juri" advancement flap technique to correct such deformities. METHODS: Ten patients of bilateral cleft lip with history of minimum five failed cleft lip surgeries and having residual lip deformity were operated using "Kapetansky-Juri" advancement flap technique and were followed up to minimum 36 months. RESULTS: All patients showed good tissue fullness and complete correction of the deformity. There was no contracture of surrounding skin or vermilion during follow-up period. In eight patients minimal scar formation was seen while two showed midline scar formation. CONCLUSION: No tissue loss due to vascular insufficiency was observed. The technique gives good tissue distribution and minimal surface scar formation.

Peripheral neurectomy: minimally invasive surgical modality for trigeminal neuralgia in Indian population: a retrospective analysis of 20 cases.

OBJECTIVE: To evaluate the efficacy of peripheral neurectomy in 20 cases of trigeminal neuralgia as minimally invasive surgical treatment modality. MATERIALS AND METHODS: Twenty (12 males and 8 females) patients with trigeminal neuralgia aged between 35 and 68 years (mean 48 years), who had undergone peripheral neurectomy, were retrospectively analyzed for relief of pain, complications, recurrence of pain, and any additional procedure required to treat recurrence, in a follow-up period of 36 months postoperatively. RESULTS: There was no significant intra-operative and post-operative complications. There was recurrence of pain in two patients (10 %) in 24 and 28 months post-operative follow-up respectively, whereas, rest of the 18 patients were symptom free during 36 months follow-up. CONCLUSION: Peripheral neurectomy is one of the minimally invasive and expeditious forms of surgical modality for the treatment of trigeminal neuralgia. This treatment option is cost effective and provides long term relief from neuralgic pain.

Evaluation of 2.0-mm Titanium Three-Dimensional Curved Angle Strut Plate in the Fixation of Mandibular Angle Fractures-A Prospective Clinical and Radiological Analysis.

The aim of the study was to evaluate the efficacy and complication rate with use of 2.0-mm titanium three-dimensional (3D) curved angle strut plate for mandibular angle fractures. Twenty cases requiring internal fixation of the mandibular angle by 2.0-mm titanium 3D curved angle strut plates were evaluated. Postoperative clinical and radiological analyses were done on 1st, 2nd, 4th, and 6th weeks, which included wound healing, transmitted movements, difficulty in function and occlusion, and neurosensory changes, if any. Reasonable level of success in terms of immediate jaw function was noted in all cases. Transient inferior alveolar nerve dysfunction was observed in three cases, which recovered gradually in 2 months, and surgical site infection was observed in two cases, which resolved with appropriate course of antibiotics and wound care. Fixation of mandibular angle fractures with a 2.0-mm titanium 3D curved angle strut plate is predictable, expeditious, and has less complication rate.

Is post-operative antibiotic therapy justified for surgical removal of mandibular third molar? A comparative study.

Surgical removal of impacted mandibular third molar (SRIMTM) is the most common procedure performed in oral and maxillofacial surgery. In the literature, many complications associated with lower third molar removal are described such as pain, swelling, trismus, infection, inflammation, and nerve damage. Antibiotics are routinely used either pre-operatively or post-operatively to reduce the chances of surgical site infection (SSI). However routine use of antibiotics for SRIMTM is still controversial. For antibiotics to be effective in reducing post-operative infective complications, the time of administration is very important. Adequate serum concentration of antibiotic must be achieved prior to the procedure. In a developing country like India, antibiotics are routinely prescribed post-operatively. The current study is designed to evaluate the efficacy of post-operative prophylactic antibiotic in SRIMTM.

Role of cone-beam computed tomography in diagnosis and management of nasopalatine duct cyst.

Nasopalatine duct cysts (NPDCs) are the most common nonodontogenic cyst of the jaw, with a reported prevalence of between 1% and 11.6% of all jaw cysts.1 It is believed to arise from epithelial remnants of the nasopalatine duct, the communication between the nasal cavity and anterior maxilla in the developing fetus. For huge NPDCs, total excision is difficult, and there is an increase in the possibility of postoperative complications including submucosal hematoma, wound dehiscence, wound infection, injury to tooth roots, injury to nasopalatine neurovascular bundles, paresthesia of the anterior palate, facial swelling, and oronasal fistula formation. This article discusses a case with a large NPDC, which was managed surgically without any complication. Radiological findings emphasizing the importance of cone-beam computed tomography in diagnosis and optimized treatment planning of NPDCs are discussed.

Necrotizing sialometaplasia: A diagnostic dilemma!

Necrotizing sialometaplasia (NS) is a benign, self-limiting inflammatory reaction of salivary gland tissue which may mimic squamous cell carcinoma or mucoepidermoid carcinoma, both clinically and histologically, that creates diagnostic dilemma leading to unwarranted aggressive surgery. Most commonly affected site is the minor salivary glands of the palate. The pathogenesis is unknown but is believed to be due to ischemia of vasculature supplying the salivary gland lobules. A simple incisional biopsy is required to confirm the histological diagnosis and to rule out more serious disease processes. It is a self-limiting disease process and requires no treatment. It will be prudent to do repeat biopsy in case if the lesion does not heal within 3 months.

Transosseous fixation of pediatric displaced mandibular fractures with polyglactin resorbable suture--a simplified technique.

Management of pediatric mandibular fractures presents a unique challenge to surgeons in terms of its numerous variations compared to adults. Both conservative and open methods have been advocated with their obvious limitations and complications. However, conservative modalities may not be possible in grossly displaced fractures, which necessitate the open method of fixation. We present a novel and simplified technique of transosseous fixation of displaced pediatric mandibular fractures with polyglactin resorbable suture, which provides adequate stability without any interference with tooth buds and which is easy to master.

Pectoralis major myocutaneous flap--still a workhorse for maxillofacial reconstruction in developing countries.

PURPOSE: To retrospectively evaluate the utility of the pectoralis major myocutaneous (PMMC) flap for head, face, and neck (HFN) reconstruction in the Indian population. MATERIALS AND METHODS: The hospital records of 496 patients in whom the PMMC flap was used (saving the deltopectoral flap) for reconstruction of HFN defects from January 1991 to December 2010 were reviewed retrospectively. All the patients were followed up for a minimum period of 6 months, and the utility of the PMMC flap was evaluated for HFN reconstruction. RESULTS: Of the 496 patients, complications developed in 84 patients. The complications included complete flap failure in 12, partial skin paddle loss in 24, wound infection in 12, peripheral wound dehiscence in 16, plate exposure in 12, and donor site morbidity such as infection and a decrease in function in 8. CONCLUSIONS: The PMMC flap or its modification was used in 496 cases of reconstruction after resection surgery for malignancy of the HFN region with minimal morbidity and 1 death. This technique is a useful alternative in places with a high incidence of HFN malignancies and microsurgical free tissue transfer is not possible or as a salvage procedure in selected large, full-thickness, oral cavity lesions. In our 19-year experience, the final functional and cosmetic results were satisfactory with this sturdy flap.

Numbness over the distribution of trigeminal nerve--trigeminal trophic syndrome or viral neuritis: a diagnostic dilemma!

Numbness and ulceration of the face, particularly erosion of ala of the nose, sometimes occur after sensory denervation in the territory of the divisions of the trigeminal nerve. The incidence is uncertain and usually follows surgical treatments for trigeminal neuralgia. Such condition is known as trigeminal trophic syndrome (TTS), although some authors believe it to be a special form of dermatitis artefacta. Trigeminal trophic syndrome most commonly affects adults, after iatrogenic, vascular, viral, or neoplastic damage to the trigeminal nerve. We present a rare case of TTS in a 32-year-old woman who was referred to us with progressive numbness in the right upper and lower lip region.

Ectopic tooth in maxillary sinus: Case series.

Ectopic eruption of a tooth within the dentate region of the jaws is often noticed in clinical practice and is well documented in the literature. But the ectopic eruption into the non dentate region is rare and scantly documented. The maxillary sinus is one such a non dentate region, apart from nasal septum, mandibular condyle, coronoid process and the palate, to accommodate such ectopic eruptions of teeth. Due to its rarity and lack of consensus over its management, the incidence deserves to be added to the literature and discussed. Early surgical intervention for removal of ectopic tooth along with enucleation of the associated cyst, if any, is the treatment of choice.