Assessment of quality of life in patients with surgically treated maxillofacial fractures.

Background: The complex nature of maxillofacial injuries can affect the surgical treatment outcomes and general well-being of the patient. To evaluate the efficiency of the surgical treatment, assessment of the quality of life (QOL) of the patients is of vital importance. Due to the absence of an exclusive QOL assessment tool for maxillofacial fractures, we introduce the 'Twenty-point quality of life assessment in facial trauma patients in Indian population'. The aim of this study was to assess and evaluate the QOL following surgical management of maxillofacial trauma patients based on the severity of the injury. Methods: The study consisted of 182 subjects divided into two groups of 91 each (Group A: severe facial injury and Group B: mild to moderate facial injury). The Facial Injury Severity Scale (FISS) was used to determine the severity of facial fractures and injuries. The twenty-point quality of life assessment tool includes Zone 1 (Psychosocial impact) and Zone 2 (Functional and aesthetic impact), with ten domains each to assess QOL. Results: In Zone 1, the mean scores for Group A and Group B were 38.6 and 39.26, respectively. In Zone 2, Group B (44.56) had higher mean scores compared to Group A (32.92) (p< 0.001). Group B (83.8) had higher mean scores compared to Group A (71.58) when the total of both Zone 1 and Zone 2 were taken into consideration (p<0,001). In Group A, 9 out of 91 patients had a total score of 81- 100 compared to 68 in the same range in Group B. Conclusions: Proper surgical management with adequate care to the hard and soft tissues can improve the QOL by reducing postoperative psychosocial and functional complications. Aesthetic outcomes play an important role in determining the QOL. Mild/ Moderate injuries show better QOL compared to severe maxillofacial injuries.

Effect of Oral and Maxillofacial Injuries on the Development of Post-Traumatic Stress Disorder: A Cross-Sectional Study

ABSTRACT Objective: To assess the influence of oral and maxillofacial trauma on the development of Post-Traumatic Stress Disorder (PTSD) and to determine the efficiency of the Impact of Event Scale-Revised (IES-R) as a diagnostic tool for detecting PTSD in patients with Oral and Maxillofacial injuries. Material and Methods: PTSD was assessed one month postoperatively by the diagnostic instrument, IES-R, to arrive at a provisional diagnosis. A structured clinician-administered PTSD Scale then assessed the patients for the Diagnostic and Statistical Manual of Mental Disorders-5th edition (CAPS-5) to establish a final diagnosis. The assessment of the severity of PTSD was done based on various types of oral and maxillofacial injuries. Results: The IES-R scale provisionally diagnosed 54 subjects with PTSD, out of which 42 were diagnosed to have PTSD by the CAPS-5 scale. Subjects with injuries involving the 'orbital complex,' those presenting with a perceptible scar in the maxillofacial region and with multiple avulsed/ luxated anterior teeth, showed a higher affinity to develop PTSD, and this was statistically significant. Conclusion: Higher levels of PTSD in patients with injuries to the maxillofacial region warrants correct diagnosis and detection, and hence the maxillofacial surgeon plays a vital role in this regard. The IES-R is a useful diagnostic tool to detect PTSD early.

The Influence of the Suture-less Anterior Releasing Incision in a Triangular Flap Design on Postoperative Healing Following Surgical Removal of Impacted Mandibular Third Molars.

OBJECTIVES: The objective of this study was to determine the effect of suture-less anterior releasing incisions on postoperative wound healing following surgical removal of impacted mandibular third molars. MATERIALS AND METHODS: A total of 112 patients were included in the study. Group 1 had 56 patients in which the anterior releasing incision was not sutured postoperatively, and group 2 had 56 patients, in whom the anterior releasing incision was sutured. The two groups were compared in terms of pain, swelling, and trismus at 1 day, 3 days, and 7 days postoperatively. The Univariate Type III Repeated-Measures ANOVA Assuming Sphericity was used to compare the two modes of treatments at different time points. The periodontal healing distal to the second molar was assessed on the first day and at 2 months following the surgical intervention. The independent t test was used to compare the periodontal healing between the two groups at two time points. RESULTS: No significant difference was observed between the two groups for pain and trismus (P > 0.05). However, the swelling was significantly greater in group 2 as compared to group 1 (P < 0.001). Periodontal healing was better in group 2, which showed lower periodontal probing depth distal to the mandibular second molar, compared to group 1 (P < 0.05). CONCLUSION: Suture-less anterior releasing incision decreases the postoperative swelling and edema, but the periodontal healing was poor when compared to the sutured anterior releasing incision cases. The type of closure technique did not have any significant influence on pain and trismus.

Anatomical variations in the cutaneous innervation on the dorsum of the foot.

Generally among the branches of common peroneal nerve, the superficial peroneal nerve provides cutaneous innervation to major part of the dorsum of the foot whereas the deep peroneal nerve innervates the skin over the first interdigital cleft region. The sural and saphenous nerves supplies the smaller lateral and medial margins of the dorsum respectively. The present study has been taken to classify the patterns of innervations of the nerves on the dorsum of the foot in South Indian population. A total of 40 formalin fixed lower limbs from 20 adult cadavers (15 males, 5 females) aged between 35 to 60 years were dissected and the branching patterns of nerves on the dorsum of the foot were noted and specimens were photographed. Gross anatomical variations were noted in the branching pattern of superficial peroneal, deep peroneal and sural nerve on the dorsum of foot. Results obtained in our study were classified into four groups. The cutaneous nerves are at risk of iatrogenic injuries during surgeries involving ankle, open reduction and internal fixation of fracture, arthroscopy etc. Knowledge of such anatomical variations of the nerves provides information to clinicians to avoid injury to them in real clinical situations.

Variations of the lingual and inferior alveolar nerves and their anomalous relationship with the maxillary artery

The infratemporal fossa is a compact space with multiple contents. Explicit anatomical knowledge regarding the relationship between these neurovascular structures becomes imperative during any surgical intervention. Literature is abounding with variations in this region. It encompasses communication between branches of the mandibular nerve or entrapment of nerves by bony bridges, or even abnormal course and branching pattern of the arteries. However, there are many other variabilities in these structures that are less reported or unreported. The present study is an effort to report the characteristic variations of the lingual and inferior alveolar nerves and their anomalous relationship with the maxillary artery in the infratemporal fossa. The study was conducted bilaterally on 26 adult cadavers. The variations in the origin and course of the lingual & inferior alveolar nerves were noted. The course of the maxillary artery and its relation to the lingual and inferior alveolar nerves was also recorded. The variations were explained under the following types: a) communication between the lingual and inferior alveolar nerves, b) existence of a pterygospinous ligament/bar overlying/separating the lingual and inferior alveolar nerves, c) abnormal course/ absence of the chorda tympani nerve and an alternate taste pathway, d) multiple roots of the lingual and inferior alveolar nerves and e) the unusual course of the maxillary artery. Knowledge of these variations would aid the head & neck surgeons in minimizing the compression symptoms and also avoiding postoperative complications

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The effects of Mucuna pruriens extract on histopathological and biochemical features in the rat model of ischemia.

Stroke is considered to be one of the most important causes of death worldwide. Global ischemia causes widespread brain injury and infarctions in various regions of the brain. Oxidative stress can be considered an important factor in the development of tissue damage, which is caused because of arterial occlusion with subsequent reperfusion. Kapikacchu or Mucuna pruriens, commonly known as velvet bean, is well known for its aphrodisiac activities. It is also used in the treatment of snakebites, depressive neurosis, and Parkinson's disease. Although this plant has different pharmacological actions, its neuroprotective activity has received minimal attention. Thus, this study was carried out with the aim of evaluating the neuroprotective action of M. pruriens in bilateral carotid artery occlusion-induced global cerebral ischemia in Wistar rats. The carotid arteries of both sides were occluded for 30 min and reperfused to induce global cerebral ischemia. The methanolic plant extract was administered to the study animals for 10 days. The brains of the Wistar rats were isolated by decapitation and observed for histopathological and biochemical changes. Cerebral ischemia resulted in significant neurological damage in the brains of the rats that were not treated by M. pruriens. The group subjected to treatment by the M. pruriens extract showed significant protection against brain damage compared with the negative control group, which indicates the therapeutic potential of this plant in ischemia.

Cadaveric Study on Morphology of Dorsal Interossei of Hand and its Anatomical Variation.

INTRODUCTION: The dorsal interossei are the abductors of the fingers and the knowledge of its variation help the surgeon in treatment of fractures, claw hand and compartment syndromes. AIM: To note the origin, insertion, pattern of muscle fibres and tendon length of all the dorsal interossei of hand. MATERIALS AND METHODS: Routinely dissected 30 formalin fixed hand in the Department of Anatomy, KMC, Manipal, were observed for origin, insertion and tendon length and muscle pattern of dorsal interossei. RESULTS: Out of 30 hands, presence of supernumerary muscle was observed in three hands. Presence of three heads of dorsal interossei was noted in one hand. CONCLUSION: The finding of present study is of importance to surgeons and orthopaedicians during conservative and surgical management of hand deformity. Adequate knowledge of these muscular variations is also important in treatment of fractures, stiff hand, claw hand or tendon transfer.

A Rare Case of Mandibular Exostoses and its Review.

Mandibular exostosis is a type of bony prominence caused due to hyperostosis in the mandibular bone. They are benign, broad-based surface masses on the outer or facial aspect of the jaw bones; slowly enlarge over the years to form the bulky masses. During the period between the 10th to 13th week of intrauterine life, changes in the structure of the Meckel's cartilage and the protrusion of the medial lamina of the mandible onto the cartilage can result in the formation of such exostosis. We discuss here a very rare case of a 49-year-old male, in which the buccal exostoses formed underwent changes in size and shape due to certain factors, resulting in a bony bar formation in the mandibular anterior region.