Nine Years of Retrospective Study of Mandibular Fractures in Semi-urban Teaching Hospital, Shimla, Himachal Pradesh, India.

Study Design: Retrospective study. Objective: To evaluate current trends in maxillofacial trauma, a retrospective study of mandibular fractures at Government Dental College and Hospital Shimla H.P was carried out. Methods: In this retrospective study, records of 910 patients with mandibular fractures were reviewed between 2007 and 2015 in the Department of Oral and Maxillofacial Surgery out of total 1656 facial fractures. These mandibular fractures were assessed according to age, sex, aetiology in addition to monthly and yearly distribution. Post-operative complications such as malocclusion, neurosensory disturbances and infection were recorded. Results: It was observed that mandibular fractures were most frequent in males (67.5%) and in the age group of 21-30 years; accidental fall was the most common etiological factor (43.8%) in the present study and in stark difference to already published reports. The most common fracture site was that of condylar region 239 (26.2%). Open reduction and internal fixation (ORIF) were done in 67.3% cases whereas 32.6% were managed by maxillomandibular fixation and circummandibular wiring. Miniplate osteosynthesis was the most favoured technique. The complication with ORIF was 16%. Conclusions: To treat mandibular fractures, currently there are many techniques. However, in minimizing complications and in achieving satisfactory functional and aesthetic results experienced surgical team plays an important role.

The Relationship Between Periodontal Disease (PD) and Recurrent Vascular Events in Ischemic Stroke/Transient Ischemic Attack (TIA) Patients: A Hospital-Based Cohort Study.

Background In this cohort study, the association between periodontal disease (PD) and recurrent vascular events was determined among the subjects with ischemic stroke/transient ischemic attack (TIA), and the extent and severity of periodontal disease were estimated among these subjects. Methods This prospective, longitudinal, hospital-based cohort study included 153 individuals who had a stroke or TIA. They were divided into two groups: high periodontal disease (HPD) (N=55, mean age: 59.40±12.21) and low periodontal disease (LPD) (N=98, mean age: 53.03±12.82). Clinical attachment loss (CAL) and probing pocket depth (PPD) were used to measure the severity of the periodontal disease. TOAST criteria were used to determine the ischemic stroke etiology, and the NIH Stroke Scale (NIHSS) was used to determine the ischemic stroke severity. A follow-up survey found that vascular incidents recurred. Results HPD individuals exhibited a higher median NIHSS (eight) than LPD patients (seven) in a subset of stroke population (N=23). Thirty-eight cardiovascular events occurred in the first three months after enrollment, including 23 strokes and seven TIAs, and five myocardial infarctions(MIs). There were three deaths from vascular causes. There was a non-significant association between PD and composite vascular events (HR 1.06, 95% CI, 1.03 to 1.09, p=0.71). Compound vascular events were not related to severe HPD (HR 1.31, 95 % CI 0.54 to 3.16, p=0.07). Conclusion In stroke/TIA patients, there is no link between high periodontal disease and recurrent vascular episodes. The proportions of stroke subtypes were not substantially different between HPD and LPD.

Radiographic factors associated with inferior alveolar nerve exposure during mandibular third molar surgery and their influence on neurosensory deficit: A prospective study.

Introduction: The inferior alveolar nerve (IAN) can occasionally be observed in the extraction socket of the mandibular third molar (M3M) intraoperatively. Exposure of inferior alveolar neurovascular bundle during surgery primarily depends upon the absence of bony cortex between the canal and root of impacted third molar or either by existence of a very thin cortical lining between two which gets broken during luxation of tooth. Accurate anatomical relationship of inferior alveolar canal with root apex of impacted (M3M) and the location of canal can be determined by Cone beam computed tomography (CBCT). Material and methods: Initially 200 patients evaluated by Orthopantomogram (OPG) for anatomical relationship of IAN with impacted (M3M) and various radiographic risk factors for nerve injury. Among these 200, 75 showed the presence of two or more than two risk factors for IAN injury which then were further evaluated by using CBCT for presence or absence of cortex of canal and location of canal on buccal, lingual, inferior, and interradicular position. Conclusion: Cortex of canal is an important barrier between the root apex and inferior alveolar neurovascular bundle. Interruption of cortex on CBCT, the interradicularly and lingually positioned neurovascular bundle become a strong affirmation for intra operative nerve exposure during (M3M) surgery. Although its exposure is affected by various factors such as bone density, sex and age of patient, surgeon's expertise, operative tissue damage, post operative edema, surgical procedure, but neurosensory deficit do not occur simply after the exposure of neurovascular bundle.

To Evaluate the Efficacy of Tissue Autofluorescence (Velscope) in the Visualization of Oral Premalignant and Malignant Lesions among High-Risk Population Aged 18 Years and Above in Haroli Block of Una, Himachal Pradesh.

Introduction: Visually enhanced lesion scope (Velscope) that identifies reduction in tissue fluorescence in dysplasia can prove to be effective in screening for potentially malignant lesions. The objective of the present study was to evaluate the effectiveness of device that utilizes the principles of tissue autofluorescence (Velscope) in the detection of dysplastic and/or neoplastic changes in oral mucosal lesions using biopsy and histopathology as "gold standard." Materials and Methods: Out of nine hundred fifty patients with suspicious oral mucosal lesions, 250 patients were subjected to conventional oral examination followed by Velscope examination. The autofluorescence characteristics of 250 patients were compared with the results of histopathology. Biopsies were obtained from all suspicious areas identified on examination. The sensitivity, specificity, positive and negative predictive values were calculated for Velscope examination. Results: The Velscope examination showed sensitivity and specificity values of 75.00% (95% CI: 69.63%-80.37%) and 61.39% (95% CI: 55.35%-67.42%) respectively while the positive and negative predictive values were 31.58% (95% CI: 25.82%-37.34%) and 91.18% (95% CI: 87.66%-94.69%) respectively. Conclusion: The definite diagnosis of the presence of dysplastic tissue changes in the oral lesions cannot be made alone with the Velscopic examination. The high number of false-positive results limits its efficiency as an adjunct despite its reasonable sensitivity. However, It can serve to alleviate patient anxiety regarding suspicious mucosal lesions in a general practice setting due to high negative predictive value. Also, a combined approach of Velscope examination and conventional oral examination may prove to be an effective diagnostic tool for early detection of malignant oral mucosal lesions.

Comparing cyanoacrylate tissue adhesive and conventional subcuticular skin sutures for maxillofacial incisions--a prospective randomized trial considering closure time, wound morbidity, and cosmetic outcome.

PURPOSE: To compare octyl-2-cyanoacrylate (2-OCA) tissue adhesive with subcuticular suture for the closure of incisions in the maxillofacial region to determine 1) whether it is faster than traditional subcuticular suturing, 2) whether the number and length of incisions affect closure time, 3) wound morbidity, 4) patient satisfaction outcome, and 5) cosmetic outcome. MATERIAL AND METHODS: In a prospective randomized clinical trial, 29 patients were allocated to 1 of 2 groups for the closure of skin incisions using 2-OCA or conventional subcuticular skin sutures. Postoperative follow-up evaluated wound healing at 5 to 10 days and at 3 months. Assessment of cosmetic outcome was performed by a plastic surgeon using a modified Hollander Wound Evaluation Scale and a validated visual analog scale. Comparisons between groups were performed using the Student t test and χ(2) test. RESULTS: Twenty incisions in 14 patients were closed with 2-OCA and 20 incisions in 15 patients were closed with subcuticular sutures. Mean time of closure was significantly (P < .005) faster with 2-OCA at 69.50 ± 33.39 seconds compared with 379.00 ± 75.39 seconds in the suture group. There was no significant difference in wound complications between the 2 groups; also, there was no significant difference in patient satisfaction and cosmetic outcome of scars at the 3-month follow-up between the 2 groups. CONCLUSIONS: 2-OCA tissue adhesive is an excellent alternative to sutures for effective, reliable, and faster skin closure of maxillofacial incisions.

Comparative evaluation of surgical procedures for trigeminal neuralgia.

Trigeminal neuralgia (TN) is a debilitating ailment. Pharmacotherapy still remains the first line therapy for the management of TN. However, often the patients become refractory to the pharmacotherapy and need surgical interventions. There is a wide array of surgical treatment modalities available for TN and it is important to select the most appropriate surgery for a patient. This review evaluates the various surgical modalities by employing a comparative analysis with respect to patient selection, success rate, complications and cost effectiveness. For the evaluation, a critical review of literature was done with predefined search terms to obtain the details of individual procedures, which were then compared, under similar parameters. The results suggested that microvascular decompression seem to be the most effective treatment in terms of patient satisfaction and long term cost effectiveness. However, if patient factors do not permit, then the peripheral procedures may be employed as a substitute, though they have higher recurrence rate and complications and have relatively lower long term cost effectiveness. The newer modalities like stereotactic radiosurgery and botulinum injections have promising results and further refinement in these procedures will provide additional options for the patients suffering from TN.

Placement of single tooth implant in healed socket with immediate temporization: Clinical study.

INTRODUCTION: Edentulous condition inadequately compensated for, by dentures, impair oral function and is accompanied by reduced self-confidence. In a continued effort to achieve these goals, implant dentistry was introduced. Immediate temporization is somehow a recent concept, which allows the maintenance of soft tissue contours, along with interdental alveolar contours. AIMS AND OBJECTIVES: Aims of the present study were to study the placement of implant in the post-extracted healed tooth socket of anterior maxilla and to evaluate the feasibility of early function on implants placed. MATERIALS AND METHODS: In the present study, HI-TECH IMPLANTS TRX-OP one-piece immediate loading implant system with the built on abutment has been used. Immediate temporisation has been done and results have been evaluated in terms of stability, gingival health, esthetics, marginal bone loss, patient's psychological attitude, and satisfaction. RESULTS: Out of eight implants, 6 successfully healed whereas 2 implants suffered failure. CONCLUSION: Overall conclusion drawn from the study is, immediate temporization is a successful method providing psychological, financial and emotional benefits to the patient.

Massive osteolysis of hemimandible: a case report.

Massive osteolysis or Gorham's stout disease or phantom bone is a rare disorder which normally appears in adulthood with no specific predilection for any sex. Work to find out exact etiology of disorder has been done. But actual cause has not yet been found. Any of the bone could be involved in this disease. A clinical, radiographic and histological evaluation of massive osteolysis of mandible is presented and discussed.