Efficacy of Exclusive Lingual Nerve Block versus Conventional Inferior Alveolar Nerve Block in Achieving Lingual Soft-tissue Anesthesia.

OBJECTIVE: The aim of this randomized clinical trial was to assess the efficacy of exclusive lingual nerve block (LNB) in achieving selective lingual soft-tissue anesthesia in comparison with conventional inferior alveolar nerve block (IANB). MATERIALS AND METHODS: A total of 200 patients indicated for the extraction of lower premolars were recruited for the study. The samples were allocated by randomization into control and study groups. Lingual soft-tissue anesthesia was achieved by IANB and exclusive LNB in the control and study group, respectively. The primary outcome variable studied was anesthesia of ipsilateral lingual mucoperiosteum, floor of mouth and tongue. The secondary variables assessed were (1) taste sensation immediately following administration of local anesthesia and (2) mouth opening and lingual nerve paresthesia on the first postoperative day. RESULTS: Data analysis for descriptive and inferential statistics was performed using SPSS (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp. Released 2013) and a P < 0.05 was considered statistically significant. In comparison with the control group, the study group (LNB) showed statistically significant anesthesia of the lingual gingiva of incisors, molars, anterior floor of the mouth, and anterior tongue. CONCLUSION: Exclusive LNB is superior to IAN nerve block in achieving selective anesthesia of lingual soft tissues. It is technically simple and associated with minimal complications as compared to IAN block.

'Stylo-mandibular complex' fracture from a maxillofacial surgeon's perspective--review of the literature and proposal of a management algorithm.

The incidence of fractures of styloid process, either in isolation or association with mandibular fractures, is rare, and frequently overlooked. When present, they pose clinical dilemma in diagnosis and management. Proper management of styloid fractures is essential, not just to alleviate the patients' symptoms, but also to prevent potential complications like post-traumatic styloid syndrome and injury to adjacent vital structures. This article features a review of literature on 'styloid fracture concomitant with mandibular fracture' along with a case report. The article explores the biomechanics resulting in styloid fracture especially when co-existing with mandibular fractures. The article also enumerates the clinical features of this unusual clinical phenomenon and aims at rationalizing the need for its medical or surgical management. A simple protocol for the management of 'stylo-mandibular complex' fracture has been proposed.