Experience with Resorbable Plates for Fixation of Mandible Fracture. A Prospective Study of 10 Cases.

Aim: This study aims to evaluate the efficacy of resorbable plates for the fixation of mandible fracture. Materials and Methods: 10 cases of fracture mandible were treated with resorbable plates using the Inion CPS system. Patients were evaluated during their entire hospital stay and recalled on 1st, 4th, and 8th postoperative weeks. A thorough evaluation was done at the recall visits for any surgical and postoperative complications such as infection, malocclusion, neural abnormalities, wound or suture dehiscence, segmental mobility, foreign body reaction, and pain on biting. Bite force measurements were taken to evaluate the return of function. Results: Clinical union of the fracture was noted at the 8th week follow-up examination for all cases. There were swelling and pain at the operated site at 8th week follow-up for one patient, which was managed conservatively. The mean bite force was recorded for different regions and it increased over the entire follow-up period progressively. Conclusion: These plates and screws are an essential tool in the treatment of mandibular fractures owing to benefits such as biodegradability, biocompatibility, and the ability to be eliminated via the body's natural processes.

Do preoperative glycosylated hemoglobin (HbA1C) and random blood glucose levels predict wound healing complications following exodontia in type 2 diabetes mellitus patients?-a prospective observational study.

BACKGROUND: Many dental surgeons consider a type 2 diabetic patient to be at higher risk for wound healing complications following exodontia. Random blood glucose (RBG) and glycosylated hemoglobin (HbA1C) values help the surgeon determine the glycemic control and assess if the patient can undergo the surgical procedure. OBJECTIVES: The purpose of this study was to analyze if preoperative HbA1C and RBG testing could predict the risk of wound healing and infectious complications in type 2 DM patients undergoing exodontia in an office setting. METHODS: This prospective observational study included 133 type 2 diabetic patients and age- and gender-matched non-diabetic patients undergoing exodontia. Preoperative HbA1C values and random blood glucose levels were obtained for patients in both groups. Wound healing and infectious complications and additional interventions performed were recorded. RESULTS: Duration of diabetes ranged from 1 to 25 years. 80.5% of diabetics were treated with oral hypoglycemics. A vast majority of patients in both groups underwent extraction of only a single tooth. There was no significant difference in non-infectious complications between the two groups. The absolute risk of infectious complications in diabetics was 10.5% compared to a 6.8% risk among the control group. Age, RBG values, HbA1C, duration of DM, and number and nature of exodontia performed did not show any statistical significance. CONCLUSION: This study observed a slight, but not statistically significant increase in the risk of infectious complications in type 2 DM patients undergoing exodontia. Surgical site infections were amenable to surgical drainage with or without oral antibiotics on an outpatient basis with favorable healing outcomes. CLINICAL RELEVANCE: The RBG and HbA1C values were not significantly associated with risk of infectious complications. Resorting to prophylactic antibiotics and warning about possible adverse healing for routine exodontia in type 2 DM patients is unnecessary.

Post-extraction bleeding complications in patients on uninterrupted dual antiplatelet therapy-a prospective study.

BACKGROUND: Dental surgeons consider patients on antiplatelet therapy (APT) to be at a risk for perioperative bleeding during dental extraction. This fear often prompts them to consider a temporary withdrawal of the medication for a few days before extraction. Such withdrawal can have serious consequences, especially in patients on dual antiplatelet therapy (DAPT). OBJECTIVES: The purpose of this study was to analyze if patients on uninterrupted DAPT undergoing dental extractions had an increased risk of bleeding complications when compared with patients on no antiplatelet therapy. METHODS: This prospective study included 120 DAPT patients and an equal number of age- and gender-matched non-APT patients undergoing dental extractions. Immediate and delayed bleeding complications in both groups were recorded. Interventions required to control the post-extraction hemorrhage were also analyzed. RESULTS: Duration of DAPT medication ranged from 6 months to 13 years. Post-percutaneous coronary intervention was the most common cause for DAPT. A vast majority of patients in both groups underwent extraction of one or two teeth. Patients on DAPT had a 7-fold increased risk of immediate bleeding complications when compared with control group. All bleeding episodes were controlled with local hemostatic measures. Transalveolar extractions and localized periodontitis had a significant relationship to bleeding complications. CONCLUSION: This study observed an increase in the risk of prolonged bleeding in uninterrupted DAPT patients undergoing dental extractions. Bleeding episodes were amenable to local hemostatic measures with favorable outcomes. CLINICAL RELEVANCE: Dental extractions in patients on uninterrupted DAPT can be done safely. Resorting to temporary withdrawal of DAPT due to a fear of excessive bleeding is unnecessary.

Improving the Quality of Oral and Maxillofacial Surgical Notes in an Indian Public Sector Hospital in Accordance with the Royal College of Surgeons Guidelines: A Completed Audit Loop Study.

AIM: Proper and adequate documentation in operation notes is a basic tool of clinical practice with medical and legal implications. An audit was done to ascertain if oral and maxillofacial surgery operative notes in an Indian public sector hospital adhered to the guidelines published by the Royal College of Surgeons England. METHODS: Fifty randomly selected operative notes were evaluated against the guidelines by RCS England with regards to the essential generic components of an operation note. Additional criteria relevant to oral and Maxillofacial Surgery were also evaluated. Changes were introduced in the form of Oral and Maxillofacial Surgery specific consent forms, diagram sheets and a computerized operation note proforma containing all essential and additional criteria along with prefilled template of operative findings. Re-audit of 50 randomly selected operation notes was performed after a 6 month period. RESULTS: In the 1st audit cycle, excellent documentation ranging from 94 to 100 % was seen in 9 essential criteria. Unsatisfactory documentation was observed in criteria like assistant name, date of surgery. Most consent forms contained abbreviations and some did not provide all details. Additional criteria specific to Oral and Maxillofacial Surgery scored poorly. In the 2nd Audit for loop completion, excellent documentation was seen in almost all essential and additional criteria. Mean percentage of data point inclusion improved from 84.6 to 98.4 % (0.001< P value <0.005). The use of abbreviations was seen in only 6 notes. CONCLUSION: Regular audits are now considered a mandatory quality improvement process that seeks to improve patient care and outcomes. To the best of our knowledge, this is the first completed audit on operation notes documentation in Oral and Maxillofacial Surgery from India. The introduction of a computerized operation note proforma showed excellent improvement in operation note documentation. Surgeons can follow the RCS guidelines to ensure standardization of operation notes.

Deep vein thrombosis: A rare complication in oral and maxillofacial surgery: A review of two cases.

Deep vein thrombosis (DVT) is caused by obstruction of blood flow of deep veins in upper and lower limb. One of the precipitating factors for DVT is surgery under general anesthesia exceeding 30 min. However, there are very few reports of DVT associated with surgery of oral and maxillofacial region. In this paper we report two cases of DVT involving left ilio-femoropopliteal deep vein in one patient treated for fractured left angle of mandible and left peroneal vein in the other patient treated for oral sub mucous fibrosis. Clinical and color Doppler examination were performed to diagnose the condition and were referred to vascular surgical unit of higher institute for further management. These cases illustrates any surgery of maxillofacial region is not free from risk of DVT, which can cause fatal pulmonary thromboembolism.

Is a patella motor response necessary for continuous femoral nerve blockade performed in conjunction with ultrasound guidance?

BACKGROUND: Successful continuous femoral nerve blockade (CFNB) has been associated with the elicitation of a patella motor response during needle and catheter insertion. We evaluated whether a patella motor response is necessary when CFNB is performed in conjunction with ultrasound (US) guidance. METHODS: Ninety-eight patients undergoing CFNB (along with sciatic nerve block and spinal anesthetic) for total knee arthroplasty participated in this cohort observational study. Using out-of-plane US guidance alone, the tip of an insulated Tuohy needle was positioned superficial to the midpoint of the femoral nerve visualized in short axis. A nerve stimulator was turned on and the type of motor response (patella versus medial muscle) and minimum stimulating current from the needle were recorded. A stimulating catheter was then inserted and the type of motor response and minimum current from the catheter were recorded. Ten milliliters mepivacaine 2% was injected through the catheter. The primary outcome was sensory block defined as loss of sensation to pinprick on the anterior surface of the distal thigh measured 20 minutes after mepivacaine injection. RESULTS: Forty-three patients demonstrated a patella motor response, 43 demonstrated a medial motor response, and 12 demonstrated no motor response from the catheter. The proportion of patients with sensory block differed according to motor response from the catheter (patella [98%], medial [91%], and no motor response [75%]; P = 0.02), but there was no significant difference between a patella (98%) and medial (91%) motor response from the catheter (P = 0.58). The proportion of patients with motor block 20 minutes after local anesthetic injection also differed according to motor response from the catheter (patella [95%], medial [77%], and no motor response [67%]; P = 0.03). In addition, there was a significant difference between a patella (95%) and medial (77%) motor response from the catheter (P = 0.01). The mean minimum stimulating currents did not differ between patella and medial motor responses elicited from the catheter (P = 0.06). Postoperative pain and analgesic consumption were similar regardless of the type of motor response from the catheter. CONCLUSION: Based on observational data, a patella or medial motor response from the catheter similarly results in sensory block of the anterior thigh when CFNB is performed in conjunction with out-of-plane US guidance.