Effect of meditation and relaxation therapy on preoperative anxiety and stress in oral squamous cell carcinoma patients scheduled for oral and maxillofacial surgery: An experimental study.

Context: The diagnosis of oral squamous cell carcinoma [OSCC] and its treatment phase is emotionally demanding for the patient and challenging for the surgeon. The induction of stress and anxiety is unavoidable in these patients. It becomes very important for the patient to have psychological as well as physical stability during this treatment phase. Various studies have reported the beneficial effect of meditation along with relaxation therapy on healthy individuals but the beneficial effect of meditation and relaxation therapy [MRT] to reduce stress and anxiety preoperatively in OSCC patients has not been reported in scientific literature. Aim: The aim of this study was to study the effect of MRT on preoperative anxiety and stress in OSCC patients undergoing for oral and maxillofacial surgery. Settings and Design: An experimental, parallel study design was carried out with randomization of patients into experimental[25] and control group[25] with allocation ratio 1:1 in 50 patients diagnosed with OSCC [stage II or III] scheduled for oral and maxillofacial surgery with general anesthesia. Materials and Methods: The biopsy which was the prerequisite for the diagnosis was taken. Twenty-one days before surgery in experimental group, patients were oriented about meditation and relaxation exercises. The reorientation of MRT was done from the day of admission twice a day till the day of surgery. Physiological parameters for stress and anxiety like heart rate [HR], blood pressure [BP], pulse rate [PR], and respiratory rate [RR] were evaluated on 1st day of MRT at 9 am and on the day of surgery. The serum cortisol which was quantitative parameter for stress was evaluated 1st day of MRT at 9 am fasting and on the day of surgery. The qualitative analysis for anxiety was done preoperatively using visual analog scale on the 1st day before MRT and compared with the values on the day of surgery after MRT at a specific time. Statistical Analysis: Paired t-test analysis was used intragroup whereas unpaired t-test was used intergroup between experimental and control groups with significance at P = 0.05 and highly significant at P = 0.0001. Results: The serum cortisol was significantly less in the experimental group over control group with t = 7.04 and P = 0.0001. The systolic and diastolic BP, pulse rate, respiratory rate, and anxiety in the experimental group reported significantly less rate compared to the control group with t = 5.66, t = 22.2, t = 11.93, t = 27.71, and P = 0.0001. Conclusion: In our study, MRT in the form of Sukhasana, Anulom Vilom, Omkar chanting, and Shavasana for 30 min twice daily has shown positive effect to reduce stress and anxiety. The serum cortisol as a quantitative parameter has been effectively evaluated in this benchmark study.

Iceberg lesion-A rare case of chronic osteomyelitis of the jaw with underlying radicular cyst: A case report.

Osteomyelitis is an inflammatory condition of the bones that often starts with an infection of the medullary cavity and swiftly extends to the haversian system and periosteum. If drainage and antimicrobials are ineffective, acute osteomyelitis may progress to chronic osteomyelitis. Here, we offer a unique case that analyzes the radiographic and clinical characteristics of osteomyelitis with underlying disease. Cysts and cyst-like lesions of the jaws must be diagnosed and evaluated using radiographic findings in conjunction with clinical complaints. This case study examines the circumstances that led to the diagnosis of osteomyelitis and demonstrates several noteworthy lessons. As decortication is less invasive and more effective at treating primary chronic osteomyelitis than peripheral or segmental excision of the jaw, and the use of vancomycin as local hard and soft tissue dressing over the surgical site, we emphasize its significance.

Evaluation of healing in mandibular molar extraction sockets with and without turmeric gel.

Context: In the present era of allopathic medication usage, there is always a risk of toxicity. Turmeric is a wonderful natural herb with excellent healing properties and a plethora of many clinical trials in dentistry. Hence, this study aims to evaluate the efficacy of healing in mandibular molar extraction sockets with and without turmeric gel. Aim: This study aimed to evaluate the efficacy of turmeric gel with the objective of analyzing the soft tissue healing in mandibular molar extraction sockets with and without turmeric gel. Settings and Design: The split-mouth study design with randomization of the sites was done using the sequentially numbered opaque sealed envelope (SNOSE) in the same patient indicated for bilateral lower molar extraction. A total of 50 patients were included in the study, who were divided into group A, 25 patients in the experimental site using turmeric gel, and group B, 25 patients in the control site without turmeric gel. Materials and Methods: Turmeric in the form of gel was used in the experimental site to evaluate its efficacy in soft tissue healing of the mandibular molar extraction socket. The extraction sites of the same patient were evaluated for soft tissue healing on postoperative day 1, day 7, and day 21 using Landry, Turn Bell, and Howley scale. Statistical Analysis: A comparison of soft tissue healing between group A and group B, which showed a consequential difference in group A on day 7 with P = 0.001 and day 21 with P = 0.001, was significant. Results: Results revealed postoperative day 1 showed a significant beginning of healthy granulation tissue formation in both the groups. There was a consequential difference in soft tissue healing in group A on postoperative day 7 and day 21 as compared to group B. The turmeric in the form of gel proved to enhance the soft tissue healing in the mandibular molar extraction socket. Conclusions: The present study revealed that enhanced soft tissue healing of the extraction socket of the mandibular molar was present in the turmeric gel group on postoperative day 7 and day 21 than in without the turmeric gel group.

Comparison of the C-Reactive Protein Level and Visual Analog Scale Scores between Piezosurgery and Rotatory Osteotomy in Mandibular Impacted Third Molar Extraction.

This study aimed to compare the C-reactive protein level and visual analog scale scores of piezo- and rotatory-based surgical extraction of the third molar. As a split-mouth study, the comparative groups consisted of 25 patients, each of whom underwent surgical removal of the third molar by piezo on one side and rotatory bur on the other side. C-reactive protein levels were quantitatively assessed (enzyme-linked immunosorbent assay) before and immediately post-extraction. The immediate postoperative blood sample (baseline) C-reactive protein levels were compared with 24 h and 72 h post-op samples, both within and between the groups. Pain was assessed using the visual analog scale at 24 h and 72 h post-operatively. The C-reactive protein levels were lower in the piezo group than in the rotatory group, although the difference was not significant (p > 0.05). The visual analog scale score was significantly (p < 0.01) lower in the piezo group than in the rotatory group. The C-reactive protein levels increased in both the rotary and piezo groups from the pre-op to the immediate post-op value, but in the piezo group, the levels dropped back after 24 h. On the contrary, in the rotatory group, the C-reactive level kept increasing until 24 h; the visual analog scale score dropped significantly from 24 to 72 h for both the rotatory and piezo groups. Surgical techniques that could spare the surrounding soft tissues, such as the piezo, could aid in reducing overall postoperative morbidity.

Comparison of TORS with Conventional Surgery for Oropharyngeal Carcinomas in T1-T4 Lesions.

OBJECTIVES: Transoral Robotic Simulation (TORS) is an innovative surgical technique indicated for resection of selected head-and-neck cancers. The authors conducted a systematic review discussing the indications, advantages, and disadvantages of this technique. DATA SOURCES: The search included MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, COCHRANE, and bibliographies of relevant studies through January 2006. MATERIALS AND METHODS: Studies included patients treated for T1-T4 stage oropharynx cancer with TORS. Study retrieval and data extraction were conducted in duplicate and resolved by consensus. Treatment specific details, as well as recurrence, survival, and adverse events, were collected. Methodological quality for each study was appraised. RESULTS: Nine studies were included which met the inclusion criteria. Patients receiving TORS required adjuvant radiotherapy (26%) or chemoradiotherapy (41%). Two-year overall survival estimates ranged from 82% to 94% for TORS. CONCLUSION: The minimally invasive transoral robotic simulation (TORS) for the treatment of oropharyngeal cancers is proved to be less time-consuming, compliant to the patients, and having less complications as compared to the more invasive techniques involving conventional surgery although the quality of this evidence is limited.

Odontome, Cyst, Impacted Tooth, and Space Infection in a Single Patient: All-in-One Diagnostic Dilemma.

This case report analyzes the clinical and radiographic features of odontogenic infection with underlying pathology. Systematic approach leads to narrow the differential diagnosis on the basis of exclusion. This results in correct diagnosis, proper treatment, and avoiding unnecessary treatment. This case report highlighted an unusual case of odontogenic infection involving adjacent fascial spaces with underlying pathology which was mimicking a cyst, tumor, and odontome. Systematic approach helped us achieve accurate diagnosis, treatment, and avoiding complications.

Piezosurgery Versus Conventional Method Alveoloplasty.

PURPOSE: Conventional alveoloplasty procedure using manual instruments results in higher resorption of the residual alveolar ridge, which is unsuitable for denture construction. The purpose of this study was to evaluate the effect of piezosurgery-assisted alveoloplasty using minimally invasive technique compared to that of the conventional technique. MATERIALS AND METHODS: This was a comparative in vivo study. The study sample consisted of 35 edentulous patients with bilateral bony spicules requiring alveoloplasty. The primary outcome variables assessed were time required for alveoloplasty, postoperative pain using visual analogue scale (VAS), and postoperative healing using Landry, Turnbull, and Howley healing index. The differences between the outcome variables were statistically analyzed using paired t-test. RESULTS: The participants consisted of 35 patients (25 men and 10 women; age range: 38-83 years) diagnosed with bilateral bony spicules on the edentulous alveolar ridge. There was a statistically highly significant difference between both groups with respect to the outcome variables such as time required, VAS at 2nd day, and healing index at 7th day with higher mean of time required (in sec), higher mean of VAS, and lower healing index for conventional group as compared to piezo group (P < 0.05). CONCLUSION: Alveoloplasty done using piezosurgery not only reduces patient's postoperative discomfort but also maintains the alveolar bone integrity by not disturbing the soft-tissue and hard-tissue architecture, allowing faster healing of tissues, which makes the future prosthesis replacement easier.

Evaluation of Efficacy of Intraligamentary Injection Technique for Extraction of Mandibular Teeth-A Prospective Study.

INTRODUCTION: Fear of dental pain is one of the most common reasons for delaying dental treatment. Local Anaesthesia (LA) is the most commonly employed technique of achieving pain control in dentistry. Pterygomandibular Nerve Block (PNB), for achieving mandibular anaesthesia has been the traditional technique used and is associated with a few set of complications which include pain, nerve injury, trismus, and rarely facial nerve palsy, and sustained soft tissue anaesthesia. These complications have resulted in a rapid need for research on alternative local anaesthetic techniques. AIM: This study was undertaken with the objective to determine pain, duration, profoundness and complications associated with administration of Intraligamentary Injection Technique (ILT). MATERIALS AND METHODS: This study was conducted on 194 patients (male=122, female=72) who reported for dental extractions in mandibular posteriors. The ILT was administered with ligajet intraligamentary jet injector using cartridge containing lignocaine hydrochloride 2% with adrenaline 1:80000 and a 30 gauge needle at buccal (mesiobuccal), lingual, mesial and distal aspect of the mandibular molars. The data was analyzed by using statistical computer software SPSS 11.0 (Statistical package for social sciences 11.O version of SPSS Inc.). Median was derived for Pain on Injection (PI) and Pain during Procedure (PP). Mean and standard deviation was derived for Duration of Anaesthesia (DA). RESULTS: Various advantages were seen such as, localized soft tissue anaesthesia, decreased PI (SD=0.83), and minimal PP (SD=0.94). The DA (SD=4.62) and mean value of 24.06 minutes. CONCLUSION: This study is one of its kinds where intraligamentary injection has been used for extraction of mandibular molars. It was also successfully used in patients with exaggerated gag reflex and patients suffering from trismus due to oral submucous fibrosis. The intraligamentary injection technique can thus be used effectively to anaesthetize mandibular molars, as a primary technique for extraction of mandibular posterior teeth.

Comparative Evaluation of Preemptive Analgesic Effect of Injected Intramuscular Diclofenac and Ketorolac after Third Molar Surgery- A Randomized Controlled Trial.

INTRODUCTION: Analgesia pre-emptively administered effect-ively aid in management of pain. Pre-emptive analgesia is anti-nociceptive treatment which prevents altered central sensitization of afferent inputs. AIM: To compare and evaluate the pre-emptive analgesic efficacy of preoperatively administered ketorolac and diclofenac for controlling postoperative pain after third molar surgery. MATERIALS AND METHODS: A total of 50 patients with symmetrically impacted third molars were divided into two groups, 30mg intramuscular injection of ketorolac and 75 mg diclofenac sodium were used in the respective groups. The visual analogue scale was used to assess post operative pain for three days and the patients were also evaluated for the number of rescue analgesia. RESULTS: The data was statistically evaluated with paired t- test. The maximum time taken for pain perception for Group A Ketoralac was 5.48 hrs and Group B Diclofenac sodium was 4.9 hrs and p=0.235 which was not significant. The mean number of tablets taken by the patients in the first three post operative days was 3.24 in Group A i.e., Ketorolac and 4.04 in Group B i.e., Diclofenac sodium. The values were compared using the paired t test. The p value = 0.004, which was significant. CONCLUSION: Ketoralac showed better pre-emptive analgesic effect for post-operative pain management after third molar extraction. The immediate post-operative pain free period provided by both ketorolac and diclofenac by intramuscular route was same.

C-reactive protein estimation: a quantitative analysis for three nonsteroidal anti-inflammatory drugs: a randomized control trial.

CONTEXT: C-reactive protein (CRP) estimation for quantitative analysis to assess anti-inflammatory action of nonsteroidal anti-inflammatory drugs (NSAIDs) after surgery in maxillofacial surgery. AIMS: This study was to evaluate the efficacy of CRP as a quantitative analysis for objective assessment of efficacy of three NSAIDs in postoperative inflammation and pain control. SETTINGS AND DESIGN: The parallel study group design of randomization was done. Totally 60 patients were divided into three groups. CRP was evaluated at baseline and postoperatively (immediate and 72 h) after surgical removal of impacted lower third molar. The respective group received the drugs by random coding postoperatively. SUBJECTS AND METHODS: The assessment of pain control and inflammation using NSAIDs postoperatively after surgical removal of impacted lower third molar was qualitatively and quantitatively assessed with CRP levels. The blood sample of the patient was assessed immediate postoperatively and after 72 h. The visual analog scale (VAS) was used for assessment of pain and its correlation with CRP levels. STATISTICAL ANALYSIS: Comparison of difference in levels of CRP levels had P < 0.05 with immediate postoperative and baseline levels. The duration of surgery with association of CRP levels P = 0.425 which was nonsignificant. The pain score was increased with mefenamic acid (P = 0.003), which was significant on VAS. RESULTS: Diclofenac had the best anti-inflammatory action. There was a significant increase in CRP levels in immediate postoperative values and 72 h. CRP test proved to be a useful indicator as a quantitative assessment tool for monitoring postsurgical inflammation and therapeutic effects of various anti-inflammatory drugs. CONCLUSIONS: CRP test is a useful indicator for quantitative assessment for comparative evaluation of NSAIDs.

Extensive giant cell tumour of the mandible: a case report with review.

Giant Cell Tumour (GCT) is a rare benign, osteolytic, pseudocystic solitary localized lesion. The lesion is common in skeletal structure but not as common in craniofacial skeleton. They are composed of sinusoidal and vascular spaces filled with blood and surrounded by fibrous tissue septa. There is a controversy as to whether it is a distinct radiological and pathological entity or a pathological change superimposed on a preexisting lesion. We present a case of a 19 year old female patient who reported with swelling and pain in the right mandible associated with pain and gradual increase in size since 4 years. On the radiographic study expansive, multilocular lesion extending to right coronoid process was observed. Incisional biopsy showed the lesion to be a dental cyst, however, enucleation with curettage of the cyst confirmed it to be GCT. GCT are non neoplastic but locally aggressive tumors with occasional rapid growth that may be differentiated from other multilocular lesions like ameloblastoma, giant cell granuloma and sarcomas. There have been reports which have appeared regarding its pathogenesis, response to treatment. However many questions remain regarding its treatment and prognosis.