Lingual Nerve Injury During Impacted Mandibular Third Molar Surgery.

OBJECTIVE: To determine the frequency of lingual nerve injury (LNI) during the surgical removal of mandibular third molar and the associated risk factors. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ayub Teaching Hospital, Abbottabad, from January to June 2021. METHODOLOGY: A total of 121 patients were included in this study who had undergone impacted third molar surgery. Data were collected on a proforma via interview. Patients were followed up after 1 week, 1 month, and 3 months of duration. Frequency of LNI and its association with various surgical procedure steps were determined. RESULTS: This study shows that out of 121 patients, frequency of LNI was found to be 3.3% (n=4). The type of impaction (p=0.047), lingual flap retraction (p<0.001), tooth splitting (p=0.029), and longer duration of surgery were found to be significantly associated with it. CONCLUSION: The frequency of LNI during mandibular impacted third molar surgery was 3.3% in this study, and significantly associated with horizontal impaction, lingual flap retraction, tooth splitting, and duration of surgery longer than 30 minutes. KEY WORDS: Lingual nerve injury, Tooth, Impaction, Third molar, Lingual flap retraction, Tooth splitting.

Frequency Of Developmentally Malformed Permanent Maxillary Lateral Incisors In Patients Visiting The Three Teaching Dental Hospitals Of Peshawar.

BACKGROUND: The permanent maxillary lateral incisor (PMLI) shows morphological variations, in the form of different crown shapes such as peg-shaped, cone-shaped, barrel-shaped and canine-shaped. The frequency of developmentally malformed permanent maxillary lateral incisors varies among different populations. The aim of this study was to document the frequency of different shapes of developmentally malformed permanent maxillary lateral incisors in patients visiting the three teaching dental hospitals of Peshawar. METHODS: It was a cross-sectional study conducted in the Oral Diagnosis department of Peshawar Dental College, Sardar Begum Dental College, and Khyber College of Dentistry from 1st Sep 2018 to 15th June 2019. A total of 82 subjects were included that fulfilled the inclusion criteria. Shape of the malformed PMLI was determined using Computer-aided design/Computer-aided manufacturing software. Descriptive statistics including frequencies and percentages for observed developmental malformation and their types were computed and Chi-square test was applied to see the relation between various shapes and their occurrence with respect to site and position within the jaws. RESULTS: The peg shaped PMLI was seen in 81 (98.87%) patients and barrel shaped was present in 1 (1.22%) patient. The malformed PMLIs was found to be unilateral in 38 (46.3%) and bilateral in 44 (53.7%) patients, with more common presence on both sides 44 (53.7%) followed by right side 20 (24.4%) and left side 18 (22.0%). CONCLUSIONS: The subjects having predominant developmental malformation in case of permanent maxillary lateral incisor was peg-shaped permanent maxillary lateral incisor.

Association Between Trigeminal Neuralgia And Unnecessary Tooth Extraction.

BACKGROUND: Trigeminal neuralgia is a very painful condition which is presented as severe pain corresponding to spastic shock. This is caused by trigeminal nerve's vascular compression at root entry zone. The pain is induced due to ipsilateral neurovascular conflict. In spite of the condition being known since centuries, it still continues to frustrate the clinician and its pathogenesis remains as enigma to the medical profession. It is very common for these patients to undergo unnecessary dental extraction without any relief in pain. This study was conducted to assess the association between trigeminal neuralgia and unnecessary tooth extraction. METHODS: This was a cross-sectional study conducted between January 2017 and July 2019 in the Department of Dentistry of Ayub Teaching Hospital, Abbottabad. A total of fifty-three cases with Trigeminal neuralgia were included. All the patients were evaluated by history, clinical examination and local anaesthetic injection. RESULTS: Fifty-three Trigeminal neuralgia cases were enrolled in this study; out of which 22 cases (41.5%) were males and 31cases (58.5%) were females. Mean age of all the patients was 53.90 years. Twenty-nine patients (54.7%) had their right side involved, while the left side was involved in 23 patients (43.4%). In only one case (1.9%) there was bilateral involvement. Regarding tooth extraction unnecessary extraction were reported by 25 (47.1%) patients before they were diagnosed to have trigeminal neuralgia. The Maxillary first Premolar was the most common tooth extracted. CONCLUSIONS: Trigeminal neuralgia is one of the most severe painful condition of the maxillofacial region which can confuse the patient and the Dentist with toothache. Patient should be evaluated in detail to rule out trigeminal Neuralgia before tooth extraction.

Clinico-radiographic study of odontogenic cysts at a tertiary care centre.

BACKGROUND: Cysts of the jaws constitute an important pathology in the oral and maxillofacial region and are broadly classified as odontogenic and non-odontogenic. Objective of this study was to document the clinical and radiographic presentation of odontogenic cysts at a tertiary care centre. METHODS: In this descriptive case-series, patients presenting with features of suspected cystic lesions of the jaws were investigated using radiographs and incisional biopsy. Subjects showing clinico- radiographic features of odontogenic cyst(s) with subsequent confirmation on histopathological examination were included. RESULTS: A total of 112 subjects were investigated for suspected jaw cysts and cystic diagnosis of odontogenic cysts was confirmed in 100 patients with 53 males (53%) and 47 females (47%). The age range of patients was from 12-55 years. Radicular cyst was the most commonly diagnosed odontogenic cyst (63%) followed by dentigerous cyst (22%) and odontogenickeratocyst (14%). Anterior maxilla was the most affected site (44%) followed by posterior mandible (30%). CONCLUSION: Odontogenic cysts constitute an established pathology affecting the jaws with varying frequency. This study augments the data cited from Western countries and re-emphasizes the need for early diagnosis and prompt management. It also highlights the differences in the presentation of odontogenic cysts as observed in the current series.

Presentation of maxillofacial injuries in the 2005 earthquake victims.

BACKGROUND: Earthquakes cause a lot of damage to life and property. Maxillofacial injuries constitute an important proportion of injuries in earthquakes and some 13% of the trauma patients after the earthquakes suffer from maxillofacial injuries. The objective of this study was to assess the presentation of maxillofacial injuries in earthquake victims. METHODS: This descriptive study was conducted at the Department of Oral and Maxillofacial Surgery, Dental Section Ayub Teaching Hospital. Abbottabad from October 8th, 2005 to January 8th, 2006. Three hundred and seventy-eight patients were included in this study in the three months following the October 8th, 2005 earthquake on consecutive nonprobability sampling basis. RESULTS: Isolated facial bone fractures rather than the multiple bone fractures were the commonest type of fractures in earthquake victims. A significant number of patients presented with only soft tissue injuries and no bony fractures. CONCLUSION: Although considerable number of patients with fracture of multiple facial bones were present in the earthquake victims but isolated facial bone fractures and soft tissue injuries were the commonest type of injuries.

Spectrum of trigeminal neuralgia.

BACKGROUND: Trigeminal neuralgia (TN) is a very painful condition characterized by paroxysmal shock like pain in the distribution of one or more branches of trigeminal nerve caused by neurovascular conflict at the root entry zone of trigeminal nerve. This study was conducted to analyse the demography and pattern of TN in our setup. METHODS: This descriptive study was conducted in the Oral Surgery unit, Department of Dentistry, Ayub Medical College. Abbottabad, from April 2009 to October 2011. A total of 117 patients were included in study by convenience (non probability) sampling technique. All the patients presenting with the clinical features of TN were included in study. RESULTS: Out of 117 cases, 49 (41.9%) were males and remaining 68 (58.1%) were females. Age of the patients ranged from 32-72 (53.90 +/- 10.21) years. Right side was involved in 63 patients (53.8%), while the left side was involved in 51 patients (43.60). In only three cases (2%) there was bilateral involvement. The maxillary division was involved in 68 cases (58.1%) and mandibular division was involved in 37 cases (31.6%). The most common site of involvement was infra-orbital, which was involved in 68 cases (58.11%). The next common site was the mental nerve which showed involvement in 35 cases (29.9%) followed by inferior alveolar nerve which was affected in 14 cases (12%). Thirty three (28.2%) patients were having mild pain. 54 (46.2%) patients having moderate, 21 (18%) patients with severe and 9 (7.7%) patients were having very severe pain. No patient in our study had a family history of TN. Among our patients 103 (88%) patients underwent dental extraction for the same pain. CONCLUSION: The incidence of TN is more in old age especially in females. TN is frequently misdiagnosed in with tooth ache, so there is need to educate the medical practitioners and masses in order to avoid un-necessary tooth extractions.

Paradigm in aetiology and management of zygomatic complex fractures in Pakistan.

OBJECTIVE: The purpose of this study was to compare the outcome of wire osteosynthesis with bone plating in the management of zygomatic complex (ZMC) fractures. The rationale was to enable the oral and maxillofacial surgeon to select either of the treatment procedure with confidence. METHODS: In this quasi experimental study, Sixty five patients of ZMC fractures were randomly allocated in groups of bone plating and wire osteosynthesis. This was done through envelope draw method. Three points fixation with either of the treatment modality was undertaken. Titanium bone plating or stain less steel wire osteosynthesis was carried out at frontozygomatic suture, infra orbital rim and at zygomaticomaxillary buttress. RESULTS: In this quasi experimental study, three patients failed to follow up. There were 31 patients in each group. Infra orbital step defect was observed in one patient of wire osteosynthesis and two patients of bone plating. Mild facial deformity was observed in two patients of wire osteosynthesis while none in that of bone plating. CONCLUSION: There is insignificant difference of proportion of infra orbital step defect and facial deformity between wire osteosynthesis and bone plating.

Root resorption of permanent incisors during three months of active orthodontic treatment.

BACKGROUND: Root resorption is one of the most common and undesirable sequelea of orthodontic treatment. The aim of this study was to evaluate the amount of root resorption in permanent incisors during 3 month active period of fixed orthodontic appliance therapy using periapical radiographs. METHODS: Periapical radiographs of a total of 138 permanent teeth (n = 138, mandibular n1 = 52, maxillary n2 = 86) were evaluated for root resorption. All patients were treated with 3M MBT multi-bonded, pre-adjusted appliances with 0.022 inch slots. Initial levelling and alignment was achieved with 0.0175 inch co-axial wires. All four incisors (maxillary and mandibular) were measured for any change in root length. The change in root length between T0 (pre-treatment) and T1 (post-treatment) was measured in millimetres and expressed in terms of percentage of original root length. RESULTS: The mean pre treatment (T0) root length for the maxillary teeth (n1 = 62) was 19.27 +/- 2.86 mm and 20.01 +/- 2.57 mm for the mandibular teeth (n2 = 31). The post-treatment (T1) root length for the maxillary teeth was 18.96 +/- 2.85 mm and 19.49 +/- 2.4 mm for the mandibular teeth showing a mean resorption of 0.31 mm and 0.52 mm for the maxillary and mandibular teeth respectively. CONCLUSION: Root resorption was strongly correlated with active orthodontic appliance therapy with maxillary and mandibular incisors being most susceptible. It was found that root resorption can be detected even in the early levelling and alignment stages of orthodontic treatment.

Demographic distribution of maxillofacial fractures in Ayub Teaching Hospital: 7-year review.

BACKGROUND: This retrospective study was carried out to determine the demographic distribution of Maxillofacial Fractures (MFF) in patients reported to Maxillofacial Surgical Unit, Ayub Teaching Hospital, Abbottabad from 2001 to 2007. METHODS: All the patients having a history of maxillofacial fractures were included according to age, gender distribution and risk factors. Isolated Nasal fractures, Naso-Orbito-Ethmiodal complex fractures and earthquake victims were excluded from this study. RESULTS: This study encompassed a total numbers of 952 patients. Males were 645 (67.8%) and females were 307 (32.2%) with male to female ratio 2.1:1. Most of the fractures occurred during third decade of life. The most common risk factor was Road Traffic Accident (RTA) n=70 (38.9%). Most of the fractures were occurred during the month of June, July and August. CONCLUSION: RTA is still the most common risk factor of maxillofacial fractures and is more common in male.

Traumatic injuries of the permanent maxillory incisors at Dental Department, Pakistan Institute of Medical Sciences Islamabad: a retrospective study.

BACKGROUND: The study aims to ascertain the prevalence of traumatic dental injures of the maxillary permanent incisors at Dental Department, Pakistan Institute of Medical Sciences Islamabad during the years 2003-2005. Information concerning age, sex, cause, type of tooth, number of injured teeth and patterns of tooth injury were recorded retrospectively from 336 patients aged between 8-40 years, comprising 498 traumatized teeth. METHODS: The dental records of all the patients presenting with dental trauma were examined for collection of data relating to age, sex, cause, number of injured teeth, type of tooth and type of tooth trauma. Type of tooth trauma was recorded according to the Andreason classification. The data was subsequently processed and analyzed using the SPSS statistical software programme. The statistical significance level was set at 5%. RESULTS: Of the 336 patients, 227 were males (67.6%) and 109 were females (32.4%). The gender difference was statistically significant (p < 0.0001). The patients had a total of 498 traumatized teeth. A large number of dental trauma occurred in patients aged between 9-11 years. Most injuries involved one tooth in 227 patients (67.6%). However two teeth in 90 patients (26.7%), three teeth in 11 patients (3.2%) and only in 8 patients (2.3%) four teeth were involved. Fractures in enamel only occurred in 74 teeth (14.6%). Uncomplicated crown fractures in 208 teeth (41.9%) were the most commonly encountered dental trauma. 137 teeth (27.6%) suffered complicated crown fractures, 44 teeth (8.9%) uncomplicated crown-root fractures, 19 teeth (3.8%) complicated crown-root fractures and avulsion in 16 teeth (3.2%) only. The main causes were falls in 225 patients (66.9%), collision with objects in 40 patients (11.9%), road traffic accident in31 patients (9.2%) violence in 21 patients (6.2%), and sports in 19 patients (5.6%). The maxillary central incisor was traumatized in 384 teeth showing a high percentage of 77%. CONCLUSION: Raising public dental awareness regarding the serious outcome of traumatic dental injuries is mandatory to improve the prognosis of dental trauma and to avoid complications.

Use of silastic as interpositional material in the management of unilateral temporomandibular joint ankylosis.

BACKGROUND: Ankylosis is a very common condition developed mainly after damage to mandibular condyles or temporomandibular joint (TMJ) at a growing age. Different autogenous and alloplastic interpositional materials have been attempted after the resection of the ankylotic bone to achieve desirable results. This condition is relatively common in Pakistan. We treated TMJ ankylosis with alloplastic medical grade silicone "silastic" interpositional arthroplasty. Eight joints accompanied ipsilateral or contralateral coronoidectomy to achieve desirable results. METHOD: All patients were presented at Punjab Dental Hospital Lahore. Sixty-one joints with unilateral TMJ ankylosis were underwent surgery after careful examination and final radiographic confirmation. The preoperative CT scan was also performed in few patients. RESULTS: The postoperative measurements of the interincisal opening with lateral and protrusive jaw movements were criteria for success of surgery. The lateral and protrusive jaw movements were assessed as excellent, good and poor. Less than 25 mm interincisal opening was considered as poor jaw opening. CONCLUSION: The overall success rate was 98.4 % with 84 % desirable interincisal jaw opening. Less than 5% patients were observed with poor jaw opening. The immediate late complications were transient and were included oedema, weakness of a branch of the facial nerve on the operated side. Two implants were infected along with one wire in the first month of surgery and were removed under local anaesthesia without further complication.

Temporomandibular joint ankylosis: experience with interpositional gap arthroplasty at Ayub Medical College Abbottabad.

BACKGROUND: Satisfactory surgical correction of temporomandibular joint ankylosis (TMA) is limited by a high recurrence rate, particularly in patients who underwent surgery without use of interpositional material. The present study describes our experience of Interpositional Gap Arthroplasty in patients presenting with primary or recurrent TMA. METHODS: The study was conducted on 12 patients presenting at the Oral and Maxillo-Facial Surgical Unit of the Ayub Medical College Abbottabad from 1999 to 2004. Interpositioning materials used included Temporalis fascia, Temporalis muscle, Silastic sheet and Cartilage (Costochondral) graft. Pre- and Postoperative assessment of temporomandibular joint (TMJ) mobility was done by clinical assessment of jaw movement and measurement of interincisal distance by vernier calipers; X-rays were done to document complications such as fibrosis and ankylosis. RESULTS: Nine of the 12 patients (75%) were new cases of ankylosis, while the remaining 3 (25%) had one, three and four prior operations. Duration of ankylosis ranged from 9 months to 12 years. Ankylosis was bilateral in 8 cases (66.7%) and unilateral in 4 cases (33.3%). Operative findings were simple bony ankylosis in 13/20 jaws (65%), soft tissue fibrosis in 4/20 jaws (20%) and massive bony growth in 3/20 jaws (15%). Preoperative interincisal distances ranged from 0-15mm; immediate postoperative distances ranged from 20-40 mm; one-month and six-month postoperative distances ranged from 25-50 mm. All patients had an uncomplicated outcome till six months follow up; one patient developed reduced mouth opening to 12 mm at one year follow up due to parental noncompliance with mouth exercises; one patient developed infection and extrusion of silastic sheet at 2.5 years follow up. CONCLUSION: Interpositional Gap Arthroplasty is a highly effective and safe surgical management option for TMA with acceptable immediate and long term outcome, particularly when temporalis fascia and muscle are used for adults and costochondral grafts with fascia interposition used for children.

Spectrum of mandibular fractures at a tertiary care dental hospital in Lahore.

BACKGROUND: Mandible being the only mobile bone of the facial skeleton plays a major role in mastication, speech and deglutition. Among the maxillofacial trauma, mandible is the high risk exponent. Its fractures result in severe loss of function and disfigurement. The increased vehicular accidents, conditions of our roads and other assaults have focused attention in recent years to prevent injuries. METHOD: A descriptive case series of 126 patients with mandibular fractures attending a tertiary referral centre over a six-month period is presented. Data concerning the patients' demographics, aetiology and pattern were obtained and analysed. RESULTS: Approximately 56% of the patients sustained fractures from road traffic accidents and 34% of the fractures occurred in the 21-30 year age range. There was a male preponderance with a male to female ratio of 9:1. Parasymphyseal fractures were the most common followed by those of the condylar and subcondylar regions. CONCLUSIONS: We need to encourage further research work in this field to provide better record keeping and quality of services to the injured people. Amendments in the traffic rules and legislation about seat-belt usage and traditional kite flying to reduce frequency of fractures are required.