PREEMPTIVE INTRAVENOUS IBUPROFEN AND LOCAL KETAMINE IMPROVE POSTOPERATIVE ANALGESIA FOLLOWING THIRD MOLAR SURGERY: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL STUDY.

OBJECTIVE: To compare the efficacy of preemptive ibuprofen, local ketamine, and their combination in managing postoperative pain and trismus following third molar surgery. MATERIALS AND METHODS: One hundred patients were randomly divided into 4 groups. The Intrafen Group had their impacted third molars surgically removed under local anesthesia after receiving intravenous (IV) ibuprofen for preemptive effect. The Ketamine Group received an IV placebo before the surgery, and the extraction process was completed with a local anesthetic-ketamine combination. The Combined Group received preemptive IV ibuprofen before the procedure, and the surgery was performed with a local anesthetic-ketamine combination. The Control Group received an IV placebo before the procedure and then had their impacted third molars removed under local anesthesia. The Visual Analogue Scale (VAS) values, corresponding to the patients' pain levels at the 2nd and 12th postoperative hours and the total amount of analgesic dose used in the first 24 hours, were recorded, and evaluated. The maximum mouth opening of the patients was measured immediately before the procedure, and on the second and seventh postoperative days. The level of patient satisfaction in all groups was assessed during the procedure. RESULTS: The mean VAS value corresponding to the second-hour pain level of the combined group was statistically significantly lower than the other groups (P = .003). A statistically significant difference was found in the mean VAS values corresponding to the pain levels of the groups, favoring the combined group compared to the other groups (P ≤ .001). A significant difference was observed between the VAS difference values corresponding to the pain levels of the Intrafen group and the Ketamine group, favoring the Intrafen group (P = .038). The Ketamine group consumed the most analgesic on average over the first 24 hours, whereas the Combined group consumed the least. No statistically significant difference was found between the mean trismus levels of the groups on days 0-2 (P = .528) and days 0-7 (P = .129). The intraoperative patient satisfaction level of the combined group was significantly higher than that of the other groups (P = .030). CONCLUSION: Preemptive Intrafen is an effective regimen for postoperative pain management and is superior to the local anesthetic-ketamine regimen. The most effective method to reduce postoperative pain following third molar surgery is to use a combination of these 2 regimens. However, none of the treatment methods used in the study had a positive effect on postoperative trismus.

The evaluation of nasolacrimal duct injury in Le Fort I osteotomy patients / Evaluación de la lesión del conducto nasolagrimal en pacientes con osteotomía Le Fort I

Background: Although Le Fort I surgeries are safe and successful procedures; nasolacrimal duct injuries may be observed due to these surgeries. The study aimed to investigate the prevalence of nasolacrimal duct injury in Le Fort I osteotomy patients. Material and Methods: The authors conducted a retrospective cohort study consisting of patients who underwent Le Fort I osteotomies between 2017 and 2021 in the Erciyes University Faculty of Dentistry. The primary predictor variables were the distance of the nasolacrimal canal to the outer cortex of the maxilla and the nasal floor, as well as the superior-inferior level of the superiorly positioned screw inserted in the maxilla aperture region relative to the nasolacrimal canal. The outcome variable was the presence of a nasolacrimal duct injury. Mann Whitney U test was used for quantitative variables between the two groups. A Pearson chi-squared analysis was used to compare categorical data. A p-value <0.05 was considered statistically significant.Results: A total of 290 nasolacrimal canals were evaluated in 145 patients, 87 females, and 58 males. The mean age was 23.47± 6.67. There was a statistically significant relationship between screw level and nasolacrimal canal perforation (p<0,001). The distance between the most anterior border of the nasolacrimal canal and the outer cortical of the maxilla was significantly less in the perforation group (p<0,001). The fixation screw was significantly closer to the nasolacrimal canal in the perforation group (p<0,001). Conclusions: In Le Fort I surgery, nasolacrimal duct injury may occur during screw fixation to the aperture region. Superiorly positioned fixation screws in the aperture region may damage the nasolacrimal canal. In patients where the nasolacrimal canal is close to the outer cortex, care should be taken when applying the fixation screws to the aperture region to avoid damaging the canal.(AU)

Which method is successful in closureof acute oroantral communication? A retrospective study / ¿Qué método tiene éxito en el cierre de la comunicación oroantral aguda? Un estudio retrospectivo

Background: This study's purpose is to retrospectively evaluate the success of surgical methods used in treatingOroantral Communication (OAC).Material and Methods: This study was designed as a retrospective cohort study on patients who developed OACafter surgery maxillary posterior region. The records of patients previously treated with OAC were scannedthrough the hospital registry software. A data set was created by recording patients' age, gender, systemic dis-ease, etiological reasons, and surgical methods. The primary predictor variable was the surgical method usedto treat OAC. Other variables were age, gender, systemic disease and etiological reasons. The primary outcomewas oroantral fistula development after the first surgical intervention. The patients who were positive in clinicalexamination and Valsalva test on control days were considered unsuccessful. One-way analysis of variance andKruskal-Wallis tests were used for quantitative variables in more than two groups. Pearson chi-square test wasused to compare categorical data.Results: This retrospective cohort study was completed with 605 patients who met the study criteria among 95,883patients who underwent surgery in the maxillary posterior region. The incidence of OAC was 0.63%. The patientsconsisted of 238 female and 367 male patients. The mean age was 41.06±14.48 years. Buccal flap and Buccal FatPad methods were used most frequently in the treatment. While treatment was completed with the first surgicalintervention in 592 (97.85%) patients, OAF developed in 13 (2.15%) patients. No statistically significant relationexisted between surgical technique and OAF development (p>0.005). The success rate of the Buccal Flap methodwas 98.7%, and the Buccal Fat Pad method was 95.8%.(AU)

Risk Factors Influencing Recovery of Neurosensory Disturbances Following Sagittal Split Ramus Osteotomy.

PURPOSE: The aim of this study is to determine the risk factors influencing the recovery time of neurosensory disturbances (NSD) following sagittal split ramus osteotomy. METHODS: One hundred twenty-seven patients (254 operated sites) underwent sagittal split ramus osteotomy due to dentofacial deformities between the period of 2011 and 2017. These patients were followed up for at least 1 year, and the data obtained from changes in sensation of inferior alveolar nerve were recorded subjectively. The subjects were categorized according to age, gender, type of deformity, nerve manipulation, side of the jaw, and the amount of the mandibular movement. The relationship between the above-mentioned parameters, and the recovery time of NSD were investigated. Pearson χ analysis was used, and the value of significance was accepted as P < 0.05. RESULTS: The recovery time of NSD is significantly correlated with the age of the patients, the amount of the mandibular movement (>7 mm), and the nerve manipulation (P < 0.05). There was no statistically significant correlation found between the recovery time of NSD and gender, type of deformity, side of the jaw (P > 0.05). CONCLUSIONS: The recovery time of NSD may prolong in cases of large amounts of mandibular movements more than 7 mm or the nerve manipulation. The older age may increase the risk of permanent NSD.

Anterior mandibular zone safe for implants.

During implantology procedures, one of the most serious complications is damage of the inferior alveolar nerve (IAN). The mandibular incisive nerve is described as a terminal branch of the IAN and provides innervation to the lower anterior teeth and canines. The incisive nerve and canal are located in the interforaminal area. Although numerous studies report IAN damage during implant placement, few reports in the literature describes sensory disturbances, such as neuropathic pain, related to mandibular incisive nerve damage. The purpose of this retrospective clinical study was to evaluate the risk of neuropathic pain caused by implant placement in the interforaminal region of the mandible. Panaromic radiographs of patients who were treated with dental implants in the Department of Maxillofacial Surgery, Faculty of Dentistry at Erciyes University, between 2007 and 2012, were examined. Fifty-five patients with suspected relationship between mandibular incisive canal and dental implant were included into this study. Computed tomography scans were obtained from 10 patients who have postoperative neuropathic pain. Relationship between dental implant and mandibular incisive nerve was evaluated using a three-dimensional software program. Mandibular incisive nerve perforation by at least 1 implant was observed in all 10 patients. Descriptive analyses were also provided. Neuropathic pain may occur after implant placement in the interforaminal region due to the perforation of the incisive canal and nerve. According to the results of this retrospective study, the incisive canal and nerve perforation should be considered as a complication of implant surgery in the mandibular anterior area.