Glass particle injury to the maxillofacial region.

A retrospective study was carried out wherein 10 patients with glass particle injury reporting to the Department of Oral and Maxillofacial Surgery between January 2011 and March 2012 were included. Preoperative photographs and radiographs were done, and detailed surgical planning followed. Ninety percent of the patients were males with involvement of the right side of the face in 70% of the cases. The most common presenting symptom was patient sensation, which was the reason for availing delayed treatment in 70% of cases, followed by delayed or fibrotic healing (20%) and pain (10%). The diagnosis and planning were done based on computed tomographic scan (50% cases), plain radiographs (30%), needle as tactile aid (10%), and palpation (10%). Eighty percent of cases were diagnosed/presented late. The timely diagnosis of glass particle injuries requires a high degree of suspicion for the same. A systematic diagnosis and treatment planning for such injuries can minimize the morbidity and prevent such injuries from being overlooked at time of primary injury.

Camel bite injury to the maxillofacial region: unusual cause and uncommon location.

Animal bite injuries are prevalent worldwide, but the causative animal and the spectrum of injuries are dependent on the kind of animals cohabitating with the human population. Camel bites as a cause are relatively rare. Camels are particularly aggressive, especially during the mating season, when conflicts between the males occasionally lead to dangerous fights resulting in the death of one or both of the combatants. We present a case of camel bite injury to the maxillofacial region inducing an uncommon fracture and the management of both soft and hard tissue injuries, especially addressing the literature for this uncommon bite injury. Because of the unique mode of injury, the ramus was horizontally fractured and displaced. The fracture was also compound because of the deep intraoral bite wounds. The ramal fracture itself is a rare entity. The issue of primary or delayed closure in such cases is addressed.

The Clinical Efficacy of EMLA as a Topical Anesthetic Agent Instead of Palatal Injection During Maxillary Dental Extractions: A Randomized Controlled Trial.

Background: Even after the invention of the modern injection techniques, palatal injection still remains a painful experience for patients, and this pain is attributed to the presence of rich nerve complement and displacement of tightly adherent palatal mucosa during anesthesia. Aim: To check the clinical efficacy of EMLA as a topical anesthetic agent instead of palatal injection during maxillary dental extractions. Methodology: The trial includes a total of 102 participants, in whom maxillary molar extractions were indicated, were randomly divided into the experimental group (eutectic mixture of local anesthesia (EMLA) topical application was used along with buccal injection) and control group (palatal injection along with buccal injection). Pain perception during extraction was recorded using the visual analog scale (VAS). Results: Mean VAS score for 'injection' in control group patients was 5.2 ± 2.08 in contrast to no pain in experimental group. In experimental group, mean VAS score on 'probing' was 0.92 ± 1.50. VAS score on 'extraction' in EMLA group was little higher though the difference was not statistically significant. The overall experience using Liekert's scale was higher in experimental group (4.0 ± 0.76) as compared to (3.3 ± 0.82) in control group leading to higher overall satisfaction among patients who underwent extraction in the experimental group. Conclusion: EMLA application produced a satisfactory level of anesthesia in the palatal tissue when compared with the palatal injection.

Quality of Life in Oral Submucous Fibrosis: A Systematic Review.

Backgrounds: Oral submucous fibrosis (OSMF) is a chronic, insidious disease and is said to have a multifactorial origin with varied clinical manifestation of repeated oral ulcers, intolerance to spicy food, mucosal blanching resulting in stiffness of the oral mucosa and formation of taut bands leading to reduced mouth opening. We designed this study to systematically review the literature on QOL in OSMF and hope to make recommendations for future course of QOL assessment in OSMF. Methods: An electronic bibliographic search of studies was done from year 1900-2019 using specified keywords. The following databases were searched: PubMed, Ovid, Google Scholar and manual search were done from references of relevant articles. Of the screened 156 articles, finally 10 studies were included after screening for inclusion/exclusion criteria. Quality assessment of studies was completed using the Effective Public Health Practice Project (EPHPP) criteria for quantitative studies. Results: Most instruments used in the studies were not disease specific for OSMF except one study. Six types of questionnaires were used. The heterogeneity in study population, study designs, QOL instruments and outcome measures made it difficult for a comparison. Therefore, a quantification analysis was not possible. Also pure OSMF data without the involvement of other lesions were less in number. Conclusions: OSMF not only physically debilitates a patient, it has its repercussions on the social, physical, psychological domains as well. Another aspect is that apart from trismus, which is the most common and evident symptom associated with OSMF, a substantial part of the suffering that ensues is also because of the ulcerations, burning sensation and worsening of dental health. Another focus was the association of worse QOL with a higher grade of disease, longer and higher tobacco abuse contact duration. This review is unable to give a confident answer to the evidence on QOL in OSMF but definitely showers light on the evident lack of robust data on the same. Robust Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation methodological and adequately powered studies on assessing QOL in OSMF using only a reliable disease specific questionnaire is the need of the hour. Clinical Trial Registration: PROSPERO Registration: CRD42018102874.

Primary Oral Mucosal Melanoma: A Case Series.

Mucosal melanoma is an exceedingly rare and aggressive neoplasm with high mortality rate. In contrast to the cutaneous melanomas, the risk factors and pathogenesis are poorly understood. It is predominantly localized in the region of the hard palate and maxillary alveolus. Surgery is the mainstay of treatment, but it may turn out to be challenging depending on the anatomic location, extent and size of the tumor and presence of metastasis. Presented here is a series of two cases of maxillary mucosal melanoma with varied presentation.

2.5% EMLA Versus 2% Lignocaine with Adrenaline Injection in Small Oral Mucosal Biopsies: A Parallel Group Randomized Controlled Trial.

TRIAL DESIGN: The study was designed as an open label randomized comparative parallel group design with a 1:1 allocation ratio. METHODS: All consecutive patients reporting for small biopsies (incisional or excisional) who gave written informed consent were included in the study between October 2018 and October 2019. They were randomized into two groups, Group A and Group B both receiving intervention in the form of 2.5% EMLA cream and 2% Lignocaine with 1:80,000 Adrenaline injection respectively, to anaesthetise tissue for small mucosal biopsies in the oral cavity. RESULTS: EMLA was found to be as effective as lignocaine infiltration with a completely painless application and higher satisfaction for overall comfort during procedure. The duration required to achieve anaesthesia was however more. A particular subgroup of pathology was found to be completely resistant to anaesthesia by EMLA. CONCLUSION: We recommend the use of EMLA as a sole anaesthetic in small mucosal biopsies and shavings in all patients. We suggest it as a higher and first line recommendation for anaesthesia in needle phobic patients and children.

Efficacy of adjuvant ozone therapy in reducing postsurgical complications following impacted mandibular third-molar surgery: A systematic review and meta-analysis.

BACKGROUND: Results from several randomized controlled trials have shown a beneficial effect of ozone in reducing postsurgical complications after impacted mandibular third-molar surgery, but the literature is lacking a systematic review and meta-analysis. METHODS: The authors conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines after exclusion and inclusion criteria were applied and the following outcome parameters were evaluated: pain, swelling, trismus, quality of life, number of analgesics consumed, and adverse events. RevMan Cochrane Collaboration software, Version 5.3, was used to perform meta-analysis and the Grading of Recommendation Assessment, Development and Evaluation approach was used to rate the certainty of evidence. RESULTS: Patients who underwent adjuvant ozone application reported lower pain scores than patients in the control group at 24 hours after surgery (95% CI, -3.94 to -1.56) and at 7 days (95% CI, -1.67 to -0.78). Pooled analysis of all 4 included trials revealed a standardized mean difference (SMD) in swelling of -0.44 at 24 hours, 0.63 at 72 hours, and -0.87 at 7 days after surgery in the experimental group. Higher mean estimates in mouth opening were experienced by patients who received ozone at 24 hours (SMD, 2.74; 95% CI, -1.93 to 7.41; 4 studies, 133 patients), 72 hours (SMD, 2.77; 95% CI, -0.63 to 6.17; 4 studies, 133 patients), and 7 days after surgery (SMD, 1.42 SMD; 95% CI, -1.34 to 4.18; 4 studies, 133 patients). PRACTICAL IMPLICATIONS: Evidence suggests that adjuvant ozone application can offer some benefit for reducing pain, improving quality of life, and decreasing mean intake of analgesics after impacted mandibular third-molar surgery, but it is not effective in reducing facial swelling and trismus, which paves the way for future research.

Role of birth companion in COVID-19: indispensable for her and an auxiliary hand for us.

The pandemic of COVID-19 has proved to be a global catastrophe. Pregnant females could be more vulnerable to the infection owing to the immune modulation. According to the World Health Organization (WHO), pregnant females including those with COVID-19 suspicion or confirmed status have right to 'safe and positive childbirth experience' which includes a companion. The birth companion, is present at all times with the patient, from the initiation of labor till breastfeeding. The COVID-19 crisis has taken its toll on the healthcare system. The number of infected antenatal females are expected to increase. If a birth companion is trained in basic intrapartum and postpartum observation and care, he/she can be utilised to minimize unnecessary patient-clinician interface and optimize manpower in this critical time.

Impact of Oral Submucous Fibrosis on Quality of Life: A Multifactorial Assessment.

BACKGROUND: Oral submucous fibrosis (OSMF) has been extensively researched for its etiopathogenesis, malignant potential, and various available treatment modalities, but its effect on different domains of patient's life has not been thoroughly investigated. The present study aimed to clearly construe the effects of OSMF like severity and demographic variables on different domains of quality of life in OSMF patients. METHODS: A cross-sectional study was conducted in the Department of Dentistry, AIIMS Jodhpur, India. A total of 200 patients (after informed consent) were selected and detailed proforma filled including patient's demographics, habits, clinical features, and quality of life using a World Health Organization Quality of life-BREF tool (WHOQOL-BREF questionnaire). Thereafter, interpretation and statistics were done by a separate trained examiner minimizing the risk of assessment bias. RESULT: Quality of life (QOL) scores differed significantly according to age, site affected, habit duration, and severity of OSMF. It, however, did not differ according to gender. CONCLUSION: In this study, there has been a statistically significant deterioration of quality of life in OSMF patients in all the domains. Realization of this would increase our chance to bring the focus of the society and its policy makers to confront the growing menace of OSMF.

Case series of adenomatoid odontogenic tumour of jaws with variations in presentation.

Adenomatoid odontogenic tumour (AOT) is a rare tumour of odontogenic origin with distinct clinicopathological appearance but is often clinically misdiagnosed as a cyst. The most common site is the anterior maxilla in the canine region. We present here two cases, one at its commonest location in the maxillary canine while the other is at the uncommon location of the anterior mandible. Its clinical features of painless slow growing swelling, association with impacted tooth and radiographic appearance of well defined predominantly radiolucent lesion are overlapping with other oral pathologies like dentigerous cyst, radicular cyst, calcifying odontogenic cyst, calcifying epithelial odontogenic tumour, unicystic ameloblastoma etc. One must be aware and updated with the variation in appearance of AOT. Encapsulation of tumour causes less cumbersome enucleation of the tumour, a successful treatment as it reduces the chances of recurrence.

Systematic Review of Lesser Known Parasitoses: Maxillofacial Dirofilariasis.

BACKGROUND: Dirofilariasis is an endemic disease in tropical and subtropical countries caused by about 40 different species of dirofilari. Dirofilariasis of the oral cavity is extremely rare and is usually seen as mucosal or submucosal nodules. We also present a case of dirofilariasis of the mandibular third molar region submucosally in a 26 year old male patient. PURPOSE: To identify, enlist and analyze the cases of dirofilariasis in maxillofacial region reported worldwide so as to understand the clinical presentation and encourage the consideration of helminthic infections as a possible differential diagnosis in maxillofacial swellings. METHODS: Two authors KC and SK independently searched the electronic database of PUBMED, OVID, Google Scholar and manual search from other sources. A general search strategy was planned and anatomic areas of interest identified. The search was made within a bracket of 1 month by the independent authors KC and SK who assessed titles, abstracts and full texts of articles based on the decided keywords. The final selection of articles was screened for the cases that were reported in the maxillofacial region including the age, gender, site of occurrence and region of the world reported in. A geographic distribution of the reported cases was tabulated. RESULTS: A total number of 265, 97, 1327, 3 articles were identified by PubMed, Ovid, GoogleScholar and manual search respectively. The final articles were manually searched for duplicates and filtered according to the inclusion/exclusion criteria which led to a final list of 58 unique articles that were included in the study. In total 99 cases were identified. CONCLUSION: Although intraoral dirofilarial infections are extremely uncommon, it should be considered in the differential diagnosis of an intraoral or facial swelling that does not completely respond to routine therapy especially in patients from endemic areas.

Unilocular anterior mandibular swelling.

PURPOSE: To report a rare case of chondromyxoid fibroma, presenting as an unilocular anterior mandibular swelling, which is one of the least common tumours of bone comprising less than 1% of bone tumours and to review the differential diagnosis and literature for a better understanding of this disease as well as addressing the controversies in respect with its treatment. MATERIALS AND METHODS: Previous reports about this lesion in literature were reviewed wherein data was recorded about the age, sex, race, location of pathology, presenting signs and symptoms, duration of pathology, size, radiographic findings, treatment and any recurrence on follow-up. RESULTS: 25 cases were studied and data compiled. Multisectional histopathological examination is advocated to differentiate it from osteosarcoma. Enucleation with or without curettage with long-term follow-up has been considered to be a satisfactory treatment modality. CONCLUSION: The rarity of the lesion, limited data on the clinical presentation, histological dilemma and treatment options replete with controversies make it a tough predicament. A thorough understanding of the disease and treatment options is indispensable to treat such a case.

Blood gas analysis for bedside diagnosis.

Arterial blood gas is an important routine investigation to monitor the acid-base balance of patients, effectiveness of gas exchange, and the state of their voluntary respiratory control. Majority of the oral and maxillofacial surgeons find it difficult to interpret and clinically correlate the arterial blood gas report in their everyday practice. This has led to underutilization of this simple tool. The present article aims to simplify arterial blood gas analysis for a rapid and easy bedside interpretation. In context of oral and maxillofacial surgery, arterial blood gas analysis plays a vital role in the monitoring of postoperative patients, patients receiving oxygen therapy, those on intensive support, or with maxillofacial trauma with significant blood loss, sepsis, and comorbid conditions like diabetes, kidney disorders, Cardiovascular system (CVS) conditions, and so on. The value of this analysis is limited by the understanding of the basic physiology and ability of the surgeon to interpret the report. Using a systematic and logical approach by using these steps would make the interpretation simple and easy to use for oral and maxillofacial surgeons.

Tuberculous osteomyelitis of zygoma: an unusual location.

Tubercular osteomyelitis of midfacial bones is extremely rare, although tuberculosis of long bones and the vertebral column is not uncommon. Because of the rare incidence, myriad presentation, and lack of specific symptoms, this condition presents a challenge in diagnosis and calls for acute clinical awareness. This article presents a case report of a 12-year-old girl with complaints of gradually increasing swelling lateral to and below her right eye for 4 months with pus discharge. She was treated with surgical curettage and 4-drug antitubercular therapy and responded with complete remission of the sinus.