Evaluating Effectiveness of Axiostat Hemostatic Material in achieving Hemostasis and Healing of Extraction Wounds in Patients on Oral Antiplatelet Drugs.

AIM: The aim of this study was to evaluate the efficacy of Axiostat Hemostatic Dental dressing in achieving hemostasis postextraction and determining its effect on pain and healing of the extraction wound, compared with control, i.e., conventional method of extraction in patients on oral antiplatelet therapy. MATERIALS AND METHODS: Totally, 40 patients on oral antiplatelet drugs were included in the study and overall 80 extractions were done applying split mouth study design, without altering patient's drug regime. Extraction sites were divided into two groups: Group I received Axiostat Hemostatic Dental Dressing (study site), and group II received conventional method; pressure pack with sterile gauze under biting pressure followed by suturing if required (control site) was used to attain hemostasis. RESULTS: Extraction sites treated with Axiostat Hemostatic Dressing achieved hemostasis earlier (mean 1 minute 13 seconds) compared with control sites (mean = 14 minutes 1 second), which was also statistically significant (p < 0.001). Postoperative pain was considerably lower and significantly better healing was seen in the study group (p < 0.001) compared with the control. CONCLUSION: Axiostat demonstrated to be an effective hemo-static agent that considerably lessens the bleeding time in patients on oral antiplatelet drugs postextraction. In addition, it even offered minimal postoperative pain and improved healing of the extraction wound. On comparing the results of this study with our study on HemCon Dental Dressing, Axiostat Dental Dressing (ADD) is found to be as effective and at par in achieving hemostasis in patients on oral antiplatelet therapy. CLINICAL SIGNIFICANCE: The past few decades have seen an upsurge in use of low-dose aspirin either alone or in combination with other drugs. When these patients require dental/maxillofacial treatment, earlier concept of stopping these medications is associated with increased risk of thromboembolic event. The present study highlights an alternative approach using ADD which aids in quick hemostasis, accentuates healing, and reduce postoperative pain.

A Comparative Study between the Effect of Combined Local Anesthetic and Low-dose Ketamine with Local Anesthetic on Postoperative Complications after Impacted Third Molar Surgery.

BACKGROUND: Postoperative pain, swelling and trismus are the most common outcome after third molar surgery. Many methods have been tried to improve postoperative comfort after surgery. Ketamine is a phencyclidine derivative that induces a state of dissociative anesthesia. It is a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist and has a distinct suppression effect on central nervous system (CNS) sensitization. Ketamine in a subanesthetic dose is set to produce analgesic and anti-inflammatory effect. MATERIALS AND METHODS: Sixty patients, between the age group of 18 and 38 years, undergoing the extraction of impacted mandibular third molar, reporting to the department of oral and maxillofacial surgery were included in the study. Patients were divided randomly into two groups: local anesthetic alone (LAA) and local anesthetic and ketamine (LAK). STATISTICAL ANALYSIS: Statistical analysis was performed using the Mann-Whitney U/unpaired--t-test and Wilcoxon signed-rank test. RESULT: There was a significant difference in mouth opening in the LAA and LAK group in the immediate postoperative period. There was a significant difference between the two groups after 1 hour (LAA: 2.37; LAK: 1.40), and 4 hours (LAA: 2.37; LAK: 1.40). There was a significant difference in terms of facial swelling in the immediate postoperative period and day 1 between the LAA and LAK group. CLINICAL SIGNIFICANCE: Use of subanesthetic dose of ketamine is not only safe but also valuable in reducing patient morbidity after third molar surgery. CONCLUSION: Combination of a local anesthetic and subanesthetic dose of ketamine during surgical extraction of third molars provides good postoperative analgesia with less swelling and significantly less trismus.

Mandibular coronoid fractures, how rare?

BACKGROUND: To study the rarity of mandibular coronoid process fractures and treatment strategies based on the displacement of these fractures. MATERIALS AND METHODS: A retrospective study of 11 cases of coronoid process fractures among 307 treated cases from 2008 to 2013 was conducted. Six patients were treated conservatively and 5 underwent ORIF with associated fractures. A statistical analysis of the data obtained after subjective and objective evaluation was done. RESULTS: The incidence of coronoid process fractures was 3.58% of all mandibular fractures analyzed. There was no statistically significant difference found between two treatment modalities, but differences in maximum interincisal opening (MIO) and pain in the postoperative period were significant. CONCLUSION: We recommend that linear coronoid fractures with minimal displacement can be managed with conservative treatment. For patients with significant displacement of coronoid process, limited mouth opening or concomitant mid-face or lower-face fractures, rigid internal fixation is recommended.

Assessment of changing patterns of Le fort fracture lines using computed tomography scan: an observational study.

OBJECTIVES: To assess the changing mid-face fracture patterns using a computed tomography scan. METHODOLOGY: Fifty patients with mid-face trauma requiring open reduction and fixation were studied using 1.6 mm axial, sagittal, coronal and 3D images. Images were evaluated clinically, intra-operatively and finally were compared with standard Le Fort lines. Results. The male population dominated the female at a ratio of 11.5:1. The majority of the mid-face fractures were seen in the age group of 21-30 years. Road traffic accident (78%) was the major etiological factor followed by work-related accidents (12%) and assaults (10%). The CT scan analysis included categorizing the patients into three groups: (1) Fracture patterns resembling Le Fort lines (24%); (2) Fracture patterns partially resembling Le Fort lines (56%); and (3) Fracture patterns that do not resemble Le Fort lines (20%). CONCLUSION: With the change in the velocity of wounding object, there is a change in the mid-face fracture patterns. The majority of the cases present as a variant of classical Le Fort fractures. Computed tomography is a valuable diagnostic tool in assessing the fractures of the mid-face. 2D images are more sensitive than 3D images. However, both the images are required in delivery of an optimal treatment plan.

Open cap splint with circummandibular wiring for management of pediatric mandibular parasymphysis/symphysis fracture as a definitive treatment modality; a case series.

Management of pediatric maxillofacial injuries is mainly governed by their psychological, physiological, developmental, and anatomical characteristics. Pediatric mandibular fractures can have variable etiologies but have similar manifestations as those in adult patients. There are various treatment modalities to treat mandibular parasymphysis/symphysis fractures in children, which have their own limitations and complications. We currently describe our experience with open cap splint as a treatment modality which involves fewer risks in treating 10 pediatric parasymphysis/symphysis mandibular fractures.

Mandibular ramus fractures: a rarity.

AIM: To determine the incidence of mandibular ramus fractures in KLE's PK Hospital and to analyze the outcome of open reduction and internal fixation of these fractures. MATERIALS AND METHODS: Using a retrospective study design, records of all trauma patients who reported to the Department of Oral and Maxillofacial Surgery, KLE's PK Hospital Belgaum, between the years January 2006 to October 2011 was obtained from the medical records office. The data variables that were analyzed were the name, age, sex, cause of injury, pretreatment occlusion, treatment given, period of MMF and post-treatment occlusion. RESULTS: Total number of mandibular fracture cases was 298. Ramus fractures were 10 in number which accounted for 3.3% of fractures. The age range of these 10 patients was seen to be between 20 to 80 years with the average age being 35.6 years. Of these 10 patients, 9 were male and 1 was female and 7 patients were treated by open reduction and internal fixation and the remaining 3 by closed reduction. The average period of MMF was 3 days for the patients who underwent open reduction and internal fixation. There was improvement in occlusion in all 10 patients post-treatment and there was no complication reported in any of the cases. CONCLUSION: Ramus fractures accounted for 3.3% of all mandibular fractures. Open reduction and internal fixation of ramus fractures ensures adequate functional and anatomic reduction. CLINICAL SIGNIFICANCE: This study makes an attempt to throw a light on the increasing incidence of ramus fractures and a successful management of these fractures by open reduction and internal fixation. How to cite this article: Kale TP, Kotrashetti SM, Louis A, Lingaraj JB, Sarvesh BU. Mandibular Ramus Fractures: A Rarity. J Contemp Dent Pract 2013;14(1):39-42. Source of support: Nil Conflict of interest: None declared.

Efficacy of Transdermal Ketoprofen Patch in Comparison to Transdermal Diclofenac Patch in Postoperative Analgesia for Orthodontic Extractions: A Randomized Split-Mouth Study.

Introduction Non-steroidal anti-inflammatory drugs (NSAIDs) are the most prescribed analgesics for controlling post-exodontia pain, administered by various routes. The transdermal route possesses the advantages of providing sustained release of the drug, being non-invasive, bypassing first-pass metabolism, and eliminating gastrointestinal adverse effects. This study compared the analgesic efficacy of diclofenac 200 mg and ketoprofen 30 mg transdermal patches for post-orthodontic exodontia pain. Materials and methods Thirty patients who underwent orthodontic bilateral maxillary and/or mandibular premolar extractions under local anaesthesia were included in the study. Each patient received single transdermal diclofenac 200 mg patch and single transdermal ketoprofen 30 mg patch on the outer, ipsilateral upper arm immediately post-extraction in the two appointments in random order. The pain score was recorded every second hourly for the first 24 hours postoperatively using a visual analog scale (VAS). The requirement of rescue analgesics at various time points and the total number of rescue analgesics taken in the first 24 hours postoperatively were noted. Any allergic reaction to the transdermal patches was also recorded. Results The analgesic efficacy of the two transdermal patches at any given time point in 24 hours by Mann-Whitney U test showed no statistically significant (p<0.05) difference. An overall intragroup statistically significant difference (p<0.05), by Wilcoxon matched pairs test, was found by comparison of VAS pain scores at different time points to that at 0-2 hours after application of transdermal ketoprofen and diclofenac patches, respectively. The mean maximum pain intensity was slightly lower for ketoprofen (2.33) than diclofenac (2.60) transdermal patch. Patients consumed the rescue analgesic within the first 12 hours postoperatively, with the mean value of the total number of rescue analgesics taken with ketoprofen transdermal patch (0.23) slightly lower than diclofenac transdermal patch (0.27) application. Conclusion Ketoprofen and diclofenac transdermal patches provide similar analgesia post orthodontic extraction. The patients required rescue analgesics only during the initial hours of the postoperative follow-up period.

Interventions for the Management of Mandibular Coronoid Process Fractures: A Systematic Review.

Background: The fracture of the coronoid process of mandible is one of the rarest fractures seen and the paucity of literature on the topic reflects the same. Despite the low incidence rate, the complications maybe grave which is why proper management is important. The treatment is controversial also because of the absence of standardized treatment protocol. This systematic review aims to compare the outcome of various treatment modalities available. Methods: Registered under PROSPERO: CRD42020200700. Systematic research was conducted across databases like PubMed, Google Scholar, Pro Quest, Wiley Online. All clinical studies done till January 2021 which included participants above 14 years of age were included. Case reports, case series and studies not mentioning the treatment plan were excluded. The studies were shortlisted by the authors based on the eligibility criteria. Risk of bias was assessed using the MINORS tool and JBI checklist. Results: A total of five studies were included. Four were retrospective studies and one was a retrospective case-controlled study. Two studies reported high, two moderate and one low risk of bias. Various treatment modalities were reported for the management of coronoid process fractures including conservative management, ORIF and coronoidectomy. Most authors preferred conservative management in asymptomatic cases and surgical management in symptomatic cases. Discussion: No randomized control trials were found on the topic. Majority of the articles were case reports. Conservative management was preferred in minimally displaced fractures of coronoid process. However, in presence of displaced coronoid process fractures causing impediment of mandibular function surgical management is preferred.

Traumatic optic neuropathy after maxillofacial trauma: a review of 8 cases.

PURPOSE: To study the incidence and prognostic factors of traumatic optic neuropathy in maxillofacial trauma cases. MATERIAL AND METHOD: Eight patients diagnosed with traumatic optic neuropathy among 354 cases of maxillofacial trauma treated from December 2008 through May 2011 were included in this retrospective study. Factors at the time of trauma, clinical findings, computed tomographic findings, and interventional modalities were studied for any improvement in vision. RESULTS: Of 354 maxillofacial trauma cases, 8 cases (2.25%) were diagnosed with traumatic optic neuropathy. Patients' ages ranged from 21 to 60 years. The causes of trauma were road traffic accidents in 7 patients and surgery for zygomaticomaxillary complex (ZMC) fractures in 1 patient. All patients had ZMC fracture; 1 patient had Le Fort II, mandible condyle, and ramus fractures and 2 had associated cranial bone fracture. Six patients were administered steroid therapy; 1 patient showed improvement in visual acuity. Two patients underwent decompression by a lateral orbital approach; 1 patient showed an improvement in visual acuity. In 2 other patients, a spontaneous recovery was observed. Four of the 8 patients underwent open reduction and fixation of the maxillofacial fractures. Of the remaining patients, 1 patient had a nondisplaced ZMC fracture that was treated without surgical intervention and the other 3 patients refused any surgical intervention. CONCLUSIONS: The present findings showed the occurrence of traumatic optic neuropathy in association with ZMC, Le Fort II, and cranial bone fractures. Additional risk factors such as a history of a loss of consciousness, injury to the superolateral orbital region, fracture of the optic canal, evidence of orbital hemorrhage, and evidence of blood within the posterior ethmoidal cells should be considered during the evaluation.

Evaluation of Banana Leaves (Musa paradisiaca) as an Alternative Wound Dressing Material Compared to Conventional Petroleum Jelly Gauze Dressing in Contused, Lacerated and Sutured Wounds Over the Head, Neck and Face Region.

Aim To evaluate the effectiveness of banana leaf dressing in patients with contused, lacerated and sutured wounds over the head, neck and face region with respect to pain during dressing change, patient comfort, status of wound bed during dressing change and handling characteristics in comparison with petroleum jelly gauze dressing. Methods and materials Sixty patients were included, out of which 30 patients were used as controls with petroleum jelly gauze dressings and 30 patients as study participants with banana leaf dressings. Pain on dressing change, handling characteristics of dressing material, patient comfort and status of wound bed on every dressing change were assessed. Results Properties of both banana leaves and petroleum jelly gauze dressings were parallel in all aspects, except pain on dressing change which was less with banana leaf dressings and had statistically significant value (p>0.001). Conclusions Banana leaves (Musa paradisiaca) can become an alternative choice of wound dressing material in contused, lacerated and sutured wounds over the head, neck and face region as they proved to cause less pain and trauma during dressing change and have other advantages such as cost and availability, comfort and ease of handling the dressing by health professionals.

Evaluation of Polyethylene Surgical Drape as an Alternative Wound Dressing Material, Compared to Banana Leaf (Musa paradisiaca) Dressing in Facial Abrasions.

BACKGROUND AND OBJECTIVES: Facial abrasions, the most common squeal of trauma, have been treated widely by moist occlusive dressings. This novel study aims to evaluate polyethylene surgical drape dressing (PESG) as an alternative to autoclaved banana leaf (Musa paradisiaca) dressing in facial abrasions. STUDY DESIGN: Sixty patients who reported to our emergency department, having abrasions over head, neck and face region secondary to trauma, were included. Thirty patients were given PESG, and 30 were given banana leaf dressings. Dressings were changed daily for 7 days. Pain on dressing change, status of wound bed on every dressing change, handling characteristics of each dressing material and comfort to the patient were assessed. RESULTS: Analysis revealed that the properties of PESG dressings are parallel to banana leaf dressing in all aspects except pain on dressing change. PESG caused no pain during dressing change which was statistically significant (p < 0.011). CONCLUSION: Facial abrasions can be effectively treated by PESG dressing. It is easily available in any hospital setting, has an ideal surface, i.e. impervious and smooth. It also maintains a moist condition, is completely painless and inexpensive. Hence, it can become a new standard for treating facial abrasions especially to poor patients in developing countries.

A Clinical Study of the Evaluation and Assessment of the Etiology and Patterns of Ocular Injuries in Midfacial Trauma in a Tertiary Care Hospital.

Aims The aim is to study the pattern of ocular injuries in midfacial trauma and to evaluate the overall incidence of ophthalmic injury of any severity following maxillofacial trauma. Methods and Materials The maxillofacial surgeon conducted routine facial examination of patients with midfacial fractures, which also included a detailed ophthalmologic examination of patients, at the time of initial presentation. These patients were then further evaluated by an ophthalmologist for thorough examination of the eye. Results The total number of recorded midface maxillofacial trauma cases was 181. Out of 181 patients, 161 had ocular injuries. Among 181 cases, 161 (88.95%) cases were due to road traffic accidents, which was the prime etiologic factor. Out of total 181 patients, 172 (95.03%) were males and 9 (4.97%) were females. The maximum number of cases were of zygomaticomaxillary complex fractures (44.75%) followed by nasal bone fractures (21.5%). Periorbital ecchymosis accounted for the maximum number of cases, amounting to 61.88%. Loss of vision or blindness was seen in eight (4.42%) patients. Conclusions The study stresses further on the importance of long-term and continuous data collection and record management of trauma patients, which may help health care providers with necessary information to develop treatment protocols and device measures for the prevention of complications.

Lymphocytoma cutis: diagnostic enigma for the maxillofacial surgeon.

Cutaneous lymphoid hyperplasia (CLH) is a cutaneous pseudolymphoma with a worldwide distribution, equally affecting all races and ethnic groups. Due to its vast array of characteristics, it is most often missed in the differential diagnosis of firm to soft lumps on the head and neck. A systematic approach to the workup and diagnosis along with treatment of such lesions is discussed in this article. A 20-year-old Asian Indian female presented to our Oral and Maxillofacial unit with a lump on the left side of her forehead for 1 month. Local examination revealed a 2.5×3.0 cm2, well circumscribed swelling over the left para median region that was firm to doughy and non-tender. There was no other significant finding on general examination. Excisional biopsy of the lesion was performed, followed by histopathologic processing. The general etiology, pathogenesis, clinical presentation, differential diagnosis, clinical course, prognosis, treatment, and prevention have been discussed in line with the recent modalities of diagnosis and treatment of CLH. Due to the overlapping clinical and histological characteristics of CLH with many other lesions, it is important to consider this lesion in the differential diagnosis of cutaneous lesions.

Infraorbital nerve transpositioning into orbital floor: a modified technique to minimize nerve injury following zygomaticomaxillary complex fractures.

OBJECTIVES: Transpositioning of the inferior alveolar nerve to prevent injury in lower jaw has been advocated for orthognathic, pre-prosthetic and for implant placement procedures. However, the concept of infra-orbital nerve repositioning in cases of mid-face fractures remains unexplored. The infraorbital nerve may be involved in trauma to the zygomatic complex which often results in sensory disturbance of the area innervated by it. Ten patients with infraorbital nerve entrapment were treated in similar way at our maxillofacial surgery centre. MATERIALS AND METHODS: In this article we are reporting three cases of zygomatico-maxillary complex fracture in which intra-operative repositioning of infra-orbital nerve into the orbital floor was done. This was done to release the nerve from fractured segments and to reduce the postoperative neural complications, to gain better access to fracture site and ease in plate fixation. This procedure also decompresses the nerve which releases it off the soft tissue entrapment caused due to trauma and the organized clot at the fractured site. RESULTS: There was no evidence of sensory disturbance during their three month follow-up in any of the patient. CONCLUSION: Infraorbital nerve transposition is very effective in preventing paresthesia in patients which fracture line involving the infraorbital nerve.

Lingual guttering technique for removal of impacted mandibular third molars.

BACKGROUND: To assess the clinical feasibility of lingual bone guttering technique for surgical extraction of mandibular third molars. MATERIALS AND METHODS: 20 patients with thick lingual cortical plate were included in the study. Surgical extraction of mandibular third molars by lingual bone guttering technique was performed in all the subjects. These subjects were evaluated for integrity of lingual cortical plate and sensation of lingual nerve postoperatively. RESULTS: All extractions done by lingual bone guttering technique were clinically feasible to perform and no complications were seen. CONCLUSION: Lingual bone guttering technique can be used safely in extraction of mandibular third molars with thick lingual cortical plate.

Effectiveness of Hemcon Dental Dressing versus Conventional Method of Haemostasis in 40 Patients on Oral Antiplatelet Drugs.

OBJECTIVES: The purpose of the study was to evaluate the effectiveness of the HemCon Dental Dressing (HDD) in controlling post extraction bleeding and to ascertain its role in healing of extraction wounds, as compared to control. METHODS: The 40 participants in the study were all receiving oral antiplatelet therapy (OAT). A total of 80 extractions were conducted without altering the patients' drug therapy. The extraction sites were divided into 2 groups: one group received a HDD, and the control group where the conventional method of pressure pack with sterile gauze under biting pressure (followed by suturing if required) was used to achieve haemostasis. RESULTS: All HemCon treated sites achieved haemostasis sooner (mean = 53 seconds) than the control sites (mean = 918 seconds) which was statistically significant (P <0.001). Postoperative pain in the HDD group (1.74) was also significantly lower than in the control group (5.26) (P <0.001). Approximately 72.5% of HDD-treated sites showed significantly better postoperative healing when compared to the control site (P <0.001). CONCLUSION: HDD proved to be an excellent haemostatic agent that significantly shortened the bleeding time following dental extraction in patients on OAT. Additionally, HDD offered significantly improved post-operative healing of the extraction socket and less postoperative pain.

A comparative study between transbuccal and extra-oral approaches in treatment of mandibular fractures.

BACKGROUND AND OBJECTIVES: Mandibular angle fractures continue to be a common type of facial injury. The objectives in treatment are to effect rapid healing by anatomic reduction and fixation and to restore function and appearance with minimal disability and complications. Traditionally, when open techniques are utilised, the extra-oral approach is performed through a skin incision concealed in the submandibular crease. However, patients develop unsightly scars and there is a risk of injury to the marginal mandibular nerve. In comparison, the trans-oral approach, performed through an oral mucosal incision, results in minimal external scarring or injury to the marginal mandibular nerve and allows direct visualisation and confirmation of the desired occlusion during the placement of the miniplates. The basic aim of the study was to provide a treatment for the mandibular fractures which results in minimal scarring and fulfills all the functional needs of the patient. STUDY DESIGN: Patients coming to KLES PK Hospital and MRC with mandibular angle fractures requiring open reduction and internal fixation admitted under OMFS were taken for the study. The sample size of the study was 15. In one group, the patients were treated by extra-oral approach and the other group by transbuccal approach. In patients treated by transbuccal approach, special armamentarium consisting of trocar, cannula, and cheek retractor were used; and in both the groups, semirigid fixation was done using two miniplates with around a distance of 1cm. RESULTS: Total of 15 patients were treated, 10 with transbuccal approach and 5 with submandibular approach. It has been found that both techniques fulfill the functional requirements of the patients. Patients treated with submandibular approach developed obvious unsightly scars, whereas transbuccal approach results in minimal scarring. CONCLUSION: The results associated with clinical observations suggest that transbuccal approach is a superior and less time consuming approach than extraoral approach, but it requires special instruments, lots of skill by the operating surgeon in using the armamentarium, and a skilled assistant.

Liquid nitrogen cryotherapy in the management of oral lesions: a retrospective clinical study.

UNLABELLED: BACKGROUND #ENTITYSTARTX00026; OBJECTIVES: The purpose of this study was to evaluate effectiveness and convenience of cryosurgical procedure, to assess the events during postoperative healing and to find out the incidence of recurrence MATERIALS AND METHODS: This study was conducted in the Department of Oral and Maxillofacial Surgery, KLESVK Institute of Dental Sciences, Belgaum. The 40 patients selected for the study were divided into 2 groups of 20 patients each irrespective of age and sex. Group I 20 patients with Pre-Malignant Lesions Group II 20 patients with Oral Mucous Cyst RESULTS: It was observed that all the 20 patients of mucocele were cured without any complication and recurrence, but in 20 patients of leukoplakia 5 patients had recurrence which was directly attributed to their persisting habits. CONCLUSION: We state that this modality of treatment is promising with good results and has certain advantage over other modalities of treatment.