Evaluation of Outcome Following Coronectomy for the Management of Mandibular Third Molars in Close Proximity to Inferior Alveolar Nerve.

INTRODUCTION: Iatrogenic damage to Inferior Alveolar Nerve (IAN) is a significant risk factor following prophylactic or therapeutic removal of impacted mandibular third molar. The risk to IAN injury increases many fold, when the third molar root overlaps the nerve canal as identified by the radiographic imaging. Various methods like orthodontic assisted extraction, staged removal of tooth or coronectomy have been advocated to reduce the incidence of IAN injury in high risk cases with variable outcome. AIM: The aim of present study was to evaluate the fate of the root (resorbed, exfoliated, covered by bone) after coronectomy or intentional root retention of impacted mandibular 3(rd) molars in patients with high risk for inferior alveolar nerve damage as evaluated by the intra oral periapical radiograph. MATERIALS AND METHODS: Twenty impacted mandibular third molar teeth, in 18 patients with high risk of injury to IAN based on Rood's Criteria in an intra oral periapical radiographic examination, between the age group of 18 to 40 years, were included in the study. Preoperatively the impacted third molars were evaluated clinically as well as radiographically. Pederson Difficulty Index and Winter's Classification of impacted tooth was recorded. Coronectomy was done at the cemento enamel junction leaving the roots 2-3mm below the alveolar crest and primary closure was done. Patients were evaluated periodically for two years at six months interval. Post operative pain, swelling, IAN injury or any other complications were observed and recorded. RESULTS: None of the patients had IAN injury and none required second surgical removal. There was no incidence of post-operative infection and none required second surgical intervention. However, two of our patients had failed coronectomy (10%) due to mobilization of roots intra operatively and the roots were removed. One patient developed profuse bleeding intra-operatively in the failed coronectomy case. One patient had temporary lingual nerve paresthesia. CONCLUSION: Coronectomy procedure is effective in controlling inferior alveolar nerve injury following third molar surgery, in radiographically evaluated high risk cases and it has very low incidence of complications.

Retrospective evaluation of airway management with blind awake intubation in temporomandibular joint ankylosis patients: A review of 48 cases.

AIM: The aim was to determine the morbidity or mortality associated with the blind awake intubation technique in temporomandibular ankylosis patients. SETTINGS AND DESIGN: A total of 48 cases with radiographically and clinically confirmed cases of temporomandibular joint (TMJ) ankylosis were included in the study for evaluation of anesthetic management and its complications. MATERIALS AND METHODS: Airway assessment was done with standard proforma including Look externally, evaluate 3-3-2 rule, Mallampati classification, Obstruction, Neck mobility (LEMON) score assessment in all TMJ ankylosis patients. The intubation was carried out with the standard departmental anesthetic protocol in all the patients. The preoperative difficulty assessment and postoperative outcome were recorded. RESULTS: Blind awake intubation was done in 92% of cases, 6% of cases were intubated by fiberoptic awake intubation, and 2% patient required surgical airway. Ninety-eight percent of the patients were cooperative during the awake intubation. The frequent complications encountered during the blind awake intubation were epistaxis and sore throat. CONCLUSION: In an anesthetic setup, where fiberoptic intubation is not available, blind awake intubation could be considered in the anesthetic management algorithm.

Evaluation of the efficacy of tranexamic acid on blood loss in orthognathic surgery. A prospective, randomized clinical study.

The purpose of this prospective, randomized, double blind study was to assess the effect of tranexamic acid on blood loss, quality of surgical field and duration of surgery in adolescent orthognathic surgery patients. 50 consecutive patients, scheduled for orthognathic surgery were included. The study group (n=25) received tranexamic acid 10mg/kg as a bolus preoperatively followed by 1mg/kg as a maintenance dose intra operatively; the control group (n=25) received placebo (normal saline). All patients received moderate hypotensive anaesthesia with nitroglycerin and had surgery according to a standard protocol. Intra operative blood loss, duration of surgery, quality of surgical field, blood transfusion and complications, if any, were recorded. The mean total blood loss was 166.1±65.49ml in the study group and 256.4±77.80ml in the control group. The results showed statistically significant reduction in blood loss (p<0.001) and improved quality of surgical field (p<0.001) in the study group. There was no significant difference in duration of surgery and transfusion requirements between the two groups. In conclusion, preoperative and intra operative administration of the antifibrinolytic agent, tranexamic acid, is effective in controlling blood loss and improving the quality of the surgical field.