Gap arthroplasty of bilateral temporomandibular joint ankylosis

@#OBJECTIVES: To present a case of bilateral temporomandibular joint ankylosis that was managed successfully through gap arthroplasty. METHODS: Design: Case Report Setting: Tertiary Government Hospital Patient: One RESULTS:A 25-year-old man presented with inability to open his mouth for 18 years after direct trauma to his chin. CT scan showed bilateral bony fusion of condyles to glenoid fossae, hypertrophic sclerosis and fusion of the condylar heads to the temporal bones. He underwent bilateral gap arthroplasty via preauricular approach with creation of a 15 mm space on the mandibular fossa. As of latest follow up, the patient maintained an inter-alveolar distance of 30 mm for five months postoperatively through continuous aggressive mouth opening exercises. CONCLUSION:Gap arthroplasty may be an efficient procedure for temporomandibular joint ankylosis in achieving satisfactory post-operative inter-alveolar opening and articular function. Early and meticulous rehabilitation is required to prevent relapse. Long-term follow up is recommended to document possible recurrence.

Effectivity of guava leaves (Psidium guajava) as mouthwash for patients with aphthous ulcers

Objective@#To determine whether Psidium guajava leaves mouthwash is effective in the management of patients with aphthous ulcers @*Methods@#Study Design: Randomized prospective open label clinical study Setting: Tertiary Government Training Hospital @*Subjects@#Thirty two patients diagnosed with aphthous ulcers were randomly divided into two groups, a treatment group using prepared guava leaves mouthwash, and a control group using isotonic sodium chloride solution mouthwash, given thrice a day for seven days. Patients were evaluated using a 10 point Visual Analog Scale. The sizes of the aphthous ulcers were measured using a caliper, and compared on day 1 and day 7 for both treatment and control groups. Results were subjected to statistical analysis using T-test, Mann-Whitney U test, and Fisher Exact test. @*Results@#Comparison of VAS scores of guava treatment and NSS control groups showed that there were no differences in pain experienced on days 1 and 2. However, the VAS scores from day 3 to 7 had p values ranging from 0.02 - 0.0001 which showed significant differences in resolution of pain. There was statistically significant marked improvement of pain symptoms as early as three days post-treatment among patients who were administered guava leaves mouthwash. Complete resolution of aphthous ulcers in 75% of the study group was observed on day 7. Mean ulcer size post-treatment with guava gargle was 0.25mm compared to 0.75mm for NSS gargle. The mean size difference at day 7 was 1.44mm for the guava treatment group and 0.88mm for the NSS control group. There was a statistically significant faster resolution of ulcer size on day 7 in 16/16 or 100 % of patients in the treatment group compared with only 10/16 or 62.5% of patients in the control group. Patients who were administered guava leaves mouthwash generally fared better than those administered isotonic sodium chloride solution.@*Conclusion@#Guava leaves mouthwash was effective for aphthous ulcers in terms of reduction of symptoms of pain and faster reduction of ulcer size. Further clinical trials comparing this mouthwash against other treatment options are recommended.