Optimal and efficient management of mandibular fractures

The aim of the study was to find out whether eliminating intraoperative intermaxillary fixation from the management of mandibular fractures has any bearing on treatment outcomes. A retrospective study was carried out on 53 mandibular fractures treated at Margalla Institute of Health Sciences and its affiliated hospitals from June 2010 to December 2014. Successful bone healing, occlusion and complications were assessed in mandibular fractures treated with open reduction and internal fixation and without the use of intraoperative intermaxillary fixation. Minor wound dehiscence was seen in 7 patients. 3 patients required hardware removal due to subsequent hardware failure; however no case of nonunion was seen. Clinically significant malocclusion [Moderate: Grade 2] was seen in only one patient after 3 months. There were negligible and comparable number of postoperative complications. It was concluded 'hand holding' of the mandibular fractures as an alternative to the more traditional IMF/MMF through various means, a reliable and predictable way of fixation of mandibular fractures

Buccal fat pad flap in management of oroantral fistula

Many options are exercised to affect surgical management of oroantral fistulae. Postoperative wound dehiscence is not uncommon, and the surgical management of such fistulae often becomes increasingly difficult because of a lingering maxillary sinus infection. This was a retrospective study done on 23 patients in which a double layered technique, consisting of buccal fat pad in conjunction with buccal advancement flap was used for surgical closure of oroantral fistulae. Only 3 of the patients had had a failure of the closure. We recommend this technique because of its many advantages and low risk of complications

Clinical study of primary hyperlipidaemia and the role of Kalonji [nigella sativa] and Saboos-e-Asapghol [plantago ovata] in its management

Lipid disorders comprise the most prevalent serious disorders in industrialized nations and are a rapidly growing problem in developing nations. The growing prevalence of obesity, type 2 diabetes mellitus, hyperlipidaemia and metabolic disorders are important risk factors for atherosclerosis. To cure the hyperlipidaemia several synthetic drugs of better efficacy are being introduced in the modern system of medicine. But most of the medications induce adverse side effects. Therefore search for safe and effective lipid lowering drugs was the main motivating factor behind this study. In Unani System of Medicine many drugs [single drugs as well as compound formulations] are used for the purpose of reducing body weight and treating the obesity. Saboos-e-Asapghol [Plantago ovata] and kalonji [Nigella sativa] are among these medicines. Their efficacy has also been proved pharmacologically and documented as good hypolipidemic. A clinical study was carried out in Ajmal Khan Tibbiya College Hospital on 60 patients of primary hyperlipidaemia. The diagnosis was made on inclusion and exclusion criteria. The Unani formulation Sufoof-e-Kalonji [Nigella sativa] 2 gm and Saboos-e-Asapghol [Plantago ovata] 4 gm twice daily before meal were given for 90 days

The combination of drugs was found to be significant in lowering the lipid level and in increasing the level of serum HDL-cholesterol, in patients of primary hyperlipidaemia. Therapeutic responses were evaluated through follow up observations at 45th day interval. The results were analyzed statistically and results were encouraging

Nasal tuberculosis: a case report

We present a case of nasal tuberculosis, a rare presentation of extrapulmonary tuberculosis. This report emphasizes how nasal tuberculosis can mimic other granulomatous disease and place a major challenge in its diagnosis and treatment

The microbiological quality of water from dental unit waterlines in Malaysian Armed Forces dental centres

Water quality in the dental unit waterlines (DUWLs) is important to the patients and dental health care personnel as they are at risk of being infected with opportunistic pathogens such as Pseudomonas or Legionella species. In this study, a total of 86 samples were collected from DUWLs of 19 dental units in 11 Malaysian Armed Forces dental centres (MAFDC). 350 ml water sample was collected in sterile thiosulphite bags from the outlets of 3–way syringe, high speed handpiece, scaler, cup filler, independent water reservoir or the tap of the same surgery respectively. Samples were transported to the laboratory within 24 hours and kept in the refrigerator at 40C. 100ml of each sample was filtered through a 0.45 μm polycarbonate membrane filter. The filter was then inoculated onto plate count agar and incubated at 370 C for 24 hours, after which the formed colonies were enumerated. Another separate 100ml of water sample was poured onto buffered charcoal yeast extract agar and cetrimide agar to culture Legionnella and Pseudomonas respectively. Identification of these bacteria were confirmed by polymerase chain reaction and sequencing. Pseudomonas aeruginosa was detected in 9.5% of the samples but Legionnella was not detected in any of the samples. 77% of the samples met American Dental Association (ADA) recommendation of less than 200 cfu/ml. The result of this study showed that it is difficult if not impossible to eliminate biofilm from the DUWLs. Regular monitor of water quality from DUWL is required to maximise the health of the dental patients and dental health care personnel.

rare case of pedunculated tonsilar mass in a child

Pedunculated polyps of palatine tonsils are rare and have been described using various terms. Most of the cases have been reported in adults with variable symptoms. We report a two and a half years old male child who presented with history of snoring and inability to lie down flat and sleep due to chocking and difficulty in breathing. Clinical examination revealed a mass extending from nasopharynx to the base of the tongue. A diagnosis of pedunculated palatine tonsilar mass was made intaoperatively and the mass was excised under general anesthesia. An unusual presentation of a rare condition in a pediatric patient has been discussed along with the airway management

Nonkeratinizing carcinoma of the sinonasal tract: A diagnosis of confusing nomenclature

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: To describe a rare case of nonkeratinizing carcinoma of the sinonasal tract and review the literature on the nomenclature of its many synonyms.<br /><br /><strong>METHODS</strong>: <br /><strong>Design</strong>: Case Report<br /><strong>Setting</strong>: Tertiary Referral Center<br /><strong>Patient</strong>: One<br /><br /><strong>RESULTS</strong>: A 45-year-old female presented with a 6-month history of left nasal obstruction associated with epistaxis. Computed tomography revealed a mass expanding the left nasal cavity with the epicenter arising from the anterior ethmoidal air cells. Endoscopic resection of the tumor was carried out but as there was residual tumor, she then underwent endoscopic-assisted medial maxillectomy via a lateral rhinotomy. A subsequent computed tomography scan showed residual tumor adhering to the ipsilateral periorbita. The patient has so far declined intensity modulated radiotherapy that was advised though she is still under regular follow-up.<br /><br /><strong>CONCLUSION</strong>: Nonkeratinizing carcinoma of the sinonasal tract is a rare entity and there are very few reports concerning this type of malignancy. This may be partly due to its many synonyms, such as cylindrical cell carcinoma, Schneiderian carcinoma and transitional cell carcinoma. Nomenclature of this tumor should be standardized to avoid confusion and misdocumentation.</p>