Efficacy of chlorhexidine gel vs chlorhexidine rinses in reducing incidence of dry socket in mandibular third molar surgery

Objective of this study was to highlight the efficacy of chlorhexidine gel in prevention of dry socket in the post-operative period of mandibular third molar surgical extraction in comparison to chlorhexidine rinses. One hundred patients seen at the department of Oral and Maxillofacial Surgery, Institute of Dentistry, CMH Lahore Medical College, were included in this study. The study was conducted from July 2012 to June 2013. The trial group [n=50] was instructed to apply 0.2% chlorhexidine gel to the extraction wound during the first postoperative week, while the control group [n=50] was prescribed a 0.2% chlorhexidine rinse for the same period. Results of this study revealed a 67% reduction in postoperative dry socket in the gel group [P < 0.05]. The incidence of postoperative dry socket in the gel group was 6% [3/50] as compared to 18% [9/50] in the mouthwash group. It was concluded that topical application of chlorhexidine gel to the extraction wound significantly reduced the incidence of dry socket

Marginal mandibular nerve and its relation with lower border of mandible and facial artery

Marginal mandibular nerve is a motor branch of facial nerve which supplies the muscles of the peri oral region. Surgical and cosmetic procedures might cause injury to this nerve resulting in functional loss and cosmetic imperfection. This study on the anatomical relation of marginal mandibular nerve, with respect to the lower border of mandible and facial artery, will benefit maxillofacial and plastic surgeons in its safe identification, hence preserving the functional integrity of this significant branch of facial nerve. Careful dissection was done on one hundred [100] hemi-faces of adult cadavers in Forensic and Anatomy departments of King Edward Medical University, Lahore from September 2009 to March 2010. Cadavers with scar, disfigurement or putrefaction in face and/or neck region were excluded. In 100 hemi faces, Marginal mandibular nerve present singly above the lower border of mandible was seen in 74% of cases. Marginal mandibular nerve having two rami, both located above the lower border was seen in 14% of cases. Two rami of marginal mandibular nerve, one present above and one below the lower border of mandible was seen in 6% of cases. Three rami of marginal mandibular nerve, two rami above and one below lower border of mandible were present in 6% of cases. In our population marginal mandibular nerve normally exits from anterior border of parotid gland above the lower border of mandible. When two or more rami of nerve are present; chances of lower most rami of nerve coursing below the inferior border of mandible increases. The nerve rami are present superficial to facial artery. It is at risk of iatrogenic injury overlying and anterior to massetter muscle where the nerve lies superficially underneath a thin layer of superficial musculoaponeurotic system

Number of rami of marginal mandibular nerve and its communication with other terminal motor branches of facial nerve in adult unclaimed cadavers - an anatomical study

Marginal mandibular nerve is one of the five terminal motor branches of facial nerve given in the substance of parotid gland. Injury to this nerve during surgical procedures hampers the actions of muscles of the lip and chin causing functional and aesthetic impairment. This study on number of rami and communication of marginal mandibular nerve will benefit maxillofacial, general, cosmetic /plastic surgeons to safely prevent iatrogenic injury to this important branch of facial nerve. Dissection of one hundred [100] hemi-faces of adult unclaimed cadavers of both genders was done [from September 2009 to March 2010] in Forensic and Anatomy departments of King Edward Medical University, Lahore. Cadavers with any scar or mutilated face/ neck were excluded from this study. In 100 hemi faces, number of rami of marginal mandibular nerve varies from 1-3. Single branch is most common [74%] followed by two [20%] and three rami [6%]. In 36% of cases communication was seen with buccal branch, 1% with cervical branch, with both buccal and cervical branches in 1% of cases. No communication with either buccal or cervical branch of facial nerve was seen in 62% of cases. Frequency of communication increases with number of Rami of marginal mandibular nerve. In our population single marginal mandibular nerve is most common [74%] which does not communicate with other branches of facial nerve frequently [74.3%]. Therefore transection of this nerve during surgical procedures can result in permanent paralysis