Serious post extraction complaint

This study was conducted to determine the predisposing factors for the development of dry socket among the patients of Peshawar Dental Collage Hospital, Khyber Pakhtunkhwa - Pakistan. Two thousand five hundred and twenty six mandibular and maxillary extractions were done over a period of one year. The data were recorded on two separate proformas and were entered in SPSS version 15 [WHO]. Analysis was done to determine the frequency and percentages for all variables. Total of 1.20% patients developed signs and symptoms of dry socket after 3-4 days. Male to female patient ratio was 1:1.5. Peak incidence occurred during 36-45 years age. Majority of patients were healthy at the time of extraction. Diabetic patients, smokers and female taking contraceptive pills frequently reported with dry socket. More dry socket was seen in Posterior mandibular extractions. Intra-ligamental anesthesia and surgical extractions with flap elevations resulted in dry socket. Majority of patients who didn't follow post extraction instructions presented more with dry sockets. It was concluded that formation of dry socket can be prevented by taking proper history of the patient, prescribing antibiotics for infections and avoiding excessive use of local anesthetic with adrenaline. Atraumatic surgical extraction will reduce the chances for the development of dry socket. Proper post extraction instructions and scheduled follow ups will further reduce the chances for dry socket

Recurrent giant cell tumor of right tibia: a case report with craniofacial manifestation

A 28 years old male from Daud Zai Peshawar came to Oral and Maxillofacial Surgery department of Khyber College of Dentistry Peshawar with chief complaint of severe pain associated with progressive swelling of right maxilla for past 15 days. Past history revealed similar swelling of left maxilla and right tibia, histopathologically confirmed to be giant cell tumor and was excised two years back. Base line investigations were found to be normal which included PTH assay, serum alkaline phosphatase, and serum calcium. Excisional biopsy of right maxilla was taken under general anesthesia and sent for histopathology. It was confirmed to be giant cell lesion of right maxilla

Predesposing factors for the infection of mandibular third molar

Impacted mandibular third molar tooth is the most frequent tooth extracted due to diverse group of infections like pericoronitis, caries and irreversible pulpitis etc. The objective of this study was to determine the frequency of infections found with the impacted mandibular third molar regarding its different angulations [Winter's classifications]. Among 100 study patients, all subjects were clinically assessed and radiographically evaluated for infections and type of angulations of lower third molar. The data collected on specially designed Performa was analyzed for variables on SPSS 10.0 version. The data obtained showed male to female ratio of 1:2.8. Fifty two percent patients presented with infection of mandibular third molar at the age of 21-25 years. The most common infection found was pericoronitis [49.0%].Based on Winter's classification most of the impacted teeth were in mesioangular [46.0%]. Pericoronitis was found to be common in vertical [23.0%] followed by mesioangular [15.0%], distoangular [8.0%] and horizontal angulation [3.0%]. Mesioangular impactions were most commonly involved with caries [25.0%]

Types of maxillary tumours and the resulting post-surgical defects in patients at a teaching hospital

To report the frequency of the types of maxillary tumours and the resulting post-surgical defects based on Aramany classification. Study design, duration and setting: This descriptive study was done during the period of 5 years [2005-11] at the Otorhinolaryngology and Head and Neck Surgery Unit, Khyber Teaching Hospital Peshawar. A pre-structured proforma was used for data collection. Data recorded included patients' age, gender, type of maxillary tumour, type of maxillectomy and approach for resection, Post-surgical defect based on Aramany classification for acquired maxillary defects, neck dissection, radiotherapy, and prosthetic rehabilitation. Data were computed for descriptive statistics including frequencies, percentages and mean values. Patients [n=53] had a male to female ratio of 1.7. Some 26.4% patients belonged to the age group of 31-40 years. Maxillectomy was done for inverted papilloma, a benign tumour in 1.9% patients as compared to malignant squamous cell carcinoma in 66% patients. Maxillary resection for fibrous dysplasia was done in 3.8% patients who were relatively younger. Maxillectomy in all cases was performed using Weber-Fergusson incision approach. Surgical resection resulted in Armanay calls I defect in 73.58% patients. In 92.5% patients a surgical obturator was provided to patients at the time of maxillectomy. Maxillectomy was mainly performed for resecting malignant tumours using Weber-Fergusson incision with the fitting of immediate surgical obturator. The resulting defect was mainly Aramany Class I defects

Trauma as a most frequent cause of TMJ ankylosis

The purpose of this study conducted at Khyber College of Dentistry hospital from January 2008 to December 2009 was to find out the most frequent cause of TMJ ankylosis. The data of 87 patients with TMJ ankylosis due to trauma were included. Recurrent TMJ ankylosis and ankylosis due to infection, MMF and degenerative joint diseases were excluded from the study. Out of eighty seven patients 64% were male. The patients were in the age group of 6-10 years. Fall [82.8%] was the most common cause of TMJ ankylosis. Unilateral involvement was 74.4%. It was concluded that trauma [fall] was the major cause of tempomandibular joint ankylosis in this sample. Disc interpositional arthroplasty showed good results when treating TMJ ankylosis due to fall

Condylar fractures in children - a study

The purpose of the study was to highlight the etiology, age, gender and site distribution, treatment options available and complications occurring as a result of condylar fractures in growing children. This retrospective study was carried out on a total of 57 patients from Jan 2008 to Oct 2009 at the department of oral and maxillofacial surgery, Khyber College of Dentistry, Peshawar, Khyber Pakhthunkhwa province of Pakistan. Fifty seven patients were recruited in this study. The male to female ratio was 1.6:1. Fall was the most common cause of condylar fractures i.e., [73.7%]. The peak incidence of condylar fracture was high among 6-10 years age group i.e. 26 [45.6%]. Forty one patients [71.9%] had unilateral condylar fractures and [28.1%] had bilateral. Maxillomandibular fixation [MMF] was performed in 28 patients [49.2%] to correct occlusal disturbance, minor deviations and to reduce the pain associated with it, while occlusion was disregarded in 29 patients [50.8%] but were put on close follow up. Overall 41 patients [71.9%] were treated successfully with conservative treatment approach but 16 patients [28.1%] have reported after 1-2 years with complications of temporomandibular joint [TMJ] Ankylosis. Among these 10 patients [62.5%] had unilateral TMJ Ankylosis. Gap arthroplasty with disc interpositioning was performed in patients with established complication of temporomandibular joint ankylosis

Maxillofacial and associated fractures of the skeleton - a study

The purpose of the present study was to evaluate the incidence of associated skeleton fractures with maxillofacial fractures and to list age gender and bone involved with poly trauma patients. The study is first of its kind in the region and will help to develop a better poly trauma management team. A Descriptive study was carried out in Oral and Maxillofacial Surgery Department of Khyber College of Dentistry, Peshawar, Pakistan for a period of one year i.e., from 20[th] June 2009 to 19[th] June 2010. All the patients presenting with maxillofacial injures and associated fractures of the skeleton were included in this study. Age, gender distribution, aetiology, associated injuries and treatment modalities undertaken in these patients were recorded. A total of 505 patients reported to oral and maxillofacial surgery unit of Khyber College of Dentistry, Peshawar, and amongst them 54 [10.6%] had associated fractures of the rest of the skeleton of the body. The most commonly involved bone was mandible [67%] followed by zygomatic complex fratures i.e. 15% in these patients. 50% of the fractures resulted because of Road Traffic Accidents. Upper limb fractures were the most common bone fractures associated with maxillofacial trauma i.e., 53.25% of the cases

Oral verruca vulgaris: a rare case with transformation of papilloma to well differentiated oral squamous cell carcinoma

Variety of verrucous and papillary lesions affect the oral mucosa. These are either benign or reactive, for example, papilloma, verruca vulgaris, fibroepithelial polyp and verruciform xanthoma, which usually present with little diagnostic difficulty. However, dysplastic and malignant verrucous present with much greater diagnostic challenges. There is evidence of some carcinomatous changes in oral lesions with some pre existing predisposing factors. The common wart or verruca vulgaris are lesions of childhood. These are benign, elevated, firm nodules with characteristic papillomatous surface projections. The most common site of occurrence is the fingers. Oral lesions are relatively rare, and are usually caused by auto inoculation from lesions on the fingers and hands. This report describes a lesion which was histopathologically diagnosed as oral verruca vulgaris that occurred in a middle-aged woman without any history of wart like lesions elsewhere in the body. But later on expanded in size, became indurated involving entire lower lip, labial sulcus, alveolar ridge and floor of the mouth. It was histopathologically confirmed as well differentiated oral squamous cell carcinoma

Trigeminal neuralgia: analysis of pain distribution and nerve involvement

The diagnosis of Trigeminal Neuralgia [TN] has been a source of confusion for clinicians and remains a difficult condition to manage. The study was conducted on 50 patients to evaluate the area of pain distribution and involved nerve. The diagnosis was based on history, clinical examination and response of pain to carbamzepine. The branch of the nerve was identified and confirmed with 2% lignocain with adrenaline 1:200,000 injection at the identified site and repeated three times on consecutive days. The age of patient's ranges from 21-79 years with a mean age 50 years. Males [60%] were affected more than female [40%] with ratio of 3:2. The right side was involved in 64% whereas left side in 36% of patients. The mandibular division was most commonly involved [n=30; 60%] followed by [n=17; 34%] and ophthalmic division [n=3;6%]. The most common site of nerve branch involved in descending order were inferior alveolar, infraorbital, long buccal and mental