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

Third molars and angle fractures

Fractures of the mandibular angle are common and mandibular third molars are frequently implicated in their pathogenesis. The study was done to investigate this cause and effect relationship. The objectives were to measure the relationship between presence and status of mandibular third molar [M3] and mandibular angle fracture. Study design was descriptive. It was carried out in the Department of Oral and Maxillofacial Surgery, Punjab Dental Hospital, attached with de, Montmorency College of Dentistry, Lahore. 87 patients with clinical and radiographic diagnosis of mandibular fracture formed the study group. The predictor variable was the presence or absence of mandibular third molar. The outcome variable was the presence or absence of angle fracture. Hemi mandibles containing a third molar were seen to have a 2.3 times increased risk of having an angle fracture [p = 0.49] than a hemi mandible without a third molar. A significant association between third molar depth and risk of angle fractures was seen [p = 0.001]. The presence and depth of mandibular third molar is associated with an increased risk for mandibular angle fracture

Firearm injuries to the maxillofacial region

Firearm or gunshot injuries have steadily increased in number and in their effects with the advent of powerful weapons and a more ready access to these. The resultant disruption of the normal anatomy may also lead to dysfunctional physiology, particularly of the upper respiratory system. This may also lead to combined challenges for the anesthesiologist as well as a maxillofacial surgeon. This editorial aims to highlight the need of close cooperation between the two

Staged correction of facial asymmetry: a case report

Management of the facial asymmetry requires meticulous clinical and radiologic assessment to assess which bones are at fault. Correction of advanced cases may require surgically addressing occlusal cant deviation with asymmetrical impactions or down-grafting of maxilla, an asymmetrical rotation of mandible using either bilateral sagittal split or other ramus osteotomies and correction of residual chin deformity with a genioplasty. This may be accomplished within a single stage or stacked in a multi-staged plan. This is done in conjunction with orthodontics. Presented here is a case report of a post-pubertal young male patient with a skeletal class III profile, lower third facial asymmetry, occlusal canting and chin deviation

Frequency of Angiotensin Converting Enzyme Inhibitor [ACEI] induced cough

The objective was to assess the frequency of ACE inhibitor induced cough in our patients. The study was prospective open labeled one centre, in and out patients of cardiology department Sheikh Zayed Hospital, Lahore 2011. 200 patients using six different types of ACEI were used. Preference was given to patients to whom ACEI were prescribed for the first time. Patients with chronic respiratory diseases were excluded. Patients were follwed up on fortnightly basis for three months. On each visit besides recording their blood pressure, they were not specifically inquired about occurrence of any cough. Patients themselves came with the complaint of cough. The dry cough frequency with different ACEI was 17%, ranging from almost 20% with Enalopril, 16.6% with Captopril, 10% with Lissinopril and Ramipril, 15% with Qurinapril and Perindopril. The dry cough was moderate in the majority of our patients and they were not willing to continue their ACEI, although their blood pressure was well controlled with it. They were switched over to other group of anti hypertensive drugs. Incidence was almost same in males and females. ACEI have a relatively high frequency of dry cough and our patients don't want to take it if cough occurs

Frequency of clot in left atrium [LA] in patients of severe mitral stenosis [MS] with atrial fibrillation [AF]

To determine the frequency of clot in left atrium [LA] in patients suffering from tight mitral stenosis [MS] with atrial fibrillation. A cross-sectional descriptive type study at two centers was performed. A total of 50 adult patients with tight MS and AF were included. A 12 leads electrocardiography was performed once for each patients to look for AF after transthoracic echocardiography [TTE] and clinical examination features revealed tight MS. Patients with AF were selected and TTE was done to detect clot in LA. Tran esophageal echocardiography [TEE] was performed whenever clot could not be detected with TTE. Among 50 patients studied. There were 20 males and 30 females, TTE was done of all patients and LA clot were detected in 10 patients [20% of total] and TEE were performed in remaining 40 patients [80% of total] and additional 12 patients [24% of total] with clot in LA were detected. Therefore total of 44% of patients had LA clot. Among them 4% had clot in LA body and 40% had in LA appendage. LA dimension was found to be relevant [P value = 0.004] with the presence of clot in patients of severe MS with AF. LA spontaneous echo contrast [LASEC] was found in all patients. LA clot was present in 44% patients with tight MS and AF. Larger LA diameters is a strong predictor- of presence of LA clot in severe MS with AF

Thrombolysis in acute thrombosis of metallic mitral valve: case report

Prosthetic valve thrombosis is a potentially life-threatening complication associated with high morbidity and mortality. Transthorasic and transoesophageal echocardiography play an important role to the diagnosis and provides incremental information about the optimal treatment strategy, while fluoroscopy is a low-cost, noninvasive imaging technique, with limited radiation exposure that allows the correct evaluation of opening and closing angles and can add diagnostic value to echocardiography. Guidelines differ on whether surgical treatment or fibrinolysis should be the treatment of choice for the management of left-sided prosthetic valve thrombosis and these uncertainties underline the need for further prospective randomized controlled trials. Thrombus size, New York Heart Association functional class of the patient, the possible contraindications, the availability of each therapeutic option and the clinician's experience are important determinants for the management of prosthetic valve thrombosis

Current concepts in central giant cell granuloma

Central Giant Cell Granuloma is a nonneoplastic intraosseous lesion, and constitutes a common nonodontogenic pathology to occur in the jaws. It is characterized histologically by cellular fibrous tissue containing multiple foci of haemorrhage, aggregations of multinucleated giant cells, and occasionally, trabeculae of woven bone. Various theories brand it from being a 'reactive' to hamartomatous to a neoplastic lesion. It has now been hypothesized that it is the mononuclear spindle shaped cell which controls the proliferative activity of this lesion, as opposed to the more frequently seen giant cell. It has an increased predilection for mandible and females, in younger age groups. Various radiological and histopathological differential diagnoses should be considered in case of giant cell lesions. Some of the lesions are thought to display a markedly 'aggressive' behaviour and a clinically 'aggressive' model of CGCG has been proposed. Smaller, 'nonaggressive' tumours generally respond very well to conservative enucleation or curettage but recurrence is seen to be common with 'aggressive' lesions. Various medical therapies including injections of intra lesional steroids, subcutaneous calcitonin and interferon have been proposed for the treatment of 'aggressive' lesions