Pattern of facial gunshot and blast injuries amongst law enforcing forces

Objective: To assesses the pattern of maxillofacial gunshot and blast injuries amongst law enforcing forces personnel

Study Design: Descriptive Study

Place and Duration of Study: Combined Military Hospital Lahore from Jan 2010 to Dec 2010

Materials and Methods: This prospective study evaluated 52 patients from Jan 2010 to Dec 2010 at Combined Military Hospital [CMH], Kohat Pakistan. All patients in this study were males as fighting corps of law enforcing forces comprises only male soldiers and officers. Patients aged from 18 to 50 years with mean age 29.12 years +/- 8.56 years

They were assessed for presence of gunshot and ballistic injuries by clinical examination and evaluation of necessary radiographic investigations

Results: Nineteen patients out of total 52 patients had no other injury which accounts for about 36.9%. In maxillofacial area upper third of face was most frequent site to receive gunshot and ballistic injuries as 10 patients received injuries to upper face which measures about 19.2%. Along with maxillofacial area upper limbs were most common site affected as 14 patients received injuries to upper limbs which is 26.9% of all patients

Conclusion: Gunshot wounds present a great challenge to oral and maxillofacial surgeons and a multidimensional team approach is required to rehabilitate the victims of gunshot injuries

Interruption of warfarin before dental surgery

Objective was to find out whether interruption of warfarin before undergoing dental surgery is necessary and to determine the effects of stopping pre-operative warfarin in Patients undergoing minor oral surgical procedures

After taking full medical history, clinical examination and an orthopantogram, randomization was then done by convenience sample technique. A preoperative International Normalized Ratio [INR] and coagulation screen were arranged, with Consent on the day of dental surgery. The group I continued taking warfarin as usual [anticoagulant group]. The group II stopped taking warfarin 2 days before their dental surgery procedure. If a patient's INR was >2, a further dose of warfarin was omitted. The dental surgery was performed under local anesthesia. Oral antibiotic prophylaxis was given for patients at risk of endocarditis in both groups

Two hundred and eighteen patients form the study group. 114 were to the anticoagulant group [Group I] and!04 to the warfarin withdrawn group [Group II]. There were no significant differences between the groups in the mean age, gender, number of teeth extracted. Mean INR for the group I was > 2.5 than the group II, at 1.6 [p=0.001]. The overall rate of bleeding complications in the group I was higher than in the group II [30% compared with 14%]

It is concluded that the minor oral surgical procedures can be done without discontinuing the warfarin

Lingual nerve damage during third molar surgery

The aim of this study was to investigate the relationship of lingual nerve damage to the experience of the operator and anesthetics modality during lower third molar surgery. A total of 300 patients had surgical removal of lower third molars. Surgeries were done under local and general anesthesia. The patients were asked about any numbness of tongue immediately after recovery or on the next morning in case of indoor patients. In the follow up appointments on first, 3rd and seventh day, they were asked again about any numbness of the tongue or any improvement noted. The frequency of 6% of altered lingual sensation was found in this study. The care was taken to include even trivial alterations in sensation of the lingual nerve occurring in the immediate post-operative period or even if there was quick recovery. The lingual nerve damage was recorded high [10%] with the most junior operator. No direct link of nerve damage was found with anesthesia but frequency of nerve damage was noted high during general anesthesia i.e., 7.14%. It was concluded that the frequency of nerve damage was more when the experience of the operator was less

Applicability of Tanaka and Johnston mixed dentition analysis in a contemproary Pakistani population

Mixed dentition analysis is carried out to predict the size of unerupted canine and premolar in the developing occlusion. The aim of this study was to assess the applicability of Tanaka and Johnston method of mixed dentition analysis in predicting the size of permanent canines and premolars in patients visiting Islamic International Dental Hospital, Islamabad. The sample consisted of 80 dental casts [40 male and 40 female], obtained from patients reporting at the department of orthodontics, Islamic International Dental College, Islamabad with the age range between 12 to 21 years. Mesiodistal tooth widths were measured with a digital vernier caliper. A paired student t test was used to compare the predicted and actual sum of the maxillary [PUCPM and AUCPM] and mandibular permanent Canines and Premolars [PLCM and ALCPM] for both genders combined and separately. Significant difference was found between PUCPM and AUCPM in maxilla for both male and female together [M + F: 0.000] and when both genders were compared separately [M: 0.032, F: 0.001]. Tanaka and Johnston method was only applicable in predicting the space for unerupted canine and premolars in mandible in both male and female sample

Prevalence of dry socket related to gender and site

The aim of this study was to assess the prevalence of dry socket in association with gender, site and age. This study includes hundred consecutive patients with dry socket coming to the OPD at Oral Surgery Department, Khyber College of Dentistry, Peshawar. A comprehensive proforma was formu-lated and filled for comparison of gender, age and site in relation to dry socket. The results of this comparative study were analyzed through chi-square test. Females were 2.37 times more prone to dry socket as compared to males. Whereas, dry socket was found 2.94 times more common in mandibular extractions as compared to maxillary. It was less common in young age group [18%] as compared to older patients [67%]

Hazards of pressure pack

The purpose of this study was to find out how the patients disposed off the pressure packs placed on the socket after tooth extraction. The study was conducted on 260 patients who had undergone dental extraction from November 2010 to April 2011. Pressure packs were placed on the socket to stop post operative bleeding. Every study patient was asked where he/she threw his/her pack after use and whether he/she touched it for adjustment before it was finally discarded. 42.3% of the patients threw the packs on the road, and 19.2% did this within the hospitals area, like corridors and toilets. Majority of patients admitted that they touched the pack for adjustment before it was finally discarded. The risk of spread of infection is increased by first touching the blood contaminated pack and then touching the doors, chairs, and tables in the waiting areas. Patients must be informed and educated about the proper handling of the packs to minimize the chances of cross infection

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

role of peripheral neurectomies in the treatment of trigeminal neuralgia in modern practice

50 patients were analyzed for indications, advantages and complications of peripheral neurectomies from June 2003 to September 2008 reported to the Department of Dentistry and Maxillofacial Surgery, Lady Reading Hospital, Peshawar. We selected only those patients who were above 40 years. After neurectomies, 35 [70% of patients had excellent pain relie lasting 2-5 years without any medication; 4 [8%] patients experienced occasional pain but no medication required; in 5 [10%] patients pain controlled with medication where as in 6[12%] patients, recurrence of pain appeared in 0-2 years which could not be controlled with medication. These patients were referred to neurosurgeon for MVD [Microvascular Decompression]. Both surgical and medical therapies are effective for trigeminal neuralgia. However, factors such as pain relief, recurrence mates and morbidity and mortality rates should be taken into account when considering which technique to use. It seems proper to start a patient suffering from trigeminal neuralgia with medical therapy but proceed early with surgical treatment if pain control is poor or side effects of medication are intolerable. The loss of sensation along the branch of the trigeminal nerve and recurrence rate are associated with peripheral neurectomy. But it is an effective and safe procedure for elderly patients; particularly those who have short life span. And in centers where facilities are not available for major neurosurgical procedures or patient is not fit for such procedures, neurectomy is-the best choice. It is possible even under local anesthesia

Midfacial fractures: different trends in management

This study was undertaken to determine the anatomic distribution and different methods of treatment of midface fractures. Ninety-seven consecutive patients with midface fractures were treated at the Department of Oral and Maxillofacial Surgery, de, Montmorency College of Dentistry, Punjab Dental Hospital, Lahore during the year 2001-2002. A review of patients' records and radiographs were conducted. Data regarding anatomic site and treatment modalities were reviewed. The zygomatic bone was the most commonly involved [64.71%], followed by maxilla [28.43%], nasal bone [3.92%] and nasoethmoidal fractures [2.94%]. Le Fort I was the most common fracture. The maxillary fractures were mostly treated with suspension wiring [31%] while in Zygomatic complex [ZC] fractures Gillies' approach [37.9%] was the common method of management. The miniplates fixation was performed in 20.7% and 13.6% cases of maxillary and ZC fractures respectively

Pattern and management of mandibular fractures: a study conducted on 264 patients

The descriptive study was undertaken to determine the pattern and different methods of treatment of maxillofacial fractures. Two hundred and sixty four patients with mandibular fractures were treated during the year 2001-2002. A review of patients' records and radiographs was conducted. Data regarding age, gender, cause of fracture, anatomic site and treatment modalities were reviewed. There was higher prevalence in male [4.8:1], with occurrence peak between 21-30 years. The principal causes of fracture in this study were RTA [Road Traffic Accidents] representing 62.8%[n=166], followed by fall [n=53; 20%], assault, sports, Fire Arm Injury [FAI]. The most injured sites were, in decreasing order, body of the mandible [30.3%] followed by condylar region [24.2%], angle, paraymphysis, dentoalveolar, symphysis, ramus, coronoid. Most patients of mandibular fractures were treated by closed reduction [eyelet wiring, arch bars with intermaxillary fixation [IMF] and splint fixation], 18.9% of patients were treated with open reduction [Interosseous and miniplates fixation. This study reflects patterns of mandibular fracture within the community and, it is hoped that assessment presented here will be valuable to government agencies and health care professionals involved in planning future programs of prevention and treatment

Maxillofacial fractures: analysis of demographic distribution in 320 patients

The descriptive study was undertaken to analyze the demographic distribution of maxillofacial fractures in 320 patients reported to the department of Oral and Maxillofacial Surgery de, Montmorency College of Dentistry, Punjab Dental Hospital, Lahore from June 2001 to Dec 2002. A review of patients records and radiographs was conducted. Data regarding age, gender and cause of fracture were reviewed. The age range was 2-76years [mean 25 yrs] with peak frequency occurring in age group 21-30 yrs. The male to female ratio was 5.4: 1. The study indicated that 64. 7% [n=206] resulted from road traffic accidents [RTAs] followed by fall [n=60; 18.8%], assault [n=26; 8.1%], sports [n=17; 5.3%], firearm injury [FA] [n=3; 0.9%]], industrial trauma [n=2; 0.6%] while 5 cases [1.65%] were associated with other causes such as bomb blast, animal injury etc. This study can provide a guide to the design of programs geared toward prevention and treatment

Myofacial pain dysfunction syndrome [MPDS] in N.W.F.P - a study conducted on 100 patients

The present study was conducted at the Department of Oral and Maxillofacial Surgery of Khyber College of Dentistry, Peshawar, Pakistan. One hundred patients were selected. The patients were referred to this department from various parts of NWFP. A comprehensive history of each patient was taken and thorough clinical examination was carried out. All patients were examined by direct manual palpation of TMJ and muscles of mastication. The clicking sound of joint was also recorded. Basic investigation and specific investigations like radiograph such as orthopanto-gram were taken to exclude dental and other pathological conditions. The diagnosis of Myofacial Pain Dysfunction Syndrome [MPDS] was established by co- relating different factors such as pain, muscle tenderness, and limited jaw movement. Male were more commonly affected, 80 out of 100 were male and 20 were female. Married persons were 70 as compared to unmarried [n=30]. The Para-functional habits like bruxism, day clinching, nail biting were noted in 40 patients. Moreover, students [n=30] between 15-25 years were affected. And married group of the society were most commonly affected; 70%