Evaluation of demographic, radiological and intraoperative factors for assessment of postoperative pain and complications in surgical removal of impacted mandibular third molar: a prospective study / Evaluación de factores demográficos, radiológicos e intraoperatorios para la evaluación del dolor postoperatorio y las complicaciones en la extracción quirúrgica del tercer molar mandibular impactado: un estudio prospectivo

Third molars usually erupt within the age of 17 ­ 21years. Usually, due to the evolution of human jaws, the size is decreasing leading to the impacted tooth. An impacted tooth may lead to external resorption of the adjacent tooth, trismus, infection, etc. Many studies have been reported in the literature for evaluating the surgical difficulty and postoperative complications secondary to impacted third molars. This study includes a sample of 100 subjects evaluated for the surgical difficulty and postoperative complications. Various demographic, radiological, and intraoperative factors were evaluated which may lead to postoperative complications. Factors responsible for postoperative sequelae were also evaluated with complications. Postoperative pain after 4 hours and 7 days was assessed to mark the factors commonly responsible. Pain at 7th postoperative day was significant involving factors like fully impacted, horizontal impaction, level C, no/very little retromolar space, and root contact. Postoperative complications were not reported in this study.

Los terceros molares suelen erupcionar entre los 17 y los 21 años de edad. Por lo general, debido a la evolución de las mandíbulas humanas, el tamaño disminuye, lo que conduce al diente impactado. Un diente impactado puede conducir a la reabsorción externa del diente adyacente, trismo, infección, etc. Se han reportado muchos estudios en la literatura para evaluar la dificultad quirúrgica y las complicaciones postoperatorias secundarias a terceros molares impactados. Este estudio incluye una muestra de 100 sujetos evaluados por la dificultad quirúrgica y las complicaciones postoperatorias. Se evaluaron diversos factores demográficos, radiológicos e intraoperatorios que pueden conducir a complicaciones postoperatorias. También se evaluaron los factores responsables de las secuelas postoperatorias con las complicaciones. Se evaluó el dolor postoperatorio después de 4 horas y 7 días para marcar los factores comúnmente responsables. El dolor al séptimo día postoperatorio fue significativo e involucró factores como impacto total, impactación horizontal, nivel C, espacio retromolar nulo o muy pequeño y contacto con la raíz. En este estudio no se informaron complicaciones posoperatorias.

Catheter associated urinary tract infections in intensive care units patients in a tertiary care hospital

Introduction: Catheter associated urinary tract infections (CAUTI) is the most common health care associated infection (HAI), accounting for 40% of all HAIs in particularly in patients admitted to intensive care units (ICU) due to their more frequent necessity of urinary catheterization and longer duration of catheter use. Knowledge about Microbiological profile and antimicrobial sensitivity pattern of CAUTI is essential to implement the infection control system in a proper manner.Aims and objectives: To study the rate and microbiological profile of catheter associated urinary tract infections and in patients admitted in Intensive Care Units.Materials and methods: A one-year prospective study was conducted in which urine samples were collected from patients admitted in Medical ICUs on indwelling urinary catheter for >48 hours and processed in Microbiology Department according to standard procedures. CA-UTI rate was calculated and their microbiological profile and various resistance patterns were studied as per CLSI guidelines.Results: Out of 1406 enrolled patients, 64 patients developed CAUTI. Overall CAUTI rate was 4.06/1000 catheter days. Most common isolate in CAUTI cases was Klebsiella spp. (32.3%), followed by Escherichia coli (24.6%). Gram negative isolates showed higher sensitivity to aminoglycosides, imipenam and nitrofurantoin as compared to cephalosporins The Enterococcus spp. were 100% sensitive to linezolid and 71.4% sensitive to both vancomycin and teicoplanin.Conclusion: CAUTI rate in our ICUs was high compared to the benchmarks. Antibiotic sensitivity pattern of the pathogens involved was also low. This study provides the data of predisposing risk factors and its causative microbial flora for CAUTI in our tertiary care.

Bilateral canine space infection secondary to odontogenic origin: a rare case report

Odontogenic infections (OI) are a major reason for consultation in dental practice. They affect people of all ages, and most of them respond well to current medical and surgical treatments. The aim of this paper is to emphasize different and rare etiological factors that can play a role in odontogenic abscesses, which can lead to complications. A 54-year-old man complaints of pain and swelling on the upper front-side of his face. Physical examination of the face showed enlargement and swelling in the upper front region. Panoramic radiograph images showed a ra-diolucent appearance of the canine region. Based on the results of the clinical and radiographic examinations, the patient was diagnosed with a bilateral canine space infection. The treatment performed was FNAC (Fine neddle aspiration cytology) from canine region followed by intraoral drainage incision at the most prominent part of swelling (Modified Hiltons method), 5 ml of pus was removed, postoperative dressing was applied and regular follow-up was done with continued antibiotic therapy. Bilateral canine space abscess is a rare odontogenic infection that can cause life-threatening complications. The success of treatment requires early recognition, determination of etiological factors, and appropriate medical and surgical management. To per-form treatment of odontogenic infections, the Oral & Maxillofacial Surgeon should understand the terminology regarding infectious diseases and pathophysiology. The success of treatment requires early recognition, determination of etiological factors, and appropriate medical and surgical management.

CRB modification to retromandibular approach for management of subcondylar fractures

The aim of this study was to evaluate the efficacy of CRB modification of retromandibular approach to gain surgical access for open reduction and internal fixation of mandibular sub-condylar fractures. A total number of 264 sustained extra-capsular subcondylar fractures from 230 patients were selected for the study over the period of 5 years. Evaluation of intraoperative accessibility, postoperative facial nerve function, postoperative complications and scar was ca-rried out. All the patients were treated using CRB Curvilinear approach. Patient follow up was re-corded for 1 year on a regular interval basis. Symptoms of postoperative facial nerve injury were seen in 2 patients which recovered with time, postoperative complications were not encountered in any case and minimum scar mark hidden in the cervical skin crease. Hence open reduction and internal fixation for Subcondylar fracture of mandible by using the CRB modification of re-tromandibular approach is a good alternative for other conventional approaches in having ease of access, ease of fixation, reduced incidences of injury to facial nerve and its branches with good aesthetic outcome

Assessment of intraoperative risk factors for surgical difficulty in surgical extraction of impacted mandibular third molar: a prospective study

The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. For proper planning of surgical extraction, espe-cially for impacted mandibular third molars the estimated level of surgical difficulty of the case is important. This study was conducted to evaluate the intraoperative risk factors contributing to surgical difficulty in extraction of impacted mandibular third molars and consequently the post-operative outcome. Here, we have undertaken a study in which the intraoperative variables were considered, to evaluate their contribution for surgical difficulty and postoperative complica-tions in surgical removal of 100 impacted mandibular third molars. Three variables were found significant associated with total surgical time intervention, i.e., surgeon's experience (p=0.006), Inter-incisal opening (p=0.032), and cheek flexibility (p=0.004). Total surgical time intervention for 'right side' was higher with 49.20 ± 17.94 minutes (p=0.691). Total surgical time intervention for 'gagging reflex present' was 50.21 ± 17.812 (p=0.674). Multiple linear regression shows that surgeon's experience was the only predictor (p<0.001). The surgical difficulty of impacted mandibular third molar are likely to depend on the intraoperative factors like Surgeon's time, surgeon's experience, check flexibility, and inter incisal mouth opening.

Evaluation of demographic and radiological risk factors for assessment of difficulty in surgical removal of impacted mandibular third molar: a prospective study

The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. Both the patient and dentist must therefore have scientific evidence-based information concerning the estimated level of surgical difficulty of every case to consider in referring cases of impacted third molars for specialists' handling. We have undertaken a study in which demographic and radiological variables were considered to-gether to evaluate the risk factors for surgical difficulty in a cohort of 100 impacted mandibular third molars. There were 13 variables evaluated for surgical difficulty. Total surgical time interven-tion was noted at the end of each surgery. Each variable was analysed with total surgical time intervention with univariate and multiple linear regression. Out of 13 variables, 9 were found sta-tistically significant. The most significant predictors for surgical difficulty were Body Mass Index, Depth of impacted tooth and Retromolar space. No postoperative complications were reported.

Multiple unerupted impacted supernumerary teeth: a rare case report of father and son / Múltiples dientes supernumerarios impactados no erupcionados: presentación de un caso raro de padre e hijo

Multiple impacted supernumerary teeth without any associated systemic conditions or syndromes are rare. The prevalence rate of supernumerary teeth in the permanent dentition is between 0.1– 6.9 percent as compared to 0.3–0.6 percent in theprimary dentition. In this article, reporting a rare family history of non-syndromic multiple impacted supernumerary teeth,found incidentally during routine radiographic examination. Though the etiologic factor of multiple impacted supernumerary teeth are still not clearly known especially in cases without any syndrome. However, thorough evaluation is necessary toexclude associated systemic conditions.

Son raros los casos de sujetos con múltiples dientes supernumerarios impactados sin ningún tipo de afectación sistémica o síndrome. La tasa de prevalencia de dientes supernumerarios en la dentición permanente varía entre 0,1­6,9 % en comparación con el 0,3­0,6 % en la dentición primaria. En este artículo, se reporta una historia familiar rara de múltiples dientes supernumerarios impactados no sindrómicos, encontrados incidentalmente durante un examen radiográfico de rutina. El factor etiológico de dientes múltiples supernumerarios impactados aún no está claro, especialmente en los casos sin ningún tipo de síndrome. Sin embargo, es necesaria una evaluación a fondo para descartar enfermedades sistémicas asociadas.