Effect of Oral and Maxillofacial Injuries on the Development of Post-Traumatic Stress Disorder: A Cross-Sectional Study

ABSTRACT Objective: To assess the influence of oral and maxillofacial trauma on the development of Post-Traumatic Stress Disorder (PTSD) and to determine the efficiency of the Impact of Event Scale-Revised (IES-R) as a diagnostic tool for detecting PTSD in patients with Oral and Maxillofacial injuries. Material and Methods: PTSD was assessed one month postoperatively by the diagnostic instrument, IES-R, to arrive at a provisional diagnosis. A structured clinician-administered PTSD Scale then assessed the patients for the Diagnostic and Statistical Manual of Mental Disorders-5th edition (CAPS-5) to establish a final diagnosis. The assessment of the severity of PTSD was done based on various types of oral and maxillofacial injuries. Results: The IES-R scale provisionally diagnosed 54 subjects with PTSD, out of which 42 were diagnosed to have PTSD by the CAPS-5 scale. Subjects with injuries involving the 'orbital complex,' those presenting with a perceptible scar in the maxillofacial region and with multiple avulsed/ luxated anterior teeth, showed a higher affinity to develop PTSD, and this was statistically significant. Conclusion: Higher levels of PTSD in patients with injuries to the maxillofacial region warrants correct diagnosis and detection, and hence the maxillofacial surgeon plays a vital role in this regard. The IES-R is a useful diagnostic tool to detect PTSD early.

Application of Piezosurgery in Surgical Extraction of Impacted Mandibular Third Molars Versus Conventional Rotatory Technique: A Randomized Controlled Trial

Objective: To compare the effectiveness of conventional rotatory and piezosurgery technique for surgical removal of lower third molars. Material and Methods: Twenty patients with impacted lower third molars (with no acute symptoms) were divided into two groups (G1 and G2) and evaluated clinically and radiographically. They were allotted alternately into rotatory (G1) and piezotome (G2). Parameters assessed were the pain, swelling, trismus, comfort, analgesics consumed, the time taken for the procedure, intraoperative soft tissue damage and any other complications. Findings were then tabulated and analyzed. Results: Findings of pain, swelling, trismus, analgesics consumed and tissue damage were favorable in the piezosurgery group. However, the time taken for the procedure was significantly more as compared to the rotatory group. Post-operative trismus, values from the piezosurgery group were found to approach normality by day seven while in the rotatory group, a significant difference was found to exist up to day 14, suggesting that patients tend to return to normal function faster in the piezo group. Conclusion: Piezosurgery was found to be a good alternative to the conventional rotatory handpiece in select cases where extraction of the tooth could be carried out with minimal bone removal.

Diagnostic Accuracy of Ultrasonography in the Assessment of Facial Fractures

Abstract Objective: To assess the diagnostic accuracy of Ultrasonography (USG) in diagnosing superficial facial fractures. Material and Methods: Patients visiting our facility with facial trauma and suspected fracture of the facial skeleton, those who had undergone CT scans, and conventional radiographic examinations and those who were conscious and cooperative were included in the study. All conventional radiographs, CT scans and ultrasound examinations were done during 0-20 days after trauma in all the patients Results: A total of 20 patients participated in our study, out of which 18 were male (90%) with a mean age of 34.4 years (range of 19-75 years). Eleven sites of the face were examined bilaterally in each patient, i.e., a total of 440 sites. Of these, 84 sites were found to be fractured according to the CT scan examination whereas conventional radiographs detected 59 and ultrasonography detected 74 fractures (of which 70 were true fractures, while 4 were false-positive results). The sensitivity and specificity of USG in all fracture sites were 83.33% and 98.88% respectively. The positive and negative predictive values were 94.59% and 96.17% respectively Conclusion: Ultrasound examination had a better sensitivity when compared to conventional radiography in detecting superficial facial fractures.