Diabetes mellitus and osteomyelitis of the jaws

The Diabetes Mellitus is a prevailing medical condition worldwide [6%] and also in Pakistan. Infection in the orofacial wounds of these patients is common. The aim of the study was to determine the effect of diabetes mellitus on the healing process of alveolar sockets/bone after tooth removal. Eighteen diabetic patients with chronic jaw bone infections were examined and managed in oral and maxillofacial surgery department of de, Montmorency College of Dentistry, Lahore from 2009 to 2013. All patients gave history of tooth extraction about two months earlier. Orthopantomograph [OPG] were used to confirm the diagnosis. Fourteen patients [77.77%] were on oral hypoglycemic agents, four did not know their diabetic status, four patients [22.22%] were on intermediate acting insulin. All patients were managed under general anesthesia for involucrum sequestrectomy followed by primary closure. One insulin dependent patient with radiated lower jaw developed osteomyelitis after tooth extraction and was also on bisphosphonate medication followed by breast cancer surgery. This patient was operated twice to resolve the osteomyelitis of the lower jaw in follow up six months. It was concluded that diabetes effects the healing of sockets after tooth removal

Frequency and pattern of presentation of neuralgia inducing cavitational osteonecrosis

Neuralgia inducing cavitational osteonecrosis is a bone disease which leads to neuralgia like pain. The aims of this study were to document the frequency and pattern of presentation of neuralgia inducing cavitational osteonecrosis and differentiate it from trigeminal neuralgia. This case series was conducted from August 2011 to July 2012 at Punjab Dental Hospital, Lahore. Patients having facial neuralgia like pain were assessed by history, clinical and radiographic examination. From these patients, seventy patients with signs and symptoms of neuralgia inducing cavitational osteonecrosis [i.e. oro-facial neuralgic pain with intra-oral trigger zone, previous history of surgical intervention and radiographic evidence of cavitational osteonecrosis in the jaws] were included in the study for surgical debridement and curettage of necrotic bone. Out of seventy patients, 25 were male [35.7%] and 45 were female [64.3%]. Age range was of 18 to 70 years. Positive diagnosis of neuralgia inducing cavitational osteonecrosis was confirmed in 45.7% of cases. Most of the patients were from fourth and fifth decade of life. Mandibular posterior region was mostly involved [61.4%] followed by maxillary posterior region [30%]. Anterior maxilla was involved [7.1%] more than anterior mandible [1.4%]. NICO most often causes sharp, shooting pain and is frequently misdiagnosed as trigeminal neuralgia. Consequently, patients are prescribed unwarranted anticonvulsant drugs and/or a variety of surgical procedures without significant pain relief. Such patients should be diagnosed properly for effective management i.e. surgical debridement of involved region

Dental caries and pericoronitis associated with impacted mandibular third molars-a clinical and radiographic study

The most common impacted tooth is mandibular third molar and knowledge and assessment of its angulation pattern, position and depth in mandibular bone helps in better treatment planning and management of patients. The objective of this study was to enlist the frequency of dental caries and pericoronitis associated with different patterns of impacted mandibular third molars in different age groups and genders. A total of 250 patients with 393 impacted mandibular third molars seen in the Department of Oral and Maxillofacial Surgery, Punjab Dental Hospital, Lahore from October 2012 to March 2013 were included in the study. The age range of these patients was of 20 to 65 years. Patients were assessed by history, clinical and radiographic examination. Patterns of mandibular third molar impactions were assessed by using classification systems developed by Winter and Pell and Gregory on periapical radiographs. Pericoronitis was assessed by patient's history and clinical evaluation of mucosa surrounding the impacted mandibular third molars. Dental caries was assessed by clinical and radiographic evaluation. The most frequent pattern of impaction was mesioangular [37.6%], with Class II ramus relationship [53.2%] and Position A depth [62.8%]. Dental caries was seen in 38.53% of patients mostly associated with mesioangular, Position A, Class I molars. Pericoronitis was seen in 29.36% of patients mostly associated with distoangular, Position A or B, Class II molars. It was concluded that the patients having third molars with the unfavourable angulations, patterns and positions could be considered as the candidates for prophylactic removal of impacted mandibular third molars to prevent dental caries or pericoronitis. Moreover, early diagnosis of percoronitis and dental caries and proper management of third molar is necessary to prevent further consequences

Treatment of odontogenic ameloblastomas and their long term follow up at tertiary centre

Fifty-two patients of ameloblastoma were operated with special emphasis on radiographic and histological appearance. The unicystic radiographico-histological [38] cases were managed conservatively with marsupialization followed by enucleation [Group A' 15 Patients] and enucleation with peripheral ostectomy [Group B' 23 Patients]. The radiographico-histological multicystic [solid] variety [Group C' 14 Patients] was treated aggressively by resection. In conservative treatment regimens Carnoy's solution was applied after enucleation of the tumour whereas, the patients of aggressive surgery were operated with minimum 5mm safety marginal clearance of the tumour. The recurrence rate with average four years follow up was 0.0% for resection, 13.33% for marsupialization followed by enucleation and 8.69% for enucleation with peripheral ostectomy. The results were encouraging for unicystic ameloblastoma treated patients [Group A' and B'], in best interest of jaw bone contour preservation

An unusual case of chronic suppurative osteomyelitis of the mandible

Osteomyelitis of the mandible, a serious complication of untreated odontogenic infection has been reported. This case report describes an interesting presentation of chronic suppurative osteomyelitis (CSO) of the mandible in a 13 years old anaemic male patient. Investigations revealed inversion of his permanent teeth leading to trans-cutaneous extra-oral eruption along with marked destruction of mandible on the affected side. The treatment included a pre surgical course of antibiotics followed by the removal of the retained second premolar tooth, surgical debridement of the affected bone, and resection of the cutaneous sinus tract. The post-operative healing was uneventful. A combination of antibiotic therapy and surgical debridement were effective in the treatment of chronic suppurative osteomyelitis.

Removal of a broken needle in the pterygomandibular space: a case report

Needle breakage following inferior alveolar nerve block is an unusual yet alarming complication in contemporary dental practice. We report a case of surgical retrieval of a broken needle in the pterygomandibular space following an inferior alveolar block in a 21 years old male. The postoperative recovery was uneventful and no complications were observed. Prompt removal of a broken needle is advisable to avoid complications.

Nasolabial cyst: a rare presentation to the oral and maxillofacial surgeon

The nasolabial cyst is non-odontogenic fissural cyst. It appears in the soft tissues of the oral cavity on the region corresponding to the nasolabial furrow and alar nose. The time of appearance of this cyst is late in origin and frequently asymptomatic swelling elevating the nasal ala. The occurrence rate is extremely low and the clinical characteristics of this lesion and histopathology play very important role to recognize this cyst. The management of the cyst is by surgical excision intraorally. The purpose of this case report is to express the occurrence and diagnostic confirmation of this cyst to oral and maxillofacial surgeons and to understand the importance of the cyst in facial disfigurement

Use of silastic as interpositional material in the management of unilateral temporomandibular joint ankylosis

Ankylosis is a very common condition developed mainly after damage to mandibular condyles or temporomandibular joint [TMJ] at a growing age. Different autogenous and alloplastic interpositional materials have been attempted after the resection of the ankylotic bone to achieve desirable results. This condition is relatively common in Pakistan. We treated TMJ ankylosis with alloplastic medical grade silicone "silastic" interpositional arthroplasty. Eight joints accompanied ipsilateral or contralateral coronoidectomy to achieve desirable results. All patients were presented at Punjab Dental Hospital Lahore. Sixty-one joints with unilateral TMJ ankylosis were underwent surgery after careful examination and final radiographic confirmation. The preoperative CT scan was also performed in few patients. The postoperative measurements of the interincisal opening with lateral and protrusive jaw movements were criteria for success of surgery. The lateral and protrusive jaw movements were assessed as excellent, good and poor. Less than 25 mm interincisal opening was considered as poor jaw opening. The overall success rate was 98.4% with 84% desirable interincisal jaw opening. Less than 5% patients were observed with poor jaw opening. The immediate late complications were transient and were included oedema, weakness of a branch of the facial nerve on the operated side. Two implants were infected along with one wire in the first month of surgery and were removed under local anaesthesia without further complication