Frequency, causes and effects of temporomandibular pain dysfunction syndrome among patients seen at Nishtar institute of dentistry, Multan

Temporomandibular joint pain dysfunction syndrome is the second most frequent cause of facial pain. The objective of this study was to find out most common etiological factor of TMD, its clinical symptoms, and distribution among gender. Etiology was multifactorial. All patients [100%] with TMD were having malocclusion and stress [100%]. Third most common factor was increased pain threshold [37%]. Out of 160 patients 82 [51%] were females and 78[48%] were males. Most patients were between 20-30 years of age group 51/160 [31.8%]. Most common presenting symptom was pain followed by clicking sounds in joint and then limited mouth opening. All these symptoms were more common in females

comparison of single versus multimodel analgesia in ablative maxillofacial surgical procedures

Objectives of this study was to evaluate the analgesic effect of single vs multimodal analgesics in postoperative pain in ablative maxillofacial surgery and to investigate whether prophylactic treatment with multimodal nociceptive blockade will delay the onset of postoperative pain, decrease analgesic requirement, speed recovery time and facilitate early discharge in this surgical group. This experimental comparative study was conducted in Maxillofacial Operation Theatre of Nishter Institute of Dentistry, Multan during the period from August 2013 to Feb 2014 equal groups of 30 each using non probability convenience sampling technique. In Group A patients an intramuscular injection of Ketorolac 0.5mg/kg was given 45 min before induction of anaesthesia preoperatively. In group B patients intramuscular injection of 0.5mg/kg ketorolac + 2mg/kg body weight of Tramadol [IM] was given 45 min before induction of anaesthesia preoperatively + local infiltratration of 0.5% injection bupivacaine was done 10 min before giving incision. In Group A patients, 17 patients [56.6%] had mild pain, 6 patients [20%] had moderate, 5 patients [16%] had severe and 2 patients [6.66%] had no pain. While in group B who received multimodal analgesia, the degree of postoperative pain was greater than in the group A in which 15 patients [50%] had mild pain, 2 patients [6%] had moderate pain and 13 patients [43.3%] had no pain. In group B, no patient suffered from severe pain. It was concluded that multimodal analgesia showed greater advantage over single analgesia in patients undergoing ablative maxillofacial surgical procedures

Postoperative analgesia; comparison of caudal bupivacaine and bupivacaine - tramadol in children with inguinal hernia repair

To compare the effects after caudal bupivacaine alone and bupivacaine-tramadol in young children with inguinal hernia repair. Department of Paediatric Anaesthesia, Children Hospital Complex, Multan. August 2008 to May 2009. A total of 100 children aged between 2-5 years were included in the study. The duration of analgesia was significantly prolonged in group-A patients [P= 0.001]. A low frequency of postoperative vomiting was observed in both groups i.e. 10% in group-A and 6.7% in group-B [P=0.64]. No respiratory depression, flushing and pruritis were observed. Low dose combination of bypivacaine and tramadol, when administered caudally, had an additive effect and provided prolonged and effective postoperative analgesia with minimal side effects

Treatment outcomes of reconstruction with iliac bone graft and rib graft in patients with mandibular defects

Iliac bone graft can be used to reconstruct alveolar defects or bone defects under 5 cm. Rib grafts have proven ideal for condylar reconstruction. Objective of this study was to assess the functional and aesthetic outcomes and post operative complications of the reconstructive method. In this study iliac bone alone or combined with rib graft was used for reconstruction of mandibular defects. Sampling technique was non probability purposive. This study was conducted in the Department of oral and maxillofacial surgery, Nishter Institute of Dentistry, Multan from March 2010 to march 2012. A total of 15 patients of hemimandibulectomy were reconstructed by iliac bone alone or combined with rib bone graft. In 3 cases iliac bone was combined with rib bone graft. There were 6 [40%] male and 9[60%] females. Mean age was 23.86+2.69y [range 20 -30y]. There were no significant post operative complications. Reconstruction with iliac bone graft combined with rib graft is an excellent method of reconstruction in patients with mandibular defects

Various surgical options in the management of basal cell carcinoma in Nishtar hospital, Multan

To describe the prevalence, mode of presentation and various surgical options of reconstruction in the management of basal cell carcinoma [BCC] with a local perspective. The present descriptive study was conducted at Nishtar Hospital, Multan from 2006 to 2009. A separate file was maintained for each patient. A thorough history and full physical examination was conducted, relevant investigations were carried out. All this was recorded in data collection for and data analysed to find frequencies and percentages using SPSS-10. Out of sixty cases, 50 [83%] were male and 10 [17%] were female. Majority of the patients presented to us above the age of 45 years and the incidence of BCC increases with the age. The male to female ratio was 5:1. Out of 60 cases 26 [20 male, 6 female] 43.3% were farmer, 16 [all male] 26.6% wee construction workers, 10 [8 male, 2 female] 16.6% were unemployed and 8 [all female] 13.3% were household. No patient presented before 5 years after the development of the lesion. 34 [30 male, 4 female] 56.6% for the last 6-10 years, 20 [16 male, 4 female] 33.3% for the last 11-15 years, 2 [all male] 3.3% for 16-20 years and 4 [2 male, 2 female] 6.6% had lesions for> 20 years. All the lesions encountered in present study occurred on exposed head and neck region as. Most of the patients had the nodular pigmented type of BCC and majority of them were male. None of them have Gorlin's syndrome. Delay in presentation has an overall negative effect on the outcome. A simple excisional biopsy technique ensure margins clearance and give surgeon more freedom for reconstruction

comparison of pressor respons following laryngeai mask airway vs laryngoscopy and endotracheal tube inserition

To test the hypothesis that laryngeal mask airway [LMA] insertion is associated with less pressor response as Compared to endotracheal intubation. A prospective, comparative study. Department of Anaesthesiology Intensive Care and Path Management, Nishtar Medical Institution Multan [Pakistan] from July 2007 to January 2008. 60 adult, ASA grades land II patients undergoing elective general surgery of less than one hour duration were divided in two groups with 30 patients in each. These patients were operated under general anaesthesia and either endotracheal tube [Group I] or LMA [Group II] was used to maintain the airway. The rise in heart rate, systolic and diastolic blood pressure was recorded before induction of anaesthesia and at one, three, five and ten minutes after insertion of laryngeal mask airway or tracheal tube and the results compared in both groups. A statistically significant rise in heart rate, systolic blood pressure and diastolic blood pressure was seen in group-I while statistically significant rise in heart rate only was seen in group-II subsequent to their insertion. Mean maximum increase was statistically more after laryngoscopy and endotracheal intubation than after laryngeal mask airway insertion. The duration of pressor responses was also longer after endotracheal intubation. Laryngeal mask airway is an acceptable alternative techinque offering advantages in terms of haemodynamic stability compared to tracheal intubation