Nasolabial and extended nasolabial flaps for reconstruction in oral submucous fibrosis

OBJECTIVES: The objective of the study was to evaluate the results of nasolabial/extended nasolabial flaps as a modality for treatment of oral submucous fibrosis. MATERIALS AND METHODS: Eleven patients of Stage III or IVa maximum interincisal opening were selected to be operated. Nasolabial/extended nasolabial flaps were done for both the sides. All of the flaps were done in a single stage and were inferiorly based. A similar flap harvest/surgical technique was utilized for all the cases. RESULTS: The preoperative mouth opening ranged from 5 to 16 mm, with a mean of 10.09 mm. At 6 months the mouth opening ranged from 29 to 39 mm. Some of the complications encountered were poor scar, wisdom tooth traumatising the flap, decreased mouth opening due to non compliance and too much bulk. All of theses were managed satisfactorily. CONCLUSION: The nasolabial flap is a very reliable flap to restore the function of oral cavity. Important adjuvant measures are habit cessation, lifestyle changes, and aggressive physiotherapy.

Efficacy of tranexemic acid in preventing alveolar osteitis after third molar extraction

Objective: to determine the efficacy of tranexemic acid in preventing alveolar osteitis after third molar extraction

Study Design: randomized control trial

Place and Duration of Study: June 2013 to June 2014. Oral and Maxillofacial Surgery department, Dental section, Punjab Medical College, Faisalabad

Materials and Methods: thirty patients, between the ages 18-35 years without any gender discrimination, presenting for removal of bilateral mandibular impacted third molars were included in the study. One side was the study group [Group A] and the other side acted as control [Group B]. Group A was given Inj Transamine 500mg IV 10 minutes before surgical removal however no pre-operative medication was given to group B. The rest of the procedure was carried out in a standard fashion in both the groups. The frequency of dry socket was assessed in both the groups and compared using Chi Square test

Results: the age ranged from 18-35 years with a mean age of 23.3+/-3.5 years. Out of these 30 patients 18 were males and 12 females with an overall M:F ratio of 1.5:1. Eight patients out of the 18 males were smokers and 3 females out of 12 were using oral contraceptives. Two patient [6.7%] developed dry socket in Group A, and 4 [13.3%] developed dry socket in Group B. Although the control group showed a greater frequency of dry socket but overall the results were statistically insignificant [P-value>0.05]

Conclusion: although IV tranexemic acid cannot prevent dry socket completely however it can decrease the incidence of dry socket formation and its use may be considered in patients who show an increased predisposition towards formation of dry socket

Efficacy of peripheral streptomycin injection in the treatment of idiopathic trigeminal neuralgia

To evaluate the efficacy of peripheral streptomycin injection in relieving the pain of idiopathic trigerninal neuralgia. Quasi experimental study. Oral and Maxillofacial Surgery Department, Armed Forces Institute of Dentistry Rawalpindi, from 1[st] June 2006 to 31[st] December 2007. Thirty patients of idiopathic trigerninal neuralgia were selected. They received five consecutive injections of streptomycin Ig in 3 ml of 2% Lignocaine [Septodont] with 1: 100,000 adrenaline at one week interval. Follow up was carried out at one, two and six months after the last injection. Age ranged from 15-78 years [mean 44.67]. Male to female ratio was 1:1.14. Right side of the face was involved in 70% and left side in 30% cases. Mandibular division of trigeminal nerve was involved in 43.3% and maxillary division in 40% of the cases. In the rest both maxillary and mandibular divisions were involved. Pain was significantly decreased from baseline to 1 month [p < 0.001]. The level of pain was increased a bit but the increase was significant at two months [p = 0.006] and at 6 months [p = 0.020]. Best treatment modality for this devastating disease is yet to evolve. Within the confines of the study it can be stated that efficacy combined with low post treatment morbidity makes streptomycin a useful treatment option

Accuracy of Pederson and modified Parant scale for predicting difficulty level of mandibular third molars

To determine the accuracy of Pederson and Parant Scale for predicting the difficulty level of mandibular third molar extraction. Prospective cross-sectional, 6 months from January 2012 to June 2012. All consecutive patients who presented for the extraction of impacted third molars were included in the study. Orthopantomograms (OPGs) were advised and on these OPGs third molars were classified as easy, moderate or difficult according to standard Pederson scale. Similarly modified Parant scale was utilized to predict the difficulty of removal of third molars. Root pattern was also noted on the OPG. These parameters were then compared with peri-operative parameters like time taken for extraction and need for crown or root sectioning using Chi Square test. A p value of 0.05) while significant results were obtained in case of Parant Scale (p value<0.05). Statistically significant results were seen for root pattern and level of difficulty (p value<0.05). These scales failed to predict difficulty level of tooth removal accurately especially in cases of distoangular impactions. When combined with root pattern, the accuracy of prediction gets significantly better.

Bioresorbable versus titanium plates for mandibular fractures

To compare bioresorbable plates with titanium plates for treatment of mandibular fractures. Randomized controlled trial. Oral and Maxillofacial Surgery Department, Armed Forces Institute of Dentistry, Rawalpindi, from January to December 2010. Patients with mandibular fracture were randomly divided in to two groups. The control group received titanium plates while the experimental group received the bioresorbable plates. All the procedures were carried out under general anaesthesia using standard surgical techniques. Frequency of plate/screw breakage or loosening, development of infection, malocclusion, malunion, wound dehiscence, the need for hardware removal and any other technical difficulties were compared between the two groups using chi-square test with significance at p < 0.05. A total of 34 patients were included in the experimental group where 53 resorbable plates were applied. The control group consisted of 35 patients and received 52 titanium plates. The mean age in the experimental group and the control group were 31.35 +/- 11.16 years and 34.31 +/- 10.69 years respectively. Breakage of 16 screws and 03 plates was seen in the experimental group while no screw or plate broke in the control group. The results showed significant association of screw breakage with resorbable plates and plate removal with titanium plates. Bioresorbable plates can be used as an alternative to titanium plates in mandibular fractures but with caution. They are a good means to stabilize fractures in patients where growth retardation and hardware removal may be a consideration

Bcl-2 protein expression in mucoepidermoid carcinoma of salivary glands: a single institution experience

Mucoepidermoid carcinoma is the most common salivary gland tumor with varying behavior among different histopathological grades. The objective of this study was to determine the expression of Bcl-2 protein in mucoepidermoid carcinoma [MEC] and to correlate with histological grades. The records of 40 cases of MEC were collected from the histopathology department. Fresh slides were prepared and fresh diagnoses were made using the grading criteria for MEC. Immunohistochemical markers for Bcl-2 were applied and the results analyzed using the chi-square test. Of 40 cases, 20 were males and 20 were females. The range in age of the patients was 6 to 67 years mean [SD] was 42.6 [1.85] years. Twenty-two were low grade [55%], 11 high grade [27.5%] and 7 [17.5%] were intermediate grade MEC. Among these 40 cases, Bcl-2 expression was positive in 24 cases and negative in 16 cases. In 22 cases of low-grade MEC, 19 were positive while only 3 were negative. In high-grade tumors, all 11 cases were found to have a negative expression of Bcl-2 protein. In intermediate-grade MEC, 5 cases showed positive expression while only 2 cases showed negative expression. Bcl-2 protein expression showed positive expression in low-grade and negative expression in high-grade MEC. Intermediate grade showed more than 50% positive results for Bcl-2. Correlation between grades of MEC and expression of Bcl-2 is statistically significant and can be used for the depicting the prognosis of MEC along with other prognostic and clinico-pathological parameters

Transpapillary versus palatal injection technique for maxillary tooth extractions

To compare the pain during injection administration and efficacy of transpapillary injection with palatal injection for simple maxillary tooth extractions. Randomized control trial. The oral and maxillofacial surgery department of Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from July to December 2009. Patients requiring simple extraction in maxilla were randomly divided into two groups each consisting of 100 patients. Group 1 was given conventional palatal injection and served as a control, whereas Group 2 received the transpapillary injection. Two percent Lignocaine with Adrenaline [1:100,000] was used for both groups. Pain during injection and then during the extraction were recorded for both groups using the Visual Analogue Scale and Faces Pain Score Scales on specially designed proformas. The data was analyzed using SPSS version 17.0 and independent t-test was applied to compare pain between both groups. P-value of less than 0.05 was considered to be statistically significant. Group 1 consisted of 61 males and 39 females with an age ranging from 11-73 years [mean= 39.92 + 14.85 years] while Group 2 consisted of 59 males and 41 females with an age ranging from 10-70 years [mean= 39.31 + 18.53 years]. Results of FPS and VAS scores for injection and procedure were analyzed using independent t-test. Difference of scores for pain during injection were found to be significant [p < 0.05] while the scores for the procedure were seen to be statistically insignificant [p > 0.05] showing that transpapillary injection is equally effective for maxillary extractions as palatal injection but with significantly decreased pain during injection. Transpapillary injection is an easy and effective way of eliminating the pain of palatal injection for maxillary extractions

maxillofacial trauma management trends at Armed Forces Institute of Dentistry, Rawalpindi

The aim of this study was to evaluate and analyze current trends in the management of trauma in patients presenting to oral and maxillofacial surgery department of Armed Forces Institute of Dentistry. Rawalpindi from Jan 2008 to Dec 2010. In this retrospective study, data of 613 patients with maxillofacial fractures treated at oral and maxillofacial surgery department, Armed Forces Institute of Dentistry was reviewed and analyzed. The main parameters recorded were gender, pattern of facial bones fracture and treatment modality of fracture. Out of these 613 patients, 564 [92%] were males and 49 [8%] were females with a male to female ratio of 11.5:1. The mandible was the most common bone to be fractured, with 307 fractures [50.1%], followed by 116 fractures [18.9%] of zygomatic bone, 83 fractures [13.5%] of maxillary bone, 64 patients [10.5%] had panfacial trauma, 26 [4.3%] were having nasal fracture while Naso-orbito-ethmoid fractures [NOE] were seen in 15 [2.4%] cases. The management of the injured face has undergone major changes, outcomes are considerably better than 30 years ago as more comprehensive assessment and management is now possible

Frequency of xerostomia in patients suffering from hepatitis B and C

The objective of the study was to assess the frequency of xerostomia in patients infected with hepatitis B and C presenting to the oral and maxillofacial surgery department of Rawal Institute of Health Sciences, Islamabad from October 2011 to February 2012. It was carried out as a prospective cross sectional study. All patients who gave the history of being infected with hepatitis B or C were included in the study. They were asked about the sensation of dryness of mouth and then were clinically evaluated for the presence of xerostomia by putting a mirror against the mucosa. Sticking of mirror to the mucosa was taken as a positive result. 38 patients presented to the oral surgery department, out of these, 6 were males and 32 females [1:5.3]. Eight [21.1%] had hepatitis B while 30 [78.9%] were suffering from hepatitis C. Xerostomia was seen in 8 [26.7%] patients with hepatitis C. None of the patients with hepatitis B presented with xerostomia. Chi Square test was used to analyze the association of xerostomia with therapy for hepatitis but no statistically significant association was observed [p>0.05]. Xerostomia may be a finding in patients with chronic liver disease and treating clinicians should be aware of it and should treat it to improve patients' quality of life

Distraction osteogenesis for correcting maxillo-mandibular deformities

To determine the effectiveness of distraction osteogenesis [DO] for correcting maxillofacial deformities. Case series. Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from June 2008 to November 2010. Patients with diverse maxillofacial deformities were selected for the study. In all cases, intraoral distractors were used. Mandibular osteotomies were done using submandibular incision and maxillary osteotomy was done using standard vestibular incision. In paediatric patients, DO was started on third postoperative day while in adults, a 7-day latency period was followed. Distraction was carried out at a rate of 0.5 mm twice daily [1 mm/day]. Distractors were removed after a consolidation period of 2 months. A total 7 cases were operated for DO. Out of these, 3 were males and 4 females. The age ranged from 2-24 years [mean 12.57 +/- 9.48 years]. Five patients had their deformity owing to temporo mandibular joint [TMJ] ankylosis, one had congenital micrognathia and one patient had skeletal class-III deformity. Five patients underwent mandibular DO, one underwent maxillary DO and in one case simultaneous maxillo-mandibular DO was carried out. Amount of distraction varied from 9.0 mm to 19.2 mm [mean 15.04 +/- 4.33 mm]. Mean follow-up was 18.14 +/- 5.39 months. Distraction osteogenesis can be employed satisfactorily to correct diverse maxillofacial deformities like retrognathia, facial asymmetry and skeletal class-III

C-reactive protein as a prognostic indicator of oral squamous cell carcinoma-a retrospective study

The objective was to determine Serum C-Reactive protein as a prognostic indicator for Oral Squamous Cell Carcinoma. It was a retrospective cross sectional study, conducted in the Department of Oral Medicine, Eastman Dental Institute, University College London. The medical records of the patients were reviewed by using NHS CDR [National Health Service Clinical Data Repository] and studying their hospital notes of the year 2005. All the patients who had histopathologically proven OSCC, being treated with surgery as primary treatment modality and had pre-operative CRP values were included in the study. Data collection included the pre-operative serum CRP values, treatment modalities, disease severity, out comes, complications and the survival time period of the patients. Thirty one patients with OSSC treated primarily with surgery were included in this study. Twenty four patients had elevated pre-operative serum CRP levels while seven patients had normal value of serum CRP. 12 were males and 19 females with male and female ratio of 1:1.6. The age of the patients ranged from 46-92 years with the mean age of 64.87+14.25 years. The pre-operative serum CRP levels ranged from 4-57.2 mg/L with the mean value of 35.94+19.68 mg/L. Higher values of CRP corresponded with higher TNM staging and poor overall 5-year survival. The study showed that patients with elevated pre-operative serum CRP levels showed the worst prognosis and almost all of them died within five years while the patients with normal CRP were alive even after 5 years of surgical resection. Hence, it can be concluded that elevated pre-operative CRP levels are prognostic indicators in patients with OSCC

Aetiology and pattern of dentoalveolar injuries in patients at armed forces institute of dentistry, Rawalpindi

To determine the aetiology and pattern of dentoalveolar injuries in patients presenting to oral surgery department of Armed Forces Institute of Dentistry, Rawalpindi. Cross sectional study. Oral Surgery department, Armed Forces Institute of Dentistry, Rawalpindi. September 2008 to August 2009. One hundred and thirty eight consecutive patients presenting to oral surgery department with dentoalveolar injuries irrespective of the age and gender were included in the study. Edentulous patients, patients with only soft tissue injury and patients with other maxillofacial injuries but no dentoalveolar injury were excluded. The included patients were asked about the cause of injury and the pattern of injury was noted clinically. This information was collected on specially designed proformas. All injuries were classified according to Andersean's classification. Out of these 138 patients, 111 [80.4%] were males with a male to female ratio of 4.1:1. The age ranged from 2-65 years with a mean age of 21.22 years. RTA was the most common cause of injury and was seen in 58 [42%] patients. Followed by fall noted in 52 [37.7%] patients. Other causes observed were contact sports in 7 [5.1%], violence in 4 [2.9%] and work place accident in 7 [5.1%] patients. Regarding pattern, the most common type of injury was avulsion and subluxation followed by crown fractures, luxation, root fractures and tooth displacements in various directions. Males especially the young lot was more affected by dentoalveolar trauma. RTA and fall remain the main causes of these injuries in our population. Avulsion, subluxation and luxation were the most common patterns of trauma observed. Maxillary incisors were the most commonly affected teeth in these traumatic episodes

Oral submucous fibrosis: reconstruction with nasolabial flap

The main objective of the study was to evaluate the efficacy of Nasolabial Flap in the reconstruction of oral sub mucous fibrosis. Case series. Oral and Maxillofacial Surgery Department, Armed Forces Institute of Dentistry, Rawalpindi from Jan 2008 to Dec 2009. A total of 5 patients with moderate to severe degree of oral submucous fibrosis were treated surgically and the reconstruction was done using bilateral nasolabial flaps. Four patients were male and one patient was female. The mean age of the patients was 24.6 years. Pre-operative mouth opening was measured before the procedure. Similarly per-operative and post operative mouth openings were also recorded and compared with the pre operative mouth opening. Pre-operative openings ranged from 8mm to 18mm [mean= 12.3mm]. After 6 months of post operative follow up and vigorous physiotherapy exercises, patients were able to maintain mouth openings ranging from 32mm to 39mm [mean =34.5mm]. Paired t-test was used to analyze the results and the value was found to be statistically significant. [p<0.05]. Bilateral Nasolabial flap is a satisfactory treatment modality for oral submucous fibrosis both functionally and esthetically

Reasons and pattern of first molar extraction - a study

The aim of this cross sectional prospective study was to determine reasons and patterns of permanent 1[st] molar extraction in patients reporting to oral and maxillofacial surgery department at Armed Forces Institute of Dentistry, Rawalpindi. All patients referred to oral and maxillofacial surgery department for extraction of permanent first molar teeth from 1st of January 2009 till 31[st] of December 2009 were included in the study irrespective of their age and gender. The primary reason of extraction was recorded along with other relevant information. The pattern of extractions of the permanent first molars was also noted. A total of 470 patients were included in the study. Out of these 291 [61.9%] were males [M: F 1.6:1]. Caries was the most common cause with 281 extractions [59.8%] in all age groups in both genders followed by periodontitis, which was responsible for 109 [23.2%] of permanent first molar extractions. Mandibular molars were more frequently extracted [62.7%] as compared to the maxillary molars [37.3%], with the mandibular left molar being the most frequently extracted tooth in the sample population

Expression of p53 in adenoid cystic carcinoma of salivary glands - a clinicopathological and immunohistochemical correlation

To document p53 protein expression in Adenoid cystic carcinoma [AdCC] of salivary glands and correlate this expression with clinicopathological parameters in prognostic assessment of AdCC at microscopic level. This Correlation study was carried out at Armed Forces Institute of Pathology [AFIP], Rawalpindi for 6 months. A total of 40 cases of AdCC diagnosed in salivary glands of five years duration [2006-2010] were retrieved from tumor registry. Clinical information was extracted from histopathology request forms submitted with the specimens. Fresh slides were prepared for histopathological [H and E stalling] and subsequent p53 immunohistochemical evaluation. Out of 20 patients [50%] belonging to 31-50 years age category, 12 were positive and 8 cases were negative for p53 expression. Majority of patients were male [n=27, 67.5%], among which 17 yielded positive while 10 had negative p53 expression. Among tumors evolving from major salivary glands [n=13], 10 showed positive whereas only 3 displayed negative results for p53 expression. Maximum number of tumors [n=17, 42.5%] were greater than 4 cm in size with 12 of them as p53-positive and 5 as p53-negative. Results for histopathological subtype and tumor grade were similar, with 34 [85%] revealing cribriform growth pattern, thus having grade Il neoplasms, with equivocal p53 staining, yielding 18 as p53-positive and 16 as p53-negative neoplasms in each parameter. Though small in count, all tumors with solid histological subtype [n=5, 13%], hence with grade Ill neoplasms exhibit positive p53 expression. Perineural invasion '.vas present in 77% [n=31] of tumors, among which 17 were having positive while 14 were having negative p53 expression. Lymphovascular invasion was present in 37 [92.5%] cases, among which 22 yielded positive while 15 had negative expression of p53. Tumors with larger size [_4cm], solid growth pattern, grade Ill neoplasm and major salivary gland as primary tumor site bear positive correlation with p53 protein. Though none of the correlation turned out as statistically significant to be used as key element in prognostic assessment of AdCC at microscopic level, however the above mentioned parameters can be considered important while planning the management which may need an aggressive approach in these cases. There is a need of more research for additional comprehensive prognostic assessment of salivary gland AdCC

Oral cancer - are the dentists doing enough for its prevention and early diagnosis? - a study

The aim of this study was to determine whether and to what extent the dental profession is helping in the prevention and early diagnosis of oral cancers. Data were collected by distributing self administered questionnaires among two hundred randomly selected dentists of Rawalpindi and Islamabad to know what role they play in the prevention and early diagnosis of this deadly disease. More than half [52%] of the dentists did not ask or asked rarely about the use of tobacco, alcohol and other risk factors and only about a third [34%] advised and helped their patients to quit these habits. Only 22% of the dentists regularly examined the entire oral mucosa of all their patients and even fewer [12%] considered the possibility and then searched for a coincidental oral cancer. Only about 06% took biopsies of suspicious lesions regularly. The findings of this study indicate that the dentists of this region need to do a lot more for the prevention and early diagnosis of oral cancer

Oral squamous cell carcinoma: a clinicopathological study of 467 cases at afip Rawalpindi, Pakistan

The purpose of this study was to determine the clinicopathological and demographical characteristics of histologically diagnosed cases of oral SCC. Evaluation is based on age, gender, site of tumor and histological differentiation. Histologically diagnosed cases of oral SCC during a period of 3 years [Jan 2007 - Dec 2009] were retrieved from the tumor records of Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan. Biopsy specimens at the institute are obtained from Armed Forces as well as public and private sector hospitals including the review cases for second opinion. All the cases were subjected to the analysis of age, gender distribution, site of tumor occurrence and grade of histological differentiation. Out of a total of 12611 tumors recorded at AFIP Tumor registry, 467 cases of oral neoplasms were diagnosed as SCC [3.7%]. Among head and neck tumors recorded in the study period, oral SCC comprises 32.9% of the total. The mean age [ +/- standard deviation] of patients was 55.9 +/- 13.3 years [range, 5-90 years] with a male predominance [52.5%], yielding male to female ratio of 1.1:1. Peak incidence is found in 60 years of age. Most common site was buccal mucosa [29.8%] followed by tongue [23.1%] and mandible [13.5%]. Most common histological grade was well differentiated [67.5%] followed by moderately differentiated [26.8%] and poorly differentiated [5.8%] histological subtypes. Oral SCC is the most common malignancy of head and neck region in our community with peak incidence in comparatively older age group. There is an overall male predominance except in younger age group, where it is more common in females. Most common site of tumor is buccal mucosa. The well differentiated grade is the most common histological type of differentiation