Influence of the margin status on the recurrence of oral cancer

Background: The prognosis of squamous cell carcinoma involving the oral cavity depends on various factors. The most important predictor of relapse and hence poor prognosis is the positive surgical margin of resected tissue. Therefore, it should be considered a priority while performing surgical resection

Objective: To estimate the frequency of presence of tumor cells on margins of histopathological specimens of oral squamous cell carcinoma after safe margin resection and the reoccurrence rate

Period: Two years from January 2015 to December 2017. Setting and design: This quasi experimental study was carried out at the department of oral and maxillofacial surgery, Mayo hospital, Lahore. Methodology: Fifty patients with squamous cell carcinoma of orofacial region requiring safe margin surgical resection were selected. Presence of tumour cells on margins of histopathological specimens was determined. And monthly follow up was done for six months to check the recurrence

Results: Histopathological results of margins of total 50 patient showed that 70% patient had negative margin,26 %patients had close margin and 4% patients had involved margin. Out of these patients 12% had recurrence of the disease

Conclusion: Margins are an important predictor of disease control and its recurrence

Utilization of nasolabial flap for reconstruction of oral cavity defects

Objective of this study was to highlight the utilization of nasolabial flap for reconstruction of oral cavity defects. The study revealed the results of 21 nasolabial flaps in 14 patients over the period of two and a half year. The patients presented at the Department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital, Lahore from November 2009 to November 2011 and at the Department of Oral and Maxillofacial Surgery, Fatima Memorial Hospital Lahore from May 2012 to October 2012. In 08[57.14%] patients the defects were secondary to Oral Submucous Fibrosis of buccal mucosae; 03[21.43%] patients were with biopsy proven Squamous Cell Carcinoma of the oral cavity and in 02[14.28%] patients flap was used to cover the post traumatic oro-antral defects secondary to firearm and machine injuries to the maxilla. One patient [7.14%] had the defect after resection of the cystic lesion of the maxilla. Uneventful flap healing was observed in 20[95.24%] and partial flap loss occurred in only 01[4.76%]. It was concluded that the nasolabial flap is a reliable and minimally traumatic local flap for reconstruction of small-to-medium sized oral cavity defects with predictable functional and good aesthetic results

Postoperative complications in primary definitive management of hard and soft tissues in mandibular gunshot injuries; a review of 47 cases

Background: Firearm injuries cause significant morbidity and mortality among its victims. The type and extent of tissue damage vary from simple small size wound to a large soft tissue or skeletal defect. The selection of the appropriate surgical technique is as important as the timing because incorrect selection or improper application of surgical techniques may also lead to infection, sequestration, wound dehiscence, graft rejection, facial deformity and subsequent re-visional operations

Objective: The present study, carried out at Oral and Maxillofacial Surgery department, King Edward Medical University/ Mayo Hospital, Lahore, was aimed at highlighting the frequency of Postoperative complications in primary definitive management of hard and soft tissues in mandibular gunshot injuries

Study design: Descriptive case series

Setting: Department of Oral and Maxillofacial Surgery, King Edward Medical University/ Mayo Hospital, Lahore, from November 2010 to November 2012; including 6 months follow up

Patients and methods: The study was conducted on 47 patients. All patients suffered gunshot injuries to the mandible and had soft and hard tissue defects at a single site. Patients ranged in age from 17 to 54 years with a mean age of 32.31 years. Males dominated in the study and were n=37 and females n=10. All patients were treated definitively in the first operation by addressing the hard and soft tissue defects

Results: All had single site fracture with angle of the mandible being most common 27 [57.44%]. For reconstruction of soft tissue defect local advancement by undermining and primary closure was carried out in 35 [74.47%] patients, buccal pad of fat in 4 [8.51%] patient, deltopectoral flap in 5 [10.64%] patients and skin graft in 3 [6.38%] patient. For hard tissue reconstruction, nonvascularized bone graft was given in all cases i.e. n=47 [100%]. Iliac crest bone graft was given in 34 [72.34%] patients, rib graft in 6 [12.77%] patients and symphyseal outer cortex bone graft in 7 [14.89%] patients. Post-operative complications were noted in terms of infection, plate exposure, plate fracture and malocclusion which appeared to be 9 [19.1%], 5 [10.6%], 2 [4.3%], 5 [10.6%] respectively

Conclusion: All patients in this series required surgical intervention for treatment of their facial gunshot wounds. Primary definitive hard and soft tissue management can be considered in patients suffering from gunshot injuries to the mandible. Although post-operative complications can result at higher rates in such injuries yet properly selected surgical techniques and post-operative infection control can produce excellent desired esthetic and functional results

Efficacy of chlorhexidine gel vs chlorhexidine rinses in reducing incidence of dry socket in mandibular third molar surgery

Objective of this study was to highlight the efficacy of chlorhexidine gel in prevention of dry socket in the post-operative period of mandibular third molar surgical extraction in comparison to chlorhexidine rinses. One hundred patients seen at the department of Oral and Maxillofacial Surgery, Institute of Dentistry, CMH Lahore Medical College, were included in this study. The study was conducted from July 2012 to June 2013. The trial group [n=50] was instructed to apply 0.2% chlorhexidine gel to the extraction wound during the first postoperative week, while the control group [n=50] was prescribed a 0.2% chlorhexidine rinse for the same period. Results of this study revealed a 67% reduction in postoperative dry socket in the gel group [P < 0.05]. The incidence of postoperative dry socket in the gel group was 6% [3/50] as compared to 18% [9/50] in the mouthwash group. It was concluded that topical application of chlorhexidine gel to the extraction wound significantly reduced the incidence of dry socket