A Comparative Study of the Effect of Primary and Secondary Closure Technique Following Removal of Impacted Mandibular Third Molars

Introduction: Surgical removal of the impacted mandibularthird molar is one of the most frequently performed surgicalprocedures in oral and maxillofacial surgery. The purpose ofthis study was to compare the primary and secondary woundclosure after surgical removal of impacted mandibular thirdmolars by evaluating the extent of facial swelling, the severityof pain and degree of trismus.Material and Methods: A prospective, randomized,clinical trial was conducted in 80 patients. The patients wererandomly divided into two groups of 40 each. In Group 1:patients underwent primary closure of the wound and inGroup 2: patients underwent secondary closure of the wound.Postoperative pain, swelling, and trismus were evaluated onthe 2nd and 7th day postoperatively.Results: Statistically significant difference was observed forfacial swelling and trismus on 2nd postoperative days betweenboth groups. Postoperative pain was less in the secondaryclosure group.Conclusion: From the outcome of the above study we canconclude that the secondary wound closure technique has asignificant advantage over primary wound closure concerningswelling and trismus.

Pneumoparotitis

The objective is to review a case of pneumoparotitis and to discuss how knowledge of this unique presentation is important when making differential diagnoses in emergency medicine. A patient with recurrent subcutaneous emphysema of the head and neck is reviewed. Stenson's duct demonstrated purulent discharge. Physical examination revealed palpable crepitance of the head and neck. Fiberoptic laryngoscopy and barium esophagram were normal. Computed tomography demonstrated left pneumoparotitis and subcutaneous emphysema from the scalp to the clavicles. This is an unusual presentation of pneumoparotitis and malingering. Emergency physicians should be aware of pneumoparotitis and its presentation when creating a differential diagnosis for pneumomediastinum, which includes more life-threatening diagnoses such as airway or esophageal injuries.

A Large Dentigerous Cyst Found in the Mandible

Dentigerous cysts are benign odontogenic cysts that are associated with the crowns of permanent teeth. They are developmental epithelial-lined lesions which are formed from fluid accumulation in the space between the reduced enamel epithelium and the surface of crown. This may occure due to the obstructin of venous return caused by tooth impaction. The most prevalent location of dentigerous cysts are the third molar of mandible. While the single dentigerous cysts are the second most common odontogenic cysts following the radicular cysts of jaw, multiple cysts are observed in patients with some conditions such as mucopolysaccharidosis type IV, basal cell nevus syndrome, and cleidocranial dysplasia. They occur in young patients in the second or third decades of life, but it is a rare occurrence for children. A sixteen-year-old girl with painful swelling in the right mandible visited to our department. All routine laboratory test results were within normal limits. However, we were able to diagnose that she had facial asymmetry. Computed tomography showed a well-defined soft tissue mass obliterating right mandible ramus with an impacted tooth. We performed total enucleation of cyst and molar tooth. The pathology revealed a non-keratinized squamous epithelial lined cyst associated with an undamaged tooth.