Trigeminal nerve compression technique for the treatment of trigeminal neuralgia: study of 80 cases in 10 years

Objective: To dtermine the outcome of trigeminal nerve compression technique [TGNC] treatment for the idiopathic trigeminal neuralgia without decompressing the nerve compressed by the offending vessel

Methodology: This case series study was conducted in Hayatabad medical complex, Lady ready hospital and Abaseen hospital, Peshawar from June 2004 to June 2014. Consent from the ethical committee and patients were taken. All patients of idiopathic trigeminal neuralgia [TGN] were included. Those TGN cases having mass lesion were excluded. All information were put in proforma. Results were analyzed by SPSS version 20 and presented in the form of tables

Results: Total number of patients included in the study were 80 in which males were 45 [56.25%] and females were 35 [43.75%]. Male to female ratio of 1.3:1 The ages ranged from 30 to 70 years and mean age was 50 +/-20. Detail history and clinical examination were performed. Routine investigations of complete blood count, HBsAg, HCV and brain MRI were done in all cases. Follow up ranged from 1 to 10 years. Outcome was 77[96.2%] patients were completely pain free while 3[3.8%] of patients developed recurrence. One patient [1.25%] developed CSF rhinorrhea, otorrhea, facial nerve paresis and deafness each

Conclusion: The compression of TN by vascular loop was not found as a cause of TGN. TGNC Technique for TGN is less invasive, safe and effective

Odontogenic infections related to impacted lower last molars

The objective of this study was to determine the frequency and severity of the infections related to the impacted lower third molar subjected to removal at Khyber college of Dentistry Peshawar. Data was collected from consecutive three hundred patients from Jan 2003 to Aug 2003 in Khyber College of dentistry Peshawar. All Patients were divided into five age groups. The impacted lower last molars were classified according to Pell and Gregory classification and also according to their angulations. The pathologies related to type of impaction and in specific age groups were analyzed mathematically. It was found that most of the impacted lower third molars [90%] were removed because of infections related to them. Pericoronitis [48.5%] was most common infection followed by caries/pulpitis and periapical infections [26.5%] and periodontal problems [10%]. Mesioangular lower third molars were commonly involved with caries/pulpitis while vertical impactions presented commonly with pericoronitis. It was shown in this study that pericoronal infections were highly severe in 50.5% of the cases while moderate in 38% of the cases. Caries/pulpitis was moderately severe in 51% of the cases while periodontal problems were mild in most of the cases [55%]. It is concluded from this study that those impacted third molars which are at high risks of infections should be removed prophylactically because sometimes these infections can be life threatening. Careful and regular checkups are required to avoid the development of any pathology in future

Associated features of temporomandibular pain dysfunction syndrome

To know the associated features of temporomandibular pain dysfunction syndrome [TMPD] in order to prepare a preliminary report about patterns of TMPDS in our population. Material and In this prospective observational study, fifty patients of TMPDS were interviewed and examined in Sardar Begum Dental College Peshawar and authors private clinic from Jul 2005 to Dec 2006. Diagnosis of TMPD was established by history and clinical examination as the presence of pain, tenderness in muscle of mastications, limitation of jaw movements and by exclusion of other dental or TMJ pathological conditions Most of the patients were in their third decade of life and mostly they were students [34%]. Female gender was more common [74%] and most of the female patients were unmarried. Parafunctional habits like bruxisum, daytime clenching of the teeth, nail biting were noted in 22 [44%] patients, difficult extractions in 3[6%] patients and orthodontic treatment in 3[6%] patients while in 17 [34%] cases associated features were unknown. Pain was the presenting complaint of all the patients [100%] followed by clicking sounds in 56% and trismus in 44% of the cases. Parafunctional habits, difficult extractions and orthodontic treatment were related with TMPD in this study and nearly all of these factors reflect the stress affecting the TMJ

Sensory impairments following surgical removal of impacted mandibular third molar

This study was carried out to investigate the importance of certain variables on the incidence of sensory impairments after the surgical extraction of impacted lower last molars. Data were collected from a series of 300 consecutive patients referred to the department of oral and maxillofacial surgery Khyber College of Dentistry Peshawar for the removal of their impacted lower last molars. Patients were examined and treatment was planned in the standard manner. Out of 300 surgical extractions 18[6%] cases of lingual nerve injury and 11 [3.67%] cases of inferior dental nerve injury were recorded. The frequency of nerve damage was found to be highest among house surgeons [19%] and lowest among Professors and Associate Professors [3.6%]. Elevation of lingual flap was found to be associated with higher chances of lingual nerve injury. Incidence of nerve damage was found to be the highest [16%] when tooth sectioning and bone removal both were performed to extract the tooth. It is concluded from this study that operator's experience, lingual flap retraction, bone cutting and tooth sectioning during tooth removal strongly influence the rate of nerve damage during third molar surgery while age and sex of the patients does nothing with the incidence of nerve damage during surgical removal of last molars

Patterns and presentations of impacted mandibular third molars subjected to removal at Khyber college of dentistry Peshawar

Two hundred consecutive patients of mandibular third molar impactions presented to the oral surgery department of Khyber College of dentistry Peshawar were studied clinically and radiographically. Purpose of the study was to determine the patterns and presentations of mandibular third molar impactions. The impacted mandibular third molars were classified according to Pell and Gregory's method of classification as well as according to their angulations. Pathologies related to each type were also documented. The most common angulation of impacted mandibular third molar was mesioangular [48%] followed by vertical [35%] and distoangular [10%]. Pell and Gregory Class II [55%] and Class I [38%] were the most common types of impacted mandibular third molars. By analyzing level of eruption, it was found that Pell and Gregory Class B [59%] and Class A [35%] were the most common types of impactions. Pericoronitis was the most common pathology [48.5%] followed by caries [26.5%] and periodontal problems [10%]. Lack of awareness and mismanagement of impacted mandibular third molar often lead to recurrent infections and irreversible damage to their adjacent structures. As a result of this study previous recommendation for the prophylactic removal of those impactions, which are at higher risk of developing pathologies is suggested; otherwise a regular clinical and radiographical follow-up is necessary

study of different predisposing factors on lingual nerve damage during lower third molar surgery

Damage to lingual nerve is one of the common complications of the removal of mandibular third molars. A random data was collected in the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar. Effects of different factors [age and sex of the patient, experience of the operator and surgical method employed] were documented. Purpose of the study was to determine the frequency of lingual nerve damage and the effects of different variables on lingual nerve damage during the removal of mandibular third molars. It was shown in this study that age of the patient, sex of the patient and side of the lower jaw [right or left] operated has no significant effect on the frequency of lingual nerve damage, while experience of the surgeon and elevation of the lingual flap during extraction of the lower third molar significantly effects the frequency of lingual nerve damage. It is suggested that lingual/Lap elevation should be avoided in each case and if it is unavoidable to elevate the lingual flap then plenty of vigilance and care is necessary for the protection of lingual nerve

Pattern of mandibular fractures at mayo hospital, Lahore

The purpose of this study was to determine age, sex, aetiology and site of fracture related to mandibular fractures. This study was conducted at the Department of Oral and Maxillofacial surgery, King Edward Medical College / Mayo Hospital Lahore from 1[st] Sep 2004 to 31[st] July 2005. The study was carried out on 120 patients with mandibular fractures. Data concerning the patients' demographics, aetiology and pattern were obtained and analyzed. Approximately 50% of the patients sustained fractures from road traffic accidents and 45% of the fractures occurred in the 21-30 years age range. There was a male preponderance with a male to female ratio of 14:1. Parasymphyseal fractures were the most common followed by those of the body of the mandible. In the light of this study we should bring amendments in the traffic rules and legislation about seat belt usage, motorbike wheeling and kite flying to reduce frequency of facial trauma