Bedside ultrasonography: a useful tool for traumatic pneumothorax

Objective: To compare the diagnostic accuracy of bedside ultrasound and supine chest radiography for the diagnosis of traumatic pneumothorax

Study Design: Analytical study

Place and Duration of Study: PIMS and PAEC General Hospital, Islamabad, from November 2014 to August 2015

Methodology: Patients coming to emergency departments of the study centres, who had sustained chest injuries, were inducted. Their portable bedside ultrasound and supine chest radiographs were taken for assessing pneumothorax and subsequently CT chest was done for confirmation as gold standard

Results: Based on CT findings, sensitivity for ultrasonography and chest radiography was found to be 83.33% and 54.76%, respectively and specificity of 100% for both modalities

Conclusion: Ultrasound can be used as a useful and suitable adjunct to CT in trauma patients as it is easily available, non-invasive, bedside, easily examined with no radiation risk

Pattern of presentation of mandibular condylar fractures in relation with known risk factors

Mandibular fractures are one of the most common fractures of facial bones. Parasymphysis is the most common site followed by condylar and subcondylar areas of the mandible. A descriptive study was carried out at Department of Oral and Maxillofacidl Surgery, King Edward Medical University I Mayo Hospital, Lahore from 27th September 2011 to 26th September 2012. The study was carried out on forty patients with mandibular condylar fractures. The fractures were classified according to the Spiessl and Schroll classification system. Objective of this study was to describe pattern of presentation of mandibular condylar fractures and to evaluate factors leading to mandibular condylar fractures in a tertiary care hospital. 32 [80%] were males and 8 [20%] females. The age ranged from 1% to 65 years with mean of 26 years [SD +/- 16.90]. Road traffic accidents including motor bike, auto-rickshaw and car accidents were found to be predominant risk factors [15 patients - 37.5%]. Type II fractures [low neck displacement] comprised the highest proportion - 16 out of 48 fractures [33.3%]

Road traffic accidents and falls were the leading risk factors for mandibular condylar fractures identified in this study. Type II fractures were seen to be the most frequent variant of condylar fracture. It was noted that no specific pattern of condylar fracture was associated with any specific risk factors

Oral squamous cell carcinoma; clinico-pathological parameters and AgNOR status in grading

The aim of this study was to evaluate clinico-pathological parameters and the status of argyrophilic nucleolar organizer regions stain in various histological grades of oral squamous cell carcinoma. A cross sectional study was conducted on fifty cases of oral squamous cell carcinoma. The specimen were collected from the department of Oral and Maxillofacial Surgery and processed for hematoxylin and eosin stain and AgNOR stain Pathology Laboratory, King Edward Medical University Lahore. Bidi smoking is associated with oral squamous cell carcinoma. The AgNOR [mAgNOR and pAgNOR] status was significantly low in well differentiated and moderately differentiated compared to poorly differentiated oral squamous cell carcinoma [p =0.001]. AgNOR size in poorly differentiated was significantly higher than the AgNOR size in well differentiated oral squamous cell carcinoma. Similarly the distribution of AgNOR in moderately and poorly differentiated oral squamous cell carcinoma was significantly high. The AgNORs index was significantly high in poorly differentiated squamous cell carcinoma as compared to well differentiated and moderately differentiated squamous cell carcinoma. The use of AgNORs stain is easy, valid and reliable method to assess the histological grading of oral squamous cell carcinoma and should be used to predict the prognosis of patients

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

Comparison of post operative complications in mandibular angle fractures treated by single versus two miniplates

The ojective of this study was to compare the complications [infection and non union] when fractures through the angle of the mandible are treated with a single noncompression miniplate versus 2 noncompression miniplates. 300 patients were randomly divided in two groups, 150 patients in each. Group A was treated by single non compression miniplate plate at superior borber of angle of mandible using intraoral approach. Group B was treated by two noncompression plates one at superior border as in group A, and other plate at lower border using extra oral approach. Patients were assessed for infection and non union on 21st, 45th and 60th days after the procedure. Mean age of patients in Group-A was 35.87 +/- 1.90 and in Group-B mean age of patients was 31.30 +/- 3.45 years respectively. Gender distribution showed that there were 241 [80.34%] [Group-A=124, Group-B=117] male and 59 [19.67%] female patients [Group-A=26, Group-B=33]. There were 10[6.67%] patients in Group-A and 22[14.67%] patients in Group-B who got infection at fracture site at 21st day.. At 45th day 6 [4%] patients in Group-A and 17[11.33%] patients in Group-B had infection. At 60th day infection was present in 10 [6.67%] patients and in Group-A only 2 patients had infection. This study shows that there are less chances of Infection when the patients are treated with one miniplate as compared to two miniplates for the treatment of displaced mandibular angle fractures

Eruption time of premolars in children at urban schools of Lahore, Pakistan

The purpose of this study was to ascertain mean eruption ages of premolars in local school children and to compare with other population groups. cross sectional study. This study was conducted in the Deptt. Of Oral Maxillofacial Surgery, KEMU,Lahore from 17.12.2009 to 17.12.2010. The mean eruption ages of permanent teeth were derived from a cross sectional study of 4000 public and private schools children in Lahore with ages ranged 8-13 years. Children were from all classes of socioeconomic status. Sample was examined in good torchlight and emergence through the gingivae was noted. Maxillary premolars erupted earlier than the mandibular ones in both genders. The mean sequence of eruption in upper and lower arch was P[1], P[2]. Maxillary 1[st] premolar was the first tooth to erupt in boys and girls; whereas mandibular 2[nd] premolar was the last one. [1] The premolars erupted slightly earlier than the standards used in our practice of text books. [2] Maxillary premolars erupted earlier than mandibular premolars. [3] Local standards should be applied while planning preventive and interceptive orthodontic measures and treatment modalities in other specialties

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

Outcomes of autogenous blood injection in the treatment of recurrent dislocation of temporomandibular joint [TMJ]

Recurrent Temporomandibular dislocation has been managed in the past with both surgical and non-surgical modalities. The objective of this study was to assess the functional results of autologous blood injection into the joint space for recurrent TMJ dislocation. This study was conducted in the department of Oral and Maxillofacial Surgery, Nishter Institute of Dentistry Multan from July 2011 to July 2012. A total of eleven patients of recurrent dislocation of jaw were managed by autogenous injection of blood into glenoid fossa with temporary intermaxillary fixation for 15 days. All patients were female with mean age 40.18+7.83 years [range from 30 to 55 year]. Diagnosis was made by clinical and radiographic judgment of OPG. The major cause of dislocation was prolonged forceful opening of jaw. Functional assessment was performed by clinical assessment after opening and closing of jaw. Mouth opening was assessed by measurement of interincisal distance pre and post operatively. Outcome measures of interincisal distance are done by inch tape and other outcomes were assessed by clinical judgment. Data was analysed using SPSS version 15. In one patient dislocation recurred after three months of procedure but frequency of dislocation reduced. In another patient dislocation occurred immediately after release of intermaxillary fixation. In other patients recurrence did not occurred after release of intermaxillary fixation at 6 months follow up. No significant treatment complication occurred. Pain on injection and swelling occurred in all patients for a brief period. Autogenous blood injection in glenoid fossa with intermaxillary fixation for 15 days is asafe and effective treatment in cases of recurrent dislocation of TMJ

Comparison of outcomes of membranous with endochondral bone graft in orbital floor reconstruction

Objective: To compare membranous with endochondral bone graft in orbital floor reconstruction in terms of donor site hematoma and correction of postoperative diplopia

Study Design: Randomized clinical trial

Place and duration of study: Department of Oral and Maxillofacial Surgery, King Edward Medical University / Mayo Hospital Lahore. One year from 01-07-09 to 30-06-10

Material and Method: 58 patients clinically and radiographically having defect in the orbital floor due to trauma were included in the study. According to the treatment, patients were randomly divided into two groups by lottery method. Group A [29 patients] received the membranous bone graft from calvariumand Group B [29 patients] received the endochondral bone graft from anterior iliac crest. The variables to be analyzed were donor site hematoma and post-operative diplopia

Results: Group A consisted of 29 patients [mean age 30.31years + 11.41] and Group B consisted of 29 patients [mean age 29.6 years + 9.05]. Donor site hematoma developed in 3 [10.3%] patients in Group A and in 9 [31.0%] patients in Group B. In Group A, postoperative diplopia persisted in 2 [6.9%] patients and in Group B, it persisted in 5 [17.2%] patients. Chi-Square test was used to compare the variables in both groups and the results were statistically significant for donor site hematoma [p value: 0.026] but insignificant for postoperative diplopia [p value: 0.113]

Conclusion: Membranous bone graft is better than endochondral bone graft in terms of donor site hematoma. When it comes to the correction of postoperative diplopia, there is no difference between two types of bone graft

Risk factors for temporomandibular joint ankylosis in different age groups

To identify the risk factors responsible for the development of temporomandibular Joint ankylosis. The study was carried out in the Department of Oral and Maxillofacial Surgery at King Edward Medical University, Lahore, Pakistan from April 2005 to April 2009. Two hundred patients with Temporo mandibular Joint Ankylosis were recruited in this study. To identify the risk factors, patients were divided in different groups according to their age so that the most common risk factor was identified amongst these patients. The groups were A. 6 months to 8 years, B. 9-17 years, C. 18-25 years. D>25 years. Risk factors identified were history of fall, road traffic accident, middle ear infection, autoimmune diseases and no obvious history. The highest percentage of the patients belonged to Group B [50%] and history of fall was the main risk factor in the development of Temporomandibular joint ankylosis [72.5%] with p value < 0.05. Trauma is the major factor of Temporomandibular joint ankylosis in all age groups in Pakistan. In this context, we conclude that this complication is a preventable entity if early post traumatic rehabilitation is instituted

Comparison of two surgical procedures in reduction of mandibular angle fracture

The purpose of this study was to determine various post operative complications associated with two surgical procedures used for reduction of mandibular angle fractures. A Quasi-Experimental study was carried out in the Department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital, Lahore. The study was carried out from 30[th] April 2006 to 30[th] April 2007on sixty patients with mandibular fractures. They were divided in to two categories. Thirty patients were treated by intra oral approach [Group A] and thirty by extra oral approach [Group B]. At different intervals of their post operative visits, these patients were evaluated for post operative complications of infection, nerve damage, hypertrophic scar, esthetic dissatisfaction, malocclusion and limitation in mouth opening. 20% of the patients treated with extraoral approach presented with post operative nerve damage and no patient treated by intra oral approach showed nerve damage [p=0.02]. Similarly postoperative esthetic dissatisfaction was present in only 6.67% of the patients treated with intraoral approach as compared to 63.33% patients treated with extraoral approach [p=0.00]. Based on this study intra oral approach was considered as more suitable method for the treatment of mandibular angle fractures

Cervical lymph node metastases in squamous cell carcinoma of tongue and floor of mouth

Oral squamous cell carcinoma has high chances of cervical lymph node metastasis. This case series describes the distribution of cervical lymph nodes in 50 cases of squamous cell carcinoma of tongue and floor of mouth. The mean age was 47.28 +/- 10.5 years. Thirty positive metastatic lymph nodes were found; 90% occurring at level l-ll mostly in T4 size but also in T1 and T2 cases. The distribution of involved lymph nodes in oral cancer affects the neck dissection extent and is, therefore, an important pre-operative feature

Correlation between childhood chin trauma, condylar fracture and TMJ ankylosis

The objective of this study was to document the TMJ ankylosis resulting from trauma to the chin during childhood. All patients presenting with TMJ ankylosis at the Oral and Maxillofacial Surgery Department of Mayo Hospital, Lahore from July 2007 to March 2009 were included in this study. Patient's age, sex, socioeconomic status, previous history of injury to the chin [scar mark under the chin], level of health care center initially contacted, initial treatment received at the time of injury were documented. A total of 180 patients presented with TMJ ankylosis during the study period. 102 [56.7%]were male and 78 [43.3%] were female patients [Male: Female ratio was 1.3:1] with an age range of 4 to 35 years [mean 12.5 years]. 174 [96.7%] patients had a scar mark under their Chin. 120[66.7%] had a history of fall from roof or a tree, 54[30%] were involved in a road traffic accident, all before the age of 10 years

Comparison of the analgesic effects of peripheral injections of streptomycin/bupivacain and anhydrous glycerol in relieving trigeminal neuralgia

Trigeminal neuralgia is an idiopathic, paroxysmal, painful, unilateral affliction of the face, evoked by trivial stimuli to the specific trigger lone, lasting from a few seconds to two minutes. Medical and surgical treatment options are available with varying degree of efficacy. The objective of the study is to compare the analgesic effects of streptomycin/bupivacain versus anhydrous glycerol injection in trigeminal neuralgia. Sixty patients were selected via Non- probability, purposive sampling technique, at the department of oral and maxillofacial surgery, king Edward Medical University Mayo Hospital Lahore, from 1[st] June 2008 to 30[th] Nov 2008. Patients were randomly distributed in to 2 equal groups. In Group A streptomycin/bupvivacain injection was administered, in Group B 1 ml anhydrous glycerol injection was administered. Patients were reviewed after one week, one month, three month and six months postoperatively. 25 [83.34%] patients of Group A had excellent pain relief, 03 [10%] had good results and 02 [6.66%] patients had poor results. 28 [93.34%] patients of Group B had excellent results, and 2 [6.66%] patients had good results while none of the patients had poor results. The p value for these two procedures is not significant [p=0.378]. The analgesic effect of streptomycin/bupvivacain injection is same as glycerol injection in trigeminal neuralgia. They are simple, quick, and easy to perform, and can be used as outpatient procedures. Trigeminal neuralgia, anhydrous glycerol, streptomycin, Visual analogue scale

Mandibular fracture osteosynthesis: a comparison of three techniques

The purpose of this study was to determine various postoperative complications associated with different regimens used for the treatment of mandibular fractures. The study design was interventional Quasi-Experimental and study was carried out in 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 sixty patients with mandibular fractures. These were divided into three categories. At different intervals of their postoperative visits, these patients were evaluated for postoperative complications and the differences between the three Groups were assessed. Data concerning the patients' demographics, aetiology and pattern of fracture were also obtained and analyzed. Patients treated by Mini plating showed less complications as compared to MMF group and TOW group i.e. 20%, 30% and 50% respectively. Based on this study mini plating was considered as the best available method for the treatment of mandibular fractures

Removal of large infratemporal fossa schwannoma; case report and review of literature

Schwannomas are encapsulated benign tumors of the Schwann cells. Schwannomas arising in the infratemporal fossa [ITF] are rarely reported. We report a case of ITF schwannoma extending to the skull base and orbital floor, involving posterior ethmoidal cells, retrobulbar region, buccal space part of posterior maxilla and right maxillary sinus. A 35-year old female presented to us with swelling on the right side of the face. Biopsy revealed a schwannoma. The tumor was successfully removed via anterior approach through modified Weber-Ferguson incision. Modified Weber-Ferguson incision is a useful approach for the removal of large benign tumors arising in the infratemporal fossa that involve the maxilla and maxillary sinus

Treatment of TMJ recurrent dislocation through eminectomy - A study

The purpose of this study was to evaluate the outcome of eminectomy in clinically diagnosed patients with recurrent temporo-mandibular joint [TMJ] dislocation. This study was carried out at May Hospital, Lahore; fifteen patients with recurrent TMJ dislocation were treated by eminectomy using pre-auricular approach. Our study showed no recurrences of complications such as restricted mouth opening, Frey's syndrome, salivary fistula and facial nerve paralysis during a follow up period of 8 months to 4 years