Frequency, causes and effects of temporomandibular pain dysfunction syndrome among patients seen at Nishtar institute of dentistry, Multan

Temporomandibular joint pain dysfunction syndrome is the second most frequent cause of facial pain. The objective of this study was to find out most common etiological factor of TMD, its clinical symptoms, and distribution among gender. Etiology was multifactorial. All patients [100%] with TMD were having malocclusion and stress [100%]. Third most common factor was increased pain threshold [37%]. Out of 160 patients 82 [51%] were females and 78[48%] were males. Most patients were between 20-30 years of age group 51/160 [31.8%]. Most common presenting symptom was pain followed by clicking sounds in joint and then limited mouth opening. All these symptoms were more common in females

comparison of single versus multimodel analgesia in ablative maxillofacial surgical procedures

Objectives of this study was to evaluate the analgesic effect of single vs multimodal analgesics in postoperative pain in ablative maxillofacial surgery and to investigate whether prophylactic treatment with multimodal nociceptive blockade will delay the onset of postoperative pain, decrease analgesic requirement, speed recovery time and facilitate early discharge in this surgical group. This experimental comparative study was conducted in Maxillofacial Operation Theatre of Nishter Institute of Dentistry, Multan during the period from August 2013 to Feb 2014 equal groups of 30 each using non probability convenience sampling technique. In Group A patients an intramuscular injection of Ketorolac 0.5mg/kg was given 45 min before induction of anaesthesia preoperatively. In group B patients intramuscular injection of 0.5mg/kg ketorolac + 2mg/kg body weight of Tramadol [IM] was given 45 min before induction of anaesthesia preoperatively + local infiltratration of 0.5% injection bupivacaine was done 10 min before giving incision. In Group A patients, 17 patients [56.6%] had mild pain, 6 patients [20%] had moderate, 5 patients [16%] had severe and 2 patients [6.66%] had no pain. While in group B who received multimodal analgesia, the degree of postoperative pain was greater than in the group A in which 15 patients [50%] had mild pain, 2 patients [6%] had moderate pain and 13 patients [43.3%] had no pain. In group B, no patient suffered from severe pain. It was concluded that multimodal analgesia showed greater advantage over single analgesia in patients undergoing ablative maxillofacial surgical procedures

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

Treatment outcomes of reconstruction with iliac bone graft and rib graft in patients with mandibular defects

Iliac bone graft can be used to reconstruct alveolar defects or bone defects under 5 cm. Rib grafts have proven ideal for condylar reconstruction. Objective of this study was to assess the functional and aesthetic outcomes and post operative complications of the reconstructive method. In this study iliac bone alone or combined with rib graft was used for reconstruction of mandibular defects. Sampling technique was non probability purposive. This study was conducted in the Department of oral and maxillofacial surgery, Nishter Institute of Dentistry, Multan from March 2010 to march 2012. A total of 15 patients of hemimandibulectomy were reconstructed by iliac bone alone or combined with rib bone graft. In 3 cases iliac bone was combined with rib bone graft. There were 6 [40%] male and 9[60%] females. Mean age was 23.86+2.69y [range 20 -30y]. There were no significant post operative complications. Reconstruction with iliac bone graft combined with rib graft is an excellent method of reconstruction in patients with mandibular defects