Comparative Evaluation of Clinical Anaesthetic Efficacy of 15 % Lidocaine Spray and 20 % Benzocaine Gel during Removal of Arch Bars

Application of arch bar is considered as a gold standard for intermaxillary fixation (IMF) in the management of mandibular fractures. Both the application and removal of arch bars can inflict pain for patients who require IMF. For removal of the arch bars, local anaesthesia (local infiltration or conduction block) is often indicated. The study aimed at comparing and validating the efficacy of topical lidocaine spray and benzocaine gel in patients undergoing removal of arch bars. METHODS30 subjects were included in this prospective randomized controlled trial. Maxillary arch was chosen as the test site. 10 patients (Group A) were anaesthetized in the upper gingiva with 15 % lidocaine spray and remaining 10 patients (Group B) were anaesthetized with 20 % benzocaine gel, following which removal of arch bar was done. 10 patients were included in the control group (Group C) where 2 % lignocaine infiltration was offered only on request. Visual analog scale and Wong-Baker Faces Pain Rating Scale was used to measure the pain perceived by the patient during the procedure. RESULTSThe mean and standard deviation of the pain scores of Group A was 2.5 ± 0.70, Group B was 2.7 ± 0.67 and Control group was 5.5 ± 0.85. Both the test groups had a significant pain reduction when compared with the control group. CONCLUSIONSTopical application of both 15 % lidocaine spray and 20 % benzocaine gel provided equally efficient analgesia and can be useful alternatives to conventional local anaesthetic infiltration during arch bar removal.

A Prospective Comparison of Octyl-2-Cyanoacrylate and Suture in Standardized Facial Incisions

Introduction: The cosmetic result is one key measure in theassessment of operation in the head and neck region. Theprinciple of wound closure, should be to achieve precisewound approximation, easy handling and working propertiesof wound closure materials and low infection rates. In ourstudy, we evaluated the efficiency of 2-OCA on extra oralincisions placed in the trauma patients.Material and Methods: A total of 20 patients were enrolledand treated for open reduction and internal fixation procedures.The extra oral incisions were placed in these patients. Thesepatients were categorized into 2 groups wherein the group Iunderwent suture closure with Ethilon 4-0 and group II, theincision closure done with 2-OCA. Wounds were evaluatedfor 24th hours, 1st week and 2ndweek post operatively for pain,inflammation, dehiscence, infection, and wound closure/wound seal. The scar and the surface texture were evaluatedonly after a minimum follow up of 1st month and 3rd monthpost operatively.Results: Clinical parameters such as pain and time taken forclosure techniques were significant difference when comparedto the sutured group, indicating the use of 2-OCA is beneficialin pain and application time taken for closure.Conclusion: 2-OCA is suitable for skin closure and easy touse alternative to conventional sutures. 2-OCA is associatedwith good esthetic and less post operative complication.

Evaluation of 3-Dimensional Titanium Miniplates in Mandibular Fractures

Introduction: Mandibular fractures are one of the mostcommon fractures of facial skeleton because of its prominentposition in maxillofacial region. Traditionally, surgeons haveattempted to achieve: anatomic reduction, immobilization andfixation, prevention of infection and rehabilitation of function.The aim of our study was to evaluate the following parameterslike surgical procedures, infection, hardware failure, wounddehiscence, neurosensoery deficit, and fate of implant.Material and methods: The present study was conducted inthe Department of Oral and Maxillofacial Unit, after obtainingethical clearance. A total of 20 patients were selected toevaluate the usefulness of 3-Dimensional titanium miniplatesin fixation of mandibular fractures. After surgical exposure,either straight 6 holed or 8 holed or curved 8 holed 3-Dtitanium miniplates are placed. The patients were in the agegroup of 21-40 years. Etiology of trauma in most of the patientwas Road traffic accident (70%).Result: The frequency of fracture site being mainlyparasymphysis fracture (50%). Two patients had infection(10%). None of the patients had malunion or nonunion. The3-Dimensional titanium miniplates are suitable for fixation ofsimple mandibular fractures and an easy to use alternative toconventional miniplates.Conclusion: This plate is associated with good stability offracture segments and low infection rate

A New Single Wire Technique for Intermaxillary Fixation – Easy Way Out

ntermaxillary fixation (IMF) plays an important role in the treatment of maxillofacial fracture. The most preferred way is upper and lower arch bar fixation or eyelet wiring and imf done by box wiring. Here we present a new type of imf technique, using 26 gauze stainless cut into 6cm length singe wire technique. It is a single, quick, economical, minimal invasive and easy technique without any arch bar or eyelet fixation. Indication for this kind of wiring is undisplaced or minimally displaced fractures, stabilization of fractures during open reduction and internal fixation, orthognathic surgery and in tumor resection surgeries.

Open reduction of mandibular fracture without maxillomandibular fixation: retrospective study

INTRODUCTION: Maxillomandibular fixation (MMF) is essential before surgery under general anesthesia in maxillofacial trauma patients. MMF is used basically to reconstruct the occlusion and occlusal stability to recover the facial shape and oral functions. The arch bar and wire is a traditional method for MMF, but it can not only bring pressure to the periodontal ligaments and teeth but also cause a penetrating injury to the surgeons. MATERIALS AND METHODS: In this study, 198 patients with an open reduction using a manual reduction without MMF from September 2005 to May 2010 in Dankook University Dental Hospital were subjected to a follow-up evaluation during the postoperative 4 months periods. This study evaluated the incidence of complications according to the condition of the patient (gender, age), the state of bony union of the fracture sites and a numeric rating scale evaluation for postoperative pain scoring. RESULTS: 1. The complications were classified into major and minor according to the seriousness, and the major complication rate was as low as 2.02%. Only 2 cases of re-operations (1.01%) were encountered. In the classification according to the fracture line, plate fracture was observed in both cases of mandibular symphysis fracture, and angle fractures and loosening of two screws were noted in the case of mandibular angle fracture. CONCLUSION: The use of MMF is not always necessary if a skilled assistant is provided to help manually reduce the fracture site. Compared to other studies of mandibular fracture surgery using MMF, the complication rate was similar using only manual reduction and the patients' discomfort was reduced without MMF.

Applying Method of Arch Bar in Maxillofacial Surgery without Orthodontic Treatment

Temporomandibular joint(TMJ) and dental occlusion are important in functional aspect as well as in cosmetic aspect for craniofacial surgery such as orthognathic and traumatic surgery. During these operations, appropriate maxillomandibular fixation(MMF) is especially necessary to conserve or reconstruct, dynamic TMJ and functional occlusion. Arch bar is one of the most popular method to gain proper MMF. Seventeen patients including 5 patients with mandibular fracture, 12 patients with orthognathic surgery(6 patients had relatively normal occlusion, however 6 patients had facial anomalies such as hemifacial microsomia with irregular occlusal plane.) were joined in this study. Arch bar was contoured on the dental cast, which was prepared for model surgery, prior to apply it on the facial anomaly patient. On using pre-contoured arch bar, patients felt better during the procedure and surgeons saved time. Moreover, well-contoured arch bar promises precise transmission of force on the bone, which implies surgeons do not need to worry about the occlusion while fixing bony structures. Authors suggest how to apply arch bar to satisfy basic theories about dental row and occlusion based on the experience. In addition, it is proposed to contour arch bar on the dental impression prior to apply it on the patient who has irregular and complex occlusal plane.