ABSTRACT
BACKGROUND: Patient who is on antiplatelet therapy had an impaired fibrin formation which leads to fibrinolysis which is the main reason behind postextraction bleeding. OBJECTIVES: The aim of the study is to manage anticoagulated patient who has to undergo dental extraction by using hemostatic agent and the objective is to rule out potential risk factor which may trigger bleeding. METHODS: One hundred patients with anticoagulant and antiplatelet therapy and having International Normalized Ratio (INR) in-between 1.9 and 3.5 were selected. Postextraction instruction use 5 ml of 10% tranexamic acid mouthrinse four times a day for next 7 days was suggested. All demographic data, history of anticoagulant and antiplatelet therapy, details of bleeding, and treatment requirement were recorded to identify potential risk factor. RESULTS: Of 100 subjects, 16 were reported postextraction bleeding on days 1 and 2 which was controlled by tranexamic acid pressure pack. Bleeding from extraction socket of 10 patients was stopped by gelatin foam. No life-threatening risk was observed. In patients with age group of 41-60 years whose INR value was ≥2.5, the number of teeth undergoing extraction, whose bleeding time was increased, and were on long duration of antiplatelet and anticoagulation therapy might increase the risk of bleeding. CONCLUSION: Use of tranexamic acid mouthrinse after extraction is an effective way to control bleeding on patients who are under antiplatelet therapy with at therapeutic INR level is a secure and allowable method of minimizing postextraction oozing.
ABSTRACT
Angle fractures represent the highest percentage of mandibular fractures. Fixation using a single miniplate ventral to oblique line of buccal cortex of the mandible was described by Champy et al. (1976). Ellis has documented low complication rate with monocortical miniplate fixation as a treatment for angle fractures. Most often used approaches are (a) extraoral approach, (b) intraoral approach, and (c) transbuccal approach. Each of these techniques has its pros and cons. We, in this note, propose an approach which sidelines the drawbacks of these approaches and has the combined advantages of these techniques. This technique results in no external scarring or injury to marginal mandibular nerve, and it also allows direct visualization and confirmation of occlusion during plate placement. This approach is through a contaminated area that poses a risk of infection. This approach of ours is based upon this pioneering works of Forrest. The approach proposed by us can aid an experienced maxillofacial surgeon to provide economical outpatient-based care to patients with minimally displaced/undisplaced angle fracture in a routine dental setup. This technique can be breakthrough for introduction of endoscopic approach for treating angle fracture.
ABSTRACT
AIM: To compare and evaluate treatment outcome and postoperative complications in subcondylar fractures of mandible-single L shape plate versus two L shape plate-using plate on plate technique. MATERIALS AND METHODS: The clinical trial had a total of ten patients (ten unilateral subcondylar fracture sites), which were divided randomly into two groups of five each. Group I patients underwent open reduction and internal fixation with single L shaped miniplate and Group II ORIF was done with two L shaped miniplates by plate on plate technique. RESULTS: Both the groups showed comparable results in terms of postoperative complications. Few cases in Group I presented with minor occlusal discrepancy which was easily corrected with transitional inter-maxillary fixation(IMF) for 1 week, and none of the Group II cases required postoperative IMF, but stability in Group II was better than Group I. CONCLUSION: The results of this trial suggested that the treatment of mandibular condylar fractures with 2 (2-D) plates placed one over the other is better suited than conventionally practiced single-plate fixation. Increased 3-dimensional stability, low morbidity and infection rates are the advantages offered by 2-plate technique of ours.
