Effectiveness and Distribution of Anesthesia for a Modified Extra Oral Maxillo-Mandibular Nerve Block for Dento-Alveolar Procedures: A Prospective Cohort Study.

Aim: To evaluate the effectiveness of a modified maxillo-mandibular nerve block technique that includes anesthetizing the maxillary and mandibular nerve with single injection. Materials and Methods: A prospective, clinical cohort study was carried out including patients who presented for surgical removal of maxillary and mandibular third molars. All patients were administered maxilla-mandibular nerve block through a single injection on one side. Three clinical neurosensory tests were used for mapping the area of anesthesia and to assess and grade objectively the effect of the block. Light touch (LT), two-point discrimination (TPD), pin prick (PP) and Electric pulp testing (EPT) were used for all branches of maxillary and mandibular nerve. An extra oral mapping chart for depth of anesthesia was maintained for each patient to categorize the grades as nil, intermediate and highly anesthetized areas. Results: 62 patients were assessed in the study. EPT showed greater depth of pulpal anesthesia in posterior teeth than the anterior in both maxilla and mandible. PP and TPD tests also showed that the anesthetic effect varied between posterior divisions demonstrating extreme anesthesia compared to the anterior divisions. Conclusion: This technique was found to be successful for surgical extractions involving the maxillary and mandibular regions. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-022-01755-w.

Distraction osteogenesis in complex facial asymmetry corrections.

This article highlights the authors' experience in the management of facial asymmetries with the use of distraction osteogenesis. It is a narrative based on the clinical experience at the Meenakshi Cleft & Craniofacial Center at Chennai.

Catheter-based donor site analgesia after rib grafting: a prospective, randomized, double-blinded clinical trial comparing ropivacaine and bupivacaine.

PURPOSE: Although ribs provide the best source of cartilage for reconstruction, its harvesting is associated with significant postoperative pain and sometimes incapacitating functional deficit. The lack of studies in the maxillofacial literature on regional analgesia for rib harvests stimulated this study design. This study compared ropivacaine with bupivacaine in providing postoperative analgesia after rib harvest. PATIENTS AND METHODS: Patients who needed rib grafting for maxillofacial reconstructive procedures were enrolled in this prospective, randomized, double-blinded clinical trial. Patients were randomly allocated to 1 of 2 groups with different modalities of anesthesia against a control group. A catheter was embedded in the rib donor site in all patients. Patients in group A received 0.75% ropivacaine, those in group B received 0.5% bupivacaine, and those in croup C patients received normal saline and served as the controls. The outcome variables were the subjective and objective pain scores, the duration of action, and the efficacy of the drugs after rib harvest. Dependent variables were the need for a rescue analgesic by the patient and the duration of hospital stay. The subjective intensity of pain at rest was calculated using the visual analog scale. The objective pain scores at function were evaluated by comparing preoperative with postoperative values of incentive spirometry, breath-holding test, maximal chest expansion, and match-blowing test. The t test and paired samples test were used to the analyze data, and a P value less than .05 was considered significant. RESULTS: Forty-two patients were enrolled in this study. Patients in groups A and B showed significant pain relief compared with group C. Patients in group A showed significantly less pain at rest (2.8±0.894) compared with those in group B (3.7±0.875; P<.05). Patients in group A also showed significantly less in pain at function (3.8±0.894) compared with those in group B (4.7±0.923; P<.05). Patients in group A showed a minimal need for a rescue bolus compared with those in group B. The duration of action for ropivacaine was longer by a mean difference of 11 hours. No noteworthy difference was seen for the duration of stay in the hospital. CONCLUSIONS: The use of catheter-based analgesia after rib harvesting provides excellent postoperative comfort, with ropivacaine providing an earlier return to normal function compared with bupivacaine. The duration of action of ropivacaine was significantly longer and, hence, decreased the need for rescue analgesics.

Incidence and consequences of bur breakage in orthognathic surgery: a retrospective study with discussion of 2 interesting clinical situations.

PURPOSE: To determine the incidence of bur breakage in routine orthognathic surgery, as well as its postsurgical sequela, and to illustrate 2 cases with more than 6 months' follow-up. PATIENTS AND METHODS: We performed a retrospective evaluation of case records of 76 consecutive orthognathic surgical procedures performed by a team of 2 surgeons over a period of 16 months, between January 2009 and July 2010, at a single center. RESULTS: Surgical bur breakage was reported in 5 patients in the series. Of these, 3 were retrieved whereas 2 were not, 1 of which caused a foreign body reaction in the patient, which persisted for a duration of almost 1 year. CONCLUSION: Instrument breakage may be a relatively common occurrence with the use of surgical burs in orthognathic surgery but its incidence is seldom recorded or reported. This study gives insight into the probability of postoperative sequela of these instruments when left in situ and a protocol for management of broken instruments.

Intraoperative and perioperative complications in anterior maxillary osteotomy: a retrospective evaluation of 103 patients.

PURPOSE: To study the intraoperative and perioperative complications associated with anterior maxillary osteotomy (AMO), and assess its safety and predictability in orthognathic surgery. PATIENTS AND METHODS: We performed a retrospective evaluation of 103 patients undergoing AMO as a single procedure, or in combination with other osteotomies over a period of 5 years, with a mean follow-up of 3 years. RESULTS: Twenty-seven (26.2%) patients in our series of 103 had complications of varying severity: 43.3% of these were soft tissue-related, and 36.6% were attributable to dental causes. All other complications accounted for the remaining 20%. CONCLUSION: Although its indications are limited, AMO is a safe and reliable procedure in routine orthognathic surgery.

Large cemento-ossifying fibroma of the maxilla causing proptosis: a case report.

Cemento-ossifying fibromas form a part of the spectrum of fibro-osseous lesions of the jaws and are considered benign but locally aggressive tumors. This report presents a 31-year-old female patient with a large cemento-ossifying fibroma of the maxilla, expanding into the orbit and causing proptosis. The report also discusses the surgical management of this lesion with successful preservation of optic nerve function and normal vision.