Utilization of Harmonic scalpel for the bloodless surgical management of a Vascular lesion of the tongue and review of the literature.

A constant search for methods to limit blood loss, especially the vascular lesions of the tongue, has led to the acceptance of ultrasonic harmonic scalpels.The harmonic scalpel's reliability exists in its ability for lasting hemostasis with minimal heat dispersion to the surrounding structures.Surgical removal of the vascular pathology in a restricted area of the oral cavity and oropharynx dictates a bloodless surgical field which further allows increased visibility of the lesion and the surrounding anatomical structures, subsequently, narrowing the surgical time frame.We report a rare case of haemangioma of the lateral border of the tongue managed with complete resection of the tumor achieved using the harmonic scalpel with reduced intraoperative blood loss, increased visibility, evidently reduced post-operative necrosis and highly preserved tissue for the histopathological examination.

Schematic Treatment Tree for the Presurgical Nasoalveolar Moulding of Patients with Cleft Lip and Palate.

Background: Cleft lip and palate is the most common and unfortunate congenital defect that is debilitating for both the patients and their parents. Such complex condition demands for a precise and judicious management, as its outcome can drastically influence the quality of life of the child. Aim: To provide a concise treatment algorithm or tree which might guide the clinicians and make it easier for them to opt for a better treatment option when confronting different severities and types of this defect. Material and Methods: The clinical experience at our center alongwith review of current literature is used to propose a decision making treatment tree. Discussion: For the better aesthetics, function and ease of cosmetic surgery, several presurgical procedures have been introduced including the nasoalveolar moulding (NAM) appliance, adhesive tapes with nasal elevators, Figueroa's appliance, Hotz appliance, etc. Conclusion: The schematic decision-making tree may prove beneficial to the healthcare providers specially pedodontists who frequently come across such situations to choose the best treatment option for their patients.

Controversies in the dental implant treatment planning for anterior maxillary aesthetic zone - A review.

The anterior maxillary region being an aesthetic zone remains critical in decision-making when it comes to replacing a tooth. Treatment planning to place dental implants in aesthetic zone like anterior maxilla needs paramount attention in order to provide best of the treatment outcomes from aesthetic point of view. As the field of dental implants tend to evolve continuously, newer concepts with inadequate research come into practise on regular basis. In this article, some of the controversies regarding dental implant placement and treatment process related to anterior maxillary aesthetic zone are discussed with literature to support evidence.

Lunch Box Penetrating Injury in the Craniofacial Region Impedes the Primary Airway Management and Surgical Intervention.

Penetrating Cranio-Maxillofacial trauma obscuring the clear view of the face in addition to an impediment to emergency airway management has been a rare occurrence in the archives of emergency trauma. A four-year-old girl reported to the emergency following a lunch box sharp rim penetrating wound to her left supraorbital region, limiting the access and clear view of her face. CT scan ruled out the serious orbital injury, but clearly revealed the piercing of the brain matter in the frontal region. The toddler's golden hour of primary management was spent in the darkness with the lunch box covering her entire face, obstructing the basic intubation methods required for primary airway management. Interpretation of the radiological investigations necessitated the multiple collaboration of the neurosurgery and maxillofacial surgeons, planning a systematic recovery of the foreign body without any major complications. Follow-up period was uneventful with no neurological and major cosmetic deficits.

Photobiomodulation Alleviates Postoperative Discomfort After Mandibular Third Molar Surgery.

PURPOSE: Surgical removal of mandibular third molars is associated with some degree of postoperative pain, trismus, and facial swelling. The purpose of the study was to evaluate the effect of photobiomodulation in reducing these postoperative side effects after surgical removal of mandibular third molars. MATERIALS AND METHODS: This randomized, double-blinded, split-mouth pilot study was carried out in the Department of Oral and Maxillofacial Surgery, Post Graduate Institute of Dental Sciences, Rohtak, India, among patients with impacted mandibular third molars. In each patient, 1 side was treated by photobiomodulation and the other side received placebo. Photobiomodulation was performed by intraoral and extraoral application of an 830-nm and 30-mW laser at different time points. Pain, trismus, and facial swelling were evaluated at all time points. The number of analgesics taken also was recorded. The data were analyzed using descriptive, bivariate and multivariate statistics. RESULTS: The study was conducted in 25 patients (56% male patients) with a mean age of 22.16 ± 4.60 years. There were 50 sites divided equally into both groups. The sites treated with photobiomodulation showed a significant reduction in pain and swelling (P < .05) compared with the sites in the placebo group. Moreover, an increase in mouth opening was noted after photobiomodulation compared with that in the placebo group, but this was not statistically significant (P > .05). CONCLUSIONS: The results of this study suggest that photobiomodulation is effective in reducing pain and swelling after mandibular third molar surgery. Hence, it can be used as an alternative and effective modality after surgical removal of mandibular third molars, thereby improving the quality of life of the patients.

A Comparative Evaluation of Closed and Open Treatment in the Management of Unilateral Displaced Mandibular Subcondylar Fractures: A Prospective Randomized Study.

The aim of the study is to evaluate closed and open treatment in the management of unilateral displaced mandibular subcondylar fractures. Twenty patients with unilateral subcondylar fractures of the mandible were evaluated with degree of displacement of more than 20 degrees and ramal height shortening of more than 10 mm. They were informed of the need for 6-month follow-up. Patients were thoroughly informed, explaining the possible advantages and disadvantages of the open and closed treatment options. Radiographic parameters included the level of fracture, deviation of fragment, and ramal height shortening. Correct anatomical reduction is achieved by open treatment as compared with closed treatment. Regarding pain, mouth opening, and lateral excursion movement, statistically significant difference was found in both groups ( p < 0.01). In radiographic assessment of ramal height shortening and fracture displacement, statistically significant difference was found ( p < 0.01). And no significant complication is found in both treatment groups. The results of this study favor the open treatment for the management of displaced subcondylar fractures. However, the treatment results are also acceptable for closed group.

Extracranial Trigeminal Schwannomas: A Retrospective Analysis.

OBJECTIVE: To analyse the clinic-radiological features and treatment outcome of extracranial trigeminal schwannomas. METHOD: Medical records and radiographs of patients treated, from January 2011 to December 2013, for neurogenic tumors were retrospectively reviewed. Extracranial schwannomas other than those of trigeminal nerve were also excluded. A number of parameters, including the patient's age, gender, site, clinical features, radiographic features, histologic variants and treatment provided as well as any associated complications were recorded and analysed. RESULT: A total of 5 patients met the inclusion criteria. The patients were males, aged 16-56 years. All the schwannomas appear to originate from the terminal branches of trigeminal nerve. CONCLUSION: Long standing asymptomatic swelling of cheek should include trigeminal schwannomas as the differential diagnosis. The diagnosis though confirmed by the histologic examination but can also be made on the basis of MRI finding. Neural function can be preserved by meticulous surgery.

Animal Bite Injuries in Children: Review of Literature and Case Series.

INTRODUCTION: Maxillofacial region in children is particularly vulnerable to animal bite injuries. These injuries may range from insignificant scratches to life-threatening neck and facial injuries. Children are the common victims, particularly of dog bites. MATERIALS AND METHODS: Three cases of animal bite injuries in children with their clinical presentation and their management are being presented along with review of literature. Surgical management included cleansing and primary closure of the wound. Rabies and tetanus prophylaxis were given. DISCUSSION: The most common site of injury was the face. For the facial injuries, the most frequently affected area was the middle third (55%), also called as the "central target area." The small stature of children, the disproportionate size of the head relative to the body, their willingness to bring their faces close to the animal, and limited motor skills to provide defense are believed to account for this. The resulting soft-tissue injuries can vary in relation to their extent. Treatment involved initial surgical exploration, and secondary repair later depending on the severity of the injury. CONCLUSION: Prompt assessment and treatment can prevent most bite wound complications. Early management of such injuries usually guarantees satisfactory outcome. Prevention strategies include close supervision of child-dog interactions, better reporting of bites, etc. HOW TO CITE THIS ARTICLE: Agrawal A, Kumar P, Singhal R, Singh V, Bhagol A. Animal Bite Injuries in Children: Review of Literature and Case Series. Int J Clin Pediatr Dent 2017;10(1):67-72.

Unilateral swelling of cheek.

A 55 year old male patient reported in the department of oral and maxillofacial surgery with a chief complaint of swelling on right side of face from last 2 months. He reported a progressive increase in the swelling. Pain and discomfort was present from last 7 days with increased swelling, and reduced mouth opening. On examination, the face appeared asymmetrical with a swelling in the right cheek which was small, smooth, dome shaped, present approximately 1.5 cm anterior to tragus. Overlying skin was of normal colour. The patient was afebrile. Mouth opening was 25 mm.

The newer aspect of dexmedetomidine use in dentistry: As an additive to local anesthesia, initial experience, and review of literature.

INTRODUCTION: Despite the availability of a wide variety of pharmacological agents in the field of anesthesia, there has always been a continuous search for newer local anesthetic agents with improved efficacy, potency, and better handling properties. Dexmedetomidine, a selective alpha-2 adrenergic receptor agonist, is an emerging agent for provision of additive local anesthetic effect if used with conventional local anesthetics, which can be implicated in dentistry for performing many minor oral surgical procedures. The present paper reports a pilot study comparing clinical efficacy and potency of this newer emerging drug in combination with lignocaine. MATERIALS AND METHODS: Ten patients undergoing orthodontic extraction for correction of malocclusion and other dentofacial deformities requiring orthodontic treatment were locally infiltrated with 2% lignocaine plus dexmedetomidine 1µ/ml and 2% lignocaine plus adrenaline in 1:200,000 dilution at two different appointments. The onset of action, duration of action, and pain threshold were assessed. RESULTS: Onset of action was found to be faster with longer duration of action with the newer drug dexmedetomidine and lignocaine combination when compared with combination of lignocaine and adrenaline. CONCLUSION: The study demonstrated that the combination of dexmedetomidine with lignocaine enhances the local anesthetic potency of lignocaine without significant systemic effects when locally injected into oral mucosa.

Treatment of Oroantral Fistula in Pediatric Patient using Buccal Fat Pad.

UNLABELLED: Brief background: Oroantral communication (OAC) is the space created between the maxillary sinus and the oral cavity, which, if not treated, will progress to oroantral fistula (OAF). Several methods of surgical OAC repair have been described, but only a few have gained recognition. MATERIALS AND METHODS: A 13 years old male child patient with complaint of difficulty in drinking water and change in voice diagnosed as OAF managed with closure with buccal fat pad (BFP). DISCUSSION: Oroantral fistula is an abnormal communication resulting most frequently from extraction of the upper posterior teeth. Many techniques have been proposed for the closure. The preferred technique may vary from one surgeon to another. CONCLUSION: The adequate availability of BFP in children, effortless mobilization excellent blood supply and minimal donor site morbidity make it a perfect flap for OAF closure in pediatric patient. How to cite this article: Agrawal A, Singhal R, Kumar P, Singh V, Bhagol A. Treatment of Oroantral Fistula in Pediatric Patient using Buccal Fat Pad. Int J Clin Pediatr Dent 2015;8(2):138-140.

Clicking hyoid: A rare case report and review.

Painful conditions of unexplained origin pose a challenging task for the clinician from both the diagnosis and treatment perspective. This might be accounted due to overlapping symptomatology; moreover, nonspecific subjective findings push the diagnostic process to a more perplexing direction. The main loophole in their management lies in difficulty to make an appropriate diagnosis. Clicking hyoid is an extremely rare anomaly of hyoid bone which produces painful clicking in throat. Here, we report a case of a young patient presented with pain and clicking in throat which aggravated on swallowing. After a series of examinations, it was diagnosed as clicking hyoid and was managed successfully by surgical treatment. The objective of this article is not only to increase awareness of the ailment so as to validate its existence but also demonstrate the significant utility of the surgical management.

Camel bite injury to the maxillofacial region: unusual cause and uncommon location.

Animal bite injuries are prevalent worldwide, but the causative animal and the spectrum of injuries are dependent on the kind of animals cohabitating with the human population. Camel bites as a cause are relatively rare. Camels are particularly aggressive, especially during the mating season, when conflicts between the males occasionally lead to dangerous fights resulting in the death of one or both of the combatants. We present a case of camel bite injury to the maxillofacial region inducing an uncommon fracture and the management of both soft and hard tissue injuries, especially addressing the literature for this uncommon bite injury. Because of the unique mode of injury, the ramus was horizontally fractured and displaced. The fracture was also compound because of the deep intraoral bite wounds. The ramal fracture itself is a rare entity. The issue of primary or delayed closure in such cases is addressed.

Pediatric maxillofacial injuries - if a new look is required?

OBJECTIVE: Maxillofacial injuries in children always present a challenge in respect of their diagnosis and management. The phenomenal increase in automotives on the road has led to a tremendous rise in the number of road traffic accidents leading to facial injuries, of which children are the most unfortunate victims. The purpose of this retrospective study was to evaluate the epidemiology, etiology and pattern of facial injuries and also to access the most feasible method for the management of facial injuries in children without hampering the facial growth. METHODS: The records and radiographs of 110 patients within the age range of 0-16 years were retrospectively reviewed who have presented with maxillofacial injuries to our department from October 2008 to June 2012. The information extracted from patient's case records included patient's gender (male/female), age, etiology, fracture type (single fractures and multiple fractures), occlusal status, fracture site and treatment performed. RESULTS: Patient's age at the time of accident ranged from 0 to 16 years, with a mean of 6.1 years. 54.54% (n = 60) of the patients were under 6 years (infants and preschool), 31.82% (n = 35) were between 6 and 11 (school age), and 13.64% (n = 15) were between 12 and 16 years (adolescents). Road side accident was the most frequent cause of injury. Most fractures occurred in the mandible (54.54%; n = 60). The fractures with minimal or no occlusal disturbance were managed by liquid diet alone. CONCLUSION: We believe that even after so much advancement in surgical techniques and armamentarium, conservative treatment is still the most reliable approach in managing maxillofacial injuries in children.

Tuberculous osteomyelitis of zygoma: an unusual location.

Tubercular osteomyelitis of midfacial bones is extremely rare, although tuberculosis of long bones and the vertebral column is not uncommon. Because of the rare incidence, myriad presentation, and lack of specific symptoms, this condition presents a challenge in diagnosis and calls for acute clinical awareness. This article presents a case report of a 12-year-old girl with complaints of gradually increasing swelling lateral to and below her right eye for 4 months with pus discharge. She was treated with surgical curettage and 4-drug antitubercular therapy and responded with complete remission of the sinus.

Superolateral dislocation of bilateral intact condyles-an unusual presentation: report of a case and review of literature.

Dislocation of the mandibular condyle is the clinical condition of the condyle head being displaced out of the glenoid fossa but still remaining within the joint capsule. However, the anatomy of the mandibular condyle, glenoid fossa, and zygomatic arch usually prevent the dislocation of intact condyles out of the glenoid fossa whenever the mandible is subjected to high impact. Complete dislocation of the mandibular condyle from the glenoid fossa can be classified into four groups: anterior, posterior, lateral, and superior dislocation. All the groups except anterior dislocation are rare. Superolateral dislocation of the intact mandibular condyle occurs very rarely. We report a case of lateral dislocation of bilateral intact condyles associated with left parasymphysis fracture. The purpose of this report is to review all of the available English literature on this dislocation and discuss the possible causative mechanism and diagnostic features, as well as clinical management.

Conventional versus 3-dimensional miniplate in management of mandibular fracture: a prospective randomized study.

OBJECTIVE: The aim of this study was to compare conventional miniplate (Champy's) and 3-dimensional miniplate fixation in the management of mandibular fracture. STUDY DESIGN: Prospective study. SETTING: The study was carried out in the Department of Oral and Maxillofacial Surgery, Govt. Dental College, Pt. B.D. Sharma University of Health Sciences, Rohtak, India. SUBJECTS AND METHODS: A prospective randomized clinical trial was carried out in 50 patients. Patients were randomly assigned to receive a 2.0-mm 3-dimensional miniplate (group A) or a 2.0-mm conventional miniplate (group B). All patients were followed up for 12 weeks postoperatively. Complications were analyzed according to the type of plate used and the site of fracture. RESULTS: Twenty-eight fracture sites were treated with the 3-dimensional miniplate and 28 with the conventional miniplate. Five complications occurred, representing 8.9% of the total. Two complications occurred in group A and 3 in group B, with complication rates equaling 7.14% and 10.71%, respectively. When comparing the overall complication rates according to plates used, the χ(2) test showed no statistically significant difference between the 2 groups (P > .05). CONCLUSION: No major difference in terms of treatment outcome is observed in both systems, and both are equally effective in managing mandibular fracture.