Efficacy of collagen-silicone bilayer membrane in the management of oral submucous fibrosis: a prospective case series.

BACKGROUND AND OBJECTIVE: Oral submucous fibrosis is a scourge of Southeastern Asia since a long time resulting in significant health and social problems. Mainstay of the treatment is concentrated on attempts to improve mouth opening and relieve the symptoms by medicinal or surgical means. In moderate to severe cases, release of fibrous bands is advocated followed by placement of graft. The present study was conducted to evaluate the use of collagen-silicone bilayer membrane as a mucosal substitute in its management. METHODOLOGY: Study consisted of 12 clinically and histologically proven cases of OSMF. After the incision and release of fibrous bands, a collagen membrane was placed and secured over the raw area by placement of a silicone sheet of adequate thickness. Parameters were assessed pre-operatively, intra-operatively, and post-operatively at 1 week, 1 month, and 3 months. The data was recorded and statistical analysis was done. RESULTS: Pre-operatively, the mean values of inter-incisal opening, cheek flexibility, and width of oral commissure were 16.92, 24.58, and 53.17 mm respectively whereas at 3 months post-operatively, it was 27.67, 26.58, and 55.00 mm, which was statistically significant. No incidence of infection was noted. CONCLUSION: The study concludes that the use of collagen membrane along with silicone sheet can be an alternative to other graft materials in context of reduced donor site morbidity as well as significant increase in inter-incisal opening. However, study with more sample size is needed to assess the long-term efficiency and surgical outcome of this material.

Incidence and risk factors for postoperative nausea and vomiting in orthognathic surgery: a 10-year retrospective study.

OBJECTIVES: Postoperative nausea and vomiting (PONV) is considered as one of the most incessant and anguishing factors for patients who have surgery under general anesthesia. The occurrence of PONV after orthognathic surgery can lead to dehydration, infection, bleeding at the surgical site, and patient discomfort, all of which leave a patient with a negative impression of anesthesia and surgery. The purpose of this study is to assess the incidence of PONV after orthognathic surgery and to correlate it with factors related to patient, anesthesia, and surgery. MATERIALS AND METHODS: A 10-year retrospective survey was done for patients who underwent orthognathic surgery between January 2008 and March 2018. The incidence of PONV was evaluated, correlations with factors related to patient, anesthesia, and surgery were studied, and the duration between the end of surgery and the occurrence of the first episode of PONV was tabulated. RESULTS: The medical records of 109 patients were screened, out of which 101 satisfied the inclusion criteria. Amongst these patients, 60 patients (59.4%) suffered from PONV. Patient's sex, induction agent used, intravenous fluids administered intraoperatively, duration and type of surgery, and the presence of a nasogastric tube were seen to have a significant influence on precipitating PONV. It was noted that among the patients who suffered from PONV, 61.7% of them experienced it 48-96 hours after the end of surgery. CONCLUSION: Despite the improved anesthetic equipments, drugs, and surgical techniques currently used, the incidence of PONV was high in our study. Certain factors that were seen to influence PONV in this study need to be considered in order to develop an efficacious protocol to reduce PONV in orthognathic surgeries.