Stumbling block for inferior alveolar nerve block in predoctoral students: An analytical observational study and review of literature of mandibular nerve block techniques.

INTRODUCTION: Dentists earnestly try to practice painless treatment. Conventional inferior alveolar nerve block technique is preferred by most of the dentists despite its various modifications.However its failure rate as per literature is quite high. Inexperienced dentists face difficulty in obtaining effective anesthesia. This may be due to limited access to inferior alveolar nerve,greater density of alveolar bone,bulky soft tissues,damage to nerve or due to risk of intravascular injection. AIM: The aim of this study is to review and clinically assess the factors causing difficulty or failure of inferior alveolar nerve block in predoctoral students and to review the mandibular nervve blocks. MATERIAL AND METHODS: Dental interns of riyadh elm university were monitored during administration of inferior alveolar nerve block for difficulty factors influencing inferior alveolar nerve block. Onset of anesthesia, efficacy anesthesia of inferior alveolar nerve, lingual nerve and long buccal nerve were ascertained. Difficulty index was used to assess the "item difficulty" with a score of 0.0 which indicates that none of the dental interns anesthetised correctly to 1.0 suggesting all the dental interns anesthetised correctly. RESULTS: Complete failure of inferior alveolar nerve block was noticed in 2.4% of predoctoral students. The most common cause for inferior alveolar nerve block failure was attributed to the difficulty in palpating the landmarks (77%), 22% of the patients refused multiple needle penetrations,and 19% of inferior alveolar nerve block failure was due to the fear of potential complications by the predoctoral students. CONCLUSION: Clinical skill of predoctoral students need adequate training in nerve blocks. Revising the current literature on alternative inferior alveolar nerve block techniques or use of evidence based dentistry to update and practice alternative nerve block techniques would aid in improving the clinical skills and treatment outcome which would therefore enable to remove the stumbling blocks in successful anesthesia.

The Effectiveness of the Bilobed Pectoralis Major Myocutaneous Flap at a Tertiary Care Hospital: A Retrospective Analytical Study.

BACKGROUND: Cosmetic defects after the major orofacial disease corrections may have an effect on the overall well-being of the patient. Head-and-neck cosmetic surgeries after a major episode of oral cancer impact the functional ability of the individual in several ways. In general, two types of flap are used in reconstructive surgery: microvascular free flaps and regional pedicle flaps. In socioeconomically poor countries like India, bilobed pectoralis major myocutaneous (PMMC) flap has been seen as a mainstay in facial reconstructive surgeries. MATERIALS AND METHODS: The present study was conducted on 100 individuals with oral neoplasm who underwent resective surgery had a soft-tissue defect. All the complications that arose after reconstructive surgery were noted. Simple proportions were recorded. RESULTS: Majority of the individuals had the buccal mucosa as the common site of oral neoplasm, and the tumor nodes and metastases staging was I + II. One individual sustained total flap necrosis. Wound infection and dehiscence were the most common complications. CONCLUSIONS: PMMC is best proven for flap reconstruction in oral neoplasm cases. It is established to be effective with good acceptability and very few complications. Due to these reasons, in spite of the known advances in facial reconstructive surgeries, this technique is widely followed in developing countries.

A Comparative Evaluation of Transbuccal versus Transoral Approach for the Management of Mandibular Angle Fractures: A Prospective, Clinical, and Radiographic Study.

INTRODUCTION: In the facial bones, the angle of the mandible is the common site of fractures. Furthermore, it is the site with the highest number of complications after fracture and hence needs an efficient fixation. The right approach is still debatable for the angle fractures. In the light of these factors, we evaluated the transoral and the transbuccal approaches for the treatment of fractures at the angle of the mandible. MATERIALS AND METHODS: Twenty patients were equally divided into two groups of transoral and transbuccal methods. The parameters such as ease of access, surgical time, occlusion, postsurgical infection, fracture gaps, scarring, and complications were noted, and the values that were compared were statistically analyzed. P < 0.05 was considered statistically significant. RESULTS: No significant variations were seen in the variables such as ease of access, occlusion, postsurgical infection, and fracture gaps. Surgical time was significantly less for the transoral method. Negligible scarring was noted in the transbuccal method. CONCLUSION: Although both the methods were comparable, the transbuccal approach was more efficient for the mandibular angular fracture treatment.