Does the Surgical Intervention for Trigeminal Neuralgia Refractory to Pharmacotherapy Improve Quality-of-Life? - A Systematic Review.

PURPOSE: Trigeminal neuralgia (TN) refractory to pharmacotherapy requires surgical interventions which vary from percutaneous procedure to microvascular decompression (MVD). The aim of the systematic review is to find evidence for the surgical treatment for TN with high success rate and low complications which improves the quality-of-life (QOL). METHODS: A systematic literature search was made on published studies from MEDLINE, SCOPUS, Science Direct, and Cochrane Library databases that report the available surgical treatment for TN up to March 2020 and studies referred in the selected papers. Relevant studies were selected based on predefined eligibility criteria. The primary outcome measured was success rate, pain relief and secondary outcome measured was QOL, recurrence and complication rate. RESULTS: Ten studies with a sum of 11,154 individuals were included in this qualitative analysis. Seven studies compared MVD whereas 4 studies compared Gamma knife radiosurgery with other techniques like percutaneous balloon compression, percutaneous glycerol rhizotomy etc. The result showed that MVD has a considerable higher rate of initial pain-free outcomes (96.6%) followed by Gamma knife radiosurgery (96.2%), cryotherapy (95.4%), percutaneous balloon compression (87%), percutaneous glycerol rhizotomy (85%) and the lowest rate of cohorts who were never pain-free (1.7%).QOL was improved to 100% as a result of pain relief which was evaluated in only 2 studies . Overall the recurrence rate was 0.45 to 52%. MVD has lower rate of long-term recurrence 0.45 and 6.1% for 2 years and 8 years, respectively, and cryotherapy has the highest rate of 52% at 6 months. CONCLUSION: Outcomes of the literature search showed that it lacks the knowledge to generally support 1 or the other treatment. Each type of TN requires individualized protocols to treat based on pain response which ultimately improve the QOL. We also propose there should be more reliable data reporting by using a universally acceptable pain scale for better analysis of treatment outcome.

Aesthetic and Functional Rehabilitation of Postburn Maxillofacial Deformity.

Postburn maxillofacial deformities, although rare, are a significant cause of morbidity. Since contracture scars have a potential role in deforming the maxillofacial skeleton, the focus of treatment should be on growing patients, where scar contractures can drastically influence growth and morphology of the maxillofacial units. There are certain aspects of severe facial burns and deformities, especially of the jaws, that deserve sincere attention to overcome aesthetic and functional disabilities such as inability to masticate and incompetent lips. The purpose of this article, therefore, is to discuss these injuries, the mechanism of development of deformities of the jaws and associated structures and their management for better aesthetic, functional, and psychological health of patient. An interpretive clinical report is presented.

High lingual split access osteotomy for ectopic third molar in mandibular ramus region - A case report and literature review.

Ectopic occurrence of mandibular third molar is a rare incidence. Usually found along with a cystic lesion or diagnosed incidentally during routine check-up. Owing to the rarity, only few cases were reported in the literature. The common site is the mandibular condyle followed by sigmoid notch, and often found in females. The frequent symptoms are obscure facial pain, trismus or the symptoms of the associated pathology like dentigerous cyst. The etiopathogenesis is uncertain and optimal management is still unclear. The symptomatic tooth should be removed either intraorally or extraorally. Here we report a case of ectopic mandibular third molar in ramus region surgically removed intra orally by high lingual split access osteotomy.

Fibular Graft-Effective Panorama for Prosthetic Rehabilitation of Resected Mandible.

Surgical management of extensive tumors in the mandibular region leads to massive disfigurement of the face. Also the prosthetic outcome of such patients rehabilitated with free soft tissue flaps is very poor. Reconstruction of extensive defects to overcome the disfigurement is a challenging procedure and can be achieved with free fibula flap. Free fibula graft provides sufficient length of bone for the reconstruction of the postsurgical defects. Excellent vascularity of fibula flap allows for easy uptake of the graft and osseointegration of the dental implants. The addition of a skin island allows for absolute tension-free intraoral closure that enhances tongue mobility. Fibula graft allows proper tissue support after mandibular reconstruction. After rehabilitation with free fibula graft we can plan for prosthodontic rehabilitation with implant retained prosthesis leading to improved masticatory function. It also helps to improve speech outcome as a stable prosthesis can be delivered with the help of implants retained in the fibula graft. It is essential to assess the outcome of surgical reconstruction with fibula graft followed by prosthetic rehabilitation with implant retained prosthesis for their recognition as a treatment of preference. This article details the clinical report along with various clinical parameters for implant retained prosthetic rehabilitation of the patient who had undergone mandibular resection and reconstruction with free fibula graft.

Fate of the Coronoid Process After Coronoidotomy and Its Effect on the Interincisal Opening: A Clinical and Radiologic Assessment.

PURPOSE: Coronoidotomy (surgical detachment of the coronoid process from the mandibular ramus) is used to treat several conditions, including coronoid hyperplasia and temporomandibular joint (TMJ) ankylosis. The stability of the outcome, however, is considered questionable because of the risk of reattachment of the coronoid process. This study aims to radiographically and clinically evaluate the long-term anatomic and physiological outcome after coronoidotomy. MATERIALS AND METHODS: In 17 patients with unilateral TMJ ankylosis, 25 coronoidotomies were performed as an additional maneuver to relieve trismus after ankylosis release. Radiologic evaluation was performed immediately and 1 year postoperatively with panoramic radiography and computed tomography to assess changes at the coronoidotomy site. Clinical assessment included measurement of the interincisal distance at the 1-, 3-, 6-, and 12-month postoperative visits. RESULTS: A sharp osteotomy margin with a 3- to 10-mm gap between the ramus and coronoid process was observed immediately postoperatively in all cases. After 1 year, 23 cases (92%) showed partial (n = 5) or complete (n = 18) osseous union to the mandibular ramus, whereas in 2 cases, no evidence of fusion was observed radiographically. The mean interincisal opening achieved at 1 year was 33 mm. CONCLUSIONS: Coronoidotomy is an effective but more straightforward adjunct to arthroplasty than coronoidectomy (surgical excision of the coronoid process) in the management of TMJ ankylosis, with achievement and maintenance of adequate postoperative mouth opening.

Autotransplantation of a Buccally Erupted Matured Mandibular Third Molar to Replace a Grossly Decayed Second Molar.

Autotransplantation can be a treatment option for tooth loss as an alternative to fixed or implant-supported prostheses. It has predictable results comparable to implants, with reported success rates often greater than 90%. In present case, buccally erupted matured third molar was autotransplanted in extraction socket of grossly carious mandibular second molar. The tooth was splinted for 1 week followed by root canal treatment. After 12 months follow up, tooth was in perfect state of function and aesthetic with healthy periapical and periodontal architecture. High success rate was found in immature tooth transplantation in previous case reports. This case report describes that even matured tooth can also be used as donor if atraumatic extraction is possible and endodontic treatment is well performed.