Efficacy of Low-Level Laser Therapy in Management of Temporomandibular Joint Pain: A Double Blind and Placebo Controlled Trial.

Background: Stomatognathic system is an interaction of the muscles of mastication, dentition, neural component, and temporomandibular joint. Any dysfunction in this system may lead to temporomandibular disorders (TMDs). Various non-surgical modalities have been employed for treating TMDs. Aim and objectives: The aim of the study was to objectively evaluate the effects of low-level laser therapy (LLLT) in treatment of patients with TMDs. Materials and Methods: Sixty individuals diagnosed with TMDs were divided randomly into two groups (Group I-placebo and Group II -LLLT). A series of 20 sessions of LLLT applied both in closed mouth and maximum mouth opening position were given over a period of 08 weeks. Assessment was done in terms of improvement in mouth opening, pain, clicking, and deviation of mandible. The data collected were analyzed statistically. Results: The results showed improvement in the pain reduction, improvement in the maximum mouth opening, reduction in deviation, and clicking in both groups but better treatment outcome in the low-level laser group. Conclusion: Though conservative measures improved the symptoms in TMD but LLLT has shown better results in comparison with the placebo group. Being non-surgical can be employed in combination with other modes for effectively treating such disorders. Keywords: Pain, Dysfunction, Temporomandibular joint disorders (TMDs), Low-level laser therapy (LLLT).

Unusual Cause for Maxillofacial Injury.

Penetrating facial injuries are potentially dangerous and may require emergency management because of the presence of vital structures in the face, and it may be life-threatening especially when the injury involves airway, major blood vessels, spinal cord, and cervical spines. Penetrating injuries of the facial region can occur due to missile injuries, blast injuries, motor vehicle accidents, and accidental fall on sharp objects. However, injury to face caused by the shattering of a protective helmet itself is extremely rare. Primary management is targeted to deal with life-threatening conditions and stabilize the patient followed by subsequent care in a well-equipped setting. We present a case of a 30-year-old male, who suffered extensive soft and hard tissue injury of the maxillofacial region due to shattering of a protective helmet causing a ballistic effect.

Role of intraoral distractors in management of cranial synostosis: An initial experience.

OBJECTIVE: The objective of the following study is to evaluate the results of strip craniectomy with distraction osteogenesis, using the intraoral distractor devices, as a modality of treatment for craniosynostosis. MATERIALS AND METHODS: Two cases of cranial synostosis were selected for this study. The cases were operated for strip craniectomy with distraction osteogenesis using a pair of miniaturized intraoral distractor devices. Distraction was carried out after a latency period of 4 days at a rate of 0.5 mm twice a day. Total separation of osteotomized segments achieved was in the range of 25-28 mm. RESULTS: Both patients were evaluated clinico-radiologically at 3, 6 and 12 months postoperatively. There was an increase in the occipital frontal circumference with improvement in the contour of the skull. Both the cases showed marked improvement of bowel habits, bladder control and cognitive behavior. Radiologically copper-beaten appearance reduced considerably suggesting improved intracranial pressure. CONCLUSION: Combination of distraction osteogenesis with strip craniectomy for the management of craniosynostosis is an effective treatment modality with promising results.

Evaluation of treatment outcome in cleft maxillary hypoplasia treated by rigid external distractor: a cephalometric study.

OBJECTIVE: The aim of the study was to cephalometrically evaluate hard and soft tissue changes in cases of cleft-induced maxillary hypoplasia treated by distraction osteogenesis using rigid external distractor (RED). METHODS: Fifteen cases of cleft-induced maxillary hypoplasia were selected applying the inclusion and exclusion criteria. The cases were operated on under general anesthesia for distraction osteogenesis using RED. Cephalometric evaluation was done at the end of presurgical orthodontics (C1), 1 week after removal of RED (C2), and at the end 12 months postoperatively (C3). The hard tissue parameters considered were Sella Nasion point A angle, Point A-Nasion-point B angle, distance from condylion to point A, anterior nasal spine-menton to Nasion-menton ratio, and upper incisor distance to N vertical. The soft tissue parameters included facial contour angle, nasolabial angle, upper lip to E-line, and lower lip to E-line. RESULT: There were 8 males and 7 females with an average age of 13.07 years. The range of maxillary advancement was 8 to 24.5 mm with an average of 14.46 mm. The cephalometric data were compared using paired t test and 1-way analysis-of-variance test. All the hard tissue changes except SNB were statistically highly significant (P > 0.0001). The percentage of relapse was 13.72% at SNA, 13.3% at ANB, 9.83% for maxillary depth, 8.99% for distance of the upper incisor to N perpendicular and 20.73% for facial contour angle, 2.16% for nasolabial angle, 25.69% for distance of UL to E-line, and 25.12% for distance of LL to E-line. Soft tissue relapse except nasolabial angle after 1 year was more as compared with hard tissue. CONCLUSIONS: All the cephalometric parameters except SNB angle showed significant improvement. However, the significant percentage of relapse should be considered in the preoperative planning.

Comparative evaluation of autogenous calvarial bone graft and alloplastic materials for secondary reconstruction of cranial defects.

OBJECTIVE: To do a comparative study and evaluate the outcome in healing of reconstructed cranial defects with an autogenous bone graft vis-à-vis alloplastic materials. METHODS: A total of 22 patients with cranial defects were selected for this study. All the subjects were men; mean age was 27 years. Secondary reconstruction was done to obturate the defects. Of the 22 patients, 11 underwent cranioplasty with autogenous calvarial bone graft, 6 patients with a titanium mesh and 5 with a polymethylmethacrylate plate. RESULTS: The follow-up period ranged from 18 to 24 months. The 11 patients who were operated on with autogenous calvarial bone grafts did not develop any postoperative infection or complications. Graft uptake was complete, and the contour of the skull was improved in all the patients. Of the 5 patients operated on for secondary reconstruction with polymethylmethacrylate plates, 3 had exposure of the implant and 1 reported with secondary infection. Of the patients where secondary reconstruction was carried out with a titanium mesh only, 1 reported with secondary infection and 2 reported with thermal sensitivity. No graft resorption was detected. CONCLUSIONS: In our study, we concluded that autogenous calvarial bone grafts have better mechanical, biologic, and immunologic properties. This procedure allows the surgeon to reconstruct moderately large cranial defect with ease of access within single or adjacent incision to the operating site with minimal postoperative morbidity and discomfort.