A Randomized Controlled Study Comparing Efficacy of Classical and Gow-Gates Technique for Providing Anesthesia During Surgical Removal of Impacted Mandibular Third Molar: A Split Mouth Design.

INTRODUCTION: Reliable profound mandibular block anesthesia is questionable when depositing the anesthetic solution at the lingula. The Gow-Gates technique is an useful alternative to the classical inferior alveolar nerve block and the incidence of unsuccessful anesthesia may be as high as classical technique. The aim of this study is to compare the clinical efficacy, degree of patient acceptability, advantages, disadvantages and limitations of the classical and Gow-Gates techniques for providing anesthesia in patients undergoing bilateral symmetrical surgical removal of impacted mandibular third molar under local anesthesia. MATERIAL AND METHODS: The split mouth design study was conducted on 100 patients aged between 20 to 40 years undergoing surgical removal of bilateral symmetrical impacted mandibular third molar performed by the same maxillofacial surgeon. 2 ml of 2 % lignocaine hydrochloride with 1:80,000 adrenaline was used as a standard local anesthetic solution in all the cases. By using four-digit numbers from a random number table, either Gow-Gates or classical inferior alveolar nerve block were randomly assigned to either left or right sides in each patient. The injections were administered by another surgeon who was blinded to the experiment. The patient was assessed for Pain experienced during injection, frequency of positive aspirations, Onset and duration of anesthesia and Nerves anesthetized. RESULTS: Results were statistically analyzed by Mann-Whitney and chi square test. A 'P' value of less than 0.05 was considered for statistical significance. Higher mean pain during injection was recorded in classical group, was found to be statistically significant. No significant association was observed between aspiration and the groups. Higher mean onset of anesthesia was recorded in Gow-gates group, was found to be statistically significant. Higher mean duration of anesthesia was recorded in Gow-gates group, was not statistically significant. Higher success rate was recorded in Gow-gates group and was statistically significant. CONCLUSION: If we ignore delayed onset of anesthesia of Gow gates technique, it is found to be more reliable, beneficial and have higher success rate than classical inferior alveolar nerve block technique.

Comparison of 'sutureless' Transconjunctival and Subciliary Approach for Treatment of Infraorbital Rim Fractures: a Clinical Study.

PURPOSE: The aim of the study is to compare subciliary incision and 'sutureless' transconjunctival incision in the treatment of infraorbital rim fractures. MATERIALS AND METHOD: In this prospective study, 40 patients with fractures of the infraorbital rim were selected and divided into 2 groups using random sampling technique. Group A patients were treated using 'sutureless' transconjunctival technique and group B patients were treated using subciliary approach. The following parameters were compared a) time taken, intraoperative ease of access, exposure achieved; b) clinical outcome and postoperative complications; c) Aesthetic outcome at intervals of 15 days, 1 month and 3 months. RESULTS: Total time taken for completion of surgery was lesser in group A patients. The presence of subconjunctival ecchymosis (at 1 month interval) and neurological deficit was found to be statistically significant (P<0.05) in the 'subciliary' group of patients. The transconjunctival approach showed better esthetic results and fewer post-operative complications. CONCLUSION: The subciliary approach gives good exposure of the infra-orbital rim and is better suited to reduce extensively displaced fractures of the infra-orbital rim. The transconjunctival approach is comparatively faster, gives better esthetic results and fewer post-operative complications but is technique sensitive and requires an additional lateral canthotomy in cases where more exposure is needed.

An unusual complication of late onset allergic contact dermatitis to povidone iodine in oral & maxillofacial surgery - a report of 2 cases.

BACKGROUND: Povidone iodine (PVP-I) is a chemical complex of polyvinylpyrrolidone (also known as povidone or PVP) and elemental iodine. Iodine containing compounds are widely and commonly used as antiseptics and disinfectants. They are available in various forms like aqueous solution, tincture, aerosol, ointment, or foam. Skin irritation to them is due to the oxidative effects of iodine. Because of the low free iodine concentration in povidone-iodine, skin irritation is less frequent from short contact (1). CASE: We report two cases, both with no history of allergy to any drugs, who developed an allergic reaction 24 hours after the usage of povidone iodine as a pre-operative antiseptic to prepare (scrub) the lower third of face before surgical removal of third molars. This case report was granted an exemption by the ethical committee of our institution review board. The Helsinki declaration doesn't apply to this case presentation. CONCLUSIONS: PVP-1 is the most commonly used antiseptic scrubbing solution prior to most surgeries. However, allergic contact dermatitis due to PVP-I has not been extensively documented or reported and hence under evaluated, compared to other commonly encountered allergens. There is almost general agreement to the proposition that PVP-I is a very rare sensitizer (2,3) though there are some conflicting reports on the matter. However, sometimes when prolonged skin contact with PVP-I occurs when used as a pre-operative antiseptic agent, it can cause allergic dermatitis (4,5). Does this finding make pre-operative testing for allergies to PVP-1 necessary in all patients? A point to ponder.

Percutaneous Radiofrequency Rhizotomy in Treatment of Trigeminal neuralgia: A Prospective Study.

INTRODUCTION: Trigeminal neuralgia (TN) often called as "Tic douloureux" is a syndrome characterized by paroxysmal facial pain, is one of the most painful and debilitating craniofacial pain disorders. The controversy regarding the etiology and treatment of TN still exists. OBJECTIVE: To evaluate the effectiveness of percutaneous radiofrequency rhizotomy (PRR) for TN, after failure of pharmacological management. METHOD: A nonrandomized, non comparative, descriptive, in vivo study of 15 patients with TN of maxillary and mandibular divisions of trigeminal nerve and patients with pain refractory to pharmacological management were done. It was performed as an O.P.D procedure. A routine follow up was done in all cases for 1 year. RESULTS: In a total of 15 patients, 8 female and 7 male patients were enrolled for the study. Early pain relief (immediately, postoperatively to 6 month) classified as excellent or good (successful), occurred in 12 of 15 patients (80 %). Fair or poor pain relief (unsuccessful) occurred in three patients (20 %).There was no mortalities and no major morbidity. SUMMARY: It was found that surgical treatment with PRR is a safe and effective way to manage patients with TN in whom pharmacologic therapy is either ineffective or not tolerated, with low side effects which are well tolerated.

"Transport distraction osteogenesis for reconstruction of mandibular defects": our experience.

INTRODUCTION: Mandibular defects usually involve a combination of osseous and soft tissue deficiency and are among the most challenging problems in maxillofacial surgery, many options are available for mandibular reconstruction. One of the options discussed in literature recently being distraction osteogenesis. AIM AND OBJECTIVE: The aims and objectives of the study were to evaluate clinically the technique of distraction osteogenesis to reconstruct mandibular defects, using indigenous transport distractors, and to evaluate the efficacy of Indigenous transport distraction osteogenesis device. MATERIALS AND METHODS: A prospective, experimental study was designed to examine the use of transport distraction osteogenesis in the treatment of defects of the mandible. Four patients with defects of the mandible were subjected to distraction osteogenesis with indigenously manufactured distraction device. The regenerate was assessed clinically and radiographically. RESULTS: The results showed that the regenerate was clinically as hard as the adjacent unaffected mandible and radiologic evidence of bone regeneration was observed. The major advantage being regeneration of hard tissue and soft tissue components without the morbidity of donor site, so that functional rehabilitation of the patient is possible. CONCLUSION: Thus from our study it is shown that transport distraction osteogenesis using indigenous distractors is a reliable yet affordable option for reconstruction of mandibular defects.