Erratum: Addendum: Comparative efficacy of bromelain and aceclofenac in limiting post-operative inflammatory sequelae in surgical removal of lower impacted third molar: a randomized controlled, triple blind clinical trial.

[This corrects the article on p. 29 in vol. 21, PMID: 33585682.].

The Comparative Evaluation of the Anesthetic Efficacy of 4% Articaine With 1:100,000 Adrenaline and 0.75% Ropivacaine for Inferior Alveolar Nerve Block in the Extraction of Impacted Lower Third Molar.

Introduction Postoperative pain management is a major concern in lower third molar surgery. Various local anesthetic agents are studied for the same. Articaine and ropivacaine are recently studied for pain control intra- and postoperatively in minor oral surgical procedure. However, there is sparse literature that compares these two agents. Therefore, the present study was designed to compare 4% articaine with 1:100,000 adrenaline and 0.75% ropivacaine for inferior alveolar nerve block in lower impacted third molar surgery. Materials and method A prospective, randomized controlled, split-mouth, double-blind study was performed. A total of 60 healthy patients requiring extraction of lower impacted third molar with similar difficulty index were included in the study. Patients were administered 4% articaine with 1:100,000 adrenaline and 0.75% ropivacaine on either side by random allocation. The procedure was performed at an interval of 14 days. Parameters assessed were time of onset of anesthesia, profoundness of anesthesia, hemodynamic parameters (heart rate and blood pressure), duration of soft tissue anesthesia, duration of postoperative analgesia, and postoperative symptom severity (PoSSe) scale. Results The time of onset of articaine was faster (69.20 + 20.13 seconds) compared to ropivacaine (104.06 + 17.66 seconds). No significant difference was observed in hemodynamic parameters. There was significant difference in duration of soft tissue anesthesia, postoperative analgesia, and PoSSe scale between the two groups. Conclusion Within the limitations of the study, 0.75% ropivacaine was effective in providing prolonged soft tissue anesthesia, postoperative analgesia, and better PoSSe scale with hemodynamic stability compared to 4% articaine.

A Rare Case of Primary Squamous Cell Carcinoma of the Submandibular Salivary Gland: Brief Overview of Diagnostic Ambiguity and Treatment Challenges.

Primary squamous cell carcinoma of the submandibular salivary gland is a rarity with obscure etiology and atypical presentation. The features include a progressively enlarging swelling in the lateral neck just below the mandible, which is rarely tender. Surgery is the mainstay of the treatment, and the role of adjuvant therapies is not defined. Precise diagnosis demands a step-by-step systematic approach to exclude the presence of any index tumor. A 65-year-old countryside male presented to our institute with a complaint of submandibular swelling of the right side. After the exclusion of the primary, he was treated surgically with safe margins, ipsilateral comprehensive neck dissection, and adjuvant therapy. One month post-chemoradiotherapy, the patient developed a second primary in the contralateral submandibular region with lung metastasis and succumbed to death due to malignant cachexia. The stage of the disease at presentation, bone and skin involvement, lymphovascular invasion, poorer differentiation, and distant metastasis are associated with dismal outcomes. An early diagnosis and comprehensive surgical management with adjuvant chemoradiotherapy must be accomplished.

Comparative Analysis of Anaesthetic Efficacy of 2% Lignocaine With Dexmedetomidine as an Adjunct in Nerve Blocks for Dental Extractions: A Randomised Controlled Study.

Introduction Adequate perioperative pain control through peripheral nerve blocks is a time-honored practice. Local anesthetic (LA) alone may fail to provide desirable pain control operatively. Dexmedetomidine (DEXMED), is a relatively latest addition to the class of α agonists. The present study was deliberated with the hypothesis that addition of DEXMED to LA does not alter the potency and efficacy of lignocaine. The primary outcome variable measured was pain. Onset, depth of anesthesia, and vital parameters duration of postoperative analgesia following administration of nerve blocks with the two solutions were also measured. Method A prospective, randomized, crossover, double-blind study was conducted on 60 systemically healthy subjects for extraction of premolars in all four quadrants. Subjects were randomly assigned to receive lignocaine mixed with epinephrine (2% lignocaine in 1:2,00,000 epinephrine) or lignocaine plus DEXMED (1µcg/ml lignocaine). On the second appointment of the study, the subjects received the other solution. Pulse rate, blood pressure, arterial oxygen saturation (SPo2), and respiratory rate were recorded as a baseline before performing, during, and two hours later. Results It showed the comparison of onset of anesthesia, and duration of anesthesia in between the two groups was found to be significant (p=0.00) in Group D and Group L. Number of subjects who consumed analgesics in Group L was 34 and in Group D was 14. The hemodynamic parameters displayed no statistically significant difference from their baseline values in the two groups. Conclusion The study concluded that dexmedetomidine when administered with lignocaine in nerve blocks provides greater hemodynamic stability and increases its anesthetic and analgesic potency making it a suitable addition to the existing list of additives for local anesthetic agents.

Primary Tubercular Osteomyelitis Affecting the Mandibular Condyle - A Case Report.

Rationale: Primary orofacial tuberculosis (TB) accounts for <3% of all cases of TB. TB of the mandibular condyle is often misdiagnosed owing to its rarity. Patient Concerns: This report presents a 19-year-old female who presented with a painful swelling over the right preauricular region. The radiographic evaluation suggested a diagnosis of suppurative osteomyelitis of the condyle. Diagnosis: Clinically, the aetiology of the swelling was considered as infective. The histopathological examination of the resected specimen showed tuberculous granuloma and the polymerase chain reaction came positive.This confirms the diagnosis of tubercular osteomyelitis. Mantoux test and sputum acid-fast bacilli were found to be negative. Treatment: The patient was subjected to sequestrectomy with high condylectomy and systemic multidrug antitubercular regimen for 6 months. Outcomes: There was a resolution of infection postoperatively with subsequent regeneration of healthy bone. Take-away Lessons: Early identification and prompt diagnosis is imperative for better treatment outcomes.

Remote Metastasis of Oral Squamous Cell Carcinoma to Cavernous Sinus: A Report of a Rare Case.

The most frequently occurring malignant tumor of epithelial origin of the head and neck region is squamous cell carcinoma (SCC). It is characterized by loco regional dissemination whilst remote metastasis (RM) is rare. The lung, bone, and liver are the frequent sites for RM whilst involvement of the brain or cavernous sinus has an exceptionally rare occurrence. Owing to its rarity, lack of awareness amongst head neck surgeons, and absence of any evidence-based protocol, the optimal management strategies in this population are controversial and, hence, associated with dismal outcomes. The present case report exhibits a rare presentation of cavernous sinus metastasis in human papillomavirus (HPV)-related primary SCC arising from the lower gingivobuccal complex.

Insight of Ethnomedicines in Dentistry: A Brief Review.

Ethnomedicines in the literature compare the therapeutic efficacy of various herbs based on active ingredients of plants and animals. The application of phytomedicines in the field of dentistry is uncommon. The main objective of this article is to access the efficacy of ethnomedicines and newly evolving treatment modalities in reducing post-op complications following dentoalveolar surgeries. Inclusion criteria were selected according to the population, intervention, control, and outcomes (PICO) format. Case reports, case series, retrospective studies, and studies with inappropriate reporting of outcomes were all excluded. An electronic search of English literature in PubMed was performed using the keywords Ethnomedicine, Anti-inflammatory, Analgesics, Therapeutic herbs, Herbal mouthwashes, Third molar surgery. A total of 25 articles were selected, of which three were on herbal mouthwashes and 22 were on anti-inflammatory effect. All the articles were regarding the therapeutic effect of the herbs. The present paper studies various traditionally used therapeutic herbs, their benefits, and shortcomings with their application in dentistry. This study has shown the different herbal alternatives to conventionally used drugs in relation to third molar.

Pre-emptive Analgesic Efficacy of Single-Dose Transdermal Ketoprofen and Diclofenac Patches in Post-operative Pain Management Following Open Treatment of Mandibular Fractures: A Randomized Controlled Study.

INTRODUCTION: The present study was deliberated to assess the pre-emptive analgesic efficacy of diclofenac sodium and ketoprofen transdermal patches following open treatment of mandibular fractures. METHODS: The present prospective, triple-blind, randomized controlled clinical study was carried out on 50 male patients with a mean age of 30-31 years having bifocal mandibular fractures. The subjects were assigned 1:1 to two groups; group K - ketoprofen group and group D - diclofenac sodium group. Patches were applied according to the group allocation one hour before induction. In the immediate post-operative (PO) phase, pain intensity was recorded using a 10-point Visual analog Scale at 2, 4, 8, 12, and 24 hourly. Statistical analysis was performed using descriptive and inferential statistics using SPSS 27.0 version (IBM SPSS, Armonk, NY) and GraphPad Prism 7.0 version (GraphPad Software, Inc., La Jolla, CA) and p<0.05 is considered a level of significance. RESULTS: The present study demonstrated a statistical difference in mean pain intensity among both groups, with lower pain scores at all time intervals and fewer rescue analgesic consumption in the ketoprofen group. CONCLUSION: The ketoprofen transdermal patch was found to be superior in comparison to the diclofenac patch in terms of providing optimal post-operative analgesia with a reduced requirement for post-operative rescue analgesics and minimal adverse events.

Primum Non Nocere: A Case Report of Iatrogenic Fracture of the Mandibular Angle During Excision of an Impacted Third Molar.

Third molar extractions are one of the most commonly performed dental procedures. It is associated with numerous complications, of which mandibular angle fracture is a rare but distressing complication. These can occur as intraoperative and postoperative (late) events. Iatrogenic fractures involving the angle of the mandible represent a unique challenge for management owing to their complex biomechanics and various anatomical factors. Intraoperative fractures occur due to various reasons, which include the position of the tooth, depth of impaction, extent of odontectomy performed, and injudicious use of dental elevators. This exhibited report describes a case of iatrogenic mandibular angle fracture (IFM) during excision of an impacted third molar in a 30-year-old female. Additionally, it discusses the various reasons and preventive strategies to avoid such complications.

Does dexmedetomidine combined with levobupivacaine in inferior alveolar nerve blocks among patients undergoing impacted third molar surgery control postoperative morbidity?

Background: Postoperative analgesia (POA) is an important determinant of successful treatment. Dexmedetomidine (DEX) has recently gained attention as a promising adjuvant to local anesthetics (LA). The present study aimed to evaluate the efficacy and safety of levobupivacaine (LB) as an adjuvant during inferior alveolar nerve block (IANB) in the extraction of lower impacted third molars (LITM). Methods: A prospective, randomized, placebo-controlled, triple-blind, parallel-arm, and clinical study was performed on 50 systemically healthy participants who required removal of an asymptomatic LITM. Using a 1:1 distribution, the participants were randomized into two groups (n = 25). Group L (control group) received 1.8 mL of 0.5% LB and 0.2 mL normal saline (placebo) and Group D (study group) received a blend of 1.8 mL of 0.5% LB and 0.2 mL (20 µg) DEX. The primary outcome variable was the duration of POA and hemodynamic stability, and the secondary variable was the total number of analgesics required postoperatively for up to 72 h. The participants were requested to record the time of rescue analgesic use and the total number of rescue analgesics taken. The area under the curve was plotted for the total number of analgesics administered. The pain was evaluated using the visual analog scale. Data analysis was performed using paired students and unpaired t-test, Mann-Whitney U test, Chi-square test, and receiver operating characteristic analysis. Statistical significance was set at P < 0.05. Results: The latency, profoundness of anesthesia, and duration of POA were statistically significant (P < 0.05). The differences between mean pain scores at 6, 12, 24, 48, and 72 h were found to be significant (each P = 0.0001). Fewer analgesics were required by participants in group D (2.12 ± 0.33) than in L (4.04 ± 0.67), with a significant difference (P = 0.0001). Conclusion: Perineurally administered LA with DEX is a safe, effective, and therapeutic approach for improving latency, providing profound POA, and reducing the need for postoperative analgesia.

Comparative efficacy of bromelain and aceclofenac in limiting post-operative inflammatory sequelae in surgical removal of lower impacted third molar: a randomized controlled, triple blind clinical trial.

BACKGROUND: Pain, edema, and trismus are predictable sequelae for surgical extraction of impacted mandibular third molars (M3M). The present study aimed to compare the anti-phlogistic potential of bromelain and aceclofenac in the reduction of post-surgical sequalae in the extraction of impacted M3M. METHOD: A randomized controlled, triple-blinded clinical study included 72 patients scheduled for surgical removal of impacted M3M under local anesthesia. Randomization was performed and subjects were equally allocated to groups A (control) and B (study), who intended to receive aceclofenac and bromelain, respectively. The primary outcome variables were pain, edema, and trismus evaluated on postoperative days 2 and 7 and compared with baseline values. The secondary variables evaluated were the quantity of rescue analgesics required and the frequency of adverse effects in both groups for 7 postoperative (PO) days. Data were analyzed with a level of significance of P < 0.05. RESULTS: Group B demonstrated a significant decrease in the severity of edema and trismus compared to group A on both PO days 2 and 7 (P < 0.001). Bromelain demonstrated similar analgesic efficacy with an insignificant difference compared to aceclofenac (P > 0.05). CONCLUSION: The present study showed that the efficacy of bromelain was comparable to that of aceclofenac in reducing inflammatory complications following surgical removal of impacted M3M. Bromelain can be considered a safe and potent alternative to routinely used aceclofenac when addressing inflammatory outcomes after surgery.

Comparative assessment of corticotomy facilitated rapid canine retraction using piezo versus bur: A randomized clinical study.

PURPOSE: The leading concern of orthodontic patients is prolonged treatment with fixed appliances and demand speedy treatment from the orthodontists. Piezocision is a relatively innovative, safe and reliable technique of corticotomy in the domain of surgically-accelerated orthodontic treatment. Our aim was to compare the efficiency of piezo corticotomy (piezocision) and conventional bur in rapid orthodontic tooth movement (OTM). SUBJECTS AND METHOD: The study employed a randomized, double-blind, split-mouth design. 24 subjects with Class II div 1 malocclusion were randomly assigned to the two interventions, viz; piezo and bur group. The primary parameters evaluated were the rate and amount of tooth movement and total treatment time required for canine retraction. Additionally, the duration of surgery and postoperative complications were also evaluated. OBSERVATIONS AND RESULTS: Rate and amount of tooth movement were significantly higher with reduction in total treatment time in piezo compared to bur group. The duration of surgery was significantly longer in piezo group with no significant difference observed in post-operative complications. CONCLUSION: Piezo-guided corticotomy was effective in providing rapid OTM with profound reduction in total treatment time and may be proposed as a suitable adjuvant to conventional corticotomy having comparable post-operative complications.

Anesthetic efficacy and safety of 2% lidocaine hydrochloride with 1:100,000 adrenaline and 4% articaine hydrochloride with 1:100,000 adrenaline as a single buccal injection in the extraction of maxillary premolars for orthodontic purposes.

BACKGROUND: Palatal injection of local anesthetics is the most painful injection. To obviate the need for palatal injections, local anesthetic agents with diffusibility are being investigated. Hence the present study was designed to analyze the anesthetic efficacy of 2% lidocaine hydrochloride (HCl) with 1:100,000 adrenaline and 4% articaine hydrochloride (HCl) with 1:100,000 adrenaline using single buccal infiltration for the extraction of maxillary premolars. METHODS: A prospective, double-blind, crossover, randomized clinical study was performed on 60 consecutive systemically healthy patients with an age range of 15-30 years, requiring extraction of asymptomatic bilateral maxillary premolars for orthodontic purposes. They received 1ml buccal infiltration of 4% articaine HCl with 1:100,000 adrenaline on one side and 2% lidocaine HCl with 1:100,000 adrenaline on the other side. The extraction procedure on either side was scheduled 14 days apart. Parameters assessed were the time of onset of anesthesia, intraoperative discomfort, hemodynamic parameters, and the duration of analgesia. Analysis of the data was done using the Mann-Whitney test, the Wilcoxon test, the Kruskal-Wallis ANOVA test, and the chi-square test. Statistical significance was established at P < 0.05. RESULTS: Articaine showed a faster time of onset and longer duration of analgesia than lidocaine. However, the difference in the intraoperative discomfort and hemodynamic parameters was statistically insignificant. CONCLUSION: Within the limitations of the study, it can be concluded that the extraction of maxillary premolars can be performed with a single buccal infiltration of 2% lidocaine HCl with 1:100,000 adrenaline, which is one of the most commonly used local anesthetic agent.

Actinomycotic Osteomyelitis of the Mandible - A Rare Case Report.

Actinomycetes are a relatively sporadic cause of infection of the head-and-neck region and their appearance is usually uncharacteristic, and hence pose a challenge for the diagnosis. The present article intends to exhibit this rarity afflicting mandible and highlight its management. The present report describes a case of a 55-year-old countryside female who presented with pain and swelling affecting the left side of the mandible. Orthopantomograph and cone-beam computed tomography imaging showed multiple ill-defined radiolucencies and perforations of the buccal and lingual cortical plates. Fine-needle aspiration microbiology was used to ascertain the microbial organism and the patient was treated with amoxicillin + clavulanic acid with curettage of the infected site. The patient responded well to prompt systemic antibiotics and local surgical measures with complete resolution of the infection and spontaneous bone regeneration. Although rare actinomycosis of the mandible is curable and should be included in the differential diagnosis of osteomyelitis of the jaw. Early and accurate diagnosis and prompt intervention confirm better outcomes.

Does diagnostic accuracy of surgeon's perception outweigh frozen section analysis in determining intraoperative clear mucosal surgical margins in oral squamous cell carcinoma patients?

INTRODUCTION: The lucrativeness of the frozen section for intraoperative margin assessment in head and neck squamous cell carcinoma is debatable till date. The purpose of this study was to evaluate whether surgeon's perception by gross examination (GE) of margin is an alternative to frozen section. AIM: The aim was to compare the diagnostic accuracy (DA) of surgeon's perception of tumor-free mucosal and soft-tissue surgical margins intraoperatively assessed by GE and frozen section analysis (FSA). METHODOLOGY: A prospective, observational study was conducted on 59 histologically proven cases of oral squamous cell carcinoma. Two hundred and thirty-six mucosal margins were assessed by an experienced surgeon (ES) and thereafter subjected subsequently to FSA. These results were compared with the gold standard histopathology (HPE). The sensitivity (SS), specificity (SP), positive predictor value (PPV), negative predictor value (NPV), and DA of surgeon's perception by GE were calculated and subsequently compared with FSA and HPE using descriptive and inferential statistics. RESULTS: The SS, SP, PPV, NPV, and DA of ES by GE were 80%, 99.12%, 80%, 99.12%, and 98.30%, respectively when compared to HPE, and the SS of 90%, SP of 98.32%, PPV, NPV, and DA were 69.23%, 99.57%, and 97.98%, respectively when compared with HPE. The results of the surgeon's perception by GE were comparable to the results of FSA. CONCLUSION: The study concludes that surgeon's perception by GE is upfront reliable alternative intraoperative method to FSA in places where FS is not available.

"Piezosurgery vs bur in impacted mandibular third molar surgery: Evaluation of postoperative sequelae".

PURPOSE: Piezosurgery is a relatively novel, precise and safe technique of ostectomy in the domain of oral and maxillofacial surgery. Our aim was to compare the inflammatory outcomes of osteotomy using piezosurgery and conventional bur in impacted mandibular third molar (IM3M) surgery. SUBJECTS AND METHOD: The study implemented a randomized, double-blind, crossover design. 120 sides in 60 patients were randomly allocated to the two interventions used, viz; conventional bur and piezosurgery. The primary outcome variables evaluated were facial swelling, trismus, pain, and paresthesia. Additionally, the duration of surgery and the frequency of soft tissue injuries with the use of two techniques were also evaluated. RESULTS: Pain, swelling, trismus, and soft tissue injuries emerged to be significantly higher with the use of bur as compared to the piezo. The duration of surgery was significantly extended in the piezo group and no significant difference was observed in the occurrence of paresthesia between the two groups. CONCLUSION: The result suggests that piezosurgical osteotomy technique is superior to conventional bur in terms of the postoperative inflammatory outcomes in IM3M surgery.

Is 0.75% ropivacaine more efficacious than 2% lignocaine with 1:80,000 epinephrine for IANB in surgical extraction of impacted lower third molar?

PURPOSE: We aim to compare and evaluate the anesthetic efficacy and safety of inferior alveolar nerve block (IANB) using 0.75% ropivacaine and 2% lignocaine with 1:80,000 epinephrine in lower impacted third molar (LI3M) surgery. PATIENTS AND METHOD: We designed a prospective randomized, double-blind, split-mouth study evaluating 60 systemically healthy patients with the presence of bilateral symmetrically oriented LI3M. The sides and sequence of drug administered were randomly allocated. The primary outcome variables analyzed were hemodynamic stability, profoundness of anesthesia, and duration of postoperative analgesia. Time of onset, duration of soft tissue anesthesia, patients requiring analgesics, and their quantity for five postoperative days were recorded. RESULTS: Early onset of anesthesia was seen in Lignocaine (68.6 ± 20.4 s) compared with Ropivacaine (104.1 ± 17.7 s) with significant differences (p = 0.001). Both the anesthetic solutions were found to be equipotent in providing profound intraoperative anesthesia. No significant difference emerged in perioperative hemodynamic stability. Ropivacaine exhibited statistically significant differences in the duration of soft tissue anesthesia (p = 0.001) and postoperative analgesia (p = 0.001). Patients requiring rescue pain medication and the number of analgesics consumed were greater on first and during five postoperative days in lignocaine when compared with that of ropivacaine with significant differences p < 0.001 and p < 0.001 respectively. CONCLUSION: The results suggest that 0.75% ropivacaine is effective in providing adequate anesthesia, prolonged postoperative analgesia, and better postoperative pain control with a safer cardiovascular profile in LI3M surgery. It can be an addition to the existing list of long-acting local anesthetics used for LI3M surgery.

Borle's triangle: A reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomy.

PURPOSE: An accurate understanding of the anatomy, identification and preservation of facial nerve is critical in performing successful functional parotidectomies. The current literature is replete with inconsistencies of various landmarks when used alone for identification of facial nerve trunk (FNT). The purpose of the paper is to introduce a new anatomical triangle, Borle's triangle (BT) for safer and reliable operative identification of FNT during parotodectomies. PATIENTS AND METHODS: Between Aug 2014 and Dec 2017, twelve patients who reported with unilateral disease of the parotid gland with intact facial nerve function who underwent superficial or complete parotidecomies were included in the study. BT was conceptualized by intersection of three imaginary lines drawn along anatomical structures and forming a triangle comprising of angles a, b and c. RESULTS: Introperatively, BT helped reliably identify the FNT and its branches successfully in all the cases. The mean distance of FNT from angle b was found to be 12.18 ±â€¯1.7 mm. Transient neurological deficits with one or more branches were seen in four cases whilst, one case had transient deficit with all the five peripheral branches. All of them spontaneously resolved completely by the end of three months post operatively. CONCLUSIONS: When used in isolation, substantial variations exist in distances measured from anatomic landmarks to the main FNT in the literature. The BT utilizes three commonly used anatomical landmarks. It predictably helps in proper anatomic orientation, identification and preservation of FNT and branches with ease in parotidectomies.

Prevalence of congenital cardiac anomalies in patients with cleft lip and palate - Its implications in surgical management.

BACKGROUND: Cleft lip and palate is one of the most common congenital craniofacial deformities seen in children. Various congenital anomalies are reported in the literature to be associated with cleft lip and palate. Cardiac anomalies are one of the most common congenital disorders associated in cleft lip and palate patientsIt includes Cyanotic and acyanotic cardiac diseases likel fallot's tetralogy, transposition of greater vessels, atresia of tricuspid, total anomalous pulmonary venous return (TAPVR), truncus arteriosus, ebstein's anomaly, hypoplastic left heart syndrome and pulmonary atresia, patent ductus arteriosus, ventricular septal defect, atrial septal defect, pulmonary stenosis, aortic stenosis and coarctation of aorta. AIM: To study the prevalence of congenital cardiac anomalies in cleft lip and palate patients. OBJECTIVES: To study different types of congenital cardiac anomalies/defects in patients with cleft lip and palate and its implications in surgical management. MATERIALS AND METHODS: This is a retrospective study carried out for a period of one year. In the present study medical records of 200 patients with cleft lip and palate were evaluated and analyzed for presence of congenital cardiac anomalies. RESULTS: Out of 200 patients of cleft lip and palate, 30 patients (15%) were associated with congenital cardiac anomalies with male to female ratio of 1:1. Associated congenital cardiac anomalies were most frequently seen in unilateral cleft palate patients (21.05%) The most common cardiac anomaly was Ventricular septal defect (36.6%).