Frequency of concomitant injuries in maxillofacial trauma in a tertiary health care centre in India: A 5-year retrospective study.

PURPOSE: Road traffic accidents (RTA), assaults, falls, and sports-related injuries are the leading causes of maxillofacial trauma. Due to quite different geographical environment and fast urbanization, the use of various protective equipment is restricted in India. Thus, compared to other countries, there might be a significant difference in the pattern and frequency of associated injuries among subjects with maxillofacial trauma. The present study was conducted to identify the causes and pattern of various maxillofacial fractures and the frequency of other related injuries among subjects with maxillofacial trauma. METHODS: This is a cross-sectional retrospective study recording 2617 subjects with maxillofacial trauma. The patient demographics, causes of trauma, types of maxillofacial injury, and associated soft and hard tissue injuries were recorded. The types of maxillofacial and associated injuries were diagnosed from details of clinical examinations and the interpretation of various radiographs available in the file. The associated injuries were divided into head injury, other bony injuries, and soft tissue and vital structure injuries. Descriptive statistics and the test of proportion were used. A p value < 0.05 was considered as a level of significance. RESULTS: The maxillofacial injuries were significantly common in patients aged 16 - 45 years (66.7%) than in patients aged ≤ 15 and > 46 years (33.3%) (p < 0.001). The RTA was the most common cause of maxillofacial injury (n = 2139, 81.7%), followed by fall (n = 206, 7.9%), other causes of injury (n = 178, 6.8%), and assaults (n = 94, 3.6%). The maxillofacial injury by 2-wheel vehicle accidents was significantly higher than that by 4-wheel vehicle and other vehicle accidents (p < 0.001). There was a significant correlation between alcohol and RTA (p < 0.001). The head injury (n = 931, 61.1%) was the most common associated injury, followed by soft tissue and vital structures injuries (n = 328, 21.5%) and other bone injuries (n = 264, 17.3%). DISCUSSION: Head injury was the most common associated injury followed by soft tissue and vital structures and bone injuries among subjects with maxillofacial trauma. Clavicle fracture and injury to the lower extremities were the most common hard and soft tissue-associated injuries.

Effect of Single dose of Methylprednisolone Injection at Stylomandibular Ligament Insertion on Pain and Various Mandibular Movements Among Patients with Ernest Syndrome: A Pilot Study.

Insertion tendinosis of stylomandibular ligament or Ernest syndrome is a rarely encountered cause of orofacial pain. The pain in this disorder originates from the stylomandibular ligament insertion site and radiates to the temporomandibular joint (TMJ), neck, shoulder, and periauricular region. Ten subjects who had undergone surgery for mandible fractures diagnosed with Ernest syndrome were considered for the present study. The origins and insertions of the stylomandibular ligament were marked and palpated using fingertip and blunt probe. The Ernest syndrome was confirmed by injecting diagnostic local anesthesia injection. A single dose of 2 ml methylprednisolone (40 mg/ml) was injected at the insertion site of a stylomandibular ligament in each subject. The effect of methylprednisolone injection on pain and various jaw movements were assessed at 1-month and 6-months after the injection. The mean pain value ranks during rest & while mouth opening in the visual analogue scale (VAS) reduced significantly after single injection (P < 0.001). The mean mouth opening increased significantly from 23.3 ± 3.94 mm before the treatment to 36.1 ± 3.07 mm at 1-week and 35.4 ± 2.17 mm at 6-months after the treatment (P < 0.001). The mandible protrusive movement increased from 4.07 ± 0.74 mm before treatment to 5.06 ± 0.62 mm at 1-week and 4.94 ± 0.62 mm at 6-months after the injection, respectively. Single dose of methylprednisolone injection at the insertion site of the stylomandibular ligament was proved effective on pain and various mandibular movements among patients with Ernest syndrome.

Gingival hyperplasia: An initial oral manifestation of acute myeloid leukemia.

Various systemic diseases can manifest oral signs and symptoms early, which may be crucial for diagnosis and outlining the treatment plan. This case report highlights the presentation of acute leukemia (a malignancy of white blood cells) in a young female. An 11-year-old girl presented with gingival overgrowth and bleeding from the gingiva, weakness, and recent history of weight loss. A detailed workup consisting of complete blood count, bone marrow examination, flow cytometric immunophenotyping, cytogenetics, and molecular studies were carried out. The investigations confirmed the infiltration of blast cells of myelomonocytic origin, and a confirmatory diagnosis of acute myeloid leukemia (French-American-British classification M5) was made. The patient was put on induction chemotherapy and responded well. She developed febrile neutropenia following chemotherapy, which was managed conservatively. Gingival overgrowth subsided after the chemotherapy, and at the time of discharge, she was asymptomatic and hemodynamically stable. The oral health-care professionals must recognize that gingival overgrowth/enlargement may represent an initial manifestation of an underlying systematic disease.

Effect of leukocyte-platelet-rich fibrin (L-PRF) on the rate of orthodontic tooth movement and expression of various biomarkers in gingival crevicular fluid.

OBJECTIVES: To assess the outcome of leukocyte-platelet-rich fibrin (L-PRF) on the rate of maxillary canine retraction and its correlation with the levels of Receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG), and RANKL:OPG in the gingival crevicular fluid (GCF) during comprehensive orthodontic treatment. SUBJECTS AND METHODS: Eighteen females who required all 1st premolars extraction for the correction of their class I bimaxillary protrusion malocclusions were included. The L-PRF plugs were placed in the experimental side 1st premolar extraction sockets. Canine retraction was performed by sliding mechanics. Canine retraction was assessed from the maxillary study models prepared just before the extraction (T0) and then at 1 week (T1), 2 weeks (T2), 4 weeks (T3), and 8 weeks (T4) after the 1st premolar extraction and placement of L-PRF plugs. The concentrations of RANKL and OPG in the GCF were evaluated at T0, T1, T2, T3, and T4. RESULTS: In experimental sides, the amount of canine retraction was statistically more during the T0-T1, T1-T2, and T2-T3 periods. The mean concentration of RANKL at T1, T2, and T3 was significantly more in the experimental sides. The mean concentration of OPG was significantly less in the experimental sides at T2, T3, and T4. The RANKL:OPG was significantly more in the experimental sides at T1, T2, T3, and T4. No significant correlation was found between amount of canine retraction and concentration of RANKL and OPG and RANKL to OPG ratio in GCF. CONCLUSIONS: The L-PRF accelerated the rate of maxillary canine retraction by 0.28 mm over an 8-week period. The L-PRF favored the local osteoclastogenesis by enhancing the RANKL and suppressing the OPG concentrations. There was no significant correlation between the rate of maxillary canine retraction and expression of RANKL, OPG, and RANKL:OPG in GCF. TRIAL REGISTRATION: The Clinical Trials Registry of India (Reg. No. CTRI/2020/10/028390, Date-13.10.2020).

Geometrical Approaches for the Accurate Identification of Normal Vertical Positions of Sella and Nasion Points in Cephalograms.

Objective: The aim of the study is to identify the normal vertical positions of sella (S) and nasion (N) points in subjects with a normal inclination of anterior cranial bases. Materials and Methods: Lateral cephalograms of 117 subjects who had a normal ∠SN-FH plane (7° ± 1°), ∠SN-palatal plane (9° ± 2°), ∠FH-palatal plane (1° ± 1°), and cranial base angles (131° ± 4°) were included in the study. Various linear and angular parameters and ratios were evaluated to determine the normal vertical positions of S and N points. An unpaired t-test was used to identify any significant differences between males and females. The P value of 0.05 was considered as the level of significance. Results: Among subjects with the normal inclinations of SN, FH, and palatal planes and cranial base angle, the mean values of ∠Ar-S-Ptm, ∠S-Ptm-Ar, and ∠S-Ar-Ptm were 59.38° ± 3.52°, 59.70° ± 3.21°, and 60.84° ± 3.56°, respectively, forming an almost equilateral triangle between S, Ar, and Ptm points. The mean values of ∠Ba-S-PNS, ∠S-PNS-Ba, and ∠S-Ba-PNS were 59.56° ± 3.17°, 59.72° ± 3.47°, and 60.76° ± 3.11°, respectively, forming another approximate equilateral triangle between S, Ba, and PNS points. The mean S-FH to N-FH ratio was 0.67 ± 0.06% for the whole sample, but it was significantly greater in males (0.69 ± 0.07%) compared to females (0.65 ± 0.06%) (P=0.002). Conclusions: Two approximate equilateral triangles were formed between S, Ar, and Ptm points; and S, Ba, and PNS points in subjects with normal inclinations of SN, FH, and palatal planes and cranial base angle. The S-FH to N-FH ratio was an excellent guide to locating the normal vertical position of S and N points.

Intra-articular injection of hyaluronic acid versus platelet-rich plasma following single puncture arthrocentesis for the management of internal derangement of TMJ: A double-blinded randomised controlled trial.

The present study aimed to compare the efficacies of intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) following single needle arthrocentesis in patients with TMJ internal derangement. This double-blinded randomised controlled trial involved the enrolment of patients diagnosed with unilateral TMD, falling into either Wilkes' stages II or III. In Group A, single needle arthrocentesis was performed using Ringer's lactate serving as a control group; in Group B, intra-articular injection of 1 ml hyaluronic acid injection was given following arthrocentesis; and in Group C, autologous intraarticular injections of 1 ml of PRP was given after arthrocentesis, twice in two weeks' interval. The primary outcome variables were maximum mouth opening and pain, while TMJ clicking sounds formed the secondary outcome variable. All the outcome variables were assessed preoperatively (T0) and postoperatively after the second dose of injection at one month (T1), three months (T2), and six months (T3). The alpha level was set to p < 0.05. Ninety patients (N = 90) comprised the final sample size of the study with thirty patients(n = 30) in each treatment group. A statistically significant decrease in the management in mean pain scores was noted between T0 [mean scores were 7.30 ± 1.05 (Group A), 7.63 ± 1.12 (Group B), and 7.56 ± 1.04(Group C)] and T3 [mean scores were 2.66 ± 0.88 (Group A), 2.4 ± 0.72 (Group B), and 1.66 ± 0.66 (Group C)] time intervals between Group A and C(p < 0.001). Significant improvement was noted in preoperative maximum mouth opening (MMO) of Group A, B, and C which was 22.83 ± 3.58, 22.17 ± 4.07, and 21.37 ± 3.69, respectively to 28.90 ± 2.72, 32.17 ± 3.97, and 34.10 ± 3.80 mm, respectively at six months postoperatively (p < 0.001). A significant decrease in joint sounds was evident for all three groups(p = 0.003 for Group A, p < 0.001 for Group B, and p < 0.001 for Group C) across the time intervals. Moreover, Group C showed a significant decrease in the prevalence of joint sound compared to the other two groups at all-time intervals postoperatively when equated to baseline (p = 0.02 at T1, p = 0.009 at T2, and p = 0.002 at T3). Within the limitations of the present study, it can be concluded that intra-articular PRP may be preferable over HA whenever appropriate, following single needle arthrocentesis in the treatment of TMJ internal derangement.

Effects of autologous leukocyte-platelet rich fibrin (L-PRF) on the rate of maxillary canine retraction and various biomarkers in gingival crevicular fluid (GCF): A split mouth randomized controlled trial.

OBJECTIVES: Primary objective: To evaluate the effect of L-PRF on the rate of maxillary canine retraction. SECONDARY OBJECTIVE: To validate the rate of maxillary canine retraction by identifying the levels of Interleukin-1ß (IL-1ß) and Tumour Necrosis Factor-α (TNF-α) in the Gingival Crevicular Fluid (GCF). MATERIALS AND METHOD: Fifteen females (age range, 18-25 years) with Class I bimaxillary dentoalveolar protrusion malocclusions were included. After levelling and alignment of maxillary arches, 1st premolars were extracted from both sides. Canines were retracted immediately after the extraction of 1st premolars in control sides and placement of L-PRF plugs in the experimental sides. The amount of canine retraction was evaluated from study models recorded before the extraction of 1st premolars (T0) and at 1-week (T1), 2-weeks (T2), 4-weeks (T3), and 8-weeks (T4) after the beginning of canine retraction by using digital model superimpositions. The concentrations of IL-1ß and TNF-α were evaluated from the GCF collected at T0, T1, T2, T3, and T4 by using commercially available human IL-1ß and TNF-α ELISA kits. RESULTS: The amount of canine retraction in the experimental sides was statistically greater during T0-T1 (P=0.038),T1-T2 (P=0.002), and T2-T3 (P=0.011) periods. Total canine retraction during T0-T4 was statistically greater in experimental sides (2.43±0.46mm) than control sides (2.08±0.28mm) (P=0.001). The concentration of IL-1ß increased significantly in the experimental sides at T1 (P=0.000),T2 (P=0.000), and T3 (P=0.032). The concentration of TNF-α increased both in the control and experimental sides, but it was statistically greater in the experimental sides compared to control sides at T1 (P=0.000) and T2 (P=0.006). A positive but not statistically significant correlation was noted between the rate of canine retraction and the concentrations of cytokines such as IL-1ß and TNF-α in GCF. CONCLUSION: Over an 8-week period, autologous L-PRF statistically accelerated the rate of maxillary canine retraction, but only by 0.35mm. This small acceleration occurred mainly in the first 4 weeks. During the following 4 weeks, the amount of canine retraction was comparable on the experimental and control sides.

Adjunctive use of a surgical splint for leveling the curve of Spee following mandibular advancement.

Deep curve of Spee is a very common problem among Class II malocclusion patients associated with mandibular deficiency. The curve of Spee is maintained and leveled following surgical mandibular advancement. The same surgical splint which is used to guide the mandibular advancement can also be used for the leveling of deep curve of Spee. This case report highlights the leveling of deep curve of Spee by the same surgical splint used during the surgical mandibular advancement. Thus, it helps to increase the lower facial height and also improves the overall facial appearance.

Functional outcome of two different grafting techniques in the surgical management of oral submucous fibrosis: a comparative evaluation.

OBJECTIVE: To evaluate the functional efficacy of two different grafting techniques following the fibrotomy among subjects with oral submucous fibrosis (OSMF). DESIGN: Forty consecutively treated OSMF subjects between 20 and 40 years who had grades 3 and 4a OSMF and mouth opening < 15 mm were included in the present study. All the subjects were randomly divided into two groups. In Group I, all the subjects received a buccal pad of fat sandwiched with a nasolabial flap following fibrotomy. In contrast, Group II subjects received a buccal pad of fat combined with a collagen graft. The effect of two different surgical protocols on mouth opening was evaluated clinically before the surgery (T0) and 1 month (T1), 6 months (T2), and 12 months (T3) after the surgery. RESULTS: In Group I subjects, the mouth opening increased significantly (P < 0.001) from 10.90 ± 1.971 mm at T0 to 34.25 ± 3.127 mm at T1, but reduced marginally to 32.15 ± 3.422 mm at T2, and 31.30 ± 3.358 mm at T3. In Group II, the mouth opening increased significantly (P < 0.001) from 10.85 ± 1.725 mm at T0 to 28.90 ± 3.059 mm, 29.10 ± 2.808 mm, and 28.20 ± 2.285 mm at T1, T2, and T3, respectively. At the end of 12 months of follow-up, the mean value improvement in the mouth opening (T0-T3) was 20.4 ± 3.5 mm and 17.3 ± 2.9 mm in Groups I and II, respectively, and the difference was statistically significant (P = 0.006). CONCLUSION: The buccal pad of fat sandwiched with a nasolabial flap for the reconstruction following fibrotomy had a slightly better beneficial effect on the postoperative mouth opening among OSMF subjects.

A rare maxillofacial manifestation of acute lymphoblastic leukemia in a 9-year-old child.

Acute lymphoblastic leukemia (ALL) is considered as the most common malignant neoplasm of childhood and the frequent cause of death from cancer before 20-years of age. The facial swelling mimicking a maxillofacial tumor is rarely associated with ALL. Clinicians should be aware of such rare manifestation of ALL. We present a case with an atypical mass in the facial region secondary to ALL, which resulted in diagnostic dilemma. Reports of such atypical swelling in patients with ALL are occasional. The swelling was aggressive and the disease had a fulminant course.

Adaptive Changes in the Posterior Pharyngeal Wall Following Large Retraction of Incisors During Comprehensive Orthodontic Treatment.

OBJECTIVE: To evaluate the effects of large retraction of incisors on the adaptive changes in the posterior pharyngeal wall and soft palate during comprehensive orthodontic treatment. METHODS: Twenty-seven females with Class I mild crowding or spacing who required non-extraction treatment (group I) and 34 females with Class I bimaxillary dentoalveolar protrusion who required all first premolars extraction for the retraction of their incisors (group II) were included in the study. The effects of non-extraction and incisor retraction following all first premolars extraction orthodontic treatment on the sagittal dimensions of pharyngeal airway passage and posterior pharyngeal wall thickness were evaluated from pre- and post-treatment cephalograms. RESULTS: The dimensions of pharyngeal airway passage were comparable among the groups. The length of the soft palate increased (P < .01) and the thickness of the soft palate decreased (P < .01) following retraction of incisors, and the difference between the groups was significant (P < .05). The posterior pharyngeal wall thickness was reduced significantly at PPWT2 (P < .05), PPWT3 (P < .001), PPWT4 (P < .001), PPWT5 (P < .001), and PPWT6 (P < .01) regions following retraction of the incisors, and the difference between the groups was statistically highly significant. CONCLUSIONS: The large retraction of incisors during comprehensive orthodontic treatment in Class I bimaxillary dentoalveolar protrusion malocclusion subjects did not affect the sagittal dimensions of pharyngeal airway passage, but the thickness of the posterior pharyngeal wall reduced significantly as an adaptation to maintain the patency of the upper airway.

Emerging Trends of Zygomaticomaxillary Complex Fractures and Their Etiological Analysis in a Tertiary Health Centre from Eastern India: A Retrospective Study.

INTRODUCTION: Maxillofacial region is one of the most complicated arrangements of bony and soft tissues in human body, superiorly bounded by cranial bones and inferiorly by the mandible with interposed dentition. This is one of the reasons which make injuries to this region difficult to manage and often controversial. The severity and patterns of these injuries have changed considerably due to the increasing reliance on fast road transportation facilities and interpersonal violence. MATERIALS AND METHODS: The aim of the present study is to analyze retrospectively the changing patterns of mid-face fractures in a sample of patients reporting to Department of Oral and Maxillofacial Surgery in AIIMS Bhubaneswar, India, from April 2017 to April 2018. A performa was prepared which included age, sex, etiology of injury, alcohol influence, and treatment given during hospital stay. RESULTS: Road traffic accidents contributed 68.11% of zygomaticomaxillary complex (ZMC) fractures, followed by assault (18.11%) and fall from height (13.76%). RTA was the major cause of atypical ZMC fractures as compared to conventional ZMC fractures (P < 0.001). DISCUSSION: Due to modern lifestyle and changes in fast transportation, recent fracture patterns do not follow the tell-tale signs or patterns and often need unique and patient-specific treatment plan, making the skills of maxillofacial surgeons the pivotal factor in better prognosis.

Decontamination Strategies for Filtering Facepiece Respirators (FFRs) in Healthcare Organizations: A Comprehensive Review.

Filtering facepiece respirators (FFRs) are made for one-time use. A massive shortage of FFRs is widespread during pandemic events and has forced many healthcare organizations to decontaminate them and re-use for a limited time. Many decontamination methods have been proposed for the decontamination of FFRs. This review highlights various aspects of decontamination methods available in the literature. Among various methods available, vaporized hydrogen peroxide, ultraviolet irradiation, and dry heat seem to be the most promising decontaminants for FFRs. On the other hand, microwave, bleach, ethylene oxide, alcohol, hydrogen peroxide liquid, sanitizing wipes, and soap and water are not recommended methods for FFR decontamination.

Morphometric characteristics of cervical vertebrae in subjects with short, normal, and long faces.

PURPOSE: The prolonged change in the head posture alters the morphological characteristics of cervical vertebrae. The difference in the head posture among subjects with short, normal, and long anterior facial heights might have a significant influence on the morphological characteristics of cervical vertebrae. Thus, the present study was conducted to evaluate the morphometric characteristics of cervical vertebrae in subjects with short, normal, and long faces. METHODS: Based on Frankfort mandibular plane angle (FMA) on lateral cephalograms, 135 subjects were equally divided into three groups, i.e. Group I [Short face], II [Normal face], and III [Long face]. The angular variables like Atlas-dens angle (ADA), Pars interarticularis-dens angle (PDA), Pars interarticularis-vertebrae angle of C3 vertebrae (PVA3), Pars interarticularis-vertebrae angle of C4 vertebrae (PVA4), Lamina-Pars interarticularis angle of C2 vertebrae (LP2), Lamina-Pars interarticularis angle of C3 vertebrae (LP3), and Lamina-Pars interarticularis angle of C4 vertebrae (LP4) in the first four cervical vertebrae were measured, analyzed, and compared. Descriptive statistics, analysis of variance, Bonferroni, and Pearson's correlation coefficient tests were used. The P value of 0.05 was considered as the level of significance. RESULTS: All parameters except PDA and PVA3 were comparable among the groups. The PDA was 54.350 ± 1.870, 57.890 ± 1.550, and 60.290 ± 2.830 in Group I, II, and III, respectively; these differences were statistically significant [P < 0.001]. The PVA3 was 42.700 ± 5.640 in Group I, 45.850 ± 3.820 in Group II, and 45.590 ± 5.530 in Group III subjects that were also statistically significant [P < 0.01]. A fairly strong positive correlation was observed between FMA and PDA. CONCLUSION: A significant difference was found in the PDA among subjects with short, normal, and long faces. The vertical height of the face had a strong correlation with the morphology of axis vertebra.

Temporary deterioration of oral health-related quality of life (OHRQoL) in nonextraction and extraction modalities of comprehensive orthodontic treatment in adolescents.

OBJECTIVE: To evaluate the effects of nonextraction and all first premolar extraction modalities of orthodontic treatment on oral health-related quality of life (OHRQoL) among adolescents. MATERIALS AND METHODS: Sixty-eight adolescents of aged 12-18 years were chosen. Subjects who required nonextraction orthodontic treatment were included in group I, and those who required all first premolar extractions for orthodontic treatment were included in group II. Baseline OHRQoL data (T0) were recorded before the start of treatment. To evaluate the impact of orthodontic treatment on OHRQoL, the Oral Health Impact Profile-14 (OHIP-14) questionnaire was presented to all subjects for retrospective evaluation at 1 month (T1), 3 months (T2), 6 months (T3) and 1 year (T4) after the start of orthodontic treatment and 1 week after completion of orthodontic treatment (T5). RESULTS: At T1 and T2, the physical pain and physical disability domains of OHIP-14 were impacted significantly by comprehensive orthodontic treatment in both groups (P < .001). The negative impact of orthodontic treatment on OHRQoL was maximum at T1 and then slowly recovered to the pretreatment level at T3 in both groups. Recovery of OHIP-14 scores was relatively faster in group I subjects compared to group II subjects. At T1 and T2, social disability and handicap domains were deteriorated significantly in group II subjects compared to group I subjects (P < .01). CONCLUSIONS: The severity of OHRQoL deterioration was similar in both modalities of orthodontic treatment, but recovery from negative impacts was relatively slower in the first premolar extraction subjects.

A study of cervical vertebra anomalies among individuals with different sagittal and vertical facial growth patterns.

OBJECTIVE: The objective was to evaluate the prevalence of cervical vertebra anomalies (CVA) in individuals with different sagittal and vertical skeletal growth patterns of jaws and also to establish the associations of anomalies with the type of growth, if any. MATERIALS AND METHODS: A total of 293 lateral cephalograms were evaluated for CVA. Based on the Frankfort mandibular plane angle, cephalograms were categorized into three groups: Group I, II, and III. Based on the ANB angle, cephalograms were classified into three classes, Class 1, 2, and 3. Six types of CVA such as partial cleft (PC), block fusion (BF), dehiscence (D), fusion between C2 and C3 (F23), occipitalization (OC), and spina bifida (SB) were identified on lateral cephalograms. Descriptive statistics were applied along with multinomial logistic regression analysis. P = 0.05 was considered as the level of statistical significance. RESULTS: PC was most common in the overall samples (36%). BF was the least common (3.2%) CVA. The frequency of various CVA was comparable between males and females in all the three classes of individuals. The association of vertical growth patterns with CVA was found to be statistically nonsignificant (P > 0.05). Class 2 malocclusion was found to be statistically significantly associated with the D (P = 0.043). CONCLUSIONS: PC, fusion, and D were the most frequently found CVA, and SB was found only among the hypodivergent growth pattern individuals. The association of CVA with vertical facial growth patterns was not significant, somewhat influenced by age, sex, and sagittal skeletal malocclusions.