Postoperative microstructural re-modelling and functional outcomes in idiopathic full thickness macular hole.

Purpose: To analyze the effect of various macular hole indices and postoperative microstructural changes of all retinal layers on postoperative functional outcomes in patients with idiopathic full-thickness macular hole (FTMH). Methods: In this prospective study, pre and post-operative optical coherence tomography (OCT) scans of 36 eyes with idiopathic FTMH were analyzed. Hole indices and microstructural changes of all retinal layers such as ellipsoid zone (EZ), external limiting membrane (ELM) integrity, outer and inner retinal defects, and cystoid resolution were studied on follow-up visits. Results: Out of 36 eyes, type-1 closure was achieved in 23 eyes (65.7%) and type-2 closure in 11 eyes (31.42%), one eye showed persistent hole, and one eye was lost to follow-up. The mean minimum diameter of hole (P = 0.026), mean MHI (P = 0.001), DHI (P = 0.158), THI (P = 0.001), and HFF (P < 0.001) showed statistical significance with the type of hole closure. Postoperatively, eyes with intact ELM and EZ had better BCVA at the final visit. The BCVA was better by logMAR 0.73 ± 0.38 (P < 0.001) in patients with absent outer retinal defects. There was a significant difference in BCVA of 0.52 ± 0.35 at 1 month and 0.64 ± 0.34 at 6 months in eyes without inner retinal defects (P < 0.001). At 6 months, cystoid resolution was observed in 28 (80%) eyes. BCVA was significantly better at 1 month (P < 0.001) and at 6 months (P = 0.001) in eyes with no DONFL. Conclusion: Macular hole indices determine the closure type. Postoperative regeneration of outer retinal layers and resolution of retinal defects significantly influence the final visual outcomes. ELM recovery is seen as a prerequisite for EZ regeneration with no new IRD after a period of 3 months.

Etiology and Pathophysiological Pathways of Ocular Complications Associated with Local Dental Anesthesia and Odontogenic Infections: A Systematic Review.

Background: Ocular complications during or after dental extraction have been reported in the literature. These complications were either due to infiltration of local anesthetic solution or due to spread of odontogenic infection extending to the ocular region. The purpose of the present study is to outline the pathophysiological pathway of such ocular complications pertaining to dental procedures due to infiltration/local anesthesia block or spread of odontogenic infection. Methodology: An exhaustive literature search was conducted in October 2020 on various online research databases to identify various etiological factors causing ocular complications during dental procedures or followed by odontogenic infections. The findings of all the articles recruited for the review were recorded and analyzed. Results: The search protocol revealed a total of 897 articles related to the study where only 208 relevant articles were recruited for detailed evaluation, which led to the exclusion of 123 articles and a total of 85 articles were included in the study. Out of the total 113 cases in 85 articles, 92 cases (81.42%) showed complications associated with the use of local anesthetic agent and 21 cases (18.58%) exhibited ocular complications due to spread of infections. Most common ocular complications reported were diplopia, followed by ptosis and ophthalmoplegia. Conclusion: Dental anesthesia can cause a reversible or irreversible ophthalmic complication, while the infectious afflictions of the orbit still remain a challenge to the practicing maxillofacial surgeon.

Foreign Bodies in Extraction Socket: An Outcome of Negligence and Proposal of a Classification with its Medico-legal Implications.

BACKGROUND: Removal of tooth is just a routine dental surgical practice, where negligence is a must avoidable contingence. Still, few complications may arise during or after the procedure. One of the rare complications is the breakage of surgical instrument or presence of any foreign body (FB) in extraction socket. This may be due to improper handling of a surgical instrument or using substandard tools, which may lead to breakage of the instrument or any negligence by the patient himself. This negligence can be on various levels, like professionals, manufacturers or patients. All these events may cause serious outcomes pertaining to the medicolegal issues. PURPOSE: The aim of this study was to classify the negligence in oral surgery for legitimacy with possible management for the retrieval of the FB and discuss various Indian Penal Codes for Medical Negligence according to the Constitution of India and its implications. METHOD: Diagnosis and surgical retrieval of FB associated with extraction socket were performed in three cases. Incision, flap reflection, identification of FB and successful retrieval followed by suturing under local anesthesia were achieved. Routine medications were prescribed. The FB were sent for stereomicroscopic examination. RESULT: All the patients were followed up after a week, and no complications were observed. Suture removal was carried out, and oral hygiene instructions were given. The FB were found to be piece of lead, broken tip of a dental elevator and broken diamond round bur. CONCLUSION: The negligence can occur at any stage, and it has its medicolegal aspects. This negligence can be apprehended in front of the Indian Penal Code for Medical Negligence. Hence, a classification is required to understand and subdivide the negligence to find the legitimacy over the medicolegal implications.

Poroelastic Modeling of a Heterogeneous Geologic Medium: A Case Study from Kanto Basin in Japan.

Vertical geological heterogeneity, such as clay content and grain size variation, may affect land subsidence caused by groundwater extraction. In order to test this hypothesis, one-dimensional pore-water mass balance and force balance equations of a water-saturated poroelastic medium were solved under different heterogeneous geological conditions. Results showed that clay content and grain size variation in sandstone could affect subsidence rates by up to an order of magnitude due to the changes in stiffness and permeability of the medium, indicating the importance of small-scale heterogeneity in subsidence simulation studies. Predicted values of subsidence were in good agreement with field measurements for two sites in the Kanto groundwater basin in Japan, showing the applicability of the model to other groundwater basins with clay-rich aquifers.

Efficacy of Infiltration Anaesthesia of 4% Articaine HCl (buccal) Versus 2% Lignocaine HCl (buccolingual) in Extraction of Mandibular Premolars: A Single Centred, Randomised, Crossover Group Study.

PURPOSE: The purpose of the study was to evaluate and compare the efficacy of buccal and lingual infiltration (B/L I) of 2% lignocaine HCl and buccal infiltration (BI) of 4% articaine for orthodontic extraction of mandibular premolars. MATERIALS AND METHOD: One hundred and four patients (age group 14-26 years) were selected with the indication of bilateral mandibular first or second premolar extraction for orthodontic treatment. Patients were randomly distributed in 2 groups. Group A received B/L I with lignocaine and Group B for BI with articaine in two different appointments in 2-week interval. The pain scores for each patient were evaluated during extraction using the visual analogue scale (VAS) and verbal pain scale (VPS). Statistical analysis was performed by descriptive and inferential statistics using Chi-square test. The agreement between VAS and VPS was obtained by applying intra-class correlation coefficient. RESULTS: No pain was experienced during extraction in 77% (VAS) and 79% (VPS) patients infiltrated in group A and 84% (VAS) and 90% (VPS) patients of group B with articaine. The difference between the groups was statistically significant. A strong positive correlation was found between VAS and VPS scores in the both groups. CONCLUSION: Buccal infiltration with articaine proved to be an effective alternative to buccal and lingual infiltration with lignocaine in the extraction of mandibular premolars.

Assessment of intraoperative risk factors for surgical difficulty in surgical extraction of impacted mandibular third molar: a prospective study

The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. For proper planning of surgical extraction, espe-cially for impacted mandibular third molars the estimated level of surgical difficulty of the case is important. This study was conducted to evaluate the intraoperative risk factors contributing to surgical difficulty in extraction of impacted mandibular third molars and consequently the post-operative outcome. Here, we have undertaken a study in which the intraoperative variables were considered, to evaluate their contribution for surgical difficulty and postoperative complica-tions in surgical removal of 100 impacted mandibular third molars. Three variables were found significant associated with total surgical time intervention, i.e., surgeon's experience (p=0.006), Inter-incisal opening (p=0.032), and cheek flexibility (p=0.004). Total surgical time intervention for 'right side' was higher with 49.20 ± 17.94 minutes (p=0.691). Total surgical time intervention for 'gagging reflex present' was 50.21 ± 17.812 (p=0.674). Multiple linear regression shows that surgeon's experience was the only predictor (p<0.001). The surgical difficulty of impacted mandibular third molar are likely to depend on the intraoperative factors like Surgeon's time, surgeon's experience, check flexibility, and inter incisal mouth opening.

Evaluation of demographic and radiological risk factors for assessment of difficulty in surgical removal of impacted mandibular third molar: a prospective study

The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. Both the patient and dentist must therefore have scientific evidence-based information concerning the estimated level of surgical difficulty of every case to consider in referring cases of impacted third molars for specialists' handling. We have undertaken a study in which demographic and radiological variables were considered to-gether to evaluate the risk factors for surgical difficulty in a cohort of 100 impacted mandibular third molars. There were 13 variables evaluated for surgical difficulty. Total surgical time interven-tion was noted at the end of each surgery. Each variable was analysed with total surgical time intervention with univariate and multiple linear regression. Out of 13 variables, 9 were found sta-tistically significant. The most significant predictors for surgical difficulty were Body Mass Index, Depth of impacted tooth and Retromolar space. No postoperative complications were reported.

Is amalgamated ligno-bupivacaine an answer to complicated minor oral surgical anesthesia? A randomized split-mouth double-blind clinical trial.

PURPOSE: The purpose of this study was to find a suitable anesthetic combination for complicated and protracted minor oral surgical procedures. METHODS: Fifty patients with bilaterally impacted deep-seated mandibular third molars were included in this study and randomly divided on the basis of anesthetic used into two groups. Group A received 2% lignocaine with 1:200,000 adrenaline while in group B, amalgamated mixture of 2% lignocaine and 0.5% bupivacaine was used. The onset time, duration of anesthetic effect, supplementary injections, pain (during local anesthetic deposition, intra and postoperatively), and postoperative analgesia were the study parameters. Chi-square and unpaired t tests were used to compare means. RESULTS: The onset time in both the groups was comparable and showed statistically significant difference between the duration of anesthetic effect with notable requirement of supplemental anesthetic injections in group A (54%) (p < 0.05). Pain scores also revealed a statistically significant intergroup difference (p < 0.05). Requirement of postoperative analgesics was delayed in group B. CONCLUSIONS: The amalgamated mixture of lignocaine and bupivacaine had equivocally rational onset and provided a more profound and in-depth anesthesia especially in complicated and protracted minor oral surgical procedures. Though this mixture is widely used in other surgical fields, its efficacy still remains unexploited and undocumented in oral and maxillofacial surgical procedures.

Utility of superiorly based platysma myocutaneous flap for reconstruction of intraoral surgical defects: our experience.

PURPOSE: Various surgical modalities have been advocated for the soft tissue reconstruction of oral cavity with variable results. This prospective study evaluates the utility of platysma myocutaneous flap (PMF) in the reconstruction of surgical defects followed by treatment of oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) in terms of healing and functional outcomes. METHODS: In this prospective study, 47 patients with OSMF and 15 of OSCC were evaluated and selected for PMF reconstruction. OSCC was selected under T1N0M0 category only. Patients were operated under general anaesthesia followed by PMF grafting. In OSCC, ipsilateral and for OSMF, bilateral PMF was used. RESULTS: In 47 patients treated for OSMF, 46 were male and 1 female while 15 cases of OSCC, 10 were male and 5 females aged between 18 and 44 years. Intraoperative mouth opening was achieved up to 48 mm in OSMF followed by 42.5 mm postoperatively after 2 years. However, uneventful healing and acceptable scar on cervical region was noted in all the cases including OSCC. In OSMF, three cases of dehiscence, four partial necrosis at end of flap and in OSCC one case shows skin loss at flap and two partial necrosis at tip of flap and extraoral localised abscess at ipsilateral donor site in one case was noted. An uneventful healing, anatomical form and functional results were restored with acceptable scarring at donor site without any evidence of difficulty in neck movements were observed. CONCLUSION: The PMF is simple, versatile and could be valued as a reconstructive alternative, with interesting visual qualities. It is a good therapeutic alternative tool for reconstruction of the buccal mucosa, especially for small- and medium-sized defects between 2 and 4 cm2 of the oral cavity.

A Rare Case of Topiramate Induced Secondary Acute Angle Closure Glaucoma.

Secondary Acute Angle Closure Glaucoma (AACG) is a known side effect of Topiramate (TPM). Here, we present a case report of a 47-year-old male who was started on TPM 25 mg/day for migraine. He presented to the ophthalmology department of our hospital with sudden blurring of vision and colored halos after one day of starting TPM. A high index of suspicion, followed by appropriate investigations and prompt management that helped to manage TPM induced bilateral AACG with quick and complete visual recovery.

Gigantic reactive lesion of mandibular gingival tissue / Lesión gigante reactiva del tejido gengival mandibula

Irritation fibroma are the most common form of reactive lesions found within the oralcavity. These lesions normally attain a small size and show a slow growth rate. This paper reports a case ofgigantic intraoral irritational fibroma with a history of rapid growth. Complete excision was performed andthe specimen was sent for immunohistochemistry (IHC) staining. It was found positive for vimentin, hencereported as irritation fibroma.

Los fibromas irritativos son las forma más común de lesiones reactivas encontradas en la cavidad oral. Estas lesiones normalmente son de pequeño tamaño y muestran una tasa de crecimiento lenta. Este artículo reporta el caso de un fibroma irritativo gigante intraoral con historia de crecimiento rápido. Se realizó la extirpación completa y fue enviado para análisis inmunohistoquímico. Arrojó positivo para Vimentina, por lo tanto, se reportó como fibroma irritativo.

Identifying the risk factors causing iatrogenic mandibular fractures associated with exodontia: a systemic meta-analysis of 200 cases from 1953 to 2015.

PURPOSE: Iatrogenic fracture of mandible (IFM) associated with exodontia though rare, they do occur with an incidence ranging from 0.0034 to 0.0075 %. Most of the data is in the form of case reports or a small case series. This is an attempt to amass the data available in literature since the last 62 years. The purpose of this meta-analysis is to identify the etiologies and risk factors leading to IFM associated with exodontia and also the measures to minimize the complication. METHODS: Articles published between 1953 and 2015 were searched in Medline database. Data was collected and analyzed based on age, gender, extracted tooth, status of dentition, pathological bone lesion adjacent to the tooth, type of impaction, angulation of the impacted third molar, site of fracture, side of fracture, time of fracture, and treatment of fracture. RESULTS: A review identified 200 documented cases of IFM associated with the removal of teeth. The reasons for its occurrence found to be multifactorial with a higher incidence in the fifth decade of life with male prevalence. Risk factors more commonly identified were removal of the third molar, fully dentate patient, associated pathology, impacted tooth, angle region, left quadrant, and time interval of 3 weeks postoperatively. CONCLUSIONS: IFM related to the removal of teeth is a rare complication. Identifying and addressing the risk factors will enable the surgeon to avoid the complication of IFM associated with exodontia.

Multiple unerupted impacted supernumerary teeth: a rare case report of father and son / Múltiples dientes supernumerarios impactados no erupcionados: presentación de un caso raro de padre e hijo

Multiple impacted supernumerary teeth without any associated systemic conditions or syndromes are rare. The prevalence rate of supernumerary teeth in the permanent dentition is between 0.1– 6.9 percent as compared to 0.3–0.6 percent in theprimary dentition. In this article, reporting a rare family history of non-syndromic multiple impacted supernumerary teeth,found incidentally during routine radiographic examination. Though the etiologic factor of multiple impacted supernumerary teeth are still not clearly known especially in cases without any syndrome. However, thorough evaluation is necessary toexclude associated systemic conditions.

Son raros los casos de sujetos con múltiples dientes supernumerarios impactados sin ningún tipo de afectación sistémica o síndrome. La tasa de prevalencia de dientes supernumerarios en la dentición permanente varía entre 0,1­6,9 % en comparación con el 0,3­0,6 % en la dentición primaria. En este artículo, se reporta una historia familiar rara de múltiples dientes supernumerarios impactados no sindrómicos, encontrados incidentalmente durante un examen radiográfico de rutina. El factor etiológico de dientes múltiples supernumerarios impactados aún no está claro, especialmente en los casos sin ningún tipo de síndrome. Sin embargo, es necesaria una evaluación a fondo para descartar enfermedades sistémicas asociadas.

Retrospective analysis of sutureless skin closure in cleft lip repair.

The technique of approximating tissues resulting in minimal amount of scar usually requires skillful suturing techniques by the surgeons, especially in cleft lip repair. Increased awareness and demand for aesthetic surgical correction with quality in tissue closure has led to the invention of new materials and techniques. Amcrylate (iso amyl 2-cyanoacrylate) is retrospectively evaluated as tissue glue in cleft lip repair, and the results are compared with skin closure by 6-0 Prolene. A retrospective analysis of 60 patients with unilateral or bilateral cleft lip repair was carried out to compare the results of skin closure with Amcrylate and 6-0 Prolene. Patients were randomly divided into 2 groups, each group containing 30, and the study was designed to evaluate the quality of scars after the use of Amcrylate tissue adhesive to close the skin during cleft lip repair and its advantages over sutures (6-0 Prolene). Both groups were analyzed for the time taken for skin closure, resultant scar, parental satisfaction, and complications, and the results were found to be statistically significant for the Amcrylate group. Amcrylate, when used as tissue glue for skin closure in cleft lip repair, definitely has an edge over conventional suturing techniques.

Fractures of angle of mandible - A retrospective study.

AIMS: This retrospective study was done to evaluate the efficacy of single miniplate osteosynthesis at superior border of angle of mandible. MATERIAL AND METHODS: In this study 50 patients were treated by single miniplate osteosynthesis according to Champy's principle. Bite force generated was used as a parameter for judging the efficacy of internal fixation. In this article we present our experience over the years in the management of the fractures of angle of mandible based on this model. RESULTS: Most patients were of 21-30 yrs of age with unilateral angle fracture of mandible except one patient who had isolated bilateral angle fracture. The patients were treated successfully according to Champy's principle of osteosynthesis. There was a progressive improvement in the bite force generated after osteosynthesis. CONCLUSIONS: The angle of the mandible is an anatomically weak and an area susceptible to fracture. The presence of an impacted or partially erupted third molar tooth further weakens it. Angle of mandible is the most common site for fracture however, bilateral angle fracture is very rare and uncommon. Osteosynthesis according to Champy's model led to an early functional improvement as demonstrated by the bite force generated.

A comparative study: efficacy of tissue glue and sutures after impacted mandibular third molar removal.

OBJECTIVE: To compare the efficacy of cyanoacrylate (tissue glue) placement after surgical removal of impacted mandibular third molars. MATERIALS AND METHODS: Thirty patients with bilaterally impacted mandibular third molars were studied in this controlled clinical trial. One side closure after surgical removal of third molar was done with conventional sutures and other side with cyanoacrylate. RESULTS: The data analysis showed that postoperative bleeding with cyanoacrylate method was less significant than with suturing on the first and second day after surgery. There was no significant difference in the severity of pain between the two methods. CONCLUSION: This study suggested that the efficacy of both, cyanoacrylate and suturing in wound closure were similar in the severity of pain, but use of cyanoacrylate showed better hemostasis.