Comparison of Efficacy of Halstead, Vazirani Akinosi and Gow Gates Techniques for Mandibular Anesthesia.

PURPOSE: Traditionally, the "Halstead block" has been widely used to provide anesthesia in mandibular teeth. Two other techniques, the Gow Gates mandibular nerve block and the Akinosi Vazirani closed-mouth mandibular nerve block, are reliable alternatives to the conventional inferior alveolar nerve block. The purpose of this study is to evaluate the onset of anesthesia, anesthetic success and incidence of positive aspiration during administration of local anesthetic solution using the Halstead, Vazirani Akinosi and Gow Gates techniques. MATERIALS AND METHOD: The study involves 210 subjects, divided into three different groups of 70 subjects each receiving Gow Gates, Vazirani Akinosi and conventional inferior alveolar nerve blocks. The onset of anesthesia, positive aspiration and anesthetic success was evaluated. RESULTS: In Vazirani Akinosi technique group, patients showed highest anesthetic success of 95.71%; there was a significant difference seen between the Gow Gates and Vazirani Akinosi techniques (p = 0.0241*). The mean value of the onset of anesthesia in Gow Gates technique showed the longest 343.71 ± 153.20 s, in Halstead technique it was 177.43 ± 59.94 s, and in Vazirani Akinosi technique it was 192.86 ± 61.20 s. There was a significant difference seen between Gow Gates and Vazirani Akinosi techniques (p = 0.0001*) and Gow Gates and inferior alveolar nerve block techniques (p = 0.0001*). CONCLUSION: The Vazirani Akinosi technique was found to be significantly better than the other two techniques with respect to both onset and success of anesthesia. Positive aspirations were slightly higher in the conventional IANB technique compared to the other two, but did not reach statistical significance.

The "Rubber Band" and "Slingshot" Effects of the Posterior Airway Space in Mandibular Orthognathic Surgeries.

INTRODUCTION: Mandibular surgeries are the most common orthognathic procedures that are undertaken. The pharyngeal airway space (PAS) is influenced by the changes in the sagittal changes of the mandible. Mandibular advancement surgeries are used to an advantage in obstructive sleep apnea cases to improve the airway space. On the contrary, there can be a considerable decrease in the airway space during mandibular setback procedures. Numerous studies have been conducted to study the effect of changes in the PAS during mandibular procedures. However, a combined radiographic and endoscopic analysis of the airway space has been sparsely done in recent literature. MATERIALS AND METHODS: Thirty-one patients with mandibular discrepancies who needed mandibular surgeries were chosen. The assessment of PAS was done using both lateral cephalograms and endoscopic examination. RESULTS: As lateral cephalograms can study only the two-dimensional changes in the PAS, endoscopic examination both pre operatively and post operatively enabled the exact assessment of mandibular surgeries on the PAS. The PAS responds to setback mandibular surgery by modifying itself- called the "Rubber band" effect and in advancement surgeries as "Slingshot effect".

Craniofacial fibrous dysplasia: Surgery and literature review.

OBJECTIVE: To highlight the clinical and radiologic features and management of craniofacial fibrous dysplasia with review of literature. MATERIALS AND METHODS: A retrospective review of 6 patients who underwent surgical treatment in a tertiary healthcare centre was done using the parameters of patients' details, clinical features, radiological findings, management and postoperative review. RESULTS: Of the six patients, 3 females and 2 males were in the 2(nd) decade of life and 1 male in the 1(st) decade of life. The disease was restricted to maxilla in 3 patients, involved the temporal and frontal bones in addition to maxilla in one, involved the frontal bone in one patient and involved frontal and parietal bones in one patient. The primary reason for seeking treatment in all the 6 cases was facial deformity. There was absence of pain in all 6 cases. For surgical treatment in all three cases involving the maxilla, the approach was intraoral while bicoronal approach was used for the other three cases. Treatment consisted of surgical contouring and reshaping the area. All cases were followed up over a period of 2 years with no signs of recurrence. CONCLUSION: Treatment of craniofacial fibro-osseous lesions is highly individualized. Most cases of craniofacial fibrous dysplasia manifest as swellings that cause facial deformity and surgical recontouring after cessation of growth seems to provide the best results.

Effect of alkalinisation of lignocaine for intraoral nerve block on pain during injection, and speed of onset of anaesthesia.

Injections of lignocaine as local anaesthetic for pain control in oral and maxillofacial surgery can themselves be painful. The time of onset of anaesthesia is from 3 to 5 min. Sodium bicarbonate has been used worldwide to reduce both these drawbacks to the injection, so making procedures more acceptable. This randomised prospective trial of 100 patients aged 18-55 years who were given 3 nerve blocks (inferior alveolar, lingual, and long buccal) was designed to assess the effect of alkalinisation of the lignocaine solution with sodium bicarbonate. All patients were given 2% lignocaine hydrochloride with adrenaline 1:80,000 and 50 patients were randomly allocated to be given 8.4% sodium bicarbonate in a 1/10 dilution. Pain was measured on a visual analogue scale (VAS). No patient given the injection with sodium bicarbonate complained of pain, compared with 39/50 (78%) not given sodium bicarbonate (p<0.0001). The mean (SD) time (seconds) to onset of local anaesthesia in the group given sodium bicarbonate was 34.4 (9.8) compared with 109.8 (31.6) in the control group (p<0.001). Our results have confirmed the efficacy of the alkalinised local anaesthetic solution in reducing pain on injection and resulting in quicker onset of anaesthesia.