Evaluation of the efficacy of platelet-rich plasma and platelet-rich fibrin in alveolar defects after removal of impacted bilateral mandibular third molars.

AIM AND OBJECTIVES: This study attempted the evaluation of the efficacy of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in alveolar defects after removal of bilateral mandibular third molars. MATERIALS AND METHODS: A total of 30 patients reporting to Department of Oral and Maxillofacial Surgery and having bilateral mandibular third molar impaction in both male and female aged between 18 and 30 years were included in this study. PRF and PRP were placed in extraction site and recalled at 2(nd), 4(th), and 6(th) month postoperatively. Data were statistically analyzed using IBM SPSS software for Windows, version 19.0. IBM Corp., Armonk, NY, USA. RESULTS: This study showed decreased probing depth in PRF group compared to PRP and control one. This signifies a better soft tissue healing of extraction sockets with PRF as compared to the PRP and the control group and increase in the bone density highlights the use of PRP and PRF certainly as a valid method in inducing hard tissue regeneration. CONCLUSION: This study indicates a definite improvement in the periodontal health distal to second molar after third molar surgery in cases treated with PRF as compared to the PRP group and control group. Hence, PRP and PRF can be incorporated as an adjunct to promote wound healing and osseous regeneration in mandibular third molar extraction sites.

Retrieval of foreign body from a postoperative defect in the mandible during the follow-up period: A bizarre occurrence.

Though reported cases of foreign bodies left intraoperatively in the oral cavity are very few, there is no case mentioned in the literature where foreign body was left behind during follow-up visits. Here, we present an operated case of unicystic ameloblastoma of mandibular ramus region, in which a needle hub was left at the operated site (cavity created because of wound dehiscence) during some of the follow-up visits, which was detected accidently by radiograph and later on retrieved. The case reported was because of negligence of trainee surgeons, might be because of overburden or because of minimal interest in these repeated follow ups. But, a trainee should understand that their work also has similar importance as that of surgeon's work.

Use of Platelet-Rich Fibrin over Skin Wounds: Modified Secondary Intention Healing.

The healing process after any surgical intervention has always posed a challenge for the surgeons. In spite of the advances in wound closure techniques and devices, there is a crucial need for newer methods of enhancing the healing process to achieve optimal outcomes. Fibrin adhesives and platelet concentrates have proven useful in various treatment modalities in the fields of microvascular and plastic surgery. This case report shows its unique use in the field of maxillofacial and cutaneous surgery. It shows an innovative technique of enhancement of skin wound healing by local application of platelet-rich fibrin.

Pattern and prevalence of maxillofacial fractures in rural children of central maharashtra, India. A retrospective study.

The aim of this study was to review the pattern and prevalence of maxillofacial fractures occurring in rural children, at Rural Dental College and Hospital, Loni, Central Maharashtra, India. A retrospective analysis of patient records and radiographs was conducted during the 5 year period between January 2005 and December 2010. Data were identified and analysed based on age group, gender and anatomic site. During the 5 year period, 156 patients with 163 maxillofacial fractures were reviewed, males formed 70 % and females formed 30 % of studied population with the peak incidence rate occurring in 10-12-year old age group. The most common fracture site in maxilla was dentoalveolar component (70 %) and in mandible common fracture site was condyle (40.9 %). Of the fractures, 43 % were from accidental fall, 24.3 % from assaults, 16 % from road traffic accidents, 13.5 % from sporting injuries and 3.2 % from other causes such as animal injuries. Our results exhibit that accidental falls were the leading cause of maxillofacial fractures, and males were three times more affected than females. There is variation of incidence and pattern of maxillofacial injuries from region to region.

Use of miniplates in parasymphysis fractures : a survey conducted among oral and maxillofacial surgeons of India.

Aim of the study was to find out the number of miniplates used by Indian Oral and Maxillofacial Surgeons for parasymphysis fractures. A survey was done among Oral and Maxillofacial Surgeons of India at the 34th annual meeting of Association of Oral and Maxillofacial Surgeons of India. Four questions were given to each individual to find out their opinion regarding use of miniplates in parasymphysis fractures. Eighty-eight per cent of Indian surgeons were in favour of using intra-operative or post-operative intermaxillary fixation. Thirty-eight per cent responded in favour of using single miniplate for parasymphysis fracture instead of using two miniplates. Fifty-four per cent maxillofacial surgeons use various modifications depending on different conditions. Forty-two per cent of maxillofacial surgeons accepted that lower arch bar can be used as a tension band. Use of miniplates for the treatment of parasymphysis fracture varies from centre to centre and from surgeon to surgeon. Though miniplates are best used following Champy's principle, still many surgeons use single miniplate. Arch bars placed for intermaxillary fixation can be used as a tension band, again eliminating the need for upper plate.

The use of ultrasonography in diagnosis and management of superficial fascial space infections.

AIMS AND OBJECTIVES: To evaluate the role of ultrasonography as a diagnostic aid to differentiate cellulitis from abscess; and efficacy of ultrasound-guided surgical drainage of superficial abscesses in the maxillofacial region. MATERIALS AND METHODS: a total of 26 patients with acute facial swellings were included in the study. Clinical examination confirmed the presence of space infection. Ultrasonographic examination of the swelling was then performed. If ultrasound images showed no collection and only thickness of subcutaneous tissue and muscle involved were increased, then the diagnosis was made as cellulitis. When collection was identified, diagnosis was made as abscess. Dimensions of abscess cavity, amount of pus collected, and depth of the center of the abscess cavity from the skin surface were recorded. Pus evacuation was then prime consideration either by needle aspiration or by incision and drainage. The amount of collection recorded on ultrasonography was compared with that drained at the time of surgery. RESULTS: of 26 patients, 14 patients were diagnosed with cellulitis and the remaining 12 patients with abscesses in the maxillofacial region. Five of 12 cases of abscess were managed with ultrasound-guided needle aspiration; rest seven cases underwent the incision and drainage procedure. Clinical specificity (69.23%) was found to be poorer than ultrasound specificity (100 %), both clinical and ultrasound showed the same percentage of sensitivity (92.30%) CONCLUSIONS: from our experience we can conclude that ultrasonography is an inexpensive and non-invasive diagnostic technique that should be used to supplement clinical examination in patients with superficial fascial space infection.

Rare carcinoma ex pleomorphic adenoma of the buccal minor salivary gland causing a therapeutic dilemma.

Carcinoma ex pleomorphic adenoma (CXPA), as a group, constitutes 12% of malignant salivary gland tumors. We present a case of CXPA of the buccal mucosa in a 17-year-old patient. The buccal mass was of a size of 3.0 cm located in the right cheek. Pleomorphic adenoma was the provisional diagnosis. The tumor was excised under local anesthesia. Histopathological evaluation revealed a pre-existing pleomorphic adenoma. However, on magnification, certain areas showed islands of dysplastic epithelial cells' invading the fibrous capsule and CXPA was diagnosed. The patient was recalled and secondary surgery of the site performed. No tumor tissue could be detected in the secondary resection specimen. There is no sign of recurrence since 2 years.

Electromyographic analysis of anterior temporalis and superficial masseter muscles in mandibular angle fractures--a pilot study.

INTRODUCTION: Fracture of the mandible occurs more frequently and the surgical anatomy of the mandible and adjacent structures is extremely important in understanding the pattern of fracture, the displacement of fractured fragments, and factors necessary for uncomplicated healing. In the field of dentistry, surface electromyography, electrokinesiography, and more recently, TMJ sound analysis have been particularly important developments. Previous electromyographic studies involving anterior temporalis and superficial masseter have been conducted in mandibular condylar fractures and in orthognathic and cosmetic procedures of the jaws. MATERIALS AND METHODS: This experimental study was undertaken to measure the electrical activity of the anterior temporalis and superficial masseter muscles in mandibular angle fracture cases (n = 6) and the changes in the electrical activity over a period of 6 months. RESULTS: The study shows that muscle activity increases significantly over a period of time but never matches the muscle activity of the normal subjects of same sex and age in a follow-up of 6 months post-trauma. DISCUSSION: Electrodiagnostic testing is a potentially valuable tool for the management of patients who have suffered craniomaxillofacial trauma. Electromyography is being employed in clinical practice, and allows the inclusion of quantitative data on the qualitative aspects of a diagnosis. These data are often of significant importance in the correct management of therapy and patient follow-up, particularly if the subject is at risk of developing a different and/or more serious disease.

Dentigerous cyst with an impacted third molar obliterating complete maxillary sinus.

Dentigerous cyst is the most commonly occurring odontogenic cyst after radicular cyst and accounts for 15% of all true cysts in the jaws. The cyst is more common in mandible than in maxilla. The dentigerous cyst is commonly associated with impacted mandibular third molars. In maxilla, the incidence is rare. Dentigerous cyst in maxillary sinus in association with an impacted third molar is an uncommon entity. We present a case of dentigerous cyst associated with an impacted third molar, completely obliterating the maxillary sinus in a 28-year-old female.

Platelet-Rich fibrin: A second generation platelet concentrate and a new friend of oral and maxillofacial surgeons.

To assess the potential use and benefits of Platelet-Rich Fibrin (PRF) over Platelet-Rich Plasma (PRP), for wound healing post oral and maxillofacial surgeries. This article describes the evolution of this second generation platelet concentrate and its multiple uses in various surgical procedures. Around 5 ml of whole venous blood is collected from the patients in each of the two sterile vacutainer tubes of 6 ml capacity without anticoagulant. The vacutainer tubes are then placed in a centrifugal machine at 3000 revolutions per minute (rpm) for 10 minutes, and the middle fraction containing the fibrin clot is then collected 2 mm below lower dividing line, to obtain the PRF. Cavities filled with PRF post oral and maxillofacial surgical procedures, at the institute, showed faster healing in half the time as compared to physiologic healing. PRF, which belongs to a new second generation of platelet concentrates, with simplified processing, and not requiring biochemical blood handling, has several advantages over traditionally prepared PRP, which has been widely used for accelerating soft tissue and hard tissue healing. However, the preparation being strictly autologous, the amount of PRF obtained is limited.

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.

Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars.

AIM: The present study attempted the evaluation of Primary and secondary closure techniques after removal of impacted third molars in terms of healing, post-operative pain and swelling. MATERIAL AND METHODS: 60 patients with impacted mandibular third molars were randomly divided into two groups of 30. Panoramic radiographs were taken to assess degree of eruption and to asses 3rd molar angulations to the long axis of 2nd molar. Teeth were extracted, and in Group 1 the socket was closed by hermetically suturing the flap. In group II a 5-6 mm wedge of mucosa distal to the second molar was removed & the flap was repositioned. Interrupted sutures were given, so as to form a triangular opening distal to second molar measuring about 5 × 5 mm. Swelling and pain were evaluated for 7 days after surgery with the VAS scale. RESULTS: Study results showed that post operative Sequale were comparatively less in secondary closure group than the primary closure group. Pain showed statistically significant difference between two groups. Pain was less in secondary closure group from day 1 to day 7. Swelling & trismus was also significantly less in secondary closure group. Evaluation of the complications of these two techniques showed that delayed wound healing occurred in 66.6% of cases (20 cases out of 30) in secondary closure group where as dehiscence of suture line occurred in 33.33% of cases (10 out of 30) in primary closure group. CONCLUSIONS: The results obtained in the present study enable us to conclude that, in cases of equal intra-operative difficulty, open healing of the surgical wound after removal of impacted third molars produces less post-operative swelling and pain than occurs with closed healing, by hermetically suturing the socket.

Autogenous mandibular symphysis graft for orbital floor reconstruction: a preliminary study.

OBJECTIVE: The present study aimed to evaluate and analyze postoperative results of Autogenous Mandibular Symphysis graft material for orbital floor reconstruction. MATERIAL AND METHODS: A retrospective study was conducted on 11 patients, having an isolated blow out fracture (n=4) or orbital floor defects associated with other fractures (n=7). These fractures were reconstructed with Mandibular symphysis bone grafts. The Grafts were used where the defects were more than 1.5 centimeter [1]in diameter. Follow up as long as 1.5 year was kept. Patients were evaluated at recall visits by checking various extraoccular movements. Evidence of any complications like diplopia or enopthalmos, or rejection of graft or any symptoms of infection, or of paresthesia was recorded. RESULTS: During a 1.5 year period of follow up, most of the patients had no postoperative complaints. There was good restoration of the orbital floor, with no clinical evidence of enopthalmos or diplopia. Extraoccular movements were intact in all patients. Only one patient presented with the symptoms of infection at a follow up period of 9 months. The infection subsided after removal of titanium plates, used for the stabilization of graft. CONCLUSION: Autogenous Mandibular Symphysis graft is a good alternative with minimal morbidity for orbital floor reconstruction. The contour as well as the size of the graft available from symphysis region best suits for orbital floor reconstruction.

Incidence and pattern of mandibular fractures in rural population: a review of 324 patients at a tertiary hospital in Loni, Maharashtra, India.

The aim of this study was to document the pattern and incidence of mandibular fractures occurring in rural population, at Rural Dental College and Hospital, Maharashtra, India. A retrospective analysis of patient records and radiographs for the 5-year period from January 2003 to December 2007 was conducted. Data were identified and analyzed based on age group, gender distribution, anatomic location, and cause of injury. A total of 324 patients with 486 injuries were reviewed, males formed 80.9% and females 19.1% of the studied population, with peak incidence occurring in the 21-30 years age group. The most common fractures site was parasymphysis (39.3%). The etiology of mandibular fractures was road traffic accidents (42.9%), followed by falls (25.9%), assaults and interpersonal violence (20.7%), and animal injuries (10.5%). Our results exhibit that road traffic accidents remain the major cause of mandibular trauma and animal injuries being found exclusively in rural population. There is a variation of incidence and pattern of maxillofacial trauma from region to region.