Comparison of Occlusal Digital Analysis Using T-Scan in Orthognathic Surgery with Only Conventional Orthodontic Patients.

Aim and Objectives: The aims of this study were to compare the changes in occlusal parameters, TMJ status clinically in patients after the completion of orthognathic surgery, and patients undergoing only orthodontic treatment and with patients having normal occlusion, using T-Scan. Methodology: This prospective controlled clinical trial, consisting of three groups with a sample size of twelve. Group 1 consisted of patients who underwent orthognathic surgery and orthodontic treatment. Group 2 consists of patients who underwent only orthodontic treatment (camouflage). Clinical examination of the patient (TMJ and Occlusal status) and T-Scan was performed at the time of debonding of the orthodontic brackets, 6 months and 1-year after first evaluation for group 1 and 2 patients. Results: The collected data between groups are compared and interpreted. The statistical analysis was performed using STATA/IC version 16.1 statistical software. Intragroup comparison for the study variables occlusion time, disocclusion time and maximum bite force between different time periods (T1, T2, T3) for all the three intervention groups using repeated measures. Hypothesis testing for maximum bite force, occlusion time and disocclusion time in orthognathic group (Group 1) as compared to orthodontic group (Group 2) for three different time periods using repeated measures ANOVA and Bonferroni test showed P value < 0.05 which is statistically significant. Conclusion: In conclusion, evaluation of occlusion using T-Scan give us an insight of the discrepancies in occlusion which is useful during pre-operative planning and especially in the post-operative follow-up period during the retention phase. Examination of TMJ in these patients at various intervals is necessary as any minor occlusal disturbances may lead to TMJ disorders.

Sequential Removal of a Large Odontoma in the Angle of the Mandible.

Odontomas are the commonly occurring benign tumors of the jaw, which are odontogenic in origin. Lesion originates as the dental components are laid down in a disorganized manner, due to failure of normal morphodifferentiation. They are considered as hamartomatous developmental malformations rather than a true neoplasm. Mostly, these asymptomatic lesions are discovered as an incidental finding. Large odontomas may give rise to local disturbances, such as eruption delay of permanent teeth, asymmetric tooth eruption, malpositioning, displacement, resorption, or occasional devitalization of adjacent teeth. Odontomas may erupt into the mouth and tend to be associated with impacted teeth and other cystic lesions. The odontomas have a tendency to become symptomatic due to local infection such as sinusitis, infected adjacent tooth, and the exposure of tumor to oral environment. The aim of this paper is to elucidate the primary features and treatment of these lesions, depending on published data and individual witness.

Neocondyle distraction osteogenesis in the management of temporomandibular joint ankylosis: Report of five cases with review of literature.

INTRODUCTION AND OBJECTIVES: Management of temporomandibular joint (TMJ) ankylosis is a challenging and rather daunting task owing to complex abnormal anatomy and its sequel to craniofacial structures. Various autogenous grafts and alloplastic materials have been tried with variable success for creation of a near-normal joint. In recent years, neocondyle distraction has added a new dimension to the management of TMJ ankylosis. The aim of this paper is to describe the role of neocondyle distraction in TMJ ankylosis. MATERIALS AND METHODS: Neocondyle distraction was carried out in five patients with TMJ ankylosis following gap arthroplasty. Computed tomogram scans were taken before surgery and 1-year postdistraction for surgical planning and postoperative assessment, respectively. The intraoral distractors (KLS Martin, Jacksonville, FL, USA) were used in this study. RESULTS: All five patients reported with adequate mouth opening and functional jaw movements. The procedure was well tolerated by all the patients. None of the patients underwent reankylosis following neocondyle distraction. CONCLUSION: With proper surgical planning and distraction protocol, neocondyle distraction is an effective and safe technique for TMJ reconstruction and preventing reankylosis.

Fever after maxillofacial surgery: a critical review.

PURPOSE: The aim of this paper is to review the pathophysiology of thermoregulation mechanism, various causes of fever after maxillofacial surgery and the different treatment protocols advised in the literature. DISCUSSION: Fever is one of the most common complaints after major surgery and is also considered to be an important clinical sign which indicates developing pathology that may go unnoticed by the clinician during post operative period. Several factors are responsible for fever after the maxillofacial surgery, inflammation and infection being the commonest. However, other rare causes such as drug allergy, dehydration, malignancy and endocrinological disorders, etc. should be ruled out prior to any definite diagnosis and initiate the treatment. Proper history and clinical examination is an essential tool to predict the causative factors for fever. Common cooling methods like tepid sponging are usually effective alone or in conjunction with analgesics to reduce the temperature. CONCLUSION: Fever is a common postoperative complaint and should not be underestimated as it may indicate a more serious underlying pathology. A specific guideline towards the management of such patients is necessary in every hospital setting to ensure optimal care towards the patients during post operative period.

Donor site analgesia after anterior iliac bone grafting in paediatric population: a prospective, triple-blind, randomized clinical trial.

The aim of this study was to compare the efficacy of femoral nerve block with indwelling catheter-based multiple infiltrations of bupivacaine for postoperative pain management after iliac bone harvesting. Sixty paediatric patients undergoing iliac harvesting were randomized into three groups: group A, preoperative femoral nerve block; group B, multiple bolus infiltration of 0.5% bupivacaine via indwelling catheter at the donor site; group C, controls--single dose of 0.5% bupivacaine infiltration given subcutaneously. The primary outcome measure was postoperative pain intensity at rest and at function. The time to maximum pain score, time to ambulation, duration of analgesia, and length of hospital stay were also assessed. Group B patients had the best pain relief and return to function, however the duration of pain relief was longer in group A. Subjects in group A had concomitant motor blockade causing delayed ambulation. Group C showed the worst outcomes. Indwelling catheter-based infiltration of bupivacaine was the most efficient method for providing enhanced pain relief after iliac bone graft harvesting. There was no increase in operating time or hospital stay. Femoral nerve block provided the next best results, but had the significant disadvantage of motor nerve blockade.

Cephalometric Evaluation of Airway Changes Following Mandibular Distraction in Patients with Nocturnal Desaturations During Sleep Secondary to TMJ Ankylosis.

OBJECTIVES: The objective of this study was to cephalometrically evaluate the changes in the oro-pharyngeal airway and its correlation to the clinical outcome following mandibular distraction in patients with sleep disordered breathing secondary to tempero-mandibular joint (TMJ) ankylosis. METHODS: Five patients diagnosed as having nocturnal desaturations during sleep secondary to TMJ ankylosis were evaluated in this study. They were evaluated pre and post mandibular distraction using cephalometry, to determine changes in their oro-pharyngeal airway space and, upper and lower airway dimensions. An attempt was made to correlate these changes to the clinical outcome of the procedure by over-night pulse-oximetry. RESULTS: The patients showed a mean increase of 31.33 % in the oro-pharyngeal airway space with a 3.8 % increase in the oxygen saturation levels. The change in the airway space dimensions and area was directly proportional to the oxygen saturation observed in the patients. CONCLUSION: The patients in this series did not show a very high apnoea hypopnoea index but had a compromised airway which resulted in sub-optimal sleep patterns. Mandibular distraction in these patients not only improved their esthetics but also proved to aid their functional rehabilitation by significantly increasing their oro-pharyngeal space and reducing their sleep disturbances.

Stem cell therapy in oral and maxillofacial region: An overview.

Cells with unique capacity for self-renewal and potency are called stem cells. With appropriate biochemical signals stem cells can be transformed into desirable cells. The idea behind this article is to shortly review the obtained literature on stem cell with respect to their properties, types and advantages of dental stem cells. Emphasis has been given to the possibilities of stem cell therapy in the oral and maxillofacial region including regeneration of tooth and craniofacial defects.

A rare variation in the course of the inferior alveolar nerve.

Extra-canalicular variations of the inferior alveolar nerve are exceedingly rare and unreported. The authors report an unusual presentation of the inferior alveolar nerve perforating the ramus of the mandible with a very short intra-bony course and exiting laterally in a 20 year old indian female diagnosed with hemifacial microsomia. There was concomitant absence of the ipsilateral inferior alveolar canal and mental foramen. Variations in nerve architecture like these are of importance to clinicians who deal with surgery of the facial skeleton.

Cementum analysis in cleidocranial dysostosis.

OBJECTIVE: Cleidocranial dysostosis (CCD) is a skeletal disorder associated with dental anomalies such as failure or delayed eruption of permanent teeth and multiple impacted supernumerary or permanent teeth. Absence of cellular cementum at the root apex is presumed to be one of the factors for failure or delayed eruption. The aim of this study was to analyze the root cementum of supernumerary(S) and permanent teeth (P) of a CCD patient and to compare the findings with those of normal individuals with special emphasis on delayed eruption. MATERIALS AND METHODS: Ground sections of 12 extracted teeth (9S + 3P) of a CCD patient and 12 teeth of normal individuals (5S + 7P) were taken for the study. The sections were longitudinal and 50 microm thick. Root characteristics were recorded with the aid of a light microscope. RESULTS: The absence of apical cellular cementum, increased root resorption and increased percentage of the gap type of cemento-enamel (C-E) junctions were significant findings noted both in the supernumerary and permanent teeth of the CCD patient. CONCLUSION: The presumption of cellular cementum is essential for tooth eruption is not supported by the findings of the present study. Delayed exception could be attributed to various other factors like mechanical obstruction, reduced serum alkaline phosphatase levels etc. Also, the significance of the increased percentage of the gap type of C-E junctions and its role in tooth eruption has to be further evaluated.

Primary mandibular distraction for management of nocturnal desaturations secondary to temporomandibular joint (TMJ) ankylosis.

OBJECTIVES: Mandibular advancement is a proven method in the management of obstructive sleep apnoea syndrome (OSAS) which may manifest as sleep disturbances with nocturnal desaturations during sleep (NDS). The purpose of this study is to evaluate the role of primary osteo-distraction prior to ankylosis release in pediatric patients, diagnosed with NDS secondary to temporomandibular joint (TMJ) ankylosis. METHODS: Three patients in the age group of 8-12 years diagnosed with OSAS secondary to TMJ ankylosis underwent primary osteo-distraction for mandibular advancement. They were evaluated pre- and post-operatively using radiographs, over night pulse oximetry, and subjective evaluation of their sleep patterns. RESULTS: All the three patients showed significant improvement in their saturation levels with a mean oxygen saturation of 94.66%. There was marked reduction in their snoring and sleep/awakening patterns. The mean advancement of the mandible in the three patients was 13.8mm. CONCLUSION: Primary mandibular distraction is an effective method of correction of nocturnal desaturations during sleep in patients with TMJ ankylosis.

Solitary intraosseous neurofibroma of mandible.

Solitary intraosseous neurofibroma is a rare benign non-odontogenic tumor. Although neurofibromas occur predominantly as a feature of neurofibromatosis affecting the soft tissue, a few cases of solitary intraosseous neurofibromas of the jaw have been reported. We herewith report a case of solitary intraosseous neurofibroma of mandible in a middle-aged woman with a discussion on its clinical, radiological, and histopathological presentation along with review of cases.

Ameloblastic fibro odontoma.

Ameloblastic fibro odontoma is relatively a rare mixed odontogenic tumor comprising of ameloblastic fibroma and ameloblastic odontoma. This group of lesions represent neoplastic and hamartomatous changes. Data regarding age, sex, and site of occurrence of these lesions have been uniquely described. A case of ameloblastic fibro odontoma in a 17-year-old male involving the left body of the mandible, and its radiographic, clinical symptoms and histological features is described herewith. A conservative surgical approach, including enucleation and mechanical curettage of the surrounding bone was done.