ABSTRACT
Acromegaly is a disorder characterized by hypersecretion of growth hormone, resulting in morbidities associated with multiple systems. Although most of the morbidities are reversed following control of the underlying disease, it may take several weeks to months for the symptoms to subside. One of the most noticeable effects of acromegaly is changes in facial features and jawbone growth, which can lead to severe pain and discomfort. This report describes a case of a 31-year-old patient with acromegaly induced bilateral condylar hyperplasia who presented with severe temporomandibular joint (TMJ), facial pain, and degenerative changes in TMJ. The patient was treated by trans-sphenoidal excision of pituitary adenoma, medications, and radiotherapy, but his hormonal levels were persistently high. Considering the refractory nature of the disease, the patient underwent bilateral high condylectomy, right articular disc removal, and abdominal dermis fat grafting. The surgery arrested the progressive mandibular enlargement and prevented further degenerative changes of TMJ. Although there was some reduction in TMJ pain, the myogenous pain and headache persisted after surgery. TMJ surgery may be selectively used for refractory cases of acromegaly and those requiring discectomy or total joint replacement. This case report describes the role of TMJ surgery in the management of morbidities and symptoms associated with TMJ in acromegaly until biochemical normalcy is achieved.
ABSTRACT
Background: Limited evidence exists regarding the optimal surgical approach for orbital floor reconstruction, resulting in uncertainty regarding the choice of approach with the best aesthetic outcomes and lowest post-operative complications. Objectives: This systematic review aimed to compare the transconjunctival and subtarsal approaches (STA) in orbital reconstruction in terms of post-operative complications and aesthetic outcomes. Data Sources: The systematic review was conducted following PRISMA guidelines. PubMed, Google Scholar and Cochrane databases were searched from January 1, 2000 and December 31, 2021. Study Eligibility Criteria: Eligible studies included clinical studies comparing the transconjunctival and STA approaches in orbital reconstruction. The outcome variables assessed were aesthetic scar, hyperaesthesia, entropion, ectropion, enophthalmos, epiphora and other complications. A total of 346 articles were initially identified, and after evaluation using Mendeley software, 292 articles were reviewed. Finally, five articles that met the inclusion criteria were included in this systematic review. Study Appraisal and Results: The transconjunctival approach demonstrated superior aesthetic outcomes compared to the STA approach. However, the STA approach had a lower incidence of post-operative complications, including hyperaesthesia, entropion, ectropion, enophthalmos and epiphora. Limitations: The main limitation of this systematic review is the limited availability of literature directly comparing these two approaches, which precluded the inclusion of randomised controlled trials. Furthermore, the search strategy was restricted to specific databases, namely PubMed/Medline, Google Scholar and the Cochrane Collaboration Library.
ABSTRACT
BACKGROUND: Lignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique. METHODS: This was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure. RESULTS: The onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate. CONCLUSION: Ropivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.
ABSTRACT
AIM: This study aims to compare the level of serum beta-2 microglobulin (ß2-M) in normal healthy individuals and patient with squamous cell carcinoma (SCC). METHODOLOGY: This study has been conducted in patients attending the Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Deralakatte, Mangalore. Sample comprises of 25 cases of clinically and histologically diagnosed oral cancer and 25 normal healthy individuals as control group. The serum was analyzed for ß2-M by enzyme-linked immunosorbent assay. RESULTS: It was observed that there was a significant increase in serum ß2-M levels in oral SCC patients as compared to controls. Circulating levels in serum ß2-M were also elevated significantly among different clinical stages with progressive rise from stage I to stage IV of the disease. CONCLUSION: The evaluation of these markers would be useful in assessing malignant change, increasing accuracy of clinical diagnosis and also in assessing the spread and invasiveness of the cancer of the oral cavity.
ABSTRACT
BACKGROUND: Natural products have been used for several years in folk medicine. Honey was used to treat infected wounds as long ago as 2000 years before bacteria was discovered to be the cause of infection. It has been reported from various clinical studies on the usage of honey as a dressing for infected wounds that the wound become sterile in 3-6 days. AIM: This study aimed to find out the efficiency of naturally occurring honey in alveolar osteitis. METHODOLOGY: Fifty patients of dry socket were selected from the outpatient department of oral and maxillofacial surgery. A diagnosis of dry socket was made clinically. Honey was used as a dry socket dressing in all these patients. Parameters such as mucosal edges, pain, and formation of granulation tissue were assessed in the postoperative period for a week. STATISTICAL ANALYSIS USED: Analysis was done by paired t-test method using SPSS software version 17. RESULTS: In this study, there was a significant reduction in inflammation, hyperemia, and mucosal edges that resulted in the reduction of pain and discomfort to the patient. There was no side effect of honey observed in our study, so it can be used as an alternative for the management of dry socket. Change in distance between mucosal edges when compared from the day of clinical presentation to 5th day postplacement was statistically significant (P < 0.001). CONCLUSIONS: There are no side effects of honey. Excess use of eugenol can lead to necrosis of bone. Thus, honey can be used as a medicament for the management of dry socket.
