Conservative management of pediatric mandibular distal fractures-A retrospective study.

BACKGROUND/AIM: Pediatric mandibular distal fractures present unique treatment challenges which are usually managed with open reduction and internal fixation (ORIF) with the risk of developing tooth bud injuries. Conservative management through maxillomandibular fixation (MMF) with orthodontic bracket-elastic as an out-patient department (OPD) service has been used for these fractures presenting with derangement of occlusion. The aim of this study was to retrospectively analyze MMF with orthodontic bracket-elastic as a treatment method and its outcome for management of pediatric mandibular distal fractures. METHODOLOGY: Data of seventeen pediatric cases diagnosed with displaced mandibular distal fractures managed with MMF with orthodontic bracket-elastic over a period of 5 years were analyzed. In this technique, two weeks of immobilization and one week for guiding elastics were used. RESULTS: The mean age of patients was 7.6 ± 1.6 years with a mean follow-up of 24 months. All fractures healed uneventfully with satisfactory occlusion. The cases included 23.5% minimally displaced, and 64.7% moderately displaced and 11.8% significantly displaced fractures with step deformity with successful remodeling of the lower border contours over a duration of 18 months ± 1 month. The developing tooth buds in the fracture line showed no complications except for root dilacerations/malformation (n = 3). CONCLUSION: MMF with orthodontic bracket-elastic is a viable and conservative technique for the management of pediatric mandibular distal fractures which need to be verified through randomized trials for generalization of the results.

Bilateral congenital mucous extravasation phenomenon: A rare case with literature review.

The purpose of this paper is to discuss a rare case of bilateral congenital mucous extravasation phenomenon on buccal mucosa near commissure of mouth. The lesions were noted at birth, subsequently enlarged to interfere with feeding. The lesion frequently ruptured, regressed, and again enlarged to interfere with normal function. The lesions were surgically removed under general anesthesia at 11 months of age and the diagnosis was confirmed by histopathological examination. Postoperative follow-up after 14 months showed no recurrence.

Post-traumatic and postoperative neurosensory deficits of the inferior alveolar nerve in mandibular fracture: a prospective study.

OBJECTIVES: We evaluated and recorded post-traumatic and postoperative neurosensory deficits of the inferior alveolar nerve (IAN) in mandibular fracture in order to identify associated risk factors. MATERIALS AND METHODS: This was a prospective cohort study composed of 60 patients treated for mandibular fracture. The primary study variable was the change between the post-traumatic IAN neurosensory examination score and the score after fracture reduction. Risk factors were categorized as demographic, anatomic, fracture displacement, and treatment. Appropriate descriptive and bivariate statistics were computed. RESULTS: Sixty patients with unilateral mandibular fracture reported within 24 hours of injury were evaluated over a one-year period. A post-traumatic neurosensory deficit was observed in 52 patients (86.7%), the percentage of which was reduced to 23.3% over the follow-up period. Abnormal postoperative neurosensory scores were significantly higher in angle fracture cases (33.3%) compared to body fracture cases (11.1%). When recovered and non-recovered neurosensory scores were compared by fracture location, 88.9% of body fracture cases showed significant recovery compared to 66.7% of mandibular angle fracture cases. Cases with less than 5 mm fracture displacement showed statistically significantly higher neurosensory recovery scores (90.6%) compared to those with more than 5 mm fracture displacement (60.7%). CONCLUSION: Use of a miniplate with mono-cortical screws does not play a role in increasing IAN post-traumatic neurosensory deficit. Early management can reduce the chances of permanent neurosensory deficit. Mandibular fracture displacement of 5 mm or more and fracture location were found to be associated with an increased risk of post-traumatic IAN neurosensory score worsening.

Clinical Performance of Indirect Composite Onlays as Esthetic Alternative to Stainless Steel Crowns for Rehabilitation of a Large Carious Primary Molar.

OBJECTIVE: The aim of the present study was to evaluate the clinical performance of indirect resin composite onlays (IRC onlay) compared to stainless steel crowns (SSCs), as an esthetic alternative for rehabilitation of extensively carious primary molars. STUDY DESIGN: Fifty pediatric patients each received either IRC onlay or SSC randomly on extensively carious endodontically treated primary molars. All the restorations were evaluated at baseline and then every 6 months till 36 months using 'modified FDI criteria' for retention, marginal integrity, occlusion, proximal contact, secondary caries and gingival health. The dental chair side treatment time and post-operative acceptability were also evaluated for both the groups. RESULTS: The cumulative survival rate of IRC onlays was 82.9% compared to 90.7% for SSCs over a time period of 36 months. The difference between the two study groups at various time intervals in terms of retention, marginal integrity, secondary caries, proximal contact, occlusion and gingival health was not statistically significant (p>0.05). The IRC onlays required significantly less mean chair side treatment time and were preferred the most by parents and children as per VAS scores compared to SSCs. CONCLUSION: IRC onlays are an acceptable esthetic alternative to SSCs and may be considered for use in aesthetically conscious children/parents as per their preference.

Bimaxillary Oral Focal Mucinosis.

Oral focal mucinosis is considered as oral counterpart of cutaneous focal mucinosis. The preoperative diagnosis of mucinosis is almost impossible because of its rarity and clinical similarity to other lesions of various etiologies. The histological diagnosis of oral mucinosis is important to better understand the etiopathogenesis, treatment modalities, and any recurrence of the lesion besides differentiating from the other soft tissue lesions.The purpose of this paper is to report the first case of bimaxillary involvement with dome-shaped elevated, rounded, asymptomatic, normally colored swelling in left posterior palatal mucosa and left mandibular posterior region in a 25-year old woman who was diagnosed as oral focal mucinosis histopathologically.

Transoral approach alone in single miniplate osteosynthesis of angle fracture - our experience.

AIM: The aim of this study was to determine the outcome of transoral approach alone to treat the mandibular angle fracture using single 2.0 mm miniplate. MATERIALS AND METHODS: In this study, 28 patients were included and treated with 2.0 mm single miniplate osteosynthesis at upper border along Champy's line of osteosynthesis using transoral approach alone. RESULTS: All the cases were treated successfully with 2.0 mm single miniplate with common complications such as infection (two cases) and plate exposure (one case) in a total of two cases. CONCLUSION: Use of single miniplates by transoral approach alone for superior border osteosynthesis is effective and simple approach without need of extra armamentarium.

A retrospective study of 72 cases diagnosed with idiopathic trigeminal neuralgia in indian populace.

CONTEXT: Trigeminal neuralgia is as a chronic, debilitating condition, which can have a major impact on quality of life. There are few reports of trigeminal neuralgia in oriental populations. OBJECTIVES: To evaluate the retrospective data of the patients diagnosed with idiopathic trigeminal neuralgia and to understanding the disorder in the Indian populace. METHODS: The retrospective data of 72 patients with typical idiopathic trigeminal neuralgia regarding age of onset, gender, site of involvement, clinical presentations and treatment received during three years of the follow up was collected and analyzed. RESULTS: In the present retrospective study, the mean age was 54.9 years; female to male ratio was 2.13:1; rural to urban ratio 1.76:1 with 62.5% suffered trigeminal neuralgic pain on the right side. Carbamazepine was found to be highly effective in 60.8% of the cases on long-term basis with maintenance doses. Other treatment modalities were employed in more refractory cases including add-on of gabapentin, which relieved the symptoms for an additional duration of 13±3months. The neurolytic alcohol bloc was given in 30% of patients who stopped responding to combination of carbamazepine and gabapentin and relieved pain for a mean duration of 17.25±2.95 months. Twenty three percent of the patients (23%) required peripheral neurectomy. CONCLUSIONS: Carbamazepine was found to be highly effective in trigeminal neuralgia. Other treatment modality includes add-on of gabapentin, neurolytic alcohol blocs and peripheral surgical intervention in more refractory cases. Only limited cases needed further neurological consideration. Key words:Trigeminal neuralgia, carbamazepine, gabapentin, alcohol bloc, peripheral neurectomy.

Odontogenic cutaneous draining sinus.

The aim of the present article was to discuss an unusual case report of the odontogenic cutaneous sinus with emphasis on diagnosis and treatment. The causative factor in this case was diagnosed intraoperatively due to infected follicular space in absence of any sign and symptoms. Timely diagnosis of the case could have prevented significant morbidity due to mistreatment medically and surgically with eventual recurrence.

School based oral health promotional intervention: Effect on knowledge, practices and clinical oral health related parameters.

BACKGROUND: No organized school oral health program is existent in India. AIM: The aim of this study is to test the feasibility and efficacy of an economical school oral health promotional intervention with educational and preventive components. SETTINGS AND DESIGN: School oral health promotional intervention carried out in one of the randomly selected school and evaluated through short duration prospective model. MATERIALS AND METHODS: A total of 100 children with an age range of 10-12 years with no previous history of dental intervention were enrolled. Interventions comprised of oral health education (delivered through lecture and demonstrations by an undergraduate dental student) and topical antibacterial therapy (fluoride varnish and povidone iodine). Outcomes consisted of Knowledge and practices (KAP) regarding oral health, clinical oral health related parameters such as plaque index (PI), gingival index (GI) and caries activity as per Modified Snyder's test. These were reported at baseline, 3 weeks and 6 months follow-up examination by a calibrated examiner. STATISTICAL ANALYSIS: McNemar Bowker's test, Student's t-test, Pearson Chi-square tests were used. RESULTS: Highly significant (P < 0.001) improvements in KAP scores, PI scores, GI scores and caries activity were reported at 3 weeks and 6 months follow-up examination. CONCLUSION: This small economical school oral health program positively influenced oral health related practices and parameters of oral health such as oral cleanliness, gingival health and caries activity.