Noma in an 18 months Toddler: A Rare Case Report with Review of Literature.

Introduction: Noma is a polymicrobial necrotizing infection of the mouth and face which destroys the soft and hard tissues of the oral and paraoral structures. Malnutrition, poverty, lack of basic hygiene, and chronic disease state etc., possess a risk of developing noma. Noma neonatorum is a progressive gangrenous disease affecting the premature infants. Aim: We present a rare case of noma in an 18 months toddler with a chronic debilitating condition predisposing to the disease progression. Results: The necrotizing infection of the face developed after six months of multiple episodes of chronic blood-tinged diarrhea. The facial defect was managed with release of fibrosis and reconstruction with a superiorly based nasolabial flap. Discussion: Noma reflects extreme malnutrition and poverty with a vast range of etiopathological agents. This case emphasizes the need to understand the host risk factors and etiopathologic agent predisposing to this rare opportunistic and dormant but devastating disease, the morbidities associated with it and measures to prevent it.

Costochondral grafts for reconstruction of acquired mandibular defects involving the temporomandibular joint: Report of two cases.

Autogenous reconstruction of temporomandibular joint (TMJ) with costochondral graft (CCG) has been a popular method of growth center transfer in children. However, unpredictable growth pattern of CCG has been reported in children that often leads to dentofacial deformities in future. This institutional study describes the results of mandibular reconstruction with CCG in two growing children, one with plexiform ameloblastoma of mandible and the other with unilateral TMJ ankylosis. Long-term follow-ups showed a significant growth of the grafts in both the patients. However, there was a lack of uniformity in the amount and rate of growth. The authors support the theory that CCG possesses innate growth potential and is a desirable option for reconstruction of acquired mandibular defects involving the TMJ in pediatric population. However, regular postoperative monitoring is necessary for such patients as the graft shows an unpredictable growth pattern.

Nasoorbitoethmoid fractures in a tertiary care hospital of eastern India: A prospective study.

PURPOSE: The purpose of this study was to report on the pattern of occurrence of nasoorbitoethmoid (NOE) fractures in Odisha and the various factors that influence their distribution. METHODS: The study period was from January 1, 2016 to December 15, 2017. After approval from the Institutional Ethics Committee, all patients diagnosed with naso-orbito-ethmoid fractures reporting to the department of OMFS and Level-1 trauma centers were included in the study. Sociodemographic data along with the etiology and type of fracture were mentioned. Associated injuries to other body parts were noted. Open reduction was possible only in five cases of NOE fractures. The treatment plan including the operative approach and postoperative results was evaluated. RESULTS: A total of 1192 patients with facial fracture were seen, of which 52 (4.36%) patients had NOE fractures. Males far outnumbered females in a ratio of 9:1. Thirty-three patients (63.46%) had unilateral NOE fracture, while the rest 19 (36.54%) had bilateral NOE fracture. Sixteen (30.76%) cases were classified as Type I, 35 (67.30%) as Type II, and 1 (1.92%) as Type III. Road traffic accidents were the most common cause of NOE fractures (69%), followed by fall (17%) and assault (10%). The most common neurological injury to be associated with NOE fractures was pneumocephalus (29%), followed by diffuse axonal injury (8%). Telecanthus (100%) was found to be the primary clinical feature in patients of NOE fracture, followed by a depressed nasal bridge (92%). Fracture of the nasal bone was invariably associated with NOE fracture. Complications observed due to untreated NOE fractures included a shortened and retruded nose, shortened palpebral fissures, telecanthus, and enophthalmos. CONCLUSION: Contemporary management of NOE complex fractures demands precise diagnosis and immediate surgical management with anatomic reduction and rigid fixation of the involved bone segments. With an improvement in socioeconomic status and increased awareness among maxillofacial surgeons, hopefully, a greater number of NOE fracture patients will avail the benefits of open reduction in future.

Comparison of Safety, Efficacy, Patient Compliance and Cost-Effectiveness of Transdermal, Oral and Intramuscular Diclofenac for Pain Control Following Oral Surgical Procedures.

PURPOSE: To evaluate transdermal diclofenac in terms of analgesic efficacy, safety, compliance and cost-effectiveness and to compare it with oral tablets and intramuscular (IM) injections following surgical removal of impacted mandibular third molars. SUBJECTS AND METHODS: A prospective, single-centre, multi-arm parallel, randomized study on subjects undergoing extraction of impacted mandibular third molars was conducted between January 2016 and December 2017. The study included 90 participants, 30 in each group. Participants received the standard once daily (OD) dosages of diclofenac in each group for three post-operative days and were advised to consume paracetamol 500 mg as rescue analgesics if the pain was not alleviated. Outcome measures such as demographics, duration of surgery, post-operative pain, the number of rescue analgesics taken, adverse drug reactions experienced and overall global assessment for three post-operative days were recorded by the participants on a questionnaire. RESULTS: Transdermal and oral forms achieved similar analgesia on all 3 days. Injectable diclofenac had significantly better pain control on the second and third post-operative days compared to tablets and on the third day compared to transdermal diclofenac. A higher number of rescue analgesics was consumed in oral group on day 1. Gastritis and vomiting were seen in 36.66% and 10% cases, respectively, in oral group. 100% of those in IM group had pain on injection. 6.6% complained of dry skin due to patch, while 3.33% had rash and pruritus. Transdermal group had better overall global assessment by patients with 16.67%, 46.67% and 20% participants reporting excellent, very good and good pain control, respectively. The cost in INR was maximum for the transdermal group. CONCLUSION: Transdermal diclofenac is an excellent alternative to oral and parenteral routes of drug administration in oral surgical procedures with adequate analgesic efficacy, good compliance and fewer side effects.

Locking versus non-locking plating system in the treatment of mandibular fractures: A randomized comparative study.

To evaluate fracture stability and complications such as infections, need for hardware removal, malunion, and nonunion when using 2.0-mm locking plating system in fixation of mandible fractures and to compare these to those associated with the 2.0-mm non-locking plating system. A prospective clinical study was conducted in a cohort of mandible fracture patients who were randomly assigned to two groups. Patients in the non-locking group were treated with 2.0-mm non-locking plating system, and those in locking group were treated with 2.0-mm locking plating system. Fracture stability, need for maxillomandibular fixation (MMF) and postoperative complications were assessed and compared. A total of 60 patients (30 in each group) were recruited. Significant differences were found between the two groups with respect to postoperative fracture stability (P = 0.001) and need for MMF (P = 0.005). Multivariate analysis revealed that type of fixation was not the only dependent variable which affected fracture stability. There were no significant differences in postoperative complications between the two groups. The 2.0-mm locking plating system provides greater stability and early functional restoration than the 2.0-mm non-locking plating system, with similar rates of postoperative complications. Thus, it can be used as a reliable and effective treatment modality for treating mandibular fractures.

Immediate dental implant placement with or without autogenous bone graft: A comparative study.

INTRODUCTION: Immediate dental implants are the most accepted contemporary treatment option for the replacement of missing teeth. One pitfall of immediate implant use, however, is the inevitable residual space that remains between the implant and the socket wall, called the jumping distance, which may lead to bone resorption and formation of a bony defect, decreasing the implant stability. When this jumping distance is more than 2 mm, use of bone grafts is recommended. However, the use of grafts when the jumping distance is <2 mm is not defined in the literature. AIM: To evaluate the peri-implant hard and soft tissue changes following immediately placed implants with a jumping distance of 2 mm with or without autogenous bone grafts. SETTINGS: The study was conducted between January 2016 and December 2017 in the Department of Oral and Maxillofacial Surgery. SUBJECTS AND METHODS: This was a prospective, single-center, two-arm, parallel, randomized study on patients undergoing replacement of missing anterior teeth with immediate implants. There were two groups: the study group which received bone graft and the control group which did not receive any graft. Temporary prosthesis was placed following implant placement which was replaced with definitive prosthesis 4 months later. Patients were followed up for a period of 9 months. The alveolar bone loss was evaluated radiologically using cone-beam computed tomography, and pain, suppuration, mobility, and periodontal probing depth were evaluated clinically. RESULTS: There were 16 participants in the study group and 17 in the control group. The alveolar bone loss was greater in the study group; however, pain, suppuration, and mobility showed no difference between the groups. CONCLUSION: The immediate implants placed with or without bone grafts had similar alveolar hard and soft tissue changes when the jumping distance was <2 mm.

Bipolar Vessel Sealing System Versus Suture Ligation in Selective Neck Dissection.

AIM: To evaluate whether the use of electrothermal bipolar vessel sealing system reduces the blood loss and operating time, with lesser complications as compared to suture ligation in selective neck dissection in patients with oral cancer. MATERIALS AND METHODS: The study was conducted in the Department of Oral and Maxillofacial Surgery of our institute from January 2015 to December 2016. The sample consisted of 60 patients, divided into Groups I and II with 30 subjects in each. In Group I electrothermal bipolar vessel sealer and in Group II suture ligation were used. The outcome measures recorded were: blood loss, operating time, quality of surgical field, postoperative pain on days 1, 2, and 3, drainage volume at 24, 48, and 72 h, edema, complications, and duration of hospital stay. RESULTS: There were 36 males and 24 females with a mean age of 50.76 ± 12.6 years. Blood loss was significantly less for Group I than for Group II (p = 0.001); the operating time was significantly less in Group I than in Group II (p = 0.001); Group I had better quality of surgical field (p = 0.001); less pain on postoperative evening, day 2 and day 3 (p < 0.05); and less drainage volume at 24 and 48 h (p < 0.05). Postoperative edema, complications, need for perioperative blood transfusion, and duration of hospital stay postsurgery were similar in both groups. CONCLUSION: The electrothermal bipolar vessel sealer was efficacious in terms of reducing blood loss and operating time while providing a better surgical field and patient compliance without increasing the perioperative morbidity.