Variations in the Position of Mandibular Foramen in Temporomandibular Ankylosis Patients.

Aim: To evaluate the variation in the position of the mandibular foramen and mandibular canal in patients with and without temporomandibular joint ankylosis. Materials and Methods: 100 temporomandibular joints were evaluated of which 50 joints were ankylosed joints (Group A) and the rest 50 were normal joints (Group B) without ankylosis. These groups were further divided into those with growing potential (less than 18 years) and those without growing potential (above 18 years). The position of the mandibular foramen was measured from its center to the glenoid fossa, sigmoid notch, coronoid notch, gonion and posterior border on CBCT scans. The position of the mandibular canal was measured from the outer aspect of the canal to the lower border of the mandible, buccal and lingual cortical plates and the alveolus in the region of the 1st, 2nd and 3rd molars. Results: The mean distance of the foramen from the base of the skull in Group A was 19.01 mm while the same for Group B was 31.26 mm. The mandibular foramen was found to be closer to the occlusal plane (5.43 mm) in Group A as compared to the mean distance of 6.21 mm reported in Group B. There was no significant difference in the position of the foramen from the posterior border, gonion and sigmoid notch between the groups. The mental foramen was seen more commonly posterior to the 2nd premolar and closer to the first molar region in Group A while in Group B it was seen anterior or near the 2nd premolar. In Group A, the mean distance of the canal to the buccal cortical plate in the 1st and 2nd molar regions was 3.65 mm and 5.76 mm, respectively, while in Group B it was 6.09 mm and 6.59 mm. The canal was further away from the lower border in ankylosis cases (8.79 mm) than the control group (7.41 mm). On comparing the unaffected side in unilateral cases with the normal mandible, the canal and the foramen location were similar to that of a normal mandible with the values in the lower range that is usually seen in normal mandibles. Conclusion: Ankylosis of the mandible is a debilitating condition especially when it develops in an individual prior completion of growth as it can affect the mandibular anatomy. Understanding the variations that accompany a deranged mandible can assist the surgeon in planning of surgical procedures in a manner that limits the possible complications resulting from surgery.

Comparison of the effectiveness of 5-Fluorouracil and modified Carnoy's solution in reducing the recurrence of odontogenic keratocyst.

Introduction: Odontogenic keratocysts (OKC) has a high potential for recurrence. Resection is currently the only fool-proof method to ensure that recurrence does not occur; however, it drastically affects the patient's function and aesthetics. Application of modified Carnoy's solution (MCS) as an adjunct to reduce the recurrence rate is currently in vogue. 5- Flurouracil (5-FU) is an anti-metabolite that has been used in the treatment of basal cell carcinoma and is relatively safer than MCS. The present study aims to compare the effectiveness of 5-UC and MCS in reducing the recurrence rate in OKC.. Material and methods: A total of 42 OKCs were enucleated followed by application of MCS (control group, n = 21) or 5-FU dressing (study group, n = 21) following enucleation. Pain, swelling, temporary and permanent paresthesia paresthesia, bone sequestrum formation, osteomyelitis and recurrence in both groups were evaluated at periodic intervals up to 12 months post-surgery. Results: There was no significant difference in terms of pain, or swelling in both groups. Permanent paresthesia and recurrence rates were higher in patients treated with MC but the difference was not statistically significant. Conclusion: 5-FU is an easy-to-use, feasible, biocompatible and cost-effective alternative for MCS in the management of OKCs. Treatment with 5-FU, therefore, reduces the risk of recurrence and also the post-surgical morbidity associated with other treatment procedures.

Assessment of Knowledge, Attitude and Practices of Health Care Professionals Working in Jumbo COVID Care Center Towards Mental Health Care Needs: A Cross Sectional Survey.

Background: The present COVID-19 pandemic is a major threat worldwide. Health professionals being within the front line of the COVID-19 outbreak response are at the highest risk of getting infected. Such pandemics are always associated with ill effects on mental health also. Materials and Methods: A cross-sectional study included all the health care professionals working in the Jumbo COVID Care Center, Mumbai. Details of health care professionals were obtained from the authority of Jumbo COVID Care Center, Mumbai. Amongst 350 health care professionals, 285 responded (Response rate: 81.42%). A questionnaire, consisting of 19 structured, self-administered, and closed-ended questions, was employed online, and information regarding age, gender, profession, etc., was collected. It was then tabulated and subjected further to an analysis. Results: Most health care professionals (96.1%) were aware that COVID-19 is not only affecting physical but mental health too, also posts on social media (86.3%) are affecting mental health more than the actual disease. A total of 95.8% agreed that health care/frontline workers are at the highest risk and felt the need for psychiatrists in the present pandemic. (81.4%) They were also worried thinking about elderly people with comorbidities in their homes. (82.1%). Conclusion: From the present study, it can be concluded that the present pandemic is affecting not only physical but mental health also, and there is an increased need for psychiatrists and mental health care professionals to overcome the same.

Management of paediatric ankylosis.

Temporomandibular joint ankylosis (TMJa) is one of the most crippling craniomaxillofacial pathological conditions characterized by replacement of normal architecture of temporomandibular joint (TMJ) with fibrous or bony tissue. The incidence of TMJa is most common in the paediatric population [first and second decades of life] and is commonly associated with maxillofacial trauma. Comprehensive management entails a thorough evaluation of the associated anatomy of the ankylotic mass and other pertinent details like the presence or absence of obstructive sleep apnoea. Categorizing patients based on these variables helps in selecting an appropriate surgical intervention. Various resective and reconstructive surgical techniques are discussed; along with their merits and demerits. Long-term physiotherapy, long-term clinical follow-up and appropriate family counselling are the essential pillars for success. In this review, the authors present an algorithmic approach to evaluation and management of paediatric TMJa. Appropriate recommendations are made based on evidence to select optimum surgical intervention.

Granular cell ameloblastoma as a solitary peripheral growth after twenty years of segmental resection of the mandible: A rare case of recurrence.

The ameloblastoma is a slowly growing, locally invasive, benign epithelial odontogenic neoplasm of the jaws with a high rate of recurrence if not removed adequately. We report an interesting case of granular cell ameloblastoma, which presented as a solitary, peripheral, soft tissue growth 20 years after initial segmental resection of the left mandible. The basal layer of oral mucosa could be the possible source of peripheral ameloblastoma in our case. In order to reduce the chances of recurrence, we suggest to incorporate mucosal stripping along with the conventional treatment as a mandatory rather than an elective procedure while treating ameloblastoma.

Comparison of anaesthetic efficacy of ropivacaine (0.75% & 0.5%) with 2% lignocaine with adrenaline (1:200000) in surgical extraction of bilateral mandibular 3rd molars using IANB:a prospective, randomized, single blind study.

AIM: To evaluate and compare the anaesthetic efficacy of 0.75% ropivacaine and 0.5% ropivacaine with 2% lignocaine with 1:200000 Adrenaline (LWA) for surgical extraction of bilateral mandibular 3rd molars using Direct inferior alveolar nerve block (IANB). MATERIAL AND METHODS: Total of 60 outpatients of both sex,age group of 18-40 included in a prospective, randomized, single blind, split mouth clinical study after satisfying inclusion and exclusion criteria. Group I includes 30 patients and 0.75% ropivacaine as test drug, Group II includes 30 patients and 0.5% ropivacaine as test drug. In both group control drug was LWA.Parameters measured were onset of action, duration of action, systolic blood pressure, diastolic blood pressure, heart rate, visual analogue scale (VAS), faces pain scale (FPS). RESULT: Onset of action of 0.75%/0.5% ropivacaine (101.84 â€‹± â€‹16.92 â€‹secs/113.03 â€‹± â€‹12.77 â€‹sec) was faster than LWA (Group I-218 â€‹± â€‹21.51 â€‹secs, Group II-196.47 â€‹± â€‹26.27 â€‹secs). Duration of action of 0.75%/0.5% ropivacaine (343.55 â€‹± â€‹16.44 â€‹mins/319.03 â€‹± â€‹19.30 â€‹mins) was longer than 2% Lignocaine with 1:200000 adrenaline (Group I I-173 â€‹± â€‹16.86 â€‹mins, Group II-175.20 â€‹± â€‹18.02 â€‹mins). In Group I - VAS/FPS of 0.75% Ropivacaine (0.97 â€‹± â€‹0.54/1.32 â€‹± â€‹0.65) was significantly lower as compared to LWA (2.90 â€‹± â€‹0.83/3.29 â€‹± â€‹0.69). In group II-VAS/FPS of 0.5% ropivacaine (1.40 â€‹± â€‹0.72/1.47 â€‹± â€‹0.50) was lower as compared to LWA (3.40 â€‹± â€‹0.89/3.30 â€‹± â€‹0.87). Mean systolic blood pressure, diastolic blood pressure, heart rate was lower for ropivacaine (0.75%, 0.5%) than LWA except mean heart rate higher for 0.75% ropivacaine at 10 â€‹min after injection. Else mean heart rate lower in other time interval. CONCLUSION: Ropivacaine (0.75%,0.5%) was more efficacious than 2% lignocaine with adrenaline (1:200000) it terms of all measured parameters in study.

Unusually rare occurrence and recurrence of temporomandibular joint ankylosis and oral submucous fibrosis simultaneously in a patient: A surgeon's dilemma.

We here present a rare case of simultaneous occurrence and recurrence of TMJ ankylosis and submucous fibrosis in the same patient. Patient presented with limited mouth opening at both occasions. However, the diagnosis of submucous fibrosis was overlooked at the first presentation. The patient reported with recurrence of both the conditions after a period of 15 years. We presume that noncompliance of jaw exercises aggravated both the conditions as one led to the other. Since fibrosis sets in earlier than bony fusion, we theorized that the patient had acquired OSMF before TMJ ankyloses recurrence. The case was managed with release of fibrous bands intraorally followed by release of TMJ ankylosis and interposition with dermis fat graft. Physiotherapy is extremely essential when either pathology is treated in patients, especially when both are present in a single patient.

Modified Cut for Gap Arthroplasty in Temporomandibular Joint Ankylosis.

Temporomandibular joint ankylosis is a debilitating disease affecting the function, esthetics and psychology of the patient. Treatment of this condition aims at establishing not only the function and esthetics but also aims to prevent reankylosis. Among the different treatment modalities, interpositional gap arthroplasty followed by aggressive jaw physiotherapy is considered most effective. This is achieved by making two horizontal osteotomy cuts at a distance of 10-15 mm in the TMJ region. The gap is then interposed with an autogenous or alloplastic graft material. However, during the application of a jaw stretcher intraoperatively with the surgical site open and with the jaw wide open, a bony contact was seen to occur between the posterior aspect of the upper and lower osteotomy cuts. Taking this into consideration, the lower osteotomy cut is modified by making the posterior one-third cut divergent. This eliminates the bony contact during maximum mouth opening and thus prevents the chances of reankylosis as well.

A Randomized Control Trial Comparing Buccal Infiltration of 4% Articaine with Buccal and Palatal Infiltration of 2% Lignocaine for the Extraction of Maxillary Premolar Teeth.

INTRODUCTION: The use of articaine has been claimed to obviate the need for routine palatal local anesthetic injections on account of its better diffusion through soft and hard tissues as compared to other local anesthetic agents. OBJECTIVE: The objective of the study is to evaluate the efficacy of 4% articaine (with 1:100,000 adrenaline) infiltrated only buccally in the extraction of maxillary premolars for orthodontic reasons. MATERIALS AND METHODS: A double-blind randomized clinical trial with a split-mouth design, where each patient (n = 100) was part of two groups, was conducted. Experimental Group 1: single buccal infiltration of 4% articaine with 1:100,000 adrenaline (Septanest™ with adrenaline 1:100,000 by Septodont). Control Group 2: routine buccal and palatal infiltrations of 2% lignocaine with 1:200,000 adrenaline (Lox™ 2% with adrenaline 1:200,000 by Neon). The parameters studied were time to onset of anesthesia, pain during the extraction procedure (not during the injecting of the local anesthetic), and frequency of extra amount of local anesthetic injected. RESULTS: The difference was not statistically significant (P > 0.05) between the two groups with respect to all three parameters. This proves that a single buccal infiltration of articaine can be used as an alternative to lignocaine for the extraction of the maxillary premolar teeth in most of the cases. CONCLUSION: This proves that a single buccal infiltration of articaine can be used as an alternative to lignocaine for the extraction of the maxillary premolar teeth in most of the cases.

Intraoperative Manipulation of Bony Segments: An Innovative Method.

INTRODUCTION: Various methods are deployed by an oral and maxillofacial surgeon to control the osteotomised/ fractured bony segments intraoperatively till the time a stable fixation in the desired position is achieved. Few of these include the use of bone holding crocodile forceps, towel clips, reduction forceps, wires, digital control (Thota and Mitchell in Br J Orthod 26(4):325, 1999). In our technique, we present the use of an IMF screw to manipulate bony segments intraoperatively. MATERIALS AND METHODS: We used this novel technique in a series of 12 patients. An IMF screw was fixed in the greatest bulk of the bony fragment so as to control it and hold it in the desired position in various surgical procedures. CONCLUSION: This technique was found to be minimally invasive and easy to perform to achieve a good hold and control of the bony segments.

Versatility of uniplanar prearthoplastic distraction osteogenesis in the correction of post-ankylosis facial deformities-a report of five different cases.

PURPOSE: Unilateral or bilateral ankylosis can lead to severe micrognathia and facial deformity that requires multiple, often, staged surgical corrections. To date, there is no ideal treatment modality that satisfactorily corrects the complex anatomy, restores the ramal height, and corrects the micrognathia and microgenia. Distraction osteogenesis has been acclaimed as a successful modality for the treatment of such deformities. It is a cost-effective approach with low morbidity and less relapse thus providing better functional and esthetic outcomes. It allows the surgeon to correct the deformity in various planes by using various devices by changing osteotomy designs and vectors, with simultaneous hard tissue and soft tissue reconstruction. PATIENTS AND METHODS: Here, we present a series of five cases where different types of distraction osteogenesis were combined with various other procedures to correct post-ankylotic facial asymmetry. In one case, simultaneous maxillo-mandibular distraction [Molina's technique] was used. RESULTS: All patients showed significant improvement in function and esthetics. Outcome assessment was made using clinical photographs and radiographs. CONCLUSION: Pre-arthroplastic distraction osteogenesis is a versatile cost effective approach that can be customized for every patient based on their needs.

Pre-arthroplastic mandibular distraction osteogenesis for the correction of OSA in TMJ ankylosis: a prospective observational study of 25 cases.

INTRODUCTION: In severe TMJ ankylosis cases, the lack of growth of the mandible creates an anatomically narrow airway with a reduced pharyngeal airway space [PAS] which predisposes these patients towards obstructive apnoea [OSA]. There is evidence in the literature that such patients experience severe discomfort during physiotherapy if such airway abnormalities are not corrected prior to ankylosis release. This eventually leads to non-compliance towards physiotherapy and increases the risk of re-ankylosis. OBJECTIVE: In our study, pre-arthroplastic mandibular distraction osteogenesis [DO] was used to increase the PAS and resolve the underlying OSA prior to releasing the ankylosis. MATERIALS AND METHODS: Twenty-five cases of TMJ ankylosis with micrognathia and OSA were included in this prospective observational sleep study. They were further divided into a paediatric group [14 subjects] and an adult group [11 subjects]. All cases presented with a history of onset of ankylosis during childhood [before the completion of craniofacial growth] as result of which there was a lack of forward growth of the mandible. Subjects included in our study underwent initial DO of the mandible followed by a second procedure for distractor removal and ankylosis release. Questionnaires, lateral cephalograms and sleep studies were taken pre-operatively (T0), immediate post-distraction to the desired length (T1) and 12 months post the distractor removal and ankylosis release (T2). The parameters studied were PAS width, apnoea hypopnea index [AHI], O2 saturation, mouth opening and mandibular advancement. RESULTS: The paediatric group variables were as follows: mean PAS width which increased from 3.5 mm [T0] to 9 mm [T2], mean AHI which decreased from 48.04 [T0] to 3.60 [T2], mouth opening which increased from 4.5 mm [T0] to 34 mm [T2] and mean O2 saturation which increased from 89.86% [T1] to 96.88% [T2]. The adult group variables were as follows: mean PAS width which increased from 5 mm [T0] to 11 mm [T2], mean AHI which decreased from 31.45 [T0] to 1.43 [T2], mouth opening which increased from 5 mm [T0] to 34 mm [T2] and mean O2 saturation which increased from 92.01% [T0] to 96.84% [T2]. Statistical analysis revealed that DO of the mandible significantly improved OSA by increasing the PAS which was evident by the lower AHI score. Mouth opening was also significantly improved post ankylosis release and maintained at the T2 interval. Ten subjects followed up beyond the T2 interval [mean 28 months post ankylosis release] and their data also revealed positive compliance towards physiotherapy, adequate mouth opening and maintenance of normal AHI. CONCLUSION: Pre-arthroplastic mandibular DO has proved to be a successful modality for treatment of OSA in TMJ ankylosis patients with stable results at 12 months. By resolving the narrow airway and OSA, compliance towards physiotherapy was improved thus reducing the risk of re-ankylosis in the long term.

Juvenile Hyaline Fibromatosis.

Syndromes, especially if they occur early in the growth phase can be very debilitating and cause severe restriction of function. Juvenile hyaline fibromatosis is one such disorder. Our case report presents a girl child who was diagnosed with this debilitating condition. The case presented with both - general characteristic features of this condition such as subcutaneous nodules and flexion deformity of the joints, as well as local manifestation in the form of gingival overgrowth. Thorough clinical and radiological investigations were done to arrive at the diagnosis which was supported conclusively with histopathology of the biopsied gingival lesions. A combination of both medicinal as well as surgical therapeutic modalities was used. This case report is an effort to comprehensively document the etiology, clinical features, and prognosis of this syndrome. There being no permanent cure for the condition, the case report highlights the unique management protocol employed by us in the form of intralesional steroid therapy with endocrine consultation and the local surgical gingival excision carried out in an attempt to optimize the quality of life for our patient.

Dandy-Walker Syndrome with Giant Cell Lesions and Cherubism.

It has been very aptly quoted, "Variety is the spice of life"; and so variations exist in all forms and kinds good or bad, and for the worst or the best! Mother nature in all her glory and beauty has been very generous, but what when she fails to provide? It is this very character of nature that gives us variations which sometimes manifest in a cruel way on the human body and gives us the eponym of syndromes. Dandy-Walker malformation is an abnormality of the central nervous system, which leads to hydrocephalus and is associated with other abnormalities. Neurologic symptoms are the norm in afflicted patients due to the inherent nature of the disease in that it affects the very center of human function-the brain. This article brings to you a very unique, challenging and rare case of a young patient with this debilitating disorder who was also affected with giant cell lesions of the maxilla and mandible along with cherubism. It highlights the unpredictable course and progression of the disease in a child and our unique protocol employed for the management of the same. It adds providence and a new perspective to the still ambiguous nature of this disorder and the unprecedented maxillofacial anomalies, i.e., giant cell lesions and Cherubism associated with the same.

To determine the efficacy of ultrasonography in the evaluation of bone fill at the regenerate site for mandibular distraction osteogenesis over clinical and radiographic assessment- An in vivo prospective study.

Until date conventional radiographs and computed tomography are the preferred diagnostic modalities to monitor the distraction osteogenesis regenerate. But these techniques do not detect the ongoing osteogenic process; moreover they obligate the patient to serial radiation exposure. In addition, anatomic overlap and metal artifacts obscure the virtual findings. In contrast, ultrasound is a noninvasive, efficient and an inexpensive way to evaluate bone healing. This study was conducted to test the efficacy of ultrasound in evaluating bone healing at the mandibular distraction site. Twenty patients underwent mandibular distraction. The wounds were assessed with an orthopantomograph and an ultrasound at the end of latency, mid distraction, end of distraction and post distraction periods i.e. 6 weeks, 8 weeks and 4months. Estimates of bone formation, using a semiquantitative radiological, ultrasonographic and intraoperative surgical bone fill scores were made. The correlation between intraoperative and ultrasonographic bone fill scores was statistically significant at 0.602, a total of 26 of the 31 sites correlated. Corresponding correlation between intraoperative and radiographic bone fill scores was 0.332, and only 13 of the 31 sites correlated. The results indicate that ultrasound is potentially an accurate noninvasive technique that is most useful in assessing the mandibular distraction regenerate.

Arch bars in the mouth for 17 years - A case report.

Arch bars are commonly used in maxillofacial surgery but their intraoral presence for an extremely long period is quite uncommon or rare. So when such a patient reports and denies having any complaints all these years, the question that presents is, how is this possible? What kept the patient so long? A review of the existing literature shows, despite being common in trauma care, failure to follow-up has not received the due attention. This study retrospectively reviews the various factors implicated for failure to follow-up and the proposed corrective measures. The objective is to identify such potential patients beforehand thereby facilitating efficient trauma care.

Adult Rhabdomyoma of the Tongue in a Child: Report of a Case and a Literature Appraisal.

Rhabdomyoma, by definition is a benign muscle tumour.. Rhabdomyomas constitute 2% of all myogenous neoplasms. This tumour is in incongruence with other benign soft tissue tumours, in that it is rarer than its malignant counterpart. They are broadly categorised as cardiac and extra-cardiac. Three different subtypes exists as 1) the adult type, 2) the fetal type and 3) the genital type, the adult type being the most common.[1] AR (Adult Rhabdomyoma) generally occurs in the 4th and 5th decade with a male predilection.[2] There have been very few presentations of this lesion in the paediatric age group. Here we present a case of lingual adult rhabdomyoma in an 11 year old girl.