Comparative Evaluation of Suture Versus Sutureless Surgery in Mandibular Third Molar Impactions.

Purpose: The purpose of this study is to compare the suture versus sutureless surgery in impacted mandibular third molar and to evaluate the morbidity and complications associated with each technique. Materials and Methods: A total of 50 patients with asymptomatic impacted mandibular third molars were randomly divided into two groups of 25 patients each. Radiographs were taken to assess the angulation and degree of eruption in the third molar. A small modified Szmyd, V-shaped flap was raised in all cases, and teeth were extracted. In Group I-Suture group (suture was used to close the flap), and in Group II-Sutureless group (no suture used to close the flap). The post-operative pain, swelling, trismus, haemorrhage, periodontal pocket, and alveolar osteitis were evaluated at 24 h, 48 h, 5th days, 7th days, and 2 weeks after surgery. The statistical analysis was done using the Chi-square "t" test and Independent Samples "t" test. Observations and Results: Pain, swelling, and trismus were found to be significantly reduced especially in the immediate post-operative period in the sutureless group as compared to the suture group (p < 0.001). There were no incidences of intra-operative and post-operative haemorrhage in any case. Follow-up of all the patients showed that there was no difference in periodontal sequelae and alveolar osteitis. Conclusions: Sutureless surgery with small flap was found to be less invasive, time-saving, and also a cost-effective method. This technique significantly reduced the early crucial phase of patient discomfort and demonstrates good results.

Quality of Life in Oral Submucous Fibrosis: A Systematic Review.

Backgrounds: Oral submucous fibrosis (OSMF) is a chronic, insidious disease and is said to have a multifactorial origin with varied clinical manifestation of repeated oral ulcers, intolerance to spicy food, mucosal blanching resulting in stiffness of the oral mucosa and formation of taut bands leading to reduced mouth opening. We designed this study to systematically review the literature on QOL in OSMF and hope to make recommendations for future course of QOL assessment in OSMF. Methods: An electronic bibliographic search of studies was done from year 1900-2019 using specified keywords. The following databases were searched: PubMed, Ovid, Google Scholar and manual search were done from references of relevant articles. Of the screened 156 articles, finally 10 studies were included after screening for inclusion/exclusion criteria. Quality assessment of studies was completed using the Effective Public Health Practice Project (EPHPP) criteria for quantitative studies. Results: Most instruments used in the studies were not disease specific for OSMF except one study. Six types of questionnaires were used. The heterogeneity in study population, study designs, QOL instruments and outcome measures made it difficult for a comparison. Therefore, a quantification analysis was not possible. Also pure OSMF data without the involvement of other lesions were less in number. Conclusions: OSMF not only physically debilitates a patient, it has its repercussions on the social, physical, psychological domains as well. Another aspect is that apart from trismus, which is the most common and evident symptom associated with OSMF, a substantial part of the suffering that ensues is also because of the ulcerations, burning sensation and worsening of dental health. Another focus was the association of worse QOL with a higher grade of disease, longer and higher tobacco abuse contact duration. This review is unable to give a confident answer to the evidence on QOL in OSMF but definitely showers light on the evident lack of robust data on the same. Robust Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation methodological and adequately powered studies on assessing QOL in OSMF using only a reliable disease specific questionnaire is the need of the hour. Clinical Trial Registration: PROSPERO Registration: CRD42018102874.

Efficacy of adjuvant ozone therapy in reducing postsurgical complications following impacted mandibular third-molar surgery: A systematic review and meta-analysis.

BACKGROUND: Results from several randomized controlled trials have shown a beneficial effect of ozone in reducing postsurgical complications after impacted mandibular third-molar surgery, but the literature is lacking a systematic review and meta-analysis. METHODS: The authors conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines after exclusion and inclusion criteria were applied and the following outcome parameters were evaluated: pain, swelling, trismus, quality of life, number of analgesics consumed, and adverse events. RevMan Cochrane Collaboration software, Version 5.3, was used to perform meta-analysis and the Grading of Recommendation Assessment, Development and Evaluation approach was used to rate the certainty of evidence. RESULTS: Patients who underwent adjuvant ozone application reported lower pain scores than patients in the control group at 24 hours after surgery (95% CI, -3.94 to -1.56) and at 7 days (95% CI, -1.67 to -0.78). Pooled analysis of all 4 included trials revealed a standardized mean difference (SMD) in swelling of -0.44 at 24 hours, 0.63 at 72 hours, and -0.87 at 7 days after surgery in the experimental group. Higher mean estimates in mouth opening were experienced by patients who received ozone at 24 hours (SMD, 2.74; 95% CI, -1.93 to 7.41; 4 studies, 133 patients), 72 hours (SMD, 2.77; 95% CI, -0.63 to 6.17; 4 studies, 133 patients), and 7 days after surgery (SMD, 1.42 SMD; 95% CI, -1.34 to 4.18; 4 studies, 133 patients). PRACTICAL IMPLICATIONS: Evidence suggests that adjuvant ozone application can offer some benefit for reducing pain, improving quality of life, and decreasing mean intake of analgesics after impacted mandibular third-molar surgery, but it is not effective in reducing facial swelling and trismus, which paves the way for future research.

Level of Evidence Analysis in Journal of Maxillofacial Oral Surgery: A Twelve-Year Bibliometric Analysis of 1300 Publications (2009-2020).

AIM: Analysing Level of Evidence (LOE) provides an insight to evidence-based medicine (EBM). The aim of our study was to evaluate and analyse trends in Levels of Evidence (LOE) in Journal of Maxillofacial and Oral Surgery (MAOS) since inception, i.e. December 2009 along with categorization into subtopics. METHODOLOGY: LOE for each article was determined according to modified American Society of Plastic Surgeons (ASPS) scale and National Health and Medical Research Council (NHMRC) Evidence Hierarchy. RESULTS: A total of 1264 articles were included in the final analysis, out of which high-quality evidence (Level A) accounted for 7% of the journal. The percentage of Level I/II (Level A) has increased from 2.09% in 2009/2010 to 12.74% in 2019/2020, representing a promising trend toward higher-quality research in just 10 years. Case reports and narrative reviews with Level of Evidence value "D" account the highest number (36%) of all the published articles. The majority of articles fell under Class 2 (Maxillofacial pathology) classification (35%) highlighting myriad of articles covering pathologies and various reconstruction methods, followed by trauma (16%). CONCLUSION: The status of LOE and categorizing of published articles are the first step to audit and quantify the nature of literature published by JMOS and may further help in refining the quality of research jointly by the researchers and the editorial board.

Comparative Analysis of the Anesthetic Efficacy of 0.5% Ropivacaine Versus 2% Lignocaine Hydrochloride with Adrenaline (1:80,000) for Inferior Alveolar Nerve Block in Surgical Removal of Impacted Mandibular Third Molars.

OBJECTIVE: To compare the onset, duration and depth of anesthesia, postoperative pain, duration of analgesia and adverse reaction between 0.5% ropivacaine and 2% Lignocaine hydrochloride with adrenaline (1:80,000) in 40 patients having bilaterally impacted mandibular third molars. PATIENTS AND METHODS: A prospective, randomized, single blind study was carried out among 40 patients requiring surgical removal of bilaterally impacted mandibular third molars having similar "difficulty index." The onset of action, duration and depth of anesthesia, duration of analgesia, postoperative pain and adverse reactions of 0.5% ropivacaine and 2% lignocaine hydrochloride with 1:80,000 adrenaline were evaluated. All patients were infiltrated intradermally with 0.5 ml of 0.5% ropivacaine as test dose to rule out any allergic reaction. The surgical extractions of the impacted third molars were done using the standard surgical procedure. RESULTS: 0.5% Ropivacaine had higher depth of anesthesia, longer duration of action and postoperative analgesic effect than 2% Lignocaine hydrochloride with 1:80,000 adrenaline with no adverse effects. CONCLUSION: 0.5% ropivacaine is safe, efficacious, clinically acceptable and equally potent local anesthetic agent when compared to 2% lignocaine with 1:80,000 adrenaline in oral and maxillofacial surgery for longer duration of surgeries.

Correction to: Evaluation of the Variations in the Levels of Perioperative Inflammatory Markers After Open Reduction and Internal Fixation of Maxillofacial Fractures.

[This corrects the article DOI: 10.1007/s12663-018-1174-4.].

Evaluation of the Variations in the Levels of Perioperative Inflammatory Markers After Open Reduction and Internal Fixation of Maxillofacial Fractures.

INTRODUCTION: Postoperative infectious complications are commonly encountered in open reduction and internal fixation (ORIF) of maxillofacial fractures. An early diagnosis of infectious processes is the key in preventing morbidity/mortality which could be in the form of loss of hardware and sepsis. To prevent these, various markers of inflammation have been studied in different disciplines of surgery but are found scarce in maxillofacial practice. MATERIAL AND METHOD: The present study was designed to evaluate the perioperative variations in the levels of inflammatory markers. We analysed temperature, TLC, DLC, ALT, AST and CRP in 50 patients of ORIF. Their values were recorded preoperatively as well as at 24 h, 48 h, third day and seventh day postoperatively. The correlation of inflammatory markers with the type of anaesthesia and length of surgery were also analysed. RESULTS: The ranges of various markers in the perioperative phase were: temperature (97.6 ºF-99.2 ºF), TLC (5100/mm3-18200/mm3), neutrophils (51-91%), AST (12-86 IU/L), ALT (12-96 IU/L) and CRP (1.2-150 mg/L). Mean values of all the inflammatory markers achieved their peak values within 24 h postoperatively. These values showed a decline thereafter, with the day 3 and day 7 values being even lower than their preoperative values. This fall in the values was highly significant (p < 0.001) except ALT where the fall was significant (p < 0.05). The data obtained could be used as a reference range by the surgeons for monitoring the recovery of the patient. It could also help in timely interception and expeditious management of an infectious episode in the postoperative phase.

Impact of Oral Submucous Fibrosis on Quality of Life: A Multifactorial Assessment.

BACKGROUND: Oral submucous fibrosis (OSMF) has been extensively researched for its etiopathogenesis, malignant potential, and various available treatment modalities, but its effect on different domains of patient's life has not been thoroughly investigated. The present study aimed to clearly construe the effects of OSMF like severity and demographic variables on different domains of quality of life in OSMF patients. METHODS: A cross-sectional study was conducted in the Department of Dentistry, AIIMS Jodhpur, India. A total of 200 patients (after informed consent) were selected and detailed proforma filled including patient's demographics, habits, clinical features, and quality of life using a World Health Organization Quality of life-BREF tool (WHOQOL-BREF questionnaire). Thereafter, interpretation and statistics were done by a separate trained examiner minimizing the risk of assessment bias. RESULT: Quality of life (QOL) scores differed significantly according to age, site affected, habit duration, and severity of OSMF. It, however, did not differ according to gender. CONCLUSION: In this study, there has been a statistically significant deterioration of quality of life in OSMF patients in all the domains. Realization of this would increase our chance to bring the focus of the society and its policy makers to confront the growing menace of OSMF.

Impact of Oral Submucous Fibrosis on Quality of Life: A Cross-Sectional Study.

BACKGROUND: Oral submucous fibrosis (OSMF) is a chronic disease of the oral cavity which presents clinically with burning sensation, leathery consistency of oral mucosa with palpable fibrous bands leading to reduced mouth opening. Though the evaluation of quality of life (QOL) in health care is gaining importance, researches regarding the evaluation of QOL in OSMF individuals are very sparse. AIM: The aim of the present study is to evaluate the QOL assessment in OSMF patients through WHOQOL-BREF questionnaire. METHODOLOGY: The study includes a total of 300 participants recruited from the outpatient department. The quality of life was assessed using the WHOQOL-BREF questionnaire. The raw scores for the physical health, psychological health, social relationships and environmental health domains were done on 4-20 scale suggested by the WHOQOL procedural manual. The analysis of variance (ANOVA) was used for the simultaneous comparison of mean scores for the four domains, and independent t test was used for the comparison of two means of domain scores. RESULTS: The participants with OSMF have a significant negative impact on the quality of life when compared with the participants without OSMF (P = 0.002). The environmental factors in the WHOQOL-BREF have shown a significant difference in the QOL of participants with OSMF than without OSMF (P = 0.001). CONCLUSION: The oral submucous fibrosis has a negative impact on the quality of life in participants with OSMF specifically in social and environmental domains of the WHOQOL-BREF questionnaire.

To Compare the Efficacy of C-Reactive Protein and Total Leucocyte Count as Markers for Monitoring the Course of Odontogenic Space Infections.

OBJECTIVE: To compare the efficacy of CRP and TLC as markers for monitoring the course of odontogenic space infections (OSI) in 50 patients. METHODS: A Clinical severity scale (CSS) was developed to grade the severity of infections in patients. Blood samples were taken preoperatively and postoperatively at day 1, day 2, day 3 and day 7 for measuring the levels of CRP and TLC. The trends of CRP and TLC were analysed against the CSS. The data was subjected to paired "t" test, ANOVA, Spearman rank correlation, Pearson's bivariate correlation as appropriate. RESULTS: The CRP values were elevated in all 50/50 (100 %) patients as compared to TLC which were elevated in 32/50 (64 %) patients only. The CSS displayed a high internal consistency and reliability (Cronbach α = 0.748). A significant strong positive correlation (ρ = 0.754) was found between CRP and CSS as compared to a moderate correlation (ρ = .607) between TLC and CSS. CONCLUSION: CRP displayed a more consistent relation with clinical severity of the infection than TLC. Hence it could be more reliably employed to judge the progress in a patient with OSI.

A review of complications of odontogenic infections.

Life-threatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. Complications include airway obstruction, mediastinitis, necrotizing fascitis, cavernous sinus thrombosis, sepsis, thoracic empyema, Lemierre's syndrome, cerebral abscess, orbital abscess, and osteomyelitis. The incidence of these "space infections" has been greatly reduced by modern antibiotic therapy. However, serious morbidity and even fatalities continue to occur. This study reviews complications of odontogenic infections. The search done was based on PubMed and Google Scholar, and an extensive published work search was undertaken. Advanced MEDLINE search was performed using the terms "odontogenic infections," "complications," and "risk factors."

Use of metronidazole as part of an empirical antibiotic regimen after incision and drainage of infections of the odontogenic spaces.

The combination of amoxicillin/clavulanate and metronidazole is a widely-accepted empirical regimen for infections of the odontogenic spaces. Once adequate drainage has been established micro-organisms are less likely to grow and multiply, particularly anaerobes. This may obviate the need for anaerobic coverage after drainage in healthy hosts. We studied 60 patients in this randomised prospective study, the objective of which was to evaluate metronidazole as part of an empirical antibiotic regimen after drainage of infections of the odontogenic spaces. Samples of pus were sent for culture and testing for sensitivity. Amoxicillin/clavulanate and metronidazole were given to all patients. After incision and drainage the patients were randomly allocated to two groups. In the first group both antibiotics were continued, and in the second metronidazole was withdrawn. The groups were compared both clinically and microbiologically. There were no significant differences between the groups in the resolution of infection. Thirteen patients (n=6 in the 2-antimicrobial group, and n=7 in the amoxicillin/clavulanate group) showed no improvement during the 48 h postoperatively. Overall there was need to substitute another antibiotic for amoxicillin/clavulanate in only 6 cases. Six patients in the amoxicillin/clavulanate group required the addition of metronidazole after drainage. We conclude that in healthy subjects metronidazole is not necessary in the period after drainage, but its prescription should be based on assessment of clinical and laboratory markers of infection.

Microbial isolations from maxillofacial operation theatre and its correlation to fumigation in a teaching hospital in India.

Postoperative infection and sepsis remain a major cause of morbidity among patients undergoing surgery. Maintenance of strict asepsis is essential if post-operative infection and its consequences are to be minimized. In developing countries maintenance of asepsis in most operation theatres is limited to fumigation and mopping. Clinical trials have confirmed that 80-90 % of bacterial contaminants found in wound after surgery come from microbes present in air of operating theatre. A study was conducted to evaluate the microbiological contamination of maxillofacial operation theatres in India and its correlation to weekly fumigation. A total of 6,723 culture plates, including 2,241 air and 4,482 swab samples were studied. Samples were collected at prefumigation, midcycle and post-fumigation stages and were cultured over three different medias. Predominant bacteria identified were Staphylococcus aureus (76 out of 83 samples by active air sampling) followed by Streptococcus while Aspergillus was the main fungal isolate. Formaldehyde based fumigation decreased the colony forming units (cfu/m(3)) of all organisms in different samples and was found to be highly effective against Fungi and E. coli. Literature suggests that for conventional operating theatres the bioload should not exceed 35 cfu/m(3) in an empty theatre. In our study the cfu levels were always lower immediately after fumigation was carried out; however they moved up beyond this limit as the days passed. This implies that once a week fumigation with formaldehyde is less than optimal to achieve acceptable levels of disinfection.

A comprehensive study on maxillofacial trauma conducted in Yamunanagar, India.

BACKGROUND: The Department of Oral and Maxillofacial Surgery, D.A.V [C] Dental College and Hospital, Yamuna Nagar, Haryana, India conducted a study on patients with maxillofacial fractures in a time span of seven years (2003-2010). The purpose of this study was to evaluate their aetiology, incidence, patterns and different modalities employed for management. METHODS: In this study, 740 patients with 1054 fractures were evaluated clinically and radiographically, based on which closed reduction and open reduction was undertaken. Review of patient records included: Age, sex, time, mechanism and etiology of injury, history of bleeding, unconsciousness and prior first aid, type of vehicle and use of preventive measures, type of fracture and treatment modalities. RESULTS: Road traffic accidents accounted for highest number of fractures predominantly occurring in the age group of 21-30 years (38.3%)1,2. Males incurred more fractures with a male female ratio of 4.2: 1.Mandible was the most commonly fractured bone with parasymphysis being the commonest affected site.76.66% patients had associated head injury and 15.68 % had history of unconsciousness. Open reduction and internal fixation was the preferred modality for mandible whereas the mid face fractures were treated more often by closed methods. CONCLUSIONS: Injuries occurred more commonly in 20-40 age range with road traffic accident being the major etiological factor. Majority of the patients were driving two wheelers and most were under the effect of alcohol. Most of the injuries occurred during night and road traffic accidents (71.89%) were found to be the major etiological factor. Out of 532 road traffic accidents, 490 patients (66.2%) were on two wheelers, among whom 49(10%) were wearing helmet. In the mandible, fractures occurred most commonly in the parasymphyseal region (224, 30.2%), and out of the 314 fractures of the middle third showed, 155 (49.4%) ZMC. OPG was the most commonly advised X-ray. With regard to treatment modalities, 36.8% of all the mandibular fractures (740) were treated by closed reduction, 62.6% were treated using open reduction and 0.5% was under observation only.

Pharyngeal and peritonsillar abscess due to Leclercia adecarboxylata in an immunocompetant patient.

Leclercia adecarboxylata was isolated in pure culture from a peritonsillar and lateral pharyngeal abscess in an immunocompetent host. To our knowledge, this is the first case of infection caused by this microorganism being found in an odontogenic area of the head and neck.

Chronic candidal osteomyelitis of mid face: A therapeutic dilemma.

Numerous explanations have been proposed for the increase in fungal infections including the use of broad-spectrum antibiotics, antineoplastic agents and prosthetic devices. Also increase in proportion of immunocompromised population predisposed to fungal infection might be a contributory factor. Candida albicans is a part of normal flora of the oral cavity. However, it is rarely implicated in maxillary osteomyelitis. Diagnosis of Candida infection is challenging as most symptoms are non-specific and cultures may only become positive late in the course of the infection. Due to scarcity of literature, there are no robust guidelines regarding the most appropriate therapeutic regimens to be employed in such cases. A case of candidal osteomyelitis of mid face is reported suggesting the need for more multicentric long-term studies to formulate and establish appropriate treatment regimens.

To evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures: A prospective study.

AIMS: The present study was undertaken to evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures and to study the morbidity associated with the use of biodegradable plates and screws. MATERIALS AND METHODS: This prospective study consisted of 10 patients with maxillofacial fractures requiring open reduction and internal fixation. Fractures with infection, comminuted and pathological fractures were excluded. All were plated with biodegradable system (Inion CPS) using standard plating principles and observed for a total period of 24 weeks. Characteristics of the fractures, ease of use of bioresorbable plate/screw system and post operative complications were assessed. RESULTS: Of total 10 patients, eight patients were of midface fracture and two pediatric patients with mandibular fracture, with nine male and one female. The mean age was 32.8 years. Out of 20 plates and 68 screws applied to the 10 fractures sites; there were three incidences of screw breakage with no other intraoperative difficulties. Paresthesia of the infraorbital nerve was present in two patients, and recovered completely in four weeks after surgery. Fracture reduction was considered to be satisfactory in all cases. One patient developed postsurgical infection and was managed with oral antibiotics and analgesics. CONCLUSIONS: Favorable healing can be observed through the use of biodegradable plates and screws to stabilize selected midface fractures in patients of all ages, as well as mandible fractures in early childhood, however further studies with more sample size are required.