Validation of Modified Hertel Exophthalmometer.

STUDY DESIGN: This is a correlation study. OBJECTIVE: The objective was to obtain normative values from modified Hertel exophthalmometer, to compare difference in values between modified and standard Hertel exophthalmometer and to statistically analyze for correlation. METHODS: The study to validate the modification done to Hertel exophthalmometer was performed at the Department of Oral and Maxillofacial Surgery at our institute. Informed consent was obtained from patients; measurement in 100 volunteers was made with Hertel and modified Hertel exophthalmometer by a single observer, and the measurements taken by the 2 devices were tabulated along with variables such as age and gender. Data were collected and statistical analysis was performed to compare and correlate the values between standard and modified exophthalmometer. Differences of ocular protrusion values in gender and age were also calculated. RESULTS: There has been no statistically significant difference in the normative data between standard Hertel and modified Hertel exophthalmometer and in relation to age and gender. CONCLUSIONS: The modification of the Hertel exophthalmometer is validated and can also be used for relative exophthalmometry to assess the need for treatment and to evaluate the globe position and orbital volume intraoperatively. The proposed modification of the instrument allows it to be used in cases when one of the lateral orbital walls is fractured or displaced due to trauma.

A Prospective Study to Assess the Efficacy of 4% Articaine, 0.5% Bupivacaine and 2% Lignocaine using a Single Buccal Supraperiosteal Injection for Maxillary Tooth Extraction.

INTRODUCTION: The aim of this study was to demonstrate if articaine hydrochloride administered alone as a single buccal infiltration in maxillary tooth extraction can provide adequate palatal anesthesia as compared to buccal and palatal injection using lidocaine and bupivacaine. MATERIALS AND METHODS: A prospective double-blinded trial was conducted on 150 patients who required maxillary tooth extraction. The patients were divided into three different groups consisting of 50 patients each. Each group was administered with 4% articaine into buccal vestibular mucosa of the tooth to be extracted, 2% lignocaine and 0.5% bupivacaine was injected into buccal and palatal side of the tooth to be extracted, respectively. Following the tooth extraction, all patients were asked to complete a 10-score Visual Analog Scale (VAS) and 5-score facial pain scale (FPS) to assess the pain on extraction. RESULTS: According to the VAS and FPS scores, the pain on extraction between buccal infiltration of articaine and the routine buccal and palatal infiltration of lignocaine was statistically significant. CONCLUSION: The routine use of a palatal injection for extraction of maxillary teeth may not be required when articaine is used as a local anesthetic solution.

A Rare Incidence of Metachronous Neurovascular Lesions in a Child.

Neurofibroma is an uncommon benign tumor arising from nerve sheath fibroblasts. The diagnosis of solitary lesions becomes difficult in patients who do not have any family history of neurofibroma. An intra-oral solitary neurofibroma comprises 6.5% of reported cases of neurofibroma. Few cases of intraosseous solitary neurofibroma have been published as per literature. Treatment-surgical resection of tumor has an excellent prognosis with extreme rare malignant transformation which is more commonly seen in neurofibromatosis. A periodic follow-up is necessary in solitary tumors to rule out syndromic cases. Leiomyoma is a benign tumor of smooth muscle origin, which is usually diagnosed in the gastrointestinal tract, uterus, and skin. The most effective treatment for solid, vascular, and epithelioid angioleiomyomas is surgical resection along with tumor capsule. Here we report an uncommon occurrence of multiple benign tumors in a pediatric patient.

Dentists' Knowledge, Attitude and Practice in Treating Patients Taking Oral Antithrombotic Medications - A Survey.

INTRODUCTION: India lists high on patients suffering from diabetes, hypertension, stroke and myocardial infarction. Hence, a large proportion of the population is on long term Oral Antithrombotic Medications (OAM). Though several guidelines exist on dental management of these patients, previous surveys have shown variation among the dentists. AIM: The purpose of this study was to assess the knowledge, attitude and practice of dentists in Chennai, India, towards dental management of patients taking OAM using a questionnaire survey. MATERIALS AND METHODS: The survey was conducted among 256 dentists in Chennai, India using a printed questionnaire containing 16 questions, at their university location. Descriptive statistical analysis was used to analyze the data. RESULTS: Of the final population of dentists who were included in the survey (n =212), majority of them were aware about drugs such as warfarin and aspirin compared to other newer drugs (dabigatran, rivaroxaban). Most participants took physician's opinion before proceeding with any invasive dental procedure and thromboembolic events were their major concern while treating patients on OAM. CONCLUSION: The survey revealed dentists are knowledgeable about management of patients on OAM. However, they tend to overestimate the bleeding risk, thus being cautious in their treatment approach. Based on the results of the study, the authors suggest that continuing dental education programs and further training on management of such medically complex patients will be beneficial in order to provide optimum dental care to people taking OAM.

"Histiocytosis X" - A Rare Case Report.

Histiocytosis X is an idiopathic disease, characterized by a disorder of the reticulo-endothelial system in the human body. Histopathological studies carried out right from the 1800s have seen a significant similarity in the pathologic process of different stages in particular clinical syndromes showing proliferation of mature histiocytes. It was then modified by Lichenstein in 1953 as "Histiocytosis X". The exact aetiology is unknown; hence, the name "Histiocytosis X". The disease classically presents with three syndromes namely Eosinophilic granuloma, Letterer-Siwe disease and Hand-Schuller-Christian disease. These syndromes present with a spectrum of clinical manifestations with histiocytic proliferation in the granulomatous lesion. The disease is neither familial nor hereditary, nor does it have any microbiological pathologic origin. This disease can be conservatively managed by antibiotics and steroids or surgical curettage with radiotherapy. We report a five-year-old male child who was incidentally diagnosed to have Histiocytosis X. This patient was managed with a moderate surgical procedure with total avoidance of radiotherapy. An adequate follow-up of this patient shows total regression of the lesion and good bone healing.

Non Infiltrating Angiolipoma of the Palate in Geriatric Patient: A Case Report with Review of Literature.

Angiolipoma is one of the rare variant of lipoma. This benign tumour consists of both fatty and vascular elements. It mostly occur in the trunk and extremities and is uncommon in head and neck region. Angiolipoma is classified as infiltrating and non- infiltrating types. Among all neoplasms of the oral cavity, lipomas account for 1 to 5% and the incidence of angiolipoma is 5 to 17% in it. There is no sex predilection for this tumour. It is classified as infiltrative and non-infiltrative type. Surgical excision is the method to be considered for both the types of angiolipoma, however the infiltrating type recurs post-surgery. We report a rare case report of 55-year-old female with non-infiltrating angiolipoma of the hard palate mimicking a mucocele treated by surgical excision with no signs of recurrence and good wound healing after three months follow up with minimal scar formation.

Comparison of gap arthroplasty with and without a temporalis muscle flap for the treatment of ankylosis.

PURPOSE: The purpose of this study was to compare gap arthroplasty with and without a temporalis muscle flap for the treatment of ankylosis. MATERIALS AND METHODS: Sixteen patients with temporomandibular joint ankylosis from 2001 to 2006 were included in the study, of which 7 were female and 9 were male. Fourteen patients had unilateral ankylosis and 2 patients had bilateral ankylosis. Sixteen patients were divided into 2 groups with 8 patients in each group. In group I patients, gap arthroplasty was performed with a mean follow-up of 20.3 months and in group II patients, interpositional arthroplasty with temporalis myofacial flap was performed with a mean follow-up of 23.1 months. All patients were assessed for mouth opening, diet consistency, and weight postoperatively. All patients were subjected to postoperative mouth opening exercises from the second postoperative day. RESULTS: There is no significant difference in postoperative mouth opening, diet consistency, and weight of the patients in both groups. Reankylosis occurred in 1 patient in both groups. CONCLUSIONS: We conclude that there is no significant difference in maximal interincisal opening, diet scores, and weight of the patients in both groups. The overall outcome of the treatment depends on patient cooperation, active physiotherapy, and regular follow-up.