Computed Tomographic Analysis of Position of Mandibular Canal and Mandibular Foramen in Patients with Mandibular Asymmetry.

Introduction: Mandibular osteotomies in facial asymmetry are complicated by the abnormal position and course of inferior alveolar nerve. This manuscript aims to evaluate the possible variations in the preoperative positions of mandibular canal and mandibular foramen in patients with mandibular asymmetry due to condylar hyperplasia or condylar hypoplasia. Materials & Methods: This study included 15 patients with mandibular asymmetry due to condylar hyperplasia or condylar hypoplasia for which bilateral sagittal split osteotomy (BSSO) was performed as a corrective procedure. The presence/absence and extent of postoperative neurosensory deficiency was recorded subjectively and objectively. The measurements were done using multiplanar reconstruction (MPR) of three-dimensional radiographic imaging and were compared to normal subjects. Discussion: The results revealed that the mandibular canal was closer to the buccal cortex on the affected side and the inferior border on both sides in the region of second molar in condylar hyperplasia. In condylar hypoplasia, the canal was nearer to the inferior border and the alveolar crest in relation to second and third molars respectively on the affected and contralateral sides.The mandibular foramen was also more superior to the occlusal plane on both sides in both condylar hyperplasia and hypoplasia. Conclusion: Based on the study outcomes, the authors propose that assessment of the positions of mandibular canal and mandibular foramen is crucial to avoid postoperative neurosensory deficiencies.

Distraction Osteogenesis Versus Orthognathic Surgery: Demystifying Differences in Concepts, Techniques and Outcomes.

INTRODUCTION: The popularity and interest evoked by orthognathic surgery and distraction osteogenesis are undisputed in the field of oral and maxillofacial surgery. However, questions regarding the individual identities of either of them with clarity in their concepts, techniques and outcomes have remained unanswered. The aim of this review is to shed light on these questions. METHODS: This review is structured as a narrative review of thirty years of literature available in the specialities of orthognathic surgery and distraction osteogenesis. CONCLUSION: The authors present a review of existing literature combined with contrasting experience gained over the years in providing an overview of the merits and demerits of the two surgical techniques which will aid the clinician in justifying the use of one technique over the other.

Simultaneous Occurrence of a Midline Sublingual Dermoid Cyst with Respiratory Epithelium and Submental Dermoid Cyst in a Paediatric Patient: A Case Report and Review of Literature.

AIM: To present the case of a simultaneously occuring sublingual dermoid cyst with respiratory epthelium and a submental dermoid cyst, and also to review literatures on the same. METHODS: A complete examination, radiograph, MRI and excision biopsy of both lesions were carried out and diagnosis was arrived at histopathologically. RESULTS: The histopathology of the submental swelling revealed orthokeratinized stratified squamous epithelium with underlying connective tissue consisting of dense irregularly arranged collagen fibres with fibroblasts along with chronic inflammatory cell infiltrate of lymphocytes and plasma cells. There was presence of sebaceous glands and sebum. Sublingual swelling showed non-keratinized stratified squamous epithelium with a fibrovascular connective tissue. Areas of pseudostratified ciliated columnar epithelium were also evident in some areas. Presence of sebaceous glands also seen. Based on these findings a confirmatory diagnosis of sublingual dermoid cyst with respiratory epithelium and submental dermoid cyst was made. CONCLUSION: This report throws light on midline lesions of the oral cavity and hopes to add this rare case into the current differential diagnosis of the same.

Fever after maxillofacial surgery: a critical review.

PURPOSE: The aim of this paper is to review the pathophysiology of thermoregulation mechanism, various causes of fever after maxillofacial surgery and the different treatment protocols advised in the literature. DISCUSSION: Fever is one of the most common complaints after major surgery and is also considered to be an important clinical sign which indicates developing pathology that may go unnoticed by the clinician during post operative period. Several factors are responsible for fever after the maxillofacial surgery, inflammation and infection being the commonest. However, other rare causes such as drug allergy, dehydration, malignancy and endocrinological disorders, etc. should be ruled out prior to any definite diagnosis and initiate the treatment. Proper history and clinical examination is an essential tool to predict the causative factors for fever. Common cooling methods like tepid sponging are usually effective alone or in conjunction with analgesics to reduce the temperature. CONCLUSION: Fever is a common postoperative complaint and should not be underestimated as it may indicate a more serious underlying pathology. A specific guideline towards the management of such patients is necessary in every hospital setting to ensure optimal care towards the patients during post operative period.

Effectiveness of tranexamic acid on intraoperative blood loss in isolated Le Fort I osteotomies--a prospective, triple blinded randomized clinical trial.

The aim of this triple blinded randomized clinical trial was to evaluate the efficacy of tranexamic acid when used in conjunction with hypotensive anaesthesia exclusively for Le Fort I osteotomies. 49 patients undergoing Le Fort I osteotomy for correction of dentofacial deformity were divided into two groups; Group 1 received a placebo of saline 5 ml and Group 2 received 10 mg/kg body weight of tranexamic acid. The operating surgeon, anaesthetist and investigator were blinded. The variables of interest recorded in this study included the change in Hb%, PCV, total blood loss, total operating time and quality of the surgical field using Fromme's Ordinal Scale. Statistically significant differences between the two groups were found between the following variables: post-operative Hb%, drop in Hb%, post-operative PCV, drop in PCV, total surgical blood loss, total operating time and quality of surgical field (P < 0.05). Group 2 patients exhibited a smaller drop in Hb% and PCV, with a lower Fromme's Ordinal Scale value and decreased total blood loss and operating time. In conclusion single preoperative administration of tranexamic acid in the dose of 10 mg/kg, when combined with hypotensive anaesthesia is effective in controlling blood loss with regards to single piece Le Fort I surgery.

Catheter-based donor site analgesia after rib grafting: a prospective, randomized, double-blinded clinical trial comparing ropivacaine and bupivacaine.

PURPOSE: Although ribs provide the best source of cartilage for reconstruction, its harvesting is associated with significant postoperative pain and sometimes incapacitating functional deficit. The lack of studies in the maxillofacial literature on regional analgesia for rib harvests stimulated this study design. This study compared ropivacaine with bupivacaine in providing postoperative analgesia after rib harvest. PATIENTS AND METHODS: Patients who needed rib grafting for maxillofacial reconstructive procedures were enrolled in this prospective, randomized, double-blinded clinical trial. Patients were randomly allocated to 1 of 2 groups with different modalities of anesthesia against a control group. A catheter was embedded in the rib donor site in all patients. Patients in group A received 0.75% ropivacaine, those in group B received 0.5% bupivacaine, and those in croup C patients received normal saline and served as the controls. The outcome variables were the subjective and objective pain scores, the duration of action, and the efficacy of the drugs after rib harvest. Dependent variables were the need for a rescue analgesic by the patient and the duration of hospital stay. The subjective intensity of pain at rest was calculated using the visual analog scale. The objective pain scores at function were evaluated by comparing preoperative with postoperative values of incentive spirometry, breath-holding test, maximal chest expansion, and match-blowing test. The t test and paired samples test were used to the analyze data, and a P value less than .05 was considered significant. RESULTS: Forty-two patients were enrolled in this study. Patients in groups A and B showed significant pain relief compared with group C. Patients in group A showed significantly less pain at rest (2.8±0.894) compared with those in group B (3.7±0.875; P<.05). Patients in group A also showed significantly less in pain at function (3.8±0.894) compared with those in group B (4.7±0.923; P<.05). Patients in group A showed a minimal need for a rescue bolus compared with those in group B. The duration of action for ropivacaine was longer by a mean difference of 11 hours. No noteworthy difference was seen for the duration of stay in the hospital. CONCLUSIONS: The use of catheter-based analgesia after rib harvesting provides excellent postoperative comfort, with ropivacaine providing an earlier return to normal function compared with bupivacaine. The duration of action of ropivacaine was significantly longer and, hence, decreased the need for rescue analgesics.