Is modified Carnoy's solution as effective as Carnoy's solution in terms of amount of bone necrosis and depth of penetration?

Carnoy's solution, a chemical cauterisation agent, has been indicated as one of the adjuvant treatment modalities for odontogenic keratocyst. In 2000, after the ban of chloroform many surgeons adopted the use of Modified Carnoy's solution. The purpose of this study is to compare the depth of penetration and amount of bone necrosis of Carnoy's versus Modified Carnoy's solution on the mandible of Wistar rats at different time intervals. Twenty-six male Wistar rats of six to eight weeks old, weighing approximately 150-200 grams, were allocated for this study. The predictor variables were type of solution and application time. The outcome variable was depth of penetration and amount of bone necrosis. Carnoy's solution was applied on the defect on the right side of the mandible and Modified Carnoy's solution on the left side for five minutes on eight rats, eight minutes on eight rats, and 10 minutes on eight rats. All specimens were subjected to histomorphometric analysis done using Mia image AR software. Univariate ANOVA test, and paired sample t test was done to compare the results. The depth of penetration for Carnoy's solution was more than Modified Carnoy's solution in the three different exposure times. Statistically significant results were observed at five minutes and eight minutes. The amount of bone necrosis was more in Modified Carnoy's solution. The results were not statistically significant at the three different exposure times. To conclude, when one wants to use Modified Carnoy's solution, the minimum exposure time should be 10 minutes to achieve similar results as those of Carnoy's solution.

Assessment of clinical outcome of surgically managed panfacial fractures with or without ancillary procedures. A 10-year retrospective study.

Purpose: The aim of this retrospective study is to analyze the demographic factors, different patterns, complications, and clinical outcomes based on various ancillary surgical procedures performed during the management of panfacial fractures. Materials and methods: Patients diagnosed with panfacial fractures, who underwent surgical management from 2011 to 2020 were included. The predictor variable was five ancillary surgical procedures, orbital reconstruction with autogenous bone graft, primary nasal bone grafting, open reduction and internal fixation or custom-made palatal splint for palatal fractures, ORIF for zygomatic arch fractures, and reattachment of Medical Canthal Ligament. The outcome variable was post-operative complications. Age, sex, etiology of trauma and pattern of panfacial fractures were the co-variates for the study. The incidence of complications with or without performing ancillary surgical procedures was analyzed. Results: A total of 1028 patients were treated for various maxillofacial trauma from 2011 to 2020.103 patients were diagnosed with panfacial fractures. 27 of 103 patients were excluded, 76 patients were included in the study with strict adherence to the inclusion criteria. Statistical Analysis was done using SPSS software version 23.0. Chi-Square test was performed to analyze the incidence of complication and fracture pattern. The results were statistically significant for three procedures which included orbital reconstruction, primary nasal bone grafting, and ORIF for palatal fractures with p-value, 0.032, 0.022, and 0.012 respectively. Conclusion: The results suggested that performing ancillary procedures in the management of panfacial fractures significantly reduces the incidence of postoperative complications and improves the clinical outcome.

Intraoperative Findings of Extraocular Muscle Necrosis in Linear Orbital Trapdoor Fractures.

PURPOSE: Orbital trapdoor fractures can constitute a relative surgical emergency. The reason for poor surgical outcomes in ocular motility disturbances and diplopia is not apparent in these fractures. The purpose of this retrospective study was to analyze the possibility of ischemic necrosis of the orbital contents in linear trapdoor fracture of the orbital floor and to evaluate the recovery period of trapdoor fractures. PATIENTS AND METHODS: The study included 11 patients with linear trapdoor fracture of the orbital floor over 5 years with minimum 1-year follow-up. Patients with associated facial bone fractures were excluded. Demographic, etiologic, and radiologic characteristics, interval from trauma to surgery, and surgical techniques were recorded. RESULTS: Patients' age range was 9 to 29 years (mean, 16.3 yr). Mean time to surgical intervention from time of injury was 3.9 days (range, 0 to 11 days). Intraoperatively, macroscopic segmental necrosis of the entrapped inferior rectus muscle was observed in 3 patients. Postoperative review was conducted for a minimum of 12 months at 1-week and 1-, 3-, 6-, and 12-month intervals. At the end of the follow-up period, incomplete recovery was observed in 5 patients, including the 3 patients with intraoperative necrosed muscle, and the other 2 patients were operated on at days 7 and 8 from time of injury. CONCLUSION: This study showed that segmental necrosis of the entrapped inferior rectus muscle is possible in linear trapdoor fracture of the orbital floor. In addition, incomplete recovery correlated with clinical evidence of inferior rectus muscle necrosis and late surgical intervention.