Assessment of complications of the open treatment of mandibular condylar fractures

The objective of our study was to analyze the complications of open treatment of mandibular condylar fractures operated via various surgical approaches. Thirtyeight patients with 42 fracture sides having moderate to severely displaced condylar fractures were studied. Open treatment was performed, and patients were assessed for complications of open treatment in terms of facial nerve paresis, unaesthetic scar, salivary fistula/sialocele. Facial nerve paresis was noted in 13 (31%) cases, mostly transient in nature (n=9, 69.2%), that recovered within 8 weeks. Furthermore, 5 (11.9%) patients had unaesthetic scar formation, while just 1 (2.4%) case of salivary fistula was observed. Facial nerve paresis was the most common complication of open treatment of mandibular condylar fractures and most of them were observed in cases operated by preauricular approach.

Functional Outcomes Of Open Versus Closed Treatment Of Unilateral Mandibular Condylar Fractures.

BACKGROUND: Although mandibular condylar fractures are among the most common fractures of maxillofacial region, the ideal method for treatment of these fractures is still a controversy. The objective of this study was to compare functional outcomes of open vs closed treatment of unilateral mandibular condylar fractures. METHODS: This study was carried out at Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi. All patients, included in our study, were randomly put in open and closed treatment groups. Patients were assessed for maximal mouth opening, deviation of mandible on opening and occlusal status six months postoperatively. Maximal mouth opening was assessed by maximal interincisal distance, deviation of mandible on opening by calculating the midline discrepancy during mouth opening and occlusion was assessed by clinical examination according the modified criteria described by Singh V et al. Independent samples t-test was used to compare means of variables in open and closed treatment groups. RESULTS: After six months of follow up the mean mouth opening was 36.39±4.72 mm in open treatment group while it was 33.74±4.72 mm in closed treatment group and difference was statistically significant. While deviation of mandible on opening was found to be 0.48±0.99 mm in open treatment group and 1.09±1.60 mm in closed treatment group. The mean occlusal disturbance was found to be 1.17±0.38 in closed treatment group while it was 1.10±0.30 in open treatment group.. CONCLUSIONS: Open treatment of unilateral mandibular condylar fractures results in better functional outcomes particularly in terms of mobility of mandible (mouth opening).

Congenital Synechia and Syngnathia: Two Case Reports.

This case report presents two cases of rare congenital malformation, i.e syngnathia. First case is of 2-day infant with bilateral fusion of maxilla and mandible, leaving a small anterior portion. After consultation with other concerned specialties, early intervention was planned and fusion was released to facilitate feeding. The infant suffered from frequent respiratory tract infections and subsequently died at the age of ten months. The second case is of 8-month baby girl with unilateral congenital maxillomandibular bony fusion without any other anomaly. She underwent general anesthesia for thorough examination and release of soft tissue union. Second surgery was performed after few months for removal of bony fusion. Good mouth opening was seen on 1 month follow-up.

Transpapillary versus palatal injection technique for maxillary tooth extractions.

OBJECTIVE: To compare the pain during injection administration and efficacy of transpapillary injection with palatal injection for simple maxillary tooth extractions. STUDY DESIGN: Randomized control trial. PLACE AND DURATION OF STUDY: The oral and maxillofacial surgery department of Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from July to December 2009. METHODOLOGY: Patients requiring simple extraction in maxilla were randomly divided into two groups each consisting of 100 patients. Group 1 was given conventional palatal injection and served as a control, whereas Group 2 received the transpapillary injection. Two percent Lignocaine with Adrenaline (1:100,000) was used for both groups. Pain during injection and then during the extraction were recorded for both groups using the Visual Analogue Scale and Faces Pain Score Scales on specially designed proformas. The data was analyzed using SPSS version 17.0 and independent t-test was applied to compare pain between both groups. P-value of less than 0.05 was considered to be statistically significant. RESULTS: Group 1 consisted of 61 males and 39 females with an age ranging from 11-73 years (mean= 39.92 + 14.85 years) while Group 2 consisted of 59 males and 41 females with an age ranging from 10-70 years (mean= 39.31 + 18.53 years). Results of FPS and VAS scores for injection and procedure were analyzed using independent t-test. Difference of scores for pain during injection were found to be significant (p < 0.05) while the scores for the procedure were seen to be statistically insignificant (p > 0.05) showing that transpapillary injection is equally effective for maxillary extractions as palatal injection but with significantly decreased pain during injection. CONCLUSION: Transpapillary injection is an easy and effective way of eliminating the pain of palatal injection for maxillary extractions.

Efficacy of intra-alveolar chlorhexidine gel in reducing frequency of alveolar osteitis in mandibular third molar surgery.

OBJECTIVE: To determine the efficacy of intra-alveolar administration of chlorhexidine (CHX) gel in reducing the frequency of alveolar osteitis (AO) after impacted mandibular third molar surgery. STUDY DESIGN: A randomized control trial study. PLACE AND DURATION OF STUDY: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from January to December 2007. METHODOLOGY: One hundred patients including 65 males and 35 females with the age range 18-40 years were divided in two equal groups (50 each in the CHX and the control groups). Surgical removal of impacted mandibular third molar was carried out and after surgery CHX gel was placed into the alveolus of CHX group. Patients were followed at the first, second and third postoperative days. A proforma indicating presence or absence of pain, blood clot disintegration, halitosis and AO was filled for each patient. Frequencies and percentages were calculated for qualitative data. Chi-square test was applied to compare both subgroups. RESULTS: Eighteen patients (18%) were diagnosed with AO (11 males and 7 females). Out of these 18 cases, 14 (28%) were found in control group (9 males and 5 females), while 4 cases (8%) in the CHX group (2 males and 2 females). This was statistically significant p=0.017. CONCLUSION: Single application of CHX gel was effective in reducing frequency of AO following mandibular third molar surgery.