Maxillofacial Injuries in an Eastern Nepal Tertiary Hospital.

BACKGROUND: Maxillofacial injury is a major health problem, and injury patterns vary in different societies. The purpose of the present study was to evaluate the pattern of maxillofacial injuries presenting to BPKIHS. METHODS: Patients with age >15 years presenting with maxillofacial injuries from May, 2019 to April, 2020 were included in this cross-sectional descriptive study. Demographic profile, etiology, delay in presentation, pattern of soft tissue/ bony/ dental injuries, treatment modality were recorded and analyzed using Microsoft excel. RESULTS: Within one year study period 190 patients with age group >15 years presented with facial injuries. There were 164 male (86.32%) and 26 female (13.68 %) patients (M:F=6.3: 1) with mean age of 34.96 years. Road Traffic Accident (RTA) (61.58%) was the most common etiology. Majority of the patients reported to hospital within 2-6 hrs of injury. Other associated injuries was present in 36.32 % of patients with orthopedic injury (60.87%) being common. Soft tissue injuries were seen in 80.53% patients, of which 49.02% were associated with facial fractures. Mandible fractures were seen in 56.19% of hard tissue injuries, of which 40.68% had multiple fractures followed by 28.81% with parasymphysis fracture. Within 37.14% patients with midface fractures, zygoma fracture (33.33%) was the commonest. Intervention was done in 80.95 % patients, with ORIF (72.38 %) being the commonest. Dentoalveolar injuries was seen in 22.63 % patients, of which 48.19% were associated with facial fractures. CONCLUSIONS: Our observations show that motor vehicle accidents were the most frequent cause of maxillofacial injury.

Tension orbit secondary to a carious primary molar-A case report.

Though rare, a pediatric dentist should have background knowledge of this kind of presentation which can greatly affect their patient's quality of life and leave them with a significant deficit at a very young age.

A Comparative Study of the Effect of Sutureless Versus Multiple Sutures Technique on Complications following Third Molar Surgery in Nepalese Subpopulation.

OBJECTIVE: To compare the effect of sutureless versus multiple sutures technique on postoperative variables such as pain, swelling, and trismus after surgical removal of the third molar in Nepalese subpopulation. Materials and Methods. Forty-eight patients were equally grouped into multiple sutures (group 1) and sutureless (group 2) groups using a computer-generated random table. The same operator performed all the surgical procedures. Postoperative variables such as pain, swelling, and trismus were measured by a single concealed observer using a 10 cm Numerical Rating Scale (NRS), flexible plastic measuring tape, and vernier caliper preoperatively and on 1st, 2nd, and 7th postoperative days. RESULTS: This study showed significantly more swelling measured from the gonion to lateral canthus in group 1 than in group 2 on all postoperative periods (P < 0.05). The mean NRS score was significantly higher in group 1 on the 1st postoperative day (P < 0.05). The mean NRS score was significantly higher in group 1 on the 1st postoperative day (. CONCLUSION: Our results support the use of sutureless technique after third molar surgery to minimize postoperative morbidity and the overall operative time and reduce the cost within the Nepalese subpopulation.

Practice of Oral and Maxillofacial Surgery in Nepal: Its Scope and Influencing Factor.

OBJECTIVES: Oral and maxillofacial surgery is a relatively newer and growing specialty of dentistry in Nepal whose scope is not yet estimated. The objective of this study was to estimate the scope and the factors influencing the scope of oral and maxillofacial surgery in Nepal. STUDY DESIGN: In this cross-sectional study, all the oral and maxillofacial surgeons who were registered in the Nepalese Association of Oral and Maxillofacial Surgeons (NAOMS) were included (purposive sampling). The structured questionnaires were distributed to them, the collected data were entered in Microsoft excel 2010, and variables were analyzed using descriptive statistics (percentage) by SPSS 16.0. RESULTS: Out of 46 questionnaires distributed, 35 were responded and returned (response rate = 76%). Majority of participants (77.1%) were in 30-39 years of age group. Male to female ratio was 4 : 1. More than half (68.6%) of the participants had practice experience of <5 years, and none had practice experience of >20 years. The ratio of the surgeons practiced in Medical/Dental Teaching Hospital to those in Government Hospital was 3 : 1. Sixteen (45.7%) participants practiced in Capital Valley and none in Far-Western Development Region. Traumatology was practiced by thirty-four (97.1%) participants although only twenty-three (65.7%) participants had primary interest in it. Each of oncology, orthognathic surgery, implantology, and cleft lip/palate surgery was performed by <8% of the participants. Common factors influencing the practice were inadequate training (71.4%) and insufficient facilities/infrastructures (45.7%). CONCLUSION: The scope of oral and maxillofacial surgery is limited in Nepal, and oncology, implantology, cleft lip/palate, and orthognathic surgery have received little attention.

Use of traction screw to aid in fracture reduction in bilateral parasymphysis fracture of mandible.

Treatment of bilateral parasymphysis fracture often requires special attention due to airway considerations and difficulty in achieving precise anatomic reduction. The central fracture fragment is often displaced posteriorly and inferiorly due to muscle pull, and this adds to difficulty in reduction and stabilization of the central fracture fragment during plate fixation. With this article, we advocate a technique using stainless steel screw and self-holding screwdriver to manipulate the central fragment and achieve an anatomic reduction. We have used this technique in 12 patients with bilateral parasymphysis fracture without any complications and have found it very effective.

Use of cervical collar in temporomandibular dislocation.

Dislocation of the temporomandibular joint represents 3 % of all reported dislocated joints. In the last 3 decades many cases of TMJ dislocation have been reported with a wide variety of treatment options ranging from non-surgical conservative approaches to open joint procedures. The question remains whether one method is superior to the others. Conservative treatments are still the option in this part of the continent due to financial constraints and as well as due to availability of skilled manpower. A variety of conservative techniques have been described for reducing dislocations, all of which require 10-14 days of immobilization of the jaw post reduction so as to prevent further episodes of dislocation. Immobilization of the jaw can be done in the form of barrel bandage, barton bandage, head chin cap or maxillomandibular fixation using arch bars. We suggest the use of a cervical collar as a form of post reduction immobilization technique to overcome the inherent disadvantages of conventional forms of immobilization techniques.

Intubation techniques: preferences of maxillofacial trauma surgeons.

OBJECTIVE: To evaluate the clinical outcomes of alternative techniques of intubation in patients sustaining maxillofacial injuries, where nasotracheal intubation (NTI) is best avoided. MATERIAL AND METHODS: Alternative techniques to standard naso-tracheal intubation like submental intubation, orotracheal intubation-retrotuberosity/retromolar and missing dentition were used and variables of clinical outcome recorded. RESULTS: Submental intubation provides an unobstructed intraoral surgical field, avoids intraoperative and postoperative complications of tracheostomy, and overcomes the disadvantages of NTI. In our experience with submental intubation (6 cases), we only had complication related to tube apparatus like damage to pilot balloon. With retrotuberosity intubation (5 cases) we did not encounter any complications and the only limitations were bulbous maxillary tuberosity. Retromolar intubation (4 cases) a safe noninvasive technique has disadvantages like tube interference within the surgical field and not feasible in case of limited retromolar space. Orotracheal-missing dentition intubation (4 cases) is of great advantage i.e. it can be used in cases where NTI is contraindicated, no specialized skill required, no added cost, avoids the need for tracheostomy, no extra-oral procedures required and does not interfere with occlusion/MMF; with disadvantage of occasional tube interference within the surgical field. CONCLUSION: Preferred techniques of securing an airway like orotracheal, nasotracheal may not always be applicable, thus a trauma surgeon-anesthesist team should always have alternative techniques in their armamentarium to reduce the morbidity associated with these patients without interference with occlusion, which is prime goal in jaw fracture reduction. We have used these techniques in a country with limited resources and found them equally effective and convenient to use.