Combating inadequate anesthesia in periapical infections, with sodium bicarbonate: a clinical double blind study.

INTRODUCTION: Local anesthetics are generally much less effective when administered in inflamed tissues. PURPOSE: This study was conducted to validate the addition of sodium bicarbonate in local anesthetics to increase its effectiveness as local infiltrations in teeth associated with periapical infections. METHODS: Two hundred subjects requiring extraction of maxillary teeth with periapical infections were enrolled. These subjects were divided in two groups of 100 subjects each. One group received local infiltration with 2 % lignocaine and 1:80,000 adrenaline, and the other group received local infiltration with sodium bicarbonate as an adjunct to the above mentioned local anesthetic solution. All extractions were performed using a consistent intra-alveolar technique by a single operator. Both the patient and the operator were blinded to the contents of local anesthetic solution. Data related to the onset of action of local anesthesia, pain experienced by the patient while undergoing extraction on two scales-"the visual analog scale and the verbal response scale", and any requirement of repeated injections during the procedure was recorded. RESULTS: Clinical and statistical data confirmed that the addition of sodium bicarbonate in local anesthetics did increase the efficacy of local anesthesia in inflamed tissues. CONCLUSION: It has been observed in this study that the action of sodium bicarbonate in local anesthetics increases the pH levels of these solutions, thus possibly making them more effective in an acidic environment.

Use of Platelet-Rich Fibrin over Skin Wounds: Modified Secondary Intention Healing.

The healing process after any surgical intervention has always posed a challenge for the surgeons. In spite of the advances in wound closure techniques and devices, there is a crucial need for newer methods of enhancing the healing process to achieve optimal outcomes. Fibrin adhesives and platelet concentrates have proven useful in various treatment modalities in the fields of microvascular and plastic surgery. This case report shows its unique use in the field of maxillofacial and cutaneous surgery. It shows an innovative technique of enhancement of skin wound healing by local application of platelet-rich fibrin.

An unusual occurrence of epidermoid cyst in the buccal mucosa: a case report with review of literature.

Intraoral dermoid and epidermoid cysts are rare and account for less than 0.01% of all the cysts in the oral cavity. A large majority of the same arise in the floor of the mouth and infrequently in other sites. These cysts often remain asymptomatic for years until they reach a size that interferes with mastication, speech and rarely, breathing. However, they also can become acutely symptomatic if they are secondarily infected. We would like to report a case of a rare epidermoid cyst in the buccal mucosa with its differential diagnosis and a review of literature.

Comprehensive management of a rare carcinoma ex pleomorphic adenoma of the lacrimal gland with a modified lateral orbitotomy access osteotomy. A case report.

BACKGROUND: Complete management of extraconal ocular tumors may require the joint efforts of a maxillofacial surgeon to provide access and an ophthalmic surgeon to completely excise the lesion. Pleomorphic adenoma is the most common benign tumor of the lacrimal glands, representing around 12% of the lacrimal fossa lesions. They may however undergo malignant changes. Carcinoma ex pleomorphic adenoma (CXPA), a type of malignant mixed tumor of the lacrimal gland has been rarely reported. CASE REPORT: We report a case of CXPA of the lacrimal gland in a 35-year-old male. He was managed by a modified lateral orbitotomy access osteotomy with complete removal of the lesion and showed postoperative uneventful recovery. DISCUSSION: Accurate clinical diagnosis of a neoplasm in the orbital cavity is important for correct therapeutic management. This paper emphasises on the comprehensive management of these lesions with a special emphasis on diagnosis and surgical technique.

Transient diplopia with ipsilateral abducent nerve palsy and ptosis following a maxillary local anesthetic injection: a case report and review of literature.

BACKGROUND: The posterior superior alveolar (PSA) nerve block is commonly used in dentistry for treatment of the maxillary molars. Although this procedure is associated with many complications, ocular complications have been rarely reported. CASE REPORT: This report details an iatrogenic paresis of the abducent nerve and partial palsy of the oculomotor nerve leading to diplopia, strabismus and ptosis following a PSA nerve block and extraction of maxillary right second molar. The patient was treated symptomatically, and the recovery was uneventful. Relevant anatomical pathways with review of literature are discussed. DISCUSSION: Although rare, the dentist should be aware of these complications to avoid being perplexed by this unexpected circumstance, thus adversely affecting the doctor-patient trust.

Adenoid cystic carcinoma associated with mucous retention cyst of the parotid gland.

Mucous retention cysts of the parotid gland are rare, and a coexistent adenoid cystic carcinoma is even an unusual occurrence. Such coexistent adenoid cystic carcinomas with mucous retention cyst of the parotid gland are difficult to diagnose clinically and, at times, stage difficulty in their management. We report a rare case of adenoid cystic carcinoma associated with mucous retention cyst of the parotid gland with its diagnostic and management dilemma in a 14-year-old adolescent girl.

Modified lateral orbitotomy approach: a novel technique in the management of lacrimal gland tumors.

Lateral orbitotomy is a well-known approach in the surgical management of lesions in the lateral orbital regions. It is still appropriate for laterally situated tumors, although contemporary cranial base approaches were defined and developed within the last decades. The extent of lateral orbitotomy should depend on the size, consistency, and nature of the lesion for easy surgical removal and reconstruction thereafter. In this regard, contrast-enhanced computed tomographic scans provide useful information for operative strategy. Although there is a wide range of histopathologic diagnosis for orbital tumors, lateral orbitotomy is a safe approach, particularly if the lesions are extraconal. We present a case of pleomorphic adenoma of lacrimal gland managed by a modified lateral orbitotomy approach with pleasing results.