Evaluation of Trigeminocardiac Reflex in Patients Undergoing Elevation of Zygomatic Fractures.

Aim Trigeminocardiac reflex (TCR) manifests as typical hemodynamic perturbations including a sudden lowering of heart rate, mean arterial blood pressure (MABP), cardiac arrhythmias, and asystole. In literature, TCR has been seen during ocular surgeries, Lefort fractures, and craniofacial surgeries. However, the prevalence of the TCR has not been studied in zygomatic complex fractures . The aim of this study was to assess the prevalence of TCR in patients undergoing elevation with/without fixation of zygomatic complex fractures and isolated zygomatic arch fractures under local anesthesia and general anesthesia and to evaluate the prevalence of TCR in different age groups. Materials and methods The study comprised 26 participants diagnosed with zygomatic fractures indicated for surgical intervention. The aim of the study was to find the prevalence of TCR in patients undergoing surgical intervention (elevation of zygomatic complex fractures with/without fixation) under local anesthesia and general anesthesia. The heart rate and blood pressure were measured preoperatively, intraoperatively and postoperatively. Results Variation in heart rate was seen in patients undergoing surgery under local anesthesia and general anesthesia. However, a decrease in the heart rate i.e., bradycardia was noted intra-operatively in 75% of the patients operated under local anesthesia. The prevalence of TCR was noted intra-operatively in 23% of cases operated under general anesthesia. No significant changes were seen in the blood pressure of the patients. Conclusion In our study, we found out that the prevalence of TCR was more in the patients operated under local anesthesia i.e., 75% of patients. Out of the patients operated under general anesthesia i.e., 23% of patients showed TCR. No significant variations in blood pressure were observed in patients operated under local anesthesia or general anesthesia. The prevalence of TCR was found more often in the age group of 31-45 years in our study.

Evaluation of Infraorbital Nerve Recovery and its Effect on Quality of Life following Open Reduction and Internal Fixation of Zygomaticomaxillary Complex Fractures - An Evaluative Study.

Introduction: The zygomaticomaxillary complex (ZMC) fractures are the second most common fractures affecting the midfacial skeleton. Neurosensory disturbances of the infraorbital nerve are one of the most common signs of ZMC fractures. The aim of the study was to evaluate the neurosensory recovery of the infraorbital nerve and its effect on the quality of life (QoL) following open reduction and internal fixation of ZMC fractures. Methods: Thirteen patients clinically and radiologically diagnosed with unilateral ZMC fractures with neurosensory deficits of the infraorbital nerve were enrolled for this study. All patients were assessed presurgically for neurosensory deficits of the infraorbital nerve using the various neurosensory tests, followed by open reduction with two-point fixation under general anaesthesia. The patients were followed up at one, three and six months postoperatively to evaluate the recovery of neurosensory deficits. Results: Recovery of tactile and pain sensation was relatively complete in 84.62% and 76.92% of patients respectively by the end of six months postoperatively. The spatial mechanoreception of the affected side improved significantly. 61.54% of patients led an excellent QoL six months postoperatively. Discussion: The majority of the patients with ZMC fractures and neurosensory deficits of the infraorbital nerve, when treated with open reduction and internal fixation, have complete recovery of the neurosensory deficits by the end of six months postoperatively. However, some patients may continue to experience some long-term residual deficits, which can affect the patient's QoL.

Use of Marsupialisation for a Conservative Approach to Huge Cystic Lesions of the Jaws - A Report of three Cases.

Rationale: The management of cystic lesions of the jaws presents a challenge to the surgeon. Marsupialisation, one of the conservative management options, has been used as a single or combined surgical treatment modality for the cystic lesions of the jaws. Patient Concerns: All patients presented with a complaint of a firm swelling of the face with one of the patients presenting with paraesthesia in the affected area. Diagnosis: Clinical and radiographic examination was carried out followed by aspiration cytology. All lesions were provisionally diagnosed with odontogenic cystic lesions. Treatment: Marsupialisation under general anaesthesia was carried out for all patients. Postoperatively, a customised obturator was fabricated. Outcomes: All the patients showed good radiological ossification postoperatively. Take-Away Lessons: The approach to larger cysts remains controversial. The long-term results following the marsupialisation of extensive cysts of this report may help surgeons to opt for a conservative approach to such lesions before aggressive options.

Maxillary and mandibular unusually large radicular cyst: A rare case report.

Radicular cysts are the most common odontogenic cyst. It is an inflammatory cyst associated with the root apex of a nonvital tooth. Most radicular cysts are small but can reach a large size causing displacement of surrounding structures. Here, we present a rare case of huge radicular cyst in both maxilla and mandible in a 36-year-old patient.