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AIM: To evaluate and compare the anaesthetic efficacy of 0.75% ropivacaine and 0.5% ropivacaine with 2% lignocaine with 1:200000 Adrenaline (LWA) for surgical extraction of bilateral mandibular 3rd molars using Direct inferior alveolar nerve block (IANB). MATERIAL AND METHODS: Total of 60 outpatients of both sex,age group of 18-40 included in a prospective, randomized, single blind, split mouth clinical study after satisfying inclusion and exclusion criteria. Group I includes 30 patients and 0.75% ropivacaine as test drug, Group II includes 30 patients and 0.5% ropivacaine as test drug. In both group control drug was LWA.Parameters measured were onset of action, duration of action, systolic blood pressure, diastolic blood pressure, heart rate, visual analogue scale (VAS), faces pain scale (FPS). RESULT: Onset of action of 0.75%/0.5% ropivacaine (101.84 â± â16.92 âsecs/113.03 â± â12.77 âsec) was faster than LWA (Group I-218 â± â21.51 âsecs, Group II-196.47 â± â26.27 âsecs). Duration of action of 0.75%/0.5% ropivacaine (343.55 â± â16.44 âmins/319.03 â± â19.30 âmins) was longer than 2% Lignocaine with 1:200000 adrenaline (Group I I-173 â± â16.86 âmins, Group II-175.20 â± â18.02 âmins). In Group I - VAS/FPS of 0.75% Ropivacaine (0.97 â± â0.54/1.32 â± â0.65) was significantly lower as compared to LWA (2.90 â± â0.83/3.29 â± â0.69). In group II-VAS/FPS of 0.5% ropivacaine (1.40 â± â0.72/1.47 â± â0.50) was lower as compared to LWA (3.40 â± â0.89/3.30 â± â0.87). Mean systolic blood pressure, diastolic blood pressure, heart rate was lower for ropivacaine (0.75%, 0.5%) than LWA except mean heart rate higher for 0.75% ropivacaine at 10 âmin after injection. Else mean heart rate lower in other time interval. CONCLUSION: Ropivacaine (0.75%,0.5%) was more efficacious than 2% lignocaine with adrenaline (1:200000) it terms of all measured parameters in study.
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INTRODUCTION: Idiopathic gingival hyperplasia is a rare entity (about one in 1,75,000 individuals). It is characterized by a slow progressive benign enlargement, affecting the attached gingiva, marginal gingiva, and interdental papilla. PRESENTATION OF CASE: This case report highlights the management of an unusual case of long standing idiopathic gingival hyperplasia involving the right maxillary sinus. DISCUSSION: Management of gingival hyperplasia depends on the severity of the condition. In this case, surgical excision was performed in both the arches, that resulted in the creation of an oroantral communication, which was protected with a prefabricated custom-made acrylic stent. Despite having a visible raw area of epithelialization evident on the 2nd post operative day, there were no significant signs of recurrence even at a follow-up of 2 years post surgery. Many authors advocate extraction of involved teeth, in addition to the gingival excision, in the presumption of a permanent cure. CONCLUSION: The patient was satisfied with the resultant esthetic and functional outcome of the treatment. But, the possibility of recurrence cannot be ruled out, so the patient should be kept under close observation. She may also require subsequent surgeries, thus making psychological counseling mandatory.
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INTRODUCTION: In severe TMJ ankylosis cases, the lack of growth of the mandible creates an anatomically narrow airway with a reduced pharyngeal airway space [PAS] which predisposes these patients towards obstructive apnoea [OSA]. There is evidence in the literature that such patients experience severe discomfort during physiotherapy if such airway abnormalities are not corrected prior to ankylosis release. This eventually leads to non-compliance towards physiotherapy and increases the risk of re-ankylosis. OBJECTIVE: In our study, pre-arthroplastic mandibular distraction osteogenesis [DO] was used to increase the PAS and resolve the underlying OSA prior to releasing the ankylosis. MATERIALS AND METHODS: Twenty-five cases of TMJ ankylosis with micrognathia and OSA were included in this prospective observational sleep study. They were further divided into a paediatric group [14 subjects] and an adult group [11 subjects]. All cases presented with a history of onset of ankylosis during childhood [before the completion of craniofacial growth] as result of which there was a lack of forward growth of the mandible. Subjects included in our study underwent initial DO of the mandible followed by a second procedure for distractor removal and ankylosis release. Questionnaires, lateral cephalograms and sleep studies were taken pre-operatively (T0), immediate post-distraction to the desired length (T1) and 12 months post the distractor removal and ankylosis release (T2). The parameters studied were PAS width, apnoea hypopnea index [AHI], O2 saturation, mouth opening and mandibular advancement. RESULTS: The paediatric group variables were as follows: mean PAS width which increased from 3.5 mm [T0] to 9 mm [T2], mean AHI which decreased from 48.04 [T0] to 3.60 [T2], mouth opening which increased from 4.5 mm [T0] to 34 mm [T2] and mean O2 saturation which increased from 89.86% [T1] to 96.88% [T2]. The adult group variables were as follows: mean PAS width which increased from 5 mm [T0] to 11 mm [T2], mean AHI which decreased from 31.45 [T0] to 1.43 [T2], mouth opening which increased from 5 mm [T0] to 34 mm [T2] and mean O2 saturation which increased from 92.01% [T0] to 96.84% [T2]. Statistical analysis revealed that DO of the mandible significantly improved OSA by increasing the PAS which was evident by the lower AHI score. Mouth opening was also significantly improved post ankylosis release and maintained at the T2 interval. Ten subjects followed up beyond the T2 interval [mean 28 months post ankylosis release] and their data also revealed positive compliance towards physiotherapy, adequate mouth opening and maintenance of normal AHI. CONCLUSION: Pre-arthroplastic mandibular DO has proved to be a successful modality for treatment of OSA in TMJ ankylosis patients with stable results at 12 months. By resolving the narrow airway and OSA, compliance towards physiotherapy was improved thus reducing the risk of re-ankylosis in the long term.
