Comparison of Buccal and Lingual-Based Triangular Flap During Mandibular Third Molar Extraction for Reducing Postoperative Complications: A Randomized Controlled Trial.

Background: Surgical removal of the mandibular third molar requires reflection of the mucoperiosteal flap. Several studies have suggested different varieties and innovative designs for flap reflection. We have designed a randomized controlled trial (RCT) to check the feasibility of two flap designs: lingual-based triangular flap (LBTF) and buccal-based triangular flap (BBTF) by calculating the duration of surgery and evaluating postoperative complications such as pain, swelling, and trismus. Materials and Method: It was a non-inferiority parallel-group RCT. The trial was registered in the Control Trial Register of India (CTRI/2021/10/037182) and was performed according to Consolidated Standards of Registered Trial (CONSORT) guidelines. Intraoperative surgery time and postoperative pain, swelling, and trismus were measured and analyzed by a two-sample t test. The Chi-square test was used to measure gender distribution in the study. Result: Of the total of 88 required subjects, gender distribution and performed surgical time were statistically insignificant with a p-value of 0.76 and 0.48, respectively. The pain was significantly higher in the LBTF group in the 5th and 7th postoperative days with a p-value of 0.02 and 0.028. The swelling was statistically higher during all the follow-ups except for the 28th day in the LBTF group with values of 0.006, 0.002 and 0.003, respectively. There was no significant difference in inter-incisional distance (IID) between the groups during postoperative check-ups. Conclusion: LBTF shows no edge over BBTF during mandibular third molar disimpaction.

Evaluation of Functional and Esthetic Outcome of Patients After Reconstruction with Mandibular Reconstruction Plates Preceded by Resection of Benign Odontogenic Neoplasms of Mandible: A Cohort Study.

Large benign odontogenic neoplasms of mandible are not rare in developing countries such as India. Treatment of choice depends not only on extent and size of the lesion but also the socio-economic status, resources and available armamentarium. Whenever resection of segment mandible is planned for these patients, goal of the treatment should not be to restore function of the mandible alone but also to give esthetic visual appearance of the face. The present study was performed to determine postoperative functional and esthetic outcome in such patients. A total of 18 patients (20-35 years) with benign odontogenic neoplasm of mandible were enrolled for the study. After surgical intervention i.e., resection and reconstruction of mandible with mandibular reconstruction plate, all the patients were evaluated post-operatively for functional and esthetic outcome at the end of 1st and 4th week. Functional outcome were assessed based on Quality of life questionnaire and esthetic outcome based on vancouver scar assessment scale, clinical and radiological assessment. The mean scores of all the functional outcomes was improved significantly like pain, drooling of saliva, eating solid and liquid and speech except deglutition. The mean score of scar was recorded as 4.67. Occlusion was achieved in 100% and lips competency in 89% of patients. It is advised to immediately reconstruct the mandible after segmental mandibulectomy which eventually helps to improve the quality of life post-operatively of patients being treated for benign odontogenic neoplasm of mandible.

Prevalence and pattern of maxillofacial injuries and treatment outcome after bear attacks in Jharkhand population.

Introduction: Sloth bear, a native species of Indian subcontinent, has a population estimate of 1200-1500 in Jharkhand. Human habitats in proximity to forest reserve cause frequent human-bear interactions and thus bear attack injuries. Face is the most common site affected. This is a prospective study performed to evaluate the incidence and pattern of maxillofacial trauma after bear attack and the outcome of the treatment provided to them. Materials and Methods: Patients with bear attack injuries reporting to the outpatient department were recruited for the study. The incidence was recorded in terms of time, month, and site. Details of maxillofacial wounds and fractures were noted. The variables used to analyze the outcome of the treatment were ugly scar, facial asymmetry (eyelid, nose, cheek, and lips), facial nerve paralysis, loss of vision, and alopecia. Results: Majority of the cases were reported in April and March. Victims were from Ranchi 4 (26.6%), Gumla 3 (20%), Lohardaga 2 (13.3%), Latehar 2 (13.3%), Simdega 1 (6.6%), Ramgarh 1 (6.6%), Khunti 1 (6.6%), and West Singhbhum 1 (6.6%) districts of Jharkhand. Zygoma (10) was the most affected fractured bone, followed by frontal (9) and mandible (6). Minor ugly scar was found in 14 (93.3%) of the patients, postoperative facial deformity in 12 (80%), unilateral facial paralysis in 2 (13.3%), and alopecia patch in the scalp in 1 (13.3%). Conclusion: Spring and early summer are the breeding seasons of sloth bears in Jharkhand. Mahua petal which attracts the wild bear falls from trees during these months causing such human attacks. Loss of vision describes the mutilating nature of bear attack.

Incidence of Maxillofacial Trauma Amid COVID-19: A Comparative Study.

Introduction: Pandemic caused by novel coronavirus has created an unprecedented situation of lockdown in India. This retrospective study was undertaken to evaluate the impact of COVID-19 restrictions on cases of maxillofacial trauma and its etiologic variation by comparing it with the previous year archived data. Materials and Methods: Patients with maxillofacial fracture visiting during the lockdown period (Phase) were compared to the patient's record during the same time period in the year 2019 (Control). They were subcategorised based on the etiology of trauma, i.e., road traffic accident (RTA), self-fall, physical assault and animal attacks. Age and gender variations were also assessed. Degree of significance was calculated using t test and p value obtained. Result: Mean age of trauma patients during lockdown and control period was 32.66 and 27.93 years, respectively. Number of cases of overall trauma had significantly decreased. Cases of RTA and self-fall were 22 and 4 in lockdown compared to 135 and 16 during control phase. Cases of physical assault increased by 50%, i.e., from 9 to 6 on comparison of both the phases. Animal attack maxillofacial injuries were 2 in each group. Conclusion: RTA and subsequent drop in numbers of maxillofacial trauma can be shown as the benefit of lockdown nonetheless on the other side increase in number of physical assaults also shows how isolation and restrictions have psychological negative impact on society.

Significance of Microbial Analysis during Removal of Miniplates at Infected Sites in the Craniomaxillofacial Region - An Evaluative Study.

INTRODUCTION: Open reduction and internal fixation (ORIF) can be complicated by miniplate exposure, loosening, or infection. Infected miniplates lead to exposure, extrusion, fistula formation, bony nonunion, and osteomyelitis. Whenever any posttreated cases of ORIF become infected, it is treated blindly with a high dose of antibiotics and surgical removal of infected miniplates or screws. The aim and objectives of the study were to identify the frequency and site of infection in craniomaxillofacial implants and significance of microbes isolated from the infected region. MATERIALS AND METHODS: Removal of miniplates was being performed on 19 patients. Among them, 14 had infection or sinus opening, 3 had plate exposure, and 2 were removed asymptomatically according to patient willingness. Aspirated fluid/pus was collected and sent for microbial culture and sensitivity test. Test of significance of individual microbes was done using Z-test and the value of P was calculated. RESULTS: Among 14 patients associated with miniplate infection, 11 (78%) had infection in the mandible and 3 at zygoma. The bacteria isolated were mainly Staphylococcus aureus (7) along with coagulase-negative Staphylococcus (2), Pseudomonas aeruginosa (3), Escherichia coli (2), Streptococcus salivarius (2), and Acinetobacter genre (1). S. aureus was predominantly present in majority of the samples and statistically significant at P = 0.023. DISCUSSION: The present study observed that in contrast to other sites in the body, there is versatility in microbial flora in the craniomaxillofacial region. It is essential for routine microbial analysis of samples and antibiotic susceptibility test for proper treatment of such cases.

Pattern of mandibular third molar impaction and its association to caries in mandibular second molar: A clinical variant.

BACKGROUND: Caries in second molar is common and prophylactic removal of the impacted teeth may be considered appropriate. Caries detection and restoration can be difficult and a restored second molar can undergo recurrent caries if the third molar is not removed prophylactically. In this study, the clinical findings related to impaction and its association with angular position and depth of impacted third molar were evaluated. MATERIALS AND METHODS: A retrospective descriptive study was carried out among the patients visiting the outpatient, department of Dentistry, RIMS, Ranchi. The clinical examination, periapical radiographs and Pre-op OPG were taken. Teeth positions were analyzed by Pell and Gregory and Winter classification. The angulation and depth of mandibular third molar impaction and caries in the second molar with the eruption status of the mandibular third molar was determined. RESULTS: A total of 200 patients were included in the study between age group 17-45 years. Majority of the Patients reported to the hospital with complaints of decayed tooth (66%) and pain (59%). The most common third molar impaction was mesioangular followed by distoangular. A statistically highly significant difference (P = 0.001) was obtained with the presence of caries in second molar adjacent to mesioangular third molar in class I and level B. CONCLUSION: According to this study, pattern of mandibular third molar impaction is in association to caries in mandibular second molar. More future studies are needed. In addition, the results of the present study can be used to screen and inform the patients about the possibility of caries in relation to third molar mandibular impaction.

Effect of pretreatment and drying methods on quality of value-added dried aonla (Emblica officinalis Gaertn) shreds.

Value added dried Indian gooseberry (aonla) shreds were prepared using aonla fruits of cv. 'NA-7'. Two blanching methods (hot water and potassium metabisulphite (KMS) at 0.1%) and two drying methods (solar and hot air oven drying) were tried for the production of aonla shreds. Common salt, black salt and ginger juice were mixed for enhancing sensory quality of the product. The best product was obtained with KMS blanching and drying in solar dryer with added common salt at 3%. The most acceptable product had ascorbic acid content 298.3 mg/100 g, tannin 2.4%, acidity 2.6%, reducing sugar 3.0%, non-reducing sugar 21.0% and total sugar 24.0%. The recovery was 8.0-8.5%.

Human visceral leishmaniasis is not associated with expansion or accumulation of Foxp3+ CD4 cells in blood or spleen.

Natural regulatory T cells (CD4(+) CD25(+) Foxp3(+)), natural regulatory T cells (nTreg), play an important role in the regulation of inflammatory immune responses. However, the immunosuppressive properties of nTreg may unfavourably affect the host's ability to clear certain infections. In human visceral leishmaniasis (VL), reports on the frequency and function of nTreg are not conclusive. A limitation of our own previous studies that did not indicate a major role for Foxp3(+) nTreg in VL pathogenesis was that Foxp3 was measured by mRNA expression alone, as other tools were not available at the time. We have in this study assessed CD4(+)CD25(+)Foxp3(+) cells in splenic aspirates and peripheral blood mononuclear cells (PBMC) from an extensive series of patients with VL and endemic controls (EC) by flow cytometry (FACS). The results do not show increased frequencies of Foxp3(+) cells in patient with VL pre- and post-treatment, neither were they elevated when compared to PBMC of EC. We conclude that active VL is not associated with increased frequencies of peripheral Foxp3 Treg or accumulation at the site of infection.