Efficacy of Silicone Gel in Healing of Lacerated Wounds in Maxillofacial Region-An Experimental Study.

Background: Face plays the most crucial part in defining personality and anything that hampers the facial esthetics foists a great amount of psychological impact. Hence, it is extremely important to manage the facial injuries efficiently and consider all the three elements of recovery, i.e., psychological, medical and esthetics. Purpose-To evaluate the efficacy of silicone gel in healing of lacerated wounds on face. Materials and methods: A sample size of 44 patients in each group undergoing suturing of contused lacerated wound (CLW) was calculated with P-67, q-52 and l-10 Using Formula, N = 4pq/l2 using Statistical Package for Social Sciences (SPSS) software version 23. Patients were divided into two groups, Group A and Group B where Group A was study group who applied silicone over sutured wounds, while Group B was control group who did not applied any gel. Results: In silicone group, a significant difference was observed between 7th day and 30th, 60th, 90th and 120th day in healing scores, while in non-silicone group, no significant difference was observed at the initial period. However, difference started to appear from 90th day and continued till 120th day. Conclusion: Silicone gel has considerable effect in healing of wound and prevention of unesthetic scarring when it is applied immediately from the day of suture removal and continued till 3 months.

Modified Eyelet Wiring: A Technical Note.

Introduction: The objective of establishing intra-operative occlusion by temporary inter-maxillary fixation remains constant even with evolving principles for the treatment of facial fractures. Material and Methods: In the novel technique, a pre-stretched 24- gauge round stainless-steel wire of six inches length is used. Results: The novel technique is a modification of the conventional eyelet wiring, which can achieve both horizontal stabilization and maxillo-mandibular fixation. Conclusions: We have devised a technique that overcomes the relative bulky and rigid arch bars which may not be welltolerated by the patients and the damage to the radicular structures during the placement of IMF screws.

Changing patterns of Oral & Maxillofacial injuries before and during COVID-19 pandemic: A retrospective study.

Introduction: Oral and maxillofacial injuries can be defined as injuries involving soft and hard tissue structures of the facial region and oral cavity, including the teeth and vital structures of the head and neck area as a result of trauma. The maxillofacial injuries are multifactorial and vary from one country to another and even from region to region. Despite, societal restrictions imposed by the government in the form of lockdowns and curfews, patients still experienced trauma and required significant healthcare services for management. Methods: Patients of either gender reporting to the emergency department of Lata Mangeshkar Hospital with maxillofacial injuries, attended by residents of OMFS from October 2019 to August 2020 were included in the retrospective study. The demographic data about age, gender and status pertaining to under the influence of alcohol was recorded. The aim of this retrospective study was to evaluate the changing patterns of the maxillofacial injuries during the Covid-19 pandemic. Results: In the present study, the road traffic accidents were 72.50% pre-lockdown which reduced to 47.37% during the alcohol ban and nationwide lockdown and gradually increased to 63.83% post-lockdown. The second most common cause of maxillofacial injury was falls which showed a significant increase from 22.50% before the lockdown to 31.58% during the lockdown and decreased to 26.6% after lockdown during the pandemic. There was an increase in the number of assaults from 2.50% pre-lockdown to 15.79% during the lockdown and again a decrease to 6.38% post-lockdown. Discussion: Our study demonstrates the impact of nationwide lockdown in the month of April and May 2020, may have an association with the significant statistical decrease in the monthly average number of trauma admissions. There was a significant decrease in the number of road traffic collisions and falls during the "lockdown period". Conclusion: The etiology and pattern of maxillofacial injuries reflect the trauma pattern within the community. We need more coordinated strategies of action to minimize maxillofacial injuries and its implication on physical and psychological wellbeing of patients.

ATOM technique: Anatomic reduction using screw-wire Traction for Open reduction and internal fixation of Mandibular fractures.

Various techniques are well documented to obtain anatomic reduction, such as reduction forceps, manual reduction, or a combination of these methods. However, these techniques have inherent drawbacks. We propose a new intra-operative technique for anatomic reduction using screw-wire traction for open reduction and internal fixation of mandibular fractures.

Management of a Giant Para-Pharyngeal Space Pleomorphic Adenoma of Deep Lobe of Parotid Gland Without Mandibular Swing Approach in a 17-Year Old Patient: Rare Case Report.

Pleomorphic adenomas comprise of 0.5% of all head and neck tumors. Pleomorphic adenoma affects patients from 4th to 6th decades. 10-12% of Pleomorphic adenomas arise from deep lobe of parotid gland that grow medially and involve the parapharyngeal space. Investigations play a role of paramount importance in treatment of para-pharyngeal tumors. CT scanning aids in evaluating the bone structures and possible calcification of the tumors. MRI provides precise tumor margins and the relationship of the tumor with its adjacent vital structures. The most common approaches to access these masses are the trans-oral, trans-mandibular, transcervical and trans-parotid trans-cervical approaches. Complete surgical excision of the lesion is the treatment of choice for such PPS tumors. The choice of surgical approach should enable the surgeon to maximize exposure for complete resection of the tumor while minimize functional and cosmetic morbidity. The various mandibulotomies are median mandibulotomy, para-symphyseal osteotomy, horizontal osteotomy, inverted 'L' osteotomy and double mandibular osteotomy. We report a rare case of giant pleomorphic adenoma arising from the deep lobe of parotid gland of the parapharyngeal space in a young patient. The excision was done in to without the mandibular swing approach making it one of the rare case reports.

Compliance of postoperative instructions following the surgical extraction of impacted lower third molars.

INTRODUCTION: The way postoperative care instructions are presented by the professional (verbal and/or written) is the key element that influences quality of treatment. Hence, the aim of the present study was planned to assess the patient's compliance with postoperative care instructions given in different forms following the surgical removal of impacted lower third molars. MATERIALS AND METHODS: Forty patients scheduled to undergo surgical extraction of impacted lower third molars under local anesthetic were randomly assigned to one of two groups. Before surgery, basic demographic data about age, gender, deleterious habits were recorded. Group A (verbal postoperative care instructions) and Group B (verbal + pictorial postoperative care instructions) were given with a prescription of medication after the surgical removal of impacted lower third molars. Patient were recalled on 7th postoperative day for suture removal and asked to fill the closed-ended questionnaire. RESULTS: Out of 20 patients in each group, one patient from Group A was eliminated as the patient did not turn for the follow-up visit. Therefore, result was based on 39 patients (19 males and 20 females) of age 28-41 years with a mean of 33.2 years (SD ± 3.3). The significance level was set at P < 0.05. The compliance of patients regarding gargling with lukewarm water and mouth opening exercises was seen more significantly in Group B (Pictorial + Verbal). CONCLUSION: Verbal instructions are inadequate due to difficulty in retention. Hence, a pictorial form of delivering postoperative instructions increases information retention which significantly increases pain relief without extending the analgesic consumption.

Infra-orbital nerve block using alar base approach: A novel landmark and technique.

The infra-orbital nerve block is given to anaesthetize the anterior part of maxilla by depositing the local anesthetic agent in proximity of the infra-orbital nerve foramen. The two intra-oral approaches well documented in the literature are the 'central incisor approach' or the 'bicuspid approach'. In 2011, Infra-orbital nerve block with extended coverage using the intra-oral 'molar approach' was employed. However, infra-orbital nerve block can pose a challenge in patients with no teeth. We have devised a novel landmark and technique for infra-orbital nerve block using the anatomical landmark alar base.

Finding a way for airway: a retrospective study.

BACKGROUND: Maxillofacial trauma is complex kind of injury that requires complex treatment, hence it is difficult in selecting the type of intubation technique depending on trauma. With the advent of various technologies and devices, surgeon and anesthetist should select right method of intubation that will benefit patient. METHODS: In a retrospective study, patients of either sex, admitted in Lata Mangeshkar Hospital under Oral and Maxillofacial Surgery unit for treating maxillofacial trauma operated during year 2018 to year 2019 as elective basis were studied. RESULTS: Of 78 patients, the majority (37, 47.4%) were in the 21-30 age group, followed by the young adults 31-40 years age group (19, 24.3%). Mandible fracture was found to be the most common injury in 35 patients (44.3%) followed by fracture zygoma in 26(33.3%) patients and panfacial in eight patients (10.2%). There was frontal bone fracture in three patients (3.8%). Fiberoptic intubation under sedation was carried out in 34 (43.5%) and submental intubation in 20 (25.6%) and nasal intubation with direct visualization of vocal cords in 14 (17.9%) and blind nasal intubation was performed in eight (10.2%). CONCLUSIONS: The results of this study suggest that the old concept of securing the airway in difficult situation by tracheostomy should be revised.

Management of Oral Myiasis Caused by Chrysomya bezziana - A Case Series.

Myiasis is a rare disease caused by infestation of tissue by larvae of flies. Oral myiasis is still rare and unique owing to the fact that the oral cavity rarely provides a necessary habitat for a larval life cycle. We discuss the definition, etiology, predisposing factors, classification, and management of myiasis. We hereby report a rare case of oral myiasis in a 75-year-old female with a history of maxillofacial trauma. She complained of pain in the lower lip and commissure region on the left side through which numerous live maggots (larvae) were seen crawling out. Postremoval of approximate seventy maggots resulted in lower lip defect along its commissure which was repaired by Bernard's modification of Gillies flap. Another case was an 18-year-old girl, a known case of congenital cerebral palsy with pain and swelling in the upper vestibule region. Prevention of myiasis involves addressing open wounds, maintaining good oral and personal hygiene, control of fly population, basic cleanliness of surrounding areas, and provision for basic sanitation and health education.