Comparison of efficacy of sodium hyaluronate and normal saline arthrocentesis in the management of internal derangement of temporomandibular joints - A prospective study.

PURPOSE: The aim of the present study was to evaluate the efficacy of arthrocentesis with and without sodium hyaluronate (SH) injection in the treatment of patients with temporomandibular joint (TMJ) internal derangement. MATERIALS AND METHODS: The study consisted of 20 patients with chief complaints of limited mouth opening, TMJ pain, and jaw deviation. Patients with disc displacement with reduction and closed lock were randomly divided into two groups. In Group 1, only arthrocentesis was performed, and in Group 2, arthrocentesis plus intra-articular injection of SH was performed. Arthrocentesis was performed under aseptic conditions using normal saline. Clinical evaluation was done for maximum mouth opening (MMO), TMJ pain, and jaw deviation before the procedure and 1 week, 2 weeks, 1 month, and 3 months following arthrocentesis. RESULTS: The mean visual analog scale (VAS) score change was statistically significant in Group 1 and Group 2 for within the group analysis. There was statistically significant difference in VAS score between Group 1 and Group 2 at all time intervals postoperatively. The increase in MMO from preoperative to 3 months postoperatively was statistically significant for within the group analysis. There was a reduction in mandibular deviation in both Group 1 and Group 2, but the difference was not statistically significant. There was no statistically significant difference in deviation between the two groups. CONCLUSION: Arthrocentesis with SH is superior to arthrocentesis alone in treating patients suffering with TMJ internal derangement, who are refractory to conservative treatment.

6-0 nylon versus 6-0 vicryl rapide in chieloplasty.

CONTEXT: Facial cosmetic result is one of the most concerning issues for the parents who get their children operated for cleft lip. Moreover, the discomfort associated with the suture removal encourages one to use any new technology that may replace the need for suture placement. The type of suture material used in surgery has been a long-standing debate among surgeons. In this study, we compared rapidly absorbable suture material (Vicryl Rapide™) with nonabsorbable suture material (nylon). AIMS: The aim of this study is to compare the appearance and course of scar, wound infection, and patient's parent perception using Vicryl Rapide and nylon in nonsyndromic congenital cleft lip repair. SETTINGS AND DESIGN: This was a randomized prospective controlled clinical trial. MATERIALS AND METHODS: Twenty patients, in the age group of 3-18 months treated for unilateral congenital cleft lip deformity, were included and randomly allocated to two groups with ten patients each. Skin suturing was done with 6-0 polyamide and 6-0 irradiated polyglactin in Groups A and B, respectively. Patients were evaluated at 1 week, 1, 3, 6 months, and 1 year postoperatively in person by the observer as well as by the patient's parent. STATISTICAL ANALYSIS USED: Descriptive statistical analysis was done using SPSS 20, and Student's t-test was applied. RESULTS: It was found that Vicryl Rapide showed more hypopigmented scars and raised scars than nylon at the end of 1 year though overall appearance was comparable between the groups. CONCLUSIONS: Vicryl Rapide showed poorer cosmetic outcomes in terms of height and pigmentation of car as compared to nylon suture of same thickness. However, since scars tend to improve with time, a bigger sample size and a longer follow-up are required to generalize this statement.

Evaluation of Retro Mandibular Approach to Open Reduction and Internal Fixation of Condylar Fractures: A Cross-sectional Study.

PURPOSE: The present study was carried out to evaluate the usefulness of mini retromandibular approach on accessibility, scarring and stability in open reduction and internal fixation of sub condylar fractures. MATERIALS AND METHODS: Fifteen patients underwent open reduction and rigid fixation of middle and low subcondylar fractures, with mini-retro mandibular approach. RESULTS: No signs of infection were observed in any patient postoperatively. Surgical scar was imperceptible and esthetically acceptable in all the cases. Out of 15 patients, only one patient had discrepancy in occlusion and after 2 months satisfactory centric occlusion was achieved. Salivary fistula (parotid fistula) was observed in 3 cases within 1 week postoperatively, which was treated spontaneously with the use of hypertonic saline. Transient facial nerve weakness was observed in 2 patients, in one patient it resolved in 4 weeks postoperatively and in second patient 3 months postoperatively. Mouth opening increased in all the patients with time. Average mouth opening at 1 week interval was 19.6 mm, at 2 months interval 28.2 mm, and after 6 months 38.33 mm suggesting that mouth opening gradually increased with time. At the end of 2 months postoperatively none of the patients had any restriction in lateral movements. At 2 months postoperatively 4 patients had deviation but none of the patients had any deviation 6 months postoperatively. CONCLUSION: It is evident from the results of our study that open reduction and internal fixation using mini-retromandibular approach is good treatment option in management of mandibular condylar fractures.

Management of parotid fistula using hypertonic saline.

Parotid fistula is a very rare, unpleasant and painful complication following surgery in the maxillofacial region. Although there is consensus in the literature that acute parotid injury must be explored primarily and all injured structures be repaired accurately, the treatment of the chronic injury is controversial. Numerous methods of treatment, conservative as well as aggressive, have been described with varying success and morbidity. This paper presents a simple but effective and conservative method of treating this complication with the use of hot hypertonic saline.