Viability and Volumetric Analysis of Free Autogenous Dermis Fat Graft as Interpositional Material in TMJ Ankylosis: A Long-Term MRI Study.

AIMS AND OBJECTIVES: Dermis fat graft has shown good clinical results as an interpositional material in temporomandibular joint (TMJ) ankylosis and prevents heterogeneous calcification following gap arthroplasty. However, survival of the graft and volume retention is still debatable. The main purpose of our study was to assess the viability of the graft, tissues changes associated with the graft and volume retention using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Fifteen patients with TMJ ankylosis underwent gap arthroplasty followed by placement of abdominal dermis fat graft and were randomly divided into two groups. Group 1 was subjected to MRI analysis of the graft at 3-6 months and Group 2 was analyzed at 1-2 years post-operatively. The graft was evaluated using T1- and T2-weighed images along with fat suppression (FS) sequences in all the three planes and the volume was also calculated. RESULTS: Both Group 1 (7 patients and 11 joints) and Group 2 (8 patients and 13 joints) showed the presence of viable fat on T1 and T2 images, confirmed by FS images. Minor tissue changes were observed at the center of the graft in 5 patients of Group 1 and 3 patients of Group 2. Average volume of the graft was 4.154 cm3 at 3-6 months and 4.269 cm3 at 1-2 years, respectively, and when compared to the original volume of the graft (4.583 cm3 in Group 1 and 4.712 cm3 in Group 2), the difference was statistically insignificant (p > 0.005). CONCLUSION: MRI shows long-term survival of autogenous dermis fat graft without significant volumetric reduction. This along with positive clinical results make dermis fat an excellent choice as an interpositional material for TMJ ankylosis.

Abdominal Dermis-Fat Graft Versus Conventional Temporalis Myofascial Flap Interposition in Temporomandibular Joint Ankylosis: A Prospective Clinical Comparative Study.

INTRODUCTION: Temporomandibular joint (TMJ) ankylosis is an extremely disabling condition with almost complete inability to open the jaws causing difficulty in chewing, speech, poor oral hygiene and cosmetic disfigurement. Temporalis myofascial flap still remains the most common interpositional material used; however, patients usually complain of pain during movement, unesthetic bulging in the temporal region and trismus due to scar contracture. The main aim of the study was to evaluate the efficacy of abdominal dermis-fat graft and compare it with temporalis myofascial flap as to see which of the two grafts offers more advantages and provides better postoperative results following TMJ ankylosis surgery. MATERIALS AND METHODS: A total of 30 diagnosed cases of TMJ ankylosis were randomly divided into two groups of 15 patients each. All the patients underwent TMJ ankylosis release under general anesthesia followed by abdominal dermis-fat interposition in Group A and temporalis muscle in Group B. The patients were assessed for pre-operative and postoperative mouth opening (immediate and 6 month postoperative), pain during physiotherapy, donor and surgical site complications and recurrence of ankylosis. RESULTS: The mean maximum inter-incisal opening in dermis-fat group was significantly higher than temporalis group both at immediate and 6 month postoperative periods (p = 0.041, 0.001). Physiotherapy was less painful in dermis-fat group than in temporalis group, and the differences in VAS scores among the 2 groups showed high statistical significance (p < 0.001). Hypertrophic scar developed at the donor site in 2 patients in dermis-fat group; however, it was located below the beltline and hardly noticeable. A total of 9 patients (4 in Group A and 5 in Group B) developed temporary facial nerve weakness, and no case of re-ankylosis was noted in either group. CONCLUSION: Dermis-fat graft in temporomandibular joint ankylosis showed better results than conventional temporalis myofascial flap in terms of postoperative mouth opening, physiotherapy and jaw function with esthetically acceptable results.

Extraction in Patients on Oral Anticoagulant Therapy With and without Stopping the Drug: A Comparative Study.

AIM AND OBJECTIVE: The aim of this study was to compare postoperative hemorrhagic complications after dental extractions in two groups of patients receiving oral anticoagulants with one group receiving oral anticoagulant without interruption and another group stopping the drug 3 days prior to extraction. MATERIALS AND METHODS: A control group consisted of 30 patients who had stopped the oral anticoagulant 3 days before undergoing dental extractions, resulting in a reduction in the average preoperative international normalized ratio (INR) from 2.8 to 1.6. The study group of 30 patients received the anticoagulant drug without any alteration before extractions and had an average preoperative INR of 2.7. All extractions were done under local anesthesia on an outpatient basis, and local measures consisting of gelfoam and sutures were used in all cases to control postoperative bleeding from extraction sockets. RESULTS: None of the patients had any immediate postoperative bleeding, and only one patient from the control group and two patients from the study group had mild delayed hemorrhage which was easily managed with local measures. CONCLUSION: There is no need to alter the dosage of oral anticoagulants prior to dental extractions provided the INR is within the therapeutic range of 2.0-4.0, extractions are done in least traumatic manner and local measures are used to control postoperative hemorrhage, thereby reducing the risk of thromboembolic episodes in these patients.

The Safety and Effectiveness of Superficial Cervical Plexus Block in Oral and Maxillofacial Surgery as an Alternative to General Anesthesia in Selective Cases: A Clinical Study.

AIM: To assess the safety and effectiveness of superficial cervical plexus (SCP) block in oral and maxillofacial surgical (OMFS) practice as an alternative to general anesthesia in selective cases. SUBJECTS AND METHODS: The total number of patients was 10, out of which 6 were male and 4 were female patients. Five patients had incision and drainage of perimandibular space infections, two patients had enucleation of cyst in the body of mandible, one patient had open reduction and internal fixation isolated angle fracture, and two patients had submandibular lymph node biopsies. Informed & written consent were obtained from the patients after they had the procedure explained to them. Medically compromised patients and those who were excessively anxious and apprehensive, patient who did not want the procedure to be done under regional anesthesia, and patients with a history of allergy to local anesthetic were excluded. All patients had their surgical procedures under regional anesthesia (SCP block with supplemental nerve blocks) performed by the same surgeon under the supervision of anesthesiologist with continuous monitoring. RESULTS: SCP block with concomitant mandibular nerve and long buccal nerve block has a high success rate, low complication rate, and high patient acceptability as shown in the study. CONCLUSION: Superficial cervical plexus block anesthesia is a safe and useful anesthetic technique with the low risk of accidents and complications, thus a good alternative for regional anesthesia in selected cases in oral and maxillofacial surgery.

Healing Potential of Platelet Rich Fibrin in Impacted Mandibular Third Molar Extraction Sockets.

BACKGROUND: Healing of both hard and soft tissues have become one of the great challenges, faced in clinical research in development of bioactive surgical additives responsible for regulating inflammation and increasing healing. Platelet-rich fibrin (PRF) represents a new step in the platelet gel therapeutic concept with simplified processing minus artificial biochemical modification. AIMS AND OBJECTIVES: The aim of this study is to evaluate the effectiveness of PRF on soft-tissue healing and bone tissue healing in terms of postoperative pain, postoperative swelling, soft tissue healing, and the quality of bone healing at the mandibular third molar socket. MATERIALS AND METHODS: A clinical study will be done on patients reporting to the Department of Oral and Maxillofacial Surgery in Government Dental College, Srinagar, requiring disimpaction of bilateral mesioangular impacted mandibular third molars in 60 patients. RESULTS: The present prospective clinical study evaluates the effect of PRF in healing of mandibular third molar extraction sockets. There was no difference in the age gender and type of impaction between the two groups as the mean postoperative pain score (visual analog scale) was lower for the PRF group (Group A) at all points of time when compared with the control (Group B), and this was statistically significant (P < 0.05). The mean percentage swelling was lower for the PRF group (Group A) at all points of time when compared with the control (Group B). Evaluating the effect of treatments (with or without PRF) on lamina dura score shows that in both the groups at different time periods, significant (P < 0.001) difference was observed on lamina dura score. CONCLUSION: The results of the present study suggest that application of autologous PRF gel has a beneficial effect on the healing of extraction sockets after third molar surgery.

Multiple Dentigerous Cysts as a Rare Presentation of Maroteaux-Lamy Syndrome.

Maroteaux-Lamy syndrome is one of the genetic disorders involving disturbances in mucopolysaccaride metabolism, due to deficiency of aryl sulfatase-B which leads to accumulation of dermatan sulfate in tissues and their excretion in urine. The diseases has several oral and dental manifestations, is first diagnosed on the basis of clinical findings. It is characterized by coarse facial features, normal intelligence, organomegaly, enlarged head, short neck, corneal clouding, enlarged tongue, and prominent metachromatic inclusions in leukocytes. Death is usually a result of either respiratory tract infection or cardiac disease, which is caused by the deposition of mucopolysaccharides. An 18-year-old with Maroteaux-Lamy syndrome is described in this article with multiple dentigerous cysts as the first presentation.