Search

Objective To compare intra-operative and postoperative outcomes between the single-puncture and the standard double-puncture techniques of arthrocentesis. Methods PubMed, Embase, ScienceDirect and CENTRAL databases were searched from inception up to 31st August 2020. Randomised controlled trials (RCTs), prospective and retrospective studies conducted on patients with temporomandibular joint disorders comparing any type of single-puncture arthrocentesis with standard double-puncture arthrocentesis and reporting intra-operative/postoperative outcomes were included. Assessment of the risk of bias was done with the Cochrane Collaboration risk assessment tool. Results Thirteen studies were included (12 were RCTs). Analysis of a limited number of studies indicated no difference in pain or maximal mouth opening (MMO) between the single-puncture type-1 or type-2 and the double-puncture technique at various follow-up intervals. Pooled analysis (four studies) demonstrated that the single-puncture type-2 technique requires significantly less operating time as compared to the double-puncture method. No such difference was noted between single-puncture type-1 and double-puncture techniques. Analysis of two studies indicated significantly reduced intra-operative needle relocations with the single-puncture techniques. Studies were not of high quality with concerns of bias in randomisation, allocation concealment and blinding. Conclusions Limited data indicate no difference in pain or MMO with single- or double-puncture techniques of arthrocentesis. Amongst the three techniques, the single-puncture type-2 technique has the advantages of significantly lower operating time and reduced intra-operative needle relocations and it may be the preferred method of TMJ arthrocentesis in clinical practice.

The aim of the study was to evaluate the effectiveness of buccal fat pad (BFP) in the reconstruction of surgical defects following sequestrectomy in medication-related osteonecrosis of the jaws (MRONJ). A total of ten patients with MRONJ underwent sequestrectomy and reconstruction using BFP. There were 3 males and 7 females. The age range was 20-70 years. Two patients were diagnosed with stage 2, and eight patients were diagnosed with stage 3 disease. Eight defects were present in the maxilla and two in the posterior mandible. Oro-antral communication was present in 8 cases. All patients have undergone sequestrectomy, debridement and reconstruction using BFP under local anaesthesia. Postoperatively, the patients were followed up at 1, 3, 6 and 12 months and evaluated for complete epithelisation of defect, infection, pain and recurrence of the lesion. Complete epithelisation with closure of the defect was achieved in all the cases. None of the patients had residual pain or inflammation at the surgical site. There was no case of postoperative infection. Reconstruction using buccal fat pad is an effective treatment modality to provide symptomatic relief and to prevent further progression of disease in MRONJ patients.

The aim of the study was to evaluate the effectiveness of seagull-shaped nasolabial flap (NLF) along with adjunctive short-term oral pentoxifylline in the surgical reconstruction of oral sub mucous fibrosis (OSMF) following fibrotomy. We retrospectively evaluated 18 patients with grade IV oral sub mucous fibrosis treated by NLF. There were 3 females and 15 males. All patients were classified as stage IV OSMF with a mean preoperative mouth opening of 8.11±3.38mm. Postoperatively, patients were administered 400mg of pentoxifylline (PTX) thrice daily for 3 months. Patients were followed up at one month, six months and one year. Mouth opening, presence or absence of malignant transformation, relapse and complications were recorded at each follow-up. We found statistically significant increase in mouth opening from 8.11±3.3 to 37.67±3.74 in the postoperative period. The complications associated with NLF were very minimal. The PTX was well tolerated by all the patients. There was no incidence of relapse or rebound fibrosis seen in our series. To the best of our knowledge, this is the first time that oral pentoxifylline has been administered along with surgical treatment of oral submucous fibrosis to prevent relapse. The use of oral PTX as an adjunct along with surgical reconstruction in OSMF improves mouth opening, reduces burning sensation and relapse.

Evidence of differences in operator-related outcomes between single and double puncture arthrocentesis is limited. The purpose of this prospective study was to compare intraoperative outcomes with single puncture types 1 and 2, and double puncture, arthrocentesis. A total of 59 patients with 60 temporomandibular joints (TMJ) were treated sequentially by single puncture type 1 (n=20), single puncture type 2 (n=20), and double puncture arthrocentesis (n=20). Total operating time, incidence of dislocation of the needle, preauricular swelling, and ease of operation were compared. Single puncture type 2 arthrocentesis took significantly less time than type 1 (p

Insertion tendinosis of stylomandibular ligament (SML) or Ernest syndrome is a very rare and under reported head and neck pain disorder. The pain originates from the insertion of stylomandibular region and radiates to the temple, lateral side of the neck and temporomandibular joint (TMJ). The diagnosis is confirmed by palpation of SML and local anesthetic block at the insertion of SML. The authors report 4 patients who presented with chronic pain which radiated to the TMJ and temple and did not respond to conservative management. All patients after diagnosed with Local anesthetic block were given methylprednisolone injection at the insertion of SML. Complete remission of pain was seen at 12 months of follow up without any recurrence. Craniofacial surgeons involved in the treatment of various head and neck pain should include this less documented syndrome in their differential diagnosis when treating TMJ disorders.

Background & aim Gun-shot trauma inflicted to the maxillofacial region results in multiple injuries which significantly impacts management and reconstructive options. The authors investigated the efficacy/outcomes of primary management of maxillofacial trauma inflicted in ballistic injuries. Methods This is a retrospective descriptive study carried out solely at 15 Corps Dental Unit, a tertiary care military hospital at Srinagar between the year 2016 & 2017. At the time of enrolment age, gender, extent of injury and definitive diagnosis were recorded. Other information such as type of surgery, hospital stay was taken from in-patient hospital record documents. An informed consent was taken from all patients. Results A total of 16 patients (all males) with a mean age of 29.6 ± 4.2 years were part of our study. The average time interval between trauma and surgery was 7 to 10 days. There was striking high prevalance of mandibular injuries in 62.5% patients, 18.7% patients having combined maxilla-mandibular defects and 12.5% patients with injuries around the mid-face. Complications such as immediate airway compromise were seen in 50% of the patients who suffered direct airway trauma necessitating tracheostomy. The 43.7% patients suffered nerve injuries at the time of presentation while 56.2% patients suffered scar contracture noted at follow-up of 1 year. One patient suffered a stellate wound with ragged and torn edges and also trauma to the parotid gland. Other salivary gland injuries were also noted in 18.7% patients. Reconstruction using local flaps was done in 3 patients of our series. The mean duration of hospital stay was 43.3 ± 33.5 days. An average follow up ranged from 12 ± 6 months. Conclusions Early and appropriate intervention to preserve and stabilise the facial skeleton and reconstruction of the facial soft tissue envelope in high-velocity ballistic injuries is highly effective and yields superior functional and esthetic outcomes.

Reconstruction of midface defects are extremely challenging owing to the lack of suitable vascularized local flaps. The temporoparietal fascia and temporalis muscle flaps make excellent choices for midface and orbito-maxillary reconstruction. The muscle provides adequate thickness while the fascia yields pliable soft tissues for lining the midface. The temporalis muscle can be divided antero-posteriorly in three parts and medio-laterally in two parts without losing its vascularity due to its segmental vascular supply. These versatile flaps can be used independently, combined or as chimeric flap based on its axial blood supply for the reconstruction of midface. When designed as a chimeric flap it makes an excellent choice for the reconstruction of composite midface defects. With the advent of micro vascular reconstruction these regional flaps are rarely used in maxillofacial reconstruction. We hereby present a case of composite orbito-maxillary defect reconstruction using a novel chimeric reverse temporalis muscle and temperopareital fascia flap with pedicled split calvarial bone.

Objective The aim of this systematic review was to assess the efficacy of splint therapy in improving outcomes after arthrocentesis for the management of temporomandibular joint disorders. Study Design A comprehensive electronic search was conducted to search for randomized control trials, controlled clinical trials, and retrospective studies comparing arthrocentesis and splint therapy with arthrocentesis alone. Results Six studies were included in this review. There was no statistical significant difference in pain reduction with or without the use of splint after arthrocentesis at 1 month (fixed: weighted mean difference [WMD] = –0.01; 95% confidence interval [CI] –0.46 to 0.44; P = .96; I2 = 0%) and 6 months (fixed: WMD = –0.08; 95% CI –0.27 to 0.42; P = .66; I2 = 0%). Similarly, no difference was seen in improvement in maximal mouth opening at 1 month (fixed: WMD = –0.16; 95% CI –1.75 to 1.42; P = .84; I2 = 44%), and 6 months (fixed: WMD = –0.83; 95% CI –0.52 to 2.18; P = .23; I2 = 0%). Conclusions Within the limitation of this review, there is some evidence that splint therapy may not improve outcomes after arthrocentesis. There is a need for well-designed RCTs evaluating the additional benefit of splint therapy after arthrocentesis for managing temporomandibular joint disorders.

Facial nerve palsy is an exceedingly debilitating condition, incapacitating functional and aesthetic facets of the face. Orthodromic transfer of temporalis muscle is an easy and predictable technique which offers early animation of oral commissure and lower face. A retrospective chart review of 6 patients of facial palsy treated with orthodromic temporalis tendon transfer for facial reanimation is presented. The technique consisted of intra-oral coronoidectomy followed by attachment of fascia lata grafts from the coronoid to the commissure, the upper and lower lips via small cutaneous incisions. Contraction of the temporalis, pulls the fascia lata extensions thereby reanimating the lower face. 4 male and 2 female patients with an age range of 25 to 49 years were treated. Simultaneous fat grafting (2 patients), depressor labi inferioris muscle resection (2 patients) and wedge excision of nasolabial fold (2 patients) was done as ancillary procedures. Post-operative smile evaluation was carried out using the Terzis and Noah facial grading system. Patients were asked to smile with and without biting, and photographs and video were taken. The results were graded from 1 to 5 based on a 5-point scale (ie, poor, fair, moderate, good, and excellent) by an independent observer. The results were excellent in 1 patient (Terzis grading 5/5) and good in the remaining 5 patients (Terzis grading 4/5). Excursion of the oral commissure ranged from 6 to 10 mm. Our experience indicates that temporalis tendon transfer for facial reanimation has a short learning curve and provides early predictable outcome without significant complications. This single-stage, day-care procedure can be easily incorporated by maxillofacial surgeons to expand their surgical spectrum.

The aim of our study was to evaluate the effectiveness of buccal fat pad (BFP) in the management of oral submucous fibrosis (OSMF). Retrospective records of 30 patients of OSMF treated with BFP with atleast a year of follow-up were analyzed. Patients were divided into groups based on the stages of OSMF. Surgical management consisted of resection of fibrous bands, bilateral temporalis myotomy, and coronoidectomy followed by grafting with BFP. There were 17 patients of stage III (mouth opening 16–25 mm) and 13 patients of stage IV OSMF (mouth opening less than 16 mm). The mean mouth opening of stage III group pre-operatively was 19.94 ± 2.19 mm which increased to a mean of 35.12 ± 5.69 mm (p

The aim of this review was to assess the efficacy of intra-articular analgesics in improving outcomes after temporomandibular joint (TMJ) arthrocentesis. An electronic search of PubMed, Scopus, and Google scholar databases was performed for papers in English published up to December 2017 reporting the use of intra-articular analgesics after TMJ arthrocentesis. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), comparative studies, retrospective studies, and case series were included while case reports, technical reports, animal studies, cadaveric studies, and review papers were excluded. Of the six studies included in the review, three were RCTs, two were randomized comparative studies, and one was a retrospective study. Both opioids and non-steroidal anti-inflammatory drugs have been used after TMJ arthrocentesis. Morphine, tramadol, fentanyl, buprenorphine, tenoxicam, and COX-2 inhibitors are the drugs used till date. Placebo-controlled studies reported improved outcomes after TMJ arthrocentesis with morphine and fentanyl but no such results with buprenorphine and tenoxicam. Tramadol was found to be better than COX-2 inhibitor. The quality of literature was not high. There is inconclusive evidence in literature on the benefits of using intra-articular analgesics after TMJ arthrocentesis. Well-designed high-quality RCTs with standard protocol studying the effects of intra-articular opioids and NSAIDS after TMJ arthrocentesis would provide stronger evidence on its use.

Objective The aim of the systematic review was to analyse the available evidence in order to assess the efficacy of dextrose prolotherapy in improving outcomes in temporomandibular joint (TMJ) hypermobility patients as compared to placebo. Methods An electronic search of PubMed, Scopus, CENTRAL and Google scholar databases was performed for English language papers published up to February 2018. Randomised clinical trials (RCTs) and controlled clinical trials (CCTs) comparing dextrose prolotherapy with placebo for TMJ hypermobility were included. Results Three RCTs were included in the review. Frequency of subluxation/dislocation was reported by two trials which found no difference between dextrose and placebo. A statistical significant difference in reduction of MMO with the use of dextrose prolotherapy was seen on pooling of data (random: MD = -3.32, 95% CI -5.26 to -1.28; P = 0.0008; I2 = 0%). A statistical significant difference in pain reduction was also seen with dextrose as compared to placebo (random: MD = -1, 95% CI -1.58 to -0.42; P = 0.0007; I2 = 0%). Conclusion Within the limitations of the study, dextrose prolotherapy may cause significant reduction in mouth opening and pain associated with TMJ hypermobility. Conclusions with regard to reduction of episodes of subluxation/dislocation cannot be drawn. There is a need of more high-quality RCTs with larger sample size and homogenous prolotherapy protocol to draw stronger conclusions on the effect of dextrose prolotherapy in patients with TMJ hypermobility.

Pterygoid hamular bursitis is a rare craniofacial pain syndrome used to describe palatal and pharyngeal pain due to an enlarged pterygoid hamulus. The pterygoid hamulus is a hook-shaped bony process located bilaterally on each medial pterygoid plate of the sphenoid bone, posterior and medial to each maxillary tuberosity. These processes project downward and anterolaterally; serve as attachment for ligaments and a network of muscles. It can be palpated in patients with a finger palpating the posteromedial to maxillary tuberosity. The pathogenesis is elusive and varies from bursitis of tensor veli palatine, elongated pterygoid hamulus, persistent trauma to the mucosa overlying the pterygoid hamulus. The clinical features include strange chronic sensation, burning, swelling, and erythema of the pterygoid hamulus region. The pain often radiates to pharynx, ipsilateral face and sometimes radiating to temporal region making it difficult to diagnose from headache, temporomandibular disorders, and dental infections like pericoronitis. The anatomical neighboring structures in relation to oropharyngeal region may give a misleading diagnosis to dentist in case of pterygoid hamulus bursitis. The understanding of pterygoid hamulus anatomy and its relation to surrounding structures is necessary to get the correct diagnosis of the inflammatory or traumatic pain in oropharyngeal region.

The aim of the study was to evaluate the effectiveness of sublingual gland flap in the reconstruction of surgical defect following sequestrectomy in medication induced osteonecrosis of jaws (MRONJ), osteomyelitis (OML), and osteoradionecrosis (ORN) of mandible. A total of 6 patients with MRONJ (n = 4) osteomyelitis (n = 1) and ORN (n = 1) underwent sequestrectomy and reconstruction with sublingual gland flap. There were 03 males and 03 females. The age range was 45-71-70 years. All defects were present in the posterior mandible. All patients' undergone sequestrectomy, debridement, and reconstruction with sublingual gland flap under local anesthesia. Postoperatively patients were followed up at 1, 3, and 6 months. Patients were monitored for complete epithelization of defect, infection, pain, and recurrence of the lesion. Complete epithelization with closure of the defect was achieved in all cases. None of the patients had residual pain or inflammation at the surgical site. None of our patients experienced any donor site morbidities. There was no case of postoperative infection. Reconstruction of intraoral defects using sublingual gland flap is an effective treatment modality to reconstruct small to medium sized defect of oral cavity.

Trauma to the naso-orbito-ethmoid region invariably results in detachment of medial canthal tendon. The shape of medial canthus is of important esthetic and functional concern. Accurate reposition of the medial canthus is important to achieve normal form and function. The various available techniques advocate open approach leaving an obvious scar in the esthetically prominent region. This technique intends to address these fractures through a closed approach with the possibility to make finer adjustments as and when required. We report the experience of treating 4 naso-orbito-ethmoid fractures with a new innovative technique with predictable results.

Migraine surgery has been recently reported as an alternative to medical management to provide long-term relief in migraine sufferers. A prospective study was designed wherein patients diagnosed with migraine were screened for surgery by injecting botulinum toxin type A at the primary trigger site. Surgery consisted of corrugator supercilii muscle resection to decompress supra-trochlear and supra-orbital nerves with avulsion of zygomaticotemporal branch of trigeminal nerve. Using pre and postsurgery questionnaires, information regarding the degree of reduction of migraines with regard to severity and frequency; and surgical site problems was acquired. Thirty patients volunteered for migraine surgery. Mean migraine headaches reduced from 15.2 ± 6.3 episodes per month to 1.9 ± 2.4 episodes per month (P < 0.0001) postsurgery. The mean intensity of migraine headache also reduced from a preoperative 7.3 ± 3.5 to a postoperative of 1.3 ± 1.4 (P < 0.0001). Fourteen (46.7%) patients reported complete elimination of migraine after surgery while an equal number reported significant relief of symptoms. Two (6.6%) patients failed to notice any significant improvement after surgery. The mean follow-up period was 11.1 ± 2 months with no major surgical complications. Results of the authors' study confirm prior published results that surgical treatment of migraine is a reality. Surgeons can easily incorporate this simple surgical procedure in their armamentarium to offer relief to numerous migraine patients.

The aim of the present study was to systematically review and analyze the available evidence on the role of surgery in improving outcomes in patients with migraine headaches.An electronic search of PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases was performed for English-language articles reporting results of peripheral nerve surgery for migraine headaches.The search strategy revealed a total of 1528 records, of which 23 studies were included in the review. A total of 1151 headache patients were treated in the included studies. The trigger site of migraine addressed varied across studies. Meta-analysis of data of 616 patients revealed that migraine surgery significantly reduces migraine headache frequency (random: mean, 9.52; 95% confidence interval, 7.14-11.9; P0.00001; I = 94%). Similarly, when data of 797 patients were analyzed, there was statistically significant reduction in migraine headache intensity in patients undergoing migraine headache surgery (random: mean, 3.97; 95% confidence interval, 3.31-4.62; P0.00001; I = 94%). On pooling of data of all 23 studies, 8.3% to 76.4% of patients reported complete elimination of headache after surgery, whereas 3.9% to 33.3% had no relief.Peripheral nerve decompression surgery is highly effective in reducing migraine headache frequency and migraine headache intensity. However, not all patients benefit from the surgical procedure, with a small subset showing no improvement. Further clinical and anatomical studies are needed to define the exact mechanism of nerve compression in migraine patients and as to why a subset of patients does not respond to surgical treatment.

Hyoid bone syndrome is a type of cervicofacial pain that is caused by degeneration of the greater cornu of the hyoid at the attachment of the stylohyoid ligament. We report four patients who presented with deep-seated, dull, aching, temporomandibular (TMJ) pain that radiated from the greater cornu of the hyoid bone and did not respond to conservative management. Diagnostic tests included a local anaesthetic block and digital palpation of the greater cornu of the hyoid bone. All four patients responded well to methylprednisolone 40 mg/ml at the greater cornu of the hyoid bone, which resulted in complete resolution of their symptoms. No patients developed postoperative complications. Oral and maxillofacial surgeons involved in the treatment of orofacial pain should consider this less documented condition in their differential diagnosis when treating temporomandibular disorders.

The treatment of condylar fractures in oral and maxillofacial trauma, where an open reduction and internal fixation has to be done, is still a controversial note. However, when taken a decision by the surgeon to operate, there are many difficulties on the operation theatre table, reducing the proximal condylar stump and applying mini fixtures. The techniques to reduce the condylar stump are endorsed in the medical literature. We report a different technique with the use of simple armamentarium, a 24G intravenous catheter, which facilitates better visualization of the proximal segment by distracting the distal segment for open reduction and internal fixation of condylar fractures.

Aim We report our experience with the use of 1.7 mm 3-dimentional (3D) strut plate for the management of mandibular angle fractures. Methods This prospective study enrolled 15 patients in whom mandibular angle fractures were treated with 1.7 mm 3D plate using trans-buccal trochar. Patients were evaluated at 72 h, 2 weeks, 6 weeks and 12 weeks for fracture stability, occlusion, soft-tissue swelling, infection and post-operative inferior alveolar nerve damage. Other complications like wound dehiscence, non-union, mal-union and hardware failure were also assessed. Results In the immediate post-operative period, fracture instability was seen in 1 (6.7%) patient which resolved by 2 weeks. Mild occlusal discrepancy was also noted in 1 (6.7%) patient. Wound dehiscence was seen in 5 (33.3%) patients and all resolved by local measures. 1 (6.7%) patient developed post-operative nerve paraesthesia. Immediate post-operative radiographic evaluation demonstrated optimal reduction in all cases with no inferior border gaping. No case of infection, hardware failure, non-union and mal-union was noted. Conclusion Within the limitations of the study, 1.7 mm 3D strut plate was found to be effective for management of non-communited mandibular angle fractures.

Trauma management has evolved significantly in the past few decades thereby reducing mortality in the golden hour. However, challenges remain, and one such area is maxillofacial injuries in a polytrauma patient. Severe injuries to the maxillofacial region can complicate the early management of a trauma patient owing to the regions proximity to the brain, cervical spine, and airway. The usual techniques of airway breathing and circulation (ABC) management are often modified or supplemented with other methods in case of maxillofacial injuries. Such modifications have their own challenges and pitfalls in an already difficult situation.

Elongated styloid process results in severe cranio-facial/cervico-facial pain. The purpose of this study is to determine the efficacy of treatment outcomes using transcervical approach in the management of styloid-stylohyoid syndrome/styloid syndrome. This is a retrospective cohort study. Subjects were enrolled from out-patient clinics reporting between the periods Jan 2016–Jan 2018. Twelve patients diagnosed with styloid syndrome based on history, thorough clinical workup, and assessment were included in the study. The primary outcomes—improvement in pain and regression of chief complaints following surgery were assessed. Elongated styloid was resected using transcervical approach under general anesthesia. The intra-operative lengths of the styloid process varied from 40 to 43 mm. No post-operative complications were encountered and the symptoms regressed completely after surgery in all the patients at follow-up of 6 months. Transcervical styloidectomy is an effective treatment for exposure and resection of the styloid process with minimal complications in patients with stylo-stylohyoid syndrome.

The aim of this systematic review was to investigate the current evidence in order to assess the efficacy of single puncture arthrocentesis vs standard double needle arthrocentesis in the management of temporomandibular joint(TMJ) disorders. An electronic search of the PubMed, Scopus, Cochrane CENTRAL and Google Scholar databases was performed to identify English studies published up until October 2017. Eligible studies were selected based on inclusion criteria and included randomised controlled trials(RCTs) comparing single puncture arthrocentesis and standard double needle arthrocentesis for the management TMJ disorders. The initial screening identified 984 records, of which only 5 fulfilled the inclusion criteria. A high degree of heterogeneity was found in the 5 studies with each reporting different sample selection and arthrocentesis protocol. All 5 studies reported no difference in reduction in pain intensity and improvement in maximal mouth opening between the single puncture technique and standard double needle technique. This review provides some evidence that single puncture arthrocentesis is clinically as efficacious as standard double needle arthrocentesis. There is a need of well-designed RCT with standard protocol of arthrocentesis comparing different single puncture techniques and standard double needle technique for the management of TMJ disorders.

The aim of the study was to evaluate the effectiveness of greater occipital nerve decompression for the management of occipital neuralgia. Eleven patients of medical refractory occipital neuralgia were enrolled in the study. Local anaesthetic blocks were used for confirming diagnosis. All of them underwent surgical decompression of greater occipital nerve at the level of semispinalis capitis and trapezial tunnel. A pre and postoperative questionnaire was used to compare the severity of pain and number of pain episodes/month. Mean pain episodes reported by patients before surgery were 17.1 ± 5.63 episodes per month. This reduced to 4.1 ± 3.51 episodes per month (P < 0.0036) postsurgery. The mean intensity of pain also reduced from a preoperative 7.18 ± 1.33 to a postoperative of 1.73 ± 1.95 (P < 0.0033). Three patients reported complete elimination of pain after surgery while 6 patients reported significant relief of their symptoms. Only 2 patients failed to notice any significant improvement. The mean follow-up period was 12.45 ± 1.29 months. Surgical decompression of greater occipital nerve is a simple and viable treatment modality for the management of occipital neuralgia.

This systematic review and meta-analysis was performed to investigate whether methylprednisolone (MP) administered via any route improves postoperative outcomes (pain, trismus, and oedema) following mandibular third molar surgery. An electronic search of the PubMed, Scopus, Cochrane CENTRAL, and Google Scholar databases was performed to identify studies published in English up until January 2018. A total of 28 studies were included in the review: 25 randomized clinical trials (RCTs) and three controlled clinical trials. Studies were grouped according to the route of administration of MP for qualitative and quantitative analysis. Three studies were of 'high' quality and 22 were of 'medium' quality; three studies had a high risk of bias. Within the purview of the limitations of this review, the results showed that MP administered via any route significantly improves oedema in the early postoperative period, but has no effect on late postoperative oedema. Oral and intra-masseteric MP also seems to reduce pain and trismus in the early postoperative period. The results also indicate that oral MP may reduce late postoperative pain, while intra-masseteric MP may improve the late trismus outcome. More high quality RCTs are required to provide stronger evidence on the use of MP in third molar surgery.

Purpose To compare short- and extended-regimen post-operative antibiotic prophylaxis after open reduction internal fixation (ORIF) of single uncomplicated mandibular fractures. Subjects and methods A prospective, single centre, randomized, double-blinded, placebo-controlled study was carried out where 39 patients with single uncomplicated mandibular fractures were treated by an intra-oral approach. They were divided into two groups: group 1 (20 patients) and group 2 (19 patients). Each group received injection amoxicillin + clavulanic acid (30 mg/kg/day) pre-operatively, intra-operatively and for 24 h post-operatively. Group 1 then received placebo and group 2 received oral amoxicillin + clavulanic acid (30 mg/kg/day) in two divided doses for the next 4 days. The patients were evaluated on the 3rd and 7th post-operative day for signs of clinical infection and suture site aspirates were collected for culture. Microbial load was evaluated against the presence or absence of clinical infection in both the groups. Results Two patients (10%) in group 1 and three patients (15.7%) in group 2 had clinical signs of infection. No statistically significant difference (p = 0.58) was seen in the incidence of infection in both the groups. Microbial load was positive in seven patients (35%) and six patients (30%) in group 1; four patients (21%) and three patients (15.8%) in group 2 on the 3rd and 7th post-operative day respectively. No statistical significance was seen with the presence of microbial load and clinical signs of infection in both groups. Conclusion After ORIF of single uncomplicated mandibular fractures, infection rates are the same with either short- or extended-antibiotic regimen.

Ameloblastic fibrodentinoma (AFD) is a rare mixed odontogenic tumor, with biological behavior similar to ameloblastic fibroma (AF). These tumors are considered less invasive than solid ameloblastomas and have low tendency for recurrence. Sarcomatous transformation of AF is rare but well-recognized. Though of the same group, ameloblastic fibrosarcoma (AFS) developing after resection of AFD has not been reported in literature. We present a case of a well-encapsulated soft tissue AFS developing 8 years after aggressive treatment of previous recurrent AFD. The unusual biological behavior of AFD and the importance of long term follow-up of such patients are emphasized.

TMJ arthrocentesis involves lavage of the upper joint space which forces the disc apart from the fossa and washes away the inflammatory components of the joint. To increase the joint space during arthrocentesis, the patient is usually asked to open the mouth and deviate it to the opposite side so as to distract the condyle from the glenoid fossa thereby increasing joint space. The authors describe a simple and rapid technique of preparing a custom-made mouth prop to hold the mandible in eccentric position during arthrocentesis. The custom-made mouth prop is an effective tool to help relax the patient in an eccentric position during the duration of arthrocentesis procedure.

Traditionally, arthrocentesis involves insertion of 2 needles into the joint space of which one acts as an inflow port and the other as the outflow port. These 2 needles must triangulate and be exactly placed in the upper joint space for the procedure to be effective. Due to the difficulty in maintaining the needle position, single-puncture arthrocentesis is gaining popularity. It is relatively easier to perform and less traumatic to the joint. The authors describe a simple technique of single-puncture arthrocentesis using parts of 2 peripheral intravenous catheters of different gauges. The outflow port is formed by the catheter tube of 1 cannula while the inflow port is formed by the needle of the second cannula. Besides beings easy to perform and cost-effective, our technique provides predictable joint lavage of the joint with minimal trauma to the tissues.

Hemophilic pseudotumor is a rare complication occurring in patients with hemophilia, frequently seen in the femur, tibia, pelvic bones, iliac bones, or rarely in the maxillofacial region. A 7-year-old male reported with a spontaneous extra-oral swelling that was managed with pre-operative transfusion of factor IX along with curettage of the lesion. Our report presents only the fourth case in literature wherein this tumor presented in a patient with hemophilia B. Hemophilic pseudotumor is a rare entity in the maxillofacial region. High degree of suspicion is required for diagnosis, and close coordination between the medical and surgical teams aids in management.

Dentigerous cysts are benign odontogenic cysts associated with the crowns of unerupted, embedded, or impacted teeth. Most of them are associated with mandibular third molars, followed by maxillary third molars and canines. They are usually asymptomatic, and rarely do they grow extensively and compress the adjacent anatomic structures. We report 5 cases of extensive maxillary dentigerous cysts presenting with sinonasal and orbital symptoms. A literature review for similar presentations of dentigerous cysts has demonstrated 21 cases. Recognition of the extensive growth potential of the dentigerous cyst, diagnosing it with its unusual presentation, and appropriate management are discussed in this article.

Objective We present our experience of success with immediate third molar transplants in young individuals while secondarily assessing factors predicting failure. Study Design A total of 57 cases of third molar transplant with both open and closed apices were studied in individuals aged 15 to 25 years. Factors influencing prognosis were analyzed by univariate and multivariate analysis. Results The replaced teeth included 17 maxillary molars (29.8%) and 40 mandibular molars (70.2%). After a follow-up of 19.9 ± 2.8 months, 49 cases (86%) were successful; 7 (12.3%) cases failed owing to root resorption, and 1 (1.7%) failed owing to infection. Pulp revascularization was seen in all successful cases with open apices. Proximal grinding of donor tooth was significantly associated with failure (odds ratio, 12.5; P = .025). Conclusions Autogenous third molar transplant is an excellent and viable treatment modality. By using proper case selection and minimizing damage to the donor tooth root, high success rates can be achieved.

We describe the use of a piezoelectric osteotome for removal of bone in patients with ankylosis of the temporomandibular joint (TMJ) and its advantages over conventional techniques. We studied 35 patients with ankylosis of 62 TMJ (27 bilateral and 8 unilateral, 2 recurrent) who were treated by gap arthroplasty between 1 January 2011 and 31 December 2012. We used a preauricular, with extended temporal, incision in all cases. The ankylosis was released with a piezoelectric scalpel. There were 23 men and 12 women, mean (SD) age 16 (9) years. We noticed a substantial reduction in bleeding with the piezoelectric bone cutter compared with the dental drill, though the operating time was longer. We noticed no bleeding from the maxillary artery or pterygoid plexus. Mean (SD) bleeding/side was 43 (5) ml, and mean (SD) operating time was 77 (8) minutes for a single joint. At 6 months' follow-up mean (SD) passive mouth opening was 35 (3) mm. Piezoelectric bone removal for the release of ankylosis of the TMJ is associated with minimal bleeding, few postoperative complications, and satisfactory mouth opening at 6 months' follow up.

Objective. To evaluate the success of autogenous transplantation of embedded/impacted third molars harvested using piezosurgery. Materials and methods. This prospective pilot study enrolled 20 healthy patients with non-restorable first/second molars and a caries-free retrievable embedded/impacted third molar. Piezosurgery was used for removing inter-radicular bone at the recipient socket as well as for bone removal around the donor teeth. Results. After an average follow-up of 16.4 months (SD = 1.9), 18 cases were successful with formation of periodontal ligament around the teeth. One tooth was lost due to infection at 1 month. One patient was lost to follow-up. There was no root resorption or ankylosis in any of the cases. In six donor teeth with complete root formation, root canal treatment was carried out. All the remaining teeth responded positively with vitality testing. Conclusion. Piezosurgery is an effective device if embedded/impacted third molars are to be harvested for successful autog...

In the maxillofacial area, osteomyelitis generally involves the mandible more commonly than the maxilla. Osteomyelitis of the mandible more often than not is odontogenic in origin and the dentate part is usually affected. In this context, involvement of the condyle and coronoid processes is very rare. This report describes 2 unique cases of condylar involvement with osteomyelitis. In these cases, the etiologies were unknown and were successfully managed by condylectomy and antibiotics. A comprehensive review of the English-language literature showed only 18 cases of osteomyelitis of the condyle. Odontogenic, otologic, and tubercular causes were the most common causes of osteomyelitis of the condyle. Radiologically, the condyle usually appeared osteolytic and eroded in osteomyelitis and radionucleotide scans were helpful in localizing the inflammation site. In most cases, condylectomy with appropriate antibiotics was required to eliminate the disease.

Temporomandibular joint (TMJ) ankylosis due to undiagnosed condylar fractures has a high incidence in India compared to western countries. We evaluated the demographics, injury pattern, hospital reporting and referral pattern of undiagnosed condylar fractures complicating TMJ ankylosis in northern India.We did a retrospective analysis by retrieving medical records of patients with post-traumatic TMJ ankylosis reporting to the Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences between 1 July 2012 and 30 June 2013.Of 90 patients with post-traumatic TMJ ankylosis, 74 (82.2%) resided in rural areas. Sixty-three (70%) patients were from the states of Uttar Pradesh, Bihar and Jharkhand. Only 8.8% had higher education and 10% had an annual income of more than `2 lakh. In 69 (84.4%) patients, fall was the aetiological factor. Primary health centres (42%) and private clinics (20.5%) received the major share of patients immediately following injury. Few patients (19.3%) had some radiographic examination done and only 17% were referred by the primary healthcare provider. Of those referred only 3 were examined by a dental practitioner. Only 10% of all were diagnosed with condylar fractures.Patients with TMJ ankylosis presenting to us have poor literacy and income levels. A missed diagnosis of condylar fractures by rural healthcare providers contributes to its high incidence in India. Improving awareness of clinicians and improved rural healthcare infrastructure can help prevent this complication.

Aim To retrospectively evaluate neurosensory disturbance (NSD) after bilateral sagittal split osteotomy (BSSO). Material and methods A retrospective review was carried out to assess inferior alveolar nerve function in patients treated by BSSO from 2010 to 2013. All patients included in the study were assessed using objective (cotton swabs and pin prick testing) and subjective testing (questionnaire) for inferior alveolar nerve function after a minimum of 1 year of follow-up. Medical records of the patients were used to assess the incidence of NSD in the immediate post-operative period. Results 15 patients (30 sides) had undergone BSSO during the specified time period. On subjective testing, NSD was reported in 22 operated sides (73.3%) in the immediate post-operative period, while 4 operated sides (13.3%) reported persistent NSD. On objective testing, immediate post-operative NSD was seen in 20 operated sides (66.7%). After a minimum of 1 year follow-up, recovery was seen in 18 operated sides while persistent NSD was seen in 2 operated sides (6.7%). Conclusion NSD of the inferior alveolar nerve is a common complication after BSSO in the immediate post-operative period. However in a long term, nerve function usually recovers.

Introduction Langer-Giedion syndrome (trichorhinophalangeal syndrome type II) is an extremely rare disorder characterized by dysmorphic facial features, multiple exostoses, mental retardation and digit deformities. We report the first case of any maxillofacial pathology in such a syndromic patient. Case presentation A 22-year-old Indian woman with mild intellectual disability presented with malaligned teeth. Routine radiographic screening demonstrated a large multilocular lesion in her right mandible. She had peculiar features such as short stature, short limbs, brachydactyly, and dysmorphic facial characters, which prompted us to evaluate her further. After findings of multiple bony exostoses she was diagnosed with Langer-Giedion syndrome. On surgical exploration of her right mandibular lesion an empty cavity was found suggestive of traumatic bone cyst. The lesion healed completely after 1 year without loss of vitality of any teeth. Conclusions Although diagnosis and management of any maxillofacial pathology can be challenging in syndromic patients, our report suggests a possible correlation between traumatic bone cyst and Langer-Giedion syndrome. Clinicians should routinely screen these patients for any undetected maxillofacial pathology. In future cases of this syndrome, one should consider the possibility of traumatic bone cyst which may not require aggressive surgical management.

A number of surgical treatment modalities have been described in literature for closure of oro-antral communications. None of the methods however provide for immediate prosthetic rehabilitation of the communication site. We describe a case of oro-antral communication treated using autogenous third molar transplantation. At 18 months of follow-up, the transplanted tooth was functioning well with radiographic evidence of lamina dura and periodontal ligament. Its root-tip was still seen projecting into the maxillary sinus. This report suggests that when possible, autotransplantation of third molar can be a simple and excellent choice for closure of oro-antral communications.

The aim of this cross-sectional study was to assess knowledge regarding autogenous tooth transplantation among oral and maxillofacial surgery (OMFS) residents in India. The sample of the survey consisted of Indian OMFS post-graduate residents attending the “1st Asian Oral and Maxillofacial Surgery PG Convention” held from 29th to 31st August, 2013 at Mangalore, India. Questions were asked regarding the participant’s preferred tooth replacement modality, the transplantation procedure (socket preparation and stabilization of transplanted tooth); fate of the transplanted tooth (pulpal and periodontal fate) and the possibility of replacing second molars with such procedure, cross-arch transplantation and transplantation after new-socket preparation. The responses of 1st, 2nd and 3rd year residents were assessed for statistical significant difference using Fishers exact test. Out of 434 residents surveyed using a pre-tested self-administered questionnaire, 287 residents responded (response rate 66 %). 74 % were aware of the possibility of autogenous third molar transplantation. Only 24 % believed a new periodontal ligament would form around the transplanted tooth. Misconceptions regarding pulp healing, socket preparation and tooth stabilization and new alveolus transplantation were also seen. 44 % had never seen the procedure and 74 % had never performed it themselves. No statistical significant difference was seen among the responses classified according to the year of training. OMFS residents were found to have inadequate knowledge regarding autogenous tooth transplantation. Tooth transplantation needs to be included in the dental curriculum and standard OMFS textbooks with practical training in post-graduation period.

Hypertrophic pachymeningitis is a rare inflammatory process that causes thickening of the dura mater. Most cases are idiopathic, but it can result from many inflammatory and infective conditions. We present a case of pachymeningitis of the cavernous sinus, the aetiology of which may have been dental.