Anson Jose

Evaluation of facial nerve following open reduction and internal fixation of subcondylar fracture through retromandibular transparotid approach

The objective of this study was to evaluate any damage to the facial nerve after a retromandibular transparotid approach for open reduction and internal fixation (ORIF) of a subcondylar fracture. We studied 38 patients with 44 subcondylar fractures (3 bilateral and 38 unilateral) treated by ORIF through a retromandibular transparotid approach. All patients were followed up for 6 months. Postoperative function of the facial nerve was evaluated within 24h of operation, and at 1, 3, and 12 weeks, and 6 months. Variables including type of fracture, degree of mouth opening, postoperative occlusion, lateral excursion of the mandible, and aesthetic outcome were also monitored. Nine of the 44 fractures resulted in transient facial nerve palsy (20%). Branches of the facial nerve that were involved were the buccal (n=7), marginal mandibular (n=2), and zygomatic (n=1). In the group with lateral displacement, 2/15 showed signs of weakness, whereas when the fracture was medially displaced or dislocated 7/23 showed signs of weakness. Of the 9 sites affected, 7 had resolved within 3 months, and the remaining 2 resolved within 6 months. The mean (range) time to recovery of function was 12 weeks (3-6 months). There was no case of permanent nerve palsy. The retromandibular transparotid approach to ORIF does not permanently damage the branches of the facial nerve. Temporary palsy, though common, resolves in 3-6 months. Postoperative occlusion, mouth opening, and lateral excursion of the mandible were within the reference ranges. We had no infections, or fractured plates, or hypertrophic or keloid scars.

Evaluating success of autotransplantation of embedded/impacted third molars harvested using piezosurgery: a pilot study.

Abstract 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 autogenous transplantation.

Management of maxillofacial trauma in emergency: An update of challenges and controversies

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.

Traumatic bone cyst of the mandible in Langer-Giedion syndrome: a case report

IntroductionLanger-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 presentationA 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.ConclusionsAlthough 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.

Odontogenic infection and pachymeningitis of the cavernous sinus

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.

Is splint therapy required after arthrocentesis to improve outcome in the management of temporomandibular joint disorders? A systematic review and meta-analysis

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.

Single puncture versus standard double needle arthrocentesis for the management of temporomandibular joint disorders: A systematic review

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.