Bd Saheeb

Feeding intervention in cleft lip and palate babies: a practical approach to feeding efficiency and weight gain

Using a disposable syringe to feed 1-14-week-old babies with cleft lip and palate (CLP) was studied. 57 CLP babies were randomly divided into: syringe-fed (intervention) and cup-and-spoon-fed groups and compared with 55 normal breast- or bottle-fed babies. Differences in weight gained from birth to 6, 10 and 14 weeks were compared. Syringe-fed CLP babies fed breast milk had a significant difference in weight gain (0.7 and 0.8 kg) compared with cup-and-spoon-fed babies (0.4 kg), at 10 and 14 weeks, respectively. Normal breast-fed babies gained 0.6 and 0.7 kg. Cup-and-spoon-fed CLP babies fed artificial and breast milk gained 0.5 and 0.6 kg; syringe-fed CLP babies gained 0.6 and 1.2 kg. Normal babies gained 1.0 and 1.7 kg for the same age and food. Average feeding times were 10 ml/1.25 min for syringe-fed and 10 ml/2.08 min for cup-and-spoon-fed CLP babies at 6 weeks. 19 (100%) cup-and-spoon-fed babies exhibited spill and regurgitation at 6 weeks compared with 30 (79%) CLP syringe-fed babies (P<0.05). In both groups spill and regurgitation decreased with age. CLP babies fed with the modified method had a faster feeding time, less spill and regurgitation and gained the same weight as normal babies at 10 and 14 weeks.

A comparative study of the effect of suture-less and multiple suture techniques on inflammatory complications following third molar surgery

The aim of this prospective randomized study was to evaluate the effect of not using sutures on postoperative pain, swelling and trismus after lower third molar surgery. 80 patients with impacted lower third molars were referred for surgical extraction (42 males; 38 females; aged 18-38 years). The patients were randomly divided into two equal groups (sutures n=40; suture-less n=40). In the experimental group, the flaps were replaced without suturing. The control group was selected using the same criteria and treated under the same surgical protocol as the experimental group, except that the flaps were apposed using multiple sutures. Pain, swelling and trismus were evaluated at 24 h, 48 h and 1 week postoperatively in both groups. The operation time was found to be significantly longer in the multiple sutures group (p<0.05). There was significantly less pain, swelling and trismus at 24 h and 48 h, respectively, in the suture-less group (p<0.05). There was no significant difference between the two treatment groups in terms of pain, swelling and trismus, at 1 week postoperatively (p>0.05). There is less postoperative pain, swelling and trismus with the suture-less technique in third molar surgery.

Comparative Study of Effect of Single and Multiple Suture Techniques on Inflammatory Complications After Third Molar Surgery

PURPOSE Pain, swelling, and trismus are the most common complications associated with third molar surgery. Several methods of alleviation of these complications have been described. The effect of single and multiple suture techniques on these complications was compared in the present study. PATIENTS AND METHODS All consecutive patients 18 years of age or older who had been referred for surgical extraction of their impacted teeth between January and December 2007 at the maxillofacial unit of the Aminu Kano Teaching Hospital were recruited and randomized into 2 groups. All selected participants underwent surgical extraction of their impacted teeth by the same surgeon under local anesthesia. The flaps in 1 group were closed by multiple sutures and those in the second group were closed by a single suture. Pain, swelling, and trismus were evaluated at postoperative days 1, 2, 3, 5, and 7. Descriptive and comparative statistical analyses were performed, and the results are presented. Significance was set at P < .05. RESULTS A total of 50 subjects participated in the present study. Both groups were comparable in terms of the age distribution (multiple suture group, 26.0 ± 4.73 years; single suture group, 25.8 ± 4.28 years, P = .755), difficulty index (multiple suture group, 5.0 ± 1.68; single suture group, 4.9 ± 4.79; P = .935), duration of surgery (multiple suture group, 29. 7 ± 6.11 minutes; single suture group, 30.0 ± 6.04 minutes; P = .835), and baseline parameters such as facial width (multiple suture group, 10.0 ± 1.32 cm; single suture group, 9.8 ± 0.37 cm; P = .115), mouth opening (multiple suture group, 4.5 ± 1.32 cm, single suture group, 4.8 ± 0.26 cm; P = .165), and preoperative pain, which was 0 in both groups. Other comparable variables included impaction type (P = .210) and indication for surgery (P = .278). A statistically significant difference was found in the level of pain at postoperative days 1, 2, and 3 (P < .05). A similar significant difference was found in swelling and trismus (P < .05). At days 5 and 7, no significant differences were found between the 2 groups for all parameters of pain, swelling, and trismus (P > .05). CONCLUSION Our study had a comparable distribution of age, gender, and operative variables, such as the pattern of impaction, preoperative difficulty index, and operative time between patients undergoing the 2 methods of closure. With that, our results have shown that the single suture closure technique was better than the multiple suture technique with regard to postoperative pain, swelling, and trismus.

Honey and wound dehiscence: A study of surgical wounds in the mandibular bed

BACKGROUND There is a paucity of literature on the use of honey in wound healing after oral and maxillofacial surgical procedures. OBJECTIVE To evaluate the efficacy of the healing properties of Obudu honey in patients who developed wound dehiscence after segmental mandibular resections. PATIENTS AND METHODS This was a prospective study of 72 patients who had benign lesions of the mandible, and were treated by segmental mandibular resection, with the surgical wounds developing dehiscence. The subjects were randomized into two treatment groups of A (control, n = 36) and B (experimental, n = 36). Unlike the control, the wounds in the experimental group were dressed in honey after debridement. RESULTS The ages of the patients ranged from 21 to 73 years with a mean age of 46.3 ± 2.1 years while the male: female ratio was 3:1. There was no significant demographic difference about age ( P = 0.44) and gender (P = 0.38) between the two groups. The smaller the initial circumference of the surgical wound, the shorter the duration of healing and this was significant (P = 0.001) in either of the treatment groups. Numerically, more healing was completed in the first 5 weeks in subjects in the experimental group (n = 19, 52.8%) than the control (n = 13, 36.1%). However, the duration of healing between the subjects in the control and experimental groups at the end of 9 weeks showed no significant difference (P = 0.23). CONCLUSION Honey speeds up the healing of dehiscence wounds of resected mandible when used as dressing more than the control.

Indications and risk factors for complications of lower third molar surgery in a Nigerian Teaching Hospital

Background: The surgical extraction of impacted third molars is a common oral surgical procedure, and it is often associated with complications such as sensory nerve damage, dry socket, pain, swelling, trismus, infection and hemorrhage. Aim: The aim of this study was to determine the surgical indications and risk factors for complications of third molar surgery at a Nigerian teaching hospital. Materials and Methods: Medical records of patients referred to the Oral Surgery Clinic of our institution for surgical extraction of their impacted mandibular third molars from January 2008 to December 2010 were retrospectively examined. Information on patients′ demography, types of impaction, operative parameters and complications were obtained and analyzed using Statistical Package for Social Sciences (SPSS Version 13), Chicago, IL, USA. A P < 0.0.5 was considered significant. Results: A total of 330 impacted teeth were extracted from 250 patients. Male comprises (104/250 [41.6%]) and female (146/250 [58.4%]). The mesioangular (176/330 [53.4%]) and distoangular (73/330 [22.1%]) impactions were the commonest types. Recurrent pericoronitis (154/330 [46.7%]) was the most common indication for extraction. The complications were delayed healing (19/330 [5.8%]), alveolar, osteitis (9/330 [2.7%]) and injury to alveolar nerve (2/330 [0.6%]). Cigarette smoking (P < 0.001), Oral contraceptives use (P = 0.01), age of the patient (P = 0.03) and the surgeon′s experience (P = 0.04) were found to be significantly associated with the development of alveolar osteitis; nerves injuries were significantly associated with the raising of a lingual flap (P < 0.001) and the technique of surgery ( P ≤ 0.001). Conclusion: The age of the patient, cigarette smoking and oral contraceptive use at the time of surgery are some of the factors affecting outcome in third molar surgery.

Spontaneous bone regeneration after segmental mandibular resection: a retrospective study of 13 cases

The aim of this study was to evaluate the clinical characteristics of cases of spontaneous bone regeneration of the mandible after segmental resection. This retrospective study covered a 23-year period and used data obtained from the hospital records; patient data were entered into a pro-forma questionnaire. Overall, the cases of 636 patients with mandibular lesions treated by segmental resection were reviewed; 13 (2.0%) had spontaneous bone regeneration. The time post-surgery at which bone regeneration was first noticed ranged from 9 to 17 weeks. Seven patients were male (53.8%) and six were female (46.2%), giving a male to female ratio of 1.2:1. The patients ranged in age from 16 to 51 years (mean 26.6±3.6 years). The periosteum was completely excised after resection in eight patients (61.5%), while it was partially preserved in five (38.5%). The younger the patient, the earlier the spontaneous bone regeneration occurred in the defect (P=0.001), particularly in those who had complete excision of the periosteum. Radiographically, the new bone formed was observed to have the same appearance as the cortical bone of the mandibular stumps, but lacked height. This study suggests that bone graft reconstructions may still be necessary for this group of patients who show spontaneous bone regeneration.

A prospective clinical evaluation of the longevity of resorbable sutures in oral surgical procedures

INTRODUCTION The objectives of this prospective randomized study were to clinically evaluate the longevity of resorbable sutures (chromic catgut and vicryl) and determine the effect of chlorhexidine mouth wash on their absorption time in oral surgical procedures. Both sutures were of size 3/0 with round body needle and were placed using the standard technique. METHODS AND MATERIALS One hundred patients selected for the study were divided into two groups of 50 patients each (vicryl and chromic catgut groups). Each group was subsequently subdivided into chlorhexidine (17 cases); warm saline mouth wash (17 cases) and warm water mouth wash (16 cases (control). RESULTS The sutures were placed during various minor surgical procedures e.g. third molar surgery (65 cases), incisional biopsy (7 cases), excisional biopsy (8 cases), sutured lacerations (10 cases) and malar elevations through intraoral upper buccal sulci approach (8 cases) and 2 cases of cystic enucleations. The mean longevity of chromic catgut for chlorhexidine was 11.4 days with a range of 5-16 days. The patients, who used warm saline mouth wash, had a mean longevity of 11.7 days with a range of 7-24 days. The mean longevity of vicryl in patients that used chlorhexidine was 22.7 days, with a range of 14-36 days and that of warm saline mouth wash was 24.5 days with a range of 14-47 days. CONCLUSION The resorbable sutures investigated have a mean longevity, which was slightly shorter than the figure stated by the manufacturer. Chlorhexidine was found to have no appreciable effect on absorption time of the sutures.

Nerve Morbidity after Mandibular Third Molar Surgery: A Prospective Study of Two Cohorts of Patients

Background: The surgical extractions of impacted mandibular third molars are sometimes associated with nerve morbidity. Objective: To determine the incidence of nerve morbidity after mandibular third molar surgery and compare the complications from the inferior alveolar and lingual nerves in two cohorts of patients. Patients and methods: This prospective study was an investigation of two cohorts of patients within duration of four years. The sample size was composed of 212 subjects, made up of 28 patients who had their impacted third molars in close contact with the inferior alveolar canal and 184 patients that did not have their molars in contact. The predictor variables were age, gender, type of impaction, indications for extraction, difficulty index and duration of surgery. The outcome variable was the development of neuro-sensory complication(s) after treatment. Descriptive and bivariate statistics were computed and the P value was set at 0.05. Results: There was no significant relationship between the predictor variables in the two groups. The result showed that 6/212 (2.8%) patients complained of numbness of the ipsilateral lower lip and part of the cheek. Out of this 4/28 (14.3%) were in those that had their molars in close contact with inferior alveolar canal while 2/184 (1.1%) were cases that didn’t make contact. No complication occurred that was related to the lingual nerve. Conclusion: Nerve morbidity occurred after third molar surgery and the incidence is commoner in cases where the third molar made contact with inferior alveolar canal.

A Prospective Randomized Clinical Study of the Influence of Primary Closure or Dressing on Post‑operative Morbidity after Mandibular Third Molar Surgery

Objective: The aim of the following study is to determine the effect of primary closure or dressing on post-operative morbidity after impacted lower third molar surgery. Materials and Methods: This was a randomized clinical study of 72 patients who had surgical extraction of impacted mandibular third molars. The subjects were divided into two groups of A and B. Group A had total closure (primary closure) and Group B had whitehead varnish dressing of the socket. Pain, swelling and trismus were evaluated pre-operatively using visual analogue scale, flexible tape measuring method and inter-incisal distance measurement with Vernier Callipers respectively as well as post-operatively on 1 st , 2 nd , 3 rd , 5 th and 7 th day. Results: The study participants consisted of 27 males and 45 females in a ratio 1:1.7. With a mean age of 24.7 ± 4.9 years (range 19-33 years) for Group A and 25.5 ± 4.3 years (range 20-39 years) for Group B. Post-operative pain was not significantly affected by the closure techniques (P > 0.05). Dressing was found to significantly reduce the degree of swelling and trismus peaking on the 2 nd day (P = 0.0207 and P = 0.010 respectively). Conclusion: The use of dressing was more effective than primary closure to reduce the degree of swelling and trismus though its effect on post-operative pain reduction was not significant.

A study on shotgun injuries to the craniomaxillofacial Region in a Nigerian Tertiary Health Center

Context: Short-range shotgun wounds of the craniomaxillofacial region are life-threatening and are as devastating as military rifle wounds. Aims: This study aimed to evaluate the pattern of presentation of craniomaxillofacial shotgun injuries, types of shotgun injuries, and the outcome of treatments in our environment. Setting and Design: This is a prospective observational study. Materials and Methods: This is a prospective observational study conducted from February 2006 to March 2012. All patients with shotgun wounds to the craniomaxillofacial region were included in the study by convenient sampling method. Glezers shotgun classification scheme was used to categorize the patients into short-, intermediate-, and long-range shotgun wounds. Data collected were analyzed using SPSS version 16. Statistical Analysis Used: Descriptive statistics were used to calculate the data. Mean and standard deviation (SD) were calculated for all quantitative variables such as age. Frequency and percentages were presented for qualitative variables. Results: A total number of 28 patients were seen. Ages ranged from 19 to 64 years with a mean (±SD) of 32.7 (±11.4) years. The two most commonly used shotguns were locally made pistol (25, 42.9%) and the cut-size gun (10, 35.7%) and the least commonly used was Dane gun (1, 3.6%). Close-range injury to the face was 17 (60.7%) while that of intermediate- and long-range injuries were 6 (21.1%) and 5 (17.9%), respectively. Conclusion: Wounds sustained from close-range shotguns to the face were the most common in this environment. The outcome of treatment was satisfactory when treated with conservative debridement and early reconstruction.