Madiha Rana

Evaluation of postoperative discomfort following third molar surgery using submucosal dexamethasone – a randomized observer blind prospective study

BACKGROUND Surgical removal of impacted lower third molar is still the most frequent procedure done by Oral and Maxillofacial surgeons and is often associated with pain, swelling and trismus. These postoperative sequelae can cause distress to the patient as a result of tissue trauma and affect the patients quality of life after surgery. Use of antiseptic mouthwashes, drains, muscle relaxants, cryotherapy, antibiotics, corticosteroids and physiotherapy seems to decrease postoperative discomfort. Among them corticosteroids are well-known adjuncts to surgery for suppressing tissue mediators of inflammation, thereby reducing transudation of fluids and lessening edema. The rationale of this study is to determine the effectiveness of submucosal injection of dexamethasone in reducing postoperative discomfort after third molar surgery. PATIENTS AND METHODS 100 patients requiring surgical removal of third molar under local anesthesia were randomly divided into 2 groups, group I receiving 4 mg dexamethasone as submucosal injection and the control group II received no steroid administration. Facial swelling was quantified by anatomical facial landmarks. Furthermore, pain and patient satisfaction, as well as neurological score and the degree of mouth opening were observed from each patient. RESULTS Patients receiving dexamethasone showed significant reduction in pain, swelling, trismus, a tendency to less neurological complaints and improved quality of life compared with the control group. CONCLUSIONS Submucosal injection of dexamethasone is more efficient to manage postoperative discomfort after removal of third molars compared to no steroid administration.

Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods: a randomized, observer-blind, prospective study

BackgroundSurgical treatment and complications in patients with zygomatic bone fractures can lead to a significant degree of tissue trauma resulting in common postoperative symptoms and types of pain, facial swelling and functional impairment. Beneficial effects of local cold treatment on postoperative swelling, edema, pain, inflammation, and hemorrhage, as well as the reduction of metabolism, bleeding and hematomas, have been described.The aim of this study was to compare postoperative cooling therapy applied through the use of cooling compresses with the water-circulating cooling face mask manufactured by Hilotherm in terms of beneficial impact on postoperative facial swelling, pain, eye motility, diplopia, neurological complaints and patient satisfaction.MethodsForty-two patients were selected for treatment of unilateral zygomatic bone fractures and were divided randomly to one of two treatments: either a Hilotherm cooling face mask or conventional cooling compresses. Cooling was initiated as soon as possible after surgery until postoperative day 3 and was applied continuously for 12 hours daily. Facial swelling was quantified through a three-dimensional optical scanning technique. Furthermore, pain, neurological complaints, eye motility, diplopia and patient satisfaction were observed for each patient.ResultsPatients receiving a cooling therapy by Hilotherm demonstrated significantly less facial swelling, less pain, reduced limitation of eye motility and diplopia, fewer neurological complaints and were more satisfied compared to patients receiving conventional cooling therapy.ConclusionsHilotherapy is more efficient in managing postoperative swelling and pain after treatment of unilateral zygomatic bone fractures than conventional cooling.Trial registrationGerman Clinical Trials Register ID: DRKS00004846

Development and evaluation of an automatic tumor segmentation tool: A comparison between automatic, semi-automatic and manual segmentation of mandibular odontogenic cysts and tumors

INTRODUCTION In the treatment of cancer in the head and neck region, computer-assisted surgery can be used to estimate location and extent by segmentation of the tumor. This article presents a new tool (Smartbrush), which allows for faster automated segmentation of the tumor. METHODS This new method was compared with other well-known techniques of segmentation. Thirty-eight patients with keratocystic odontogenic tumors were included in this study. The tumors were segmented using manual segmentation, threshold-based segmentation and segmentation using Smartbrush. All three methods were compared concerning usability, time expenditure and accuracy. RESULTS The results suggest that segmentation using Smartbrush is significantly faster with comparable accuracy. CONCLUSIONS After a period of adjustment to the program, one can comfortably get reliable results that, compared with other methods, are not as dependent on the users experience. Smartbrush segmentation is a reliable and fast method of segmentation in tumor surgery.

Management of comminuted but continuous mandible defects after gunshot injuries.

INTRODUCTION Firearm injuries continue as a major public health problem, contributing significant morbidity, mortality, and expense to our society. There are four main steps in the management of patients with gunshot wounds to the face: securing an airway, controlling haemorrhage, identifying other injuries and definitive repair of the traumatic facial deformities. The objective of this study was to determine late outcome of two treatment options by open reduction and internal fixation versus closed reduction and maxillomandibular fixation (MMF) in the treatment of gunshot injuries of the mandible. METHODS Sixty patients of gunshot injury were randomly allocated in two groups. In group A, 30 patients were treated by open reduction and internal fixation and in group B, 30 patients were treated by closed reduction and maxillomandibular fixation. Patients were discharged as the treatment completed and recalled for follow up. Up to 3 months after injury, fortnightly complications like infection, malocclusion, malunion of fractured fragments, facial asymmetry, sequestration of bone and exposed plates were evaluated and the differences between two groups were assessed. The follow-up period ranged from 3 months to 10 months. RESULTS Patients treated by open reduction tended to have less complications as compared to closed reduction. CONCLUSION Based on this study open reduction and internal fixation is the best available method for the treatment of gunshot mandible fractures without continuity defect.

Assessment of cervical lymph node metastasis for therapeutic decision-making in squamous cell carcinoma of buccal mucosa: a prospective clinical analysis.

BackgroundCervical metastasis has a tremendous impact on the prognosis in patients with carcinomas of the head and neck and the frequency of such spread is greater than 20% for most squamous cell carcinomas. With emerging evidence, focus is shifting to conservative neck procedures aimed at achieving good shoulder function without compromising oncologic safety. The purpose of this study was to analyze the pattern of nodal metastasis in patients presenting with squamous cell carcinoma of buccal mucosa.Materials and methodsThis was a prospective clinical analysis of patients who were histologically diagnosed with squamous cell carcinoma of the buccal cavity and clinically N1 and had not received treatment anywhere else. Patients were analyzed for age and sex distribution, tumor staging, location, and metastasis.ResultsThe incidence of metastatic lymph node in T4 (n=44) was the highest, that is, level I was 100% (44/44), level II was 43.18% (19/44), level III was 15.90% (7/44), and level IV was 4.5% (2/44). Level V was free of metastasis. Among T3 (n=10) lesions, incidence of metastasis in level I was 100% (10/10), level II was 20% (2/10), and level III, IV, and V were free of metastasis. Among T2 (n=6) lesions, incidence of lymph node metastasis in level I was 100% (6/6) and all other levels of lymph nodes were found free of metastasis.ConclusionLymphatic spread from carcinoma of the buccal mucosa is low. Involvement of level IV is seen in only 3% of patients. A more conservative approach to the neck in patients with carcinoma of the buccal mucosa is recommended.

Reconstructive management of the rare bilateral oral submucos fibrosis using nasolabial flap in comparison with free radial forearm flap--a randomised prospective trial.

BackgroundOral sub mucous fibrosis is a rare chronic, progressive, pre malignant collagendisorder of oral mucosa in people of Asian descent characterized by trismus,blanching and stiffness of mucosa, burning sensation in mouth and hypomobility ofsoft palate and tongue with loss of gustatory sensation. Betel nut chewing is themost common etiological agent. Surgery remains the main stay in severe cases andaims at release of fibrotic bands and resurfacing the raw areas with differentoptions. Reconstruction can be done by using nasolabial flap or radial freeforearm flap. The purpose of this study was to compare the mouth opening after thereconstruction with either nasolabial flap or radial free forearm flap.MethodsThis study was carried out on fifty (50) patients with oral sub mucous fibrosis.Twenty five (25) of these were reconstructed by nasolabial flap and twenty five(25) were reconstructed by radial free forearm flap. At different intervals oftheir post-operative visits, they were evaluated for the interincisal distance andthe difference between the two groups was assessed.ResultsAverage increase in interincisal distance was greater in patients reconstructedwith radial free forearm flap compared with patient reconstructed by nasolabialflap i.e. 18.96 mm and 15.16 mm respectively with ‘P’ value >0.05.ConclusionsBased on the results of this study, there was no significant difference in mouthopening after reconstruction with radial forearm free flap compared to nasolabialflap.

Trajectory-guided biopsy of orbital tumor – Technology, principal considerations and clinical implementation

Intraorbital space-occupying lesions always pose a challenge, both in terms of definite surgical removal as well as preoperative sampling for histopathological examination. Despite the use of modern high-resolution imaging techniques, the dignity of orbital lesions can often not be determined with sufficient certainty preoperatively. As the amount and complexity of treatment possibilities continue to increase, detailed diagnostics in advance of treatment choice are essential. Histological classification of orbital lesions can still be considered the gold standard for reliable diagnoses, leading to appropriate treatment. Over recent years minimally invasive surgical approaches have gained more importance in the treatment and diagnosis of cranio-maxillo-facial tumor and trauma. The aim of our study was to adapt and establish a precise procedure for orbital biopsies. 23 patients suffering from space-occupying lesions of unknown dignity were included. Trajectory-guided procedures were pre-planned for all cases. In most cases minimally invasive procedures were suitable for taking biopsies of the orbit. For only two patients a conventional, non-minimally invasive, lateral orbitotomy had to be performed. Further evaluation of the presented procedure demonstrates clearly that trajectory-guided biopsies of the orbit can be performed correctly and effectively, regardless of the suspected lesions size.