Satish Dhasmana

The maxillofacial injuries: A study

Objectives: The aim of this study was to evaluate the incidence and etiology of maxillofacial fractures and also to evaluate different treatment modalities. Study design: The sample consisted of 1,038 patients, with maxillofacial injuries treated at our center from June 2006 to June 2011. Cause, type, site of injury, gender, age and treatment given to them, all these parameter are evaluated. Conclusion: The results of this study exhibit that road traffic accidents is the main reason for maxilla facial injuries followed by fall from height. Maxillofacial injuries are more frequent in male than in female. The mandible was most frequently involved facial bone. The miniplate osteosynthesis was the most widespread of the fixation technique but conservative management of the fractured bone also has a significance importance in treatment modalities.

Condylar Hyperplasia and Facial Asymmetry: Report of Five Cases

Condylar hyperplasia of mandible is overdevelopment of condyle, unilaterally or bilaterally, leading to facial asymmetry, mandibular deviation, malocclusion and articular dysfunction. This is a series of five such patients managed at our centre.

Use of 3-d plate in displaced angle fracture of mandible.

Introduction Mandibular angle fractures can be treated by various methods, but even the most popular methods may not be able to give satisfactory results, as the pterygomasseteric sling and masticatory forces can result in displaced angle fracture. These displaced fragments cannot be satisfactorily retained by single miniplate fixation. The aim of this study is to assess treatment of displaced angle fracture with 3-D miniplate fixation. This study can also be considered as a therapeutic study with level V evidence. Materials and Methods This study was designed to assess the feasibility of 3-D matrix miniplate fixation in displaced angle fractures. Eighteen patients with displaced angle fractures were included in this study. Matrix miniplate fixation was done transorally under general anesthesia. Results All these cases were treated successfully, and common complications like infection (5.5% of patients), wound dehiscence (11%), paresthesia (16.7%), and malocclusion (11%) were observed in our study. Conclusions Three-dimensional miniplate fixation in displaced angle fractures provides better stability and function.

Nasotracheal Fiberoptic Intubation: Patient Comfort, Intubating Conditions and Hemodynamic Stability During Conscious Sedation with Different Doses of Dexmedetomidine

[This corrects the article DOI: 10.1007/s12663-012-0469-0.].

Zygomatic complex fracture: A comparative evaluation of stability using titanium and bio-resorbable plates as one point fixation.

Background: The malar bone represents a strong bone on fragile support and its processes - frontal, orbital, maxillary and zygomatic are frequently the site of fracture. Current study was done to compare the stability of zygomatic complex fracture using Biodegradable plates and titanium miniplates with one point fixation. Materials and Methods: Twenty patients of zygomatic complex fracture were randomly selected and divided in two groups which were further divided into two subgroups (A, B). Group I patients were treated with titanium miniplate at zygomatic buttress and Group II was treated by bio-resorbable plates. One point fixation was done either at zygomatic buttress or at frontozygomatic suture and it was observed that both the site have been the most favored site of rigid internal fixation in terms of stability, aesthetics and prevention of rotation of the fracture segment in either vertical or horizontal axis. Conclusion: There is no significant difference in post operative outcomes between two groups, but still bioresorbable system has some advantage over titanium system as these plates resorbs over a period of time and does not cause any interference with growth and post operative radiotherapy. However application of biodegradable system demands highly précised technique.

The odontomes: Report of five cases

Odontoma seems to result from budding of extra-odontogenic epithelial cells from the dental lamina. This cluster of cells forms a large mass of tissues that may be deposited in an abnormal arrangement, but consists of normal enamel, dentin, cementum and pulp. World Health Organization (WHO) classification defines a lesion as a malformation in which all the dental tissues are represented in a more orderly pattern than in the complex odontoma so that the lesion consists of many tooth-like structures. This article presents a report of five cases of odontomes.

Clinical evaluation of cissus quadrangularis and moringa oleifera and osteoseal as osteogenic agents in mandibular fracture.

Background: Ayurveda the ancient science of medicine describes various herb preparations that achieve the hastening of bone healing. Harjor showed clinical efficacy in the treatment of fractures. Objectives: The comparative evaluation of herbal agents as osteogenic agents in mandibular fractures. Study design: The patients were divided into four groups. Group 1: Osteoseal; Group 3: Harjor (Cissus quadrangularis); Group 2: Moringa (Moringa Oleifera); Group 4: Placebo. Result and Conclusion: Pain, Swelling, Tenderness, Mobility reduction is maximum in Osteoseal group and minimum in Placebo. There was an increase in the serum calcium and phosphorus level at different follow-ups in each groups but there was a decrease in the placebo group. Ca, Ca+, Phosphrous increase was maximum in the group 1.

Awake Blind Nasotracheal Intubation in Temporomandibular Joint Ankylosis Patients under Conscious Sedation Using Fentanyl and Midazolam

Background and ObjectivesIntubating a patient with temporomandibular joint ankylosis is always a challenge particularly when fibreoptic laryngoscope is not available. Awake blind nasotracheal intubation requires sufficient patient co operation and comfort. Presently available short-acting analgesics and amnesics are excellent choices for this exercise.Study DesignThis prospective randomized double blind study was designed to determine an appropriate dosage of fentanyl for awake blind nasotracheal intubation. We compared two different dosage of fentanyl. Eighty patients were randomly assigned to receive midazolam 0.05 mg/kg and fentanyl 2μg/kg in bolus (group I), or midazolam 0.05 mg/kg, fentanyl 3μg/kg in bolus (group II).ResultsBoth dosage regimen ensured patient comfort and sedation. Patients in group II were more calm and sedated as compared to group I. Hemodynamics was also more stable in group II.ConclusionFor awake blind nasotracheal intubation, we therefore recommend midazolam 0.05mg/kg plus fentanyl 3μg/kg in bolus.

Temporomandibular joint interpositional gap arthroplasty under intravenous (I.V) conscious sedation

Ankylosis may be defined as the fusion of joint surfaces. Temporomandibular joint (TMJ) ankylosis is a condition that may cause chewing, digestion, speech, esthetic and psychological disorders. It is a devastating disorder resulting in inability to open the mouth. As a result of this, General anaesthesia, is very difficult to administer because laryngeal inlet is not directly visualized. Even the blind nasal intubation is difficult because of small mandible and tongue fall following relaxation. There are various techniques to overcome these challenges. At times these techniques fail and tracheostomy has to be done. All the risks associated with difficult intubation, and general anaesthesia can be avoided if the surgery is done under conscious sedation. Conscious sedation, a simple but safe and effective method of anaesthesia is described here, which allows successful temporomandibular joint interpositional gap arthroplasty.

The combined analgesic effect of gabapentin and transdermal fentanyl patch on acute and chronic pain after maxillary cancer surgeries

AbstractPurpose of this study was to evaluate the combined analgesic effect of gabapentin and transdermal fentanyl patch, on acute and chronic pain after surgery for maxillary cancer.Study designThe Study was double blind and prospective. 100 subjects belonging to ASA grade I and II, 30–50 years age group, scheduled for maxillary cancer surgery were randomized into two groups; treatment group (GT): to receive gabapentin, transdermal fentanyl patch or control group ©: two placebos. For acute postoperative pain (Visual Analogue Score) and analgesic requirements were assessed 2, 4, 8 hours and 7 days after surgery. Subjects were also assessed for chronic pain 2, 4, 6 months later.ResultsSubjects in treatment group required lesser dose of analgesic, as compared to control group, in the post operative period. Visual Analogue Scores were also significantly lower in the treatment group throughout the post operative period. Occurrence of side effects was non significant between both groups. 2, 4 and 6 months after surgery, 40, 35 and 28 subjects respectively, out of total 45 subjects of the control group, reported chronic pain. In comparison, 25, 10 and 4 subjects out of 42 subjects in the treatment group reported chronic pain 2, 4, 6 months respectively after surgery. 15, 10 and 6 out of 45 of the control group required analgesics, whereas 2, 0 and 0 out of 42 in the treatment group, required analgesics respectively 2, 4 and 6 months after surgeryConclusionAcute and chronic pain after maxillary cancer surgery is significantly reduced by multimodal analgesia.