Journal of Maxillofacial & Oral Surgery最新文献

Aims and objectives: Dexmedetomidine is a relatively new, potent, and highly selective α2-adrenergic receptor agonist used for perioperative sympatholytic, analgesia, and sedation. We conducted this study to evaluate the effects of dexmedetomidine as an adjunct to local anaesthesia for maxillofacial soft tissue injuries as day care in the emergency department on patient hemodynamics and analgesic efficacy.

Materials and methods: Eighty patients gave informed consent to participate in the study. They were divided into Groups P and D, each of which consisted of 40 participants. Patients received saline injections in Group P, and Group D received dexmedetomidine (DEX) with local anaesthesia infiltration to both groups. Hemodynamic parameters, duration of surgery, pain of first rescue analgesia, Pain score, patient satisfaction, and surgeons satisfaction were recorded and quantified using unpaired t tests or Mann-Whitney and ANOVA tests. Data and qualitative data parameters were compared using Chi-square test. A P value < 0.05 was considered significant.

Results: Our study showed statistically significant reduced heart rate, systolic, and diastolic blood pressures in DEX compared to the placebo group where none had hypotension or bradycardia in clinical settings. The dexmedetomidine group had shorter operative time and decreased need for analgesia due to lower VAS scores. Patient and surgeon satisfaction were superior in the DEX group compared to the other groups.

Conclusion: Dexmedetomidine effectively suppresses the hemodynamic stress response during minor surgical procedures. We conclude that dexmedetomidine is an effective medication to be used in the emergency room for day-care procedures, as a potent analgesic, anxiolytic providing hemodynamically stable patients, with minimal side effects. We summarise that considering the above properties of dexmedetomidine can be incorporated into ERAS (early return after surgery) protocol, making it an optimal drug of choice as an alternative to moderate sedative drugs, in managing soft tissue injuries of maxillofacial region.

Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) presents significant clinical challenges with uncertain treatment outcomes. Teriparatide, a fragment of human parathyroid hormone, shows potential in prevention strategies for BRONJ.

Objective: This study investigates the impact of a single local dose of teriparatide on BRONJ prevention in an animal model.

Methods: BRONJ was induced on 26 male Wistar rats via intraperitoneal injections of 0.06 mg/kg Zoledronic acid weekly for four weeks. Following tooth extraction under general anesthesia, rats were divided into two groups: one received teriparatide via Gelatamp in the tooth socket and the other as a local injection in the vestibule. Control groups received the treatment without teriparatide. Histopathological assessments for bone remodeling, osteoclast number, inflammation, angiogenesis, and necrosis were performed after four weeks.

Results: Histopathological analysis indicated a significant improvement in bone remodeling and new bone formation in both treatment groups compared to controls, with notably better outcomes in the injection group (p = 0.01). Necrosis in the Gelatamp group was significantly higher in the control group than in the treatment group (p = 0.01), and bone formation was significantly higher in the injection group compared to the Gelatamp group (p = 0.03).

Conclusion: Local administration of teriparatide significantly enhances bone remodeling and reduces necrosis, suggesting a potential role in the prevention of BRONJ. These findings support further clinical investigation into teriparatide as a preventive strategy against BRONJ.

Introduction: Reconstruction of mandibular disarticulation defects is a challenging area of head and neck surgery, with a variety of options available for replacement of the condylar head. The gold standard is autogenous reconstruction of the condyle-ramus unit. The use of a prosthetic condylar head is controversial, but in challenging cases, and those with a likely poor prognosis it may be considered and can achieve a good functional result. The objective of this study is to evaluate the outcomes of its use in a high volume head and neck reconstructive unit.

Materials and methods: A retrospective analysis of all patients treated at the Queen Elizabeth Hospital, Birmingham who underwent mandibular disarticulation resections and prosthetic condylar reconstruction from January 2008 to December 2019 were included.

Results: This retrospective review included 25 patients; 16 for malignant disease (16), osteoradionecrosis (4), osteomyelitis (2), medication related osteonecrosis (1), and secondary reconstruction(2). Free flap reconstruction was performed in 23 cases; 18 bony composite free flaps, 3 patients required double flap reconstruction, and 2 underwent soft tissue flaps only. Mean follow up was 43 months. Prosthesis related complications were encountered in 6 patients, all malignant cases. Four prosthetic condyles required removal due to recurrent infections and glenoid fossa perforation, This appeared to be related to significant surrounding dead space, and limited bony reconstruction. Rate of complications was lowest for non-malignant cases, and patients who had concurrent bony reconstruction extending up the ascending ramus. Functional outcomes were good with majority of patients having a balanced occlusion and oral intake.

Conclusion: Prosthetic condyle outcomes are best when concurrent bony free flap reconstruction is performed with ascending ramus reconstruction. Avoid prosthetic condyles in cases where the articular disc is removed, and cases where a large amount of dead space is expected around the prosthesis. Careful attention to occlusal factors and vertical support of the reconstruction plate can lead to good functional outcomes. A review of the literature and potential future advances is also presented.

Background: This paper aims to evaluate and standardize measurements of 11 nasal parameters specific to the South Indian population. This is significant because different ethnicities exhibit varying nasal proportions. The findings of this study will serve as a foundation for rhinoplasty procedures performed on the South Indian population as currently there is a lack of literature in this area of study.

Methodology: A total of 136 young individuals of age group 18-30 were taken as a sample; 34 from each state that is Kerala, Karnataka, Tamil Nadu, and Andhra Pradesh were taken up for the study. Standardized photographs of the nose were taken. Eleven nasal parameters were measured using Digimiser software and analyzed.

Results: Eight out of eleven parameters have statistically significant differences among the population of all four South Indian states, while three parameters did not have much of a statistically significant difference.

Conclusion: When compared to the standard values of nasal parameters of the Indian population, only radix height and nasolabial angle were similar. The nasal index of all four South Indian ethnicities was platyrrhine. The nasal parameters did not differ among males and females in all the four South Indian populations.

Aim: The post-operative sequelae of third molar surgical extractions need to be controlled in order to reduce patient morbidity. Dexamethasone is a well-researched drug which has established its merit as an anti-inflammatory agent. The aim of this randomized clinical study was to compare the patient-centric outcomes after pre-emptive intramuscular injection of dexamethasone into the masseter and deltoid, respectively.

Materials and methods: The outcomes measured were pain, facial swelling and mouth-opening postoperatively on Day 1, 3 and 7. The subjects were randomly divided into two groups. Group 1 received an intra-oral injection of 8 mg of dexamethasone into the masseter muscle and a placebo injection of distilled-water into the deltoid muscle 2 h before surgical removal of impacted mandibular third molar. Group 2 received an intra-oral placebo injection of distilled-water into masseter muscle and an 8 mg injection of dexamethasone into deltoid muscle.

Results: On comparison, Group 1 patients experienced statistically significant less pain (VAS score on day 1, 3, and 7), facial swelling (day 1, 3), and restricted mouth-opening (day 1, 3).

Conclusion: The study concluded that pre-emptive dexamethasone injection, at masseter or deltoid, is helpful in reducing post-operative sequelae of mandibular third molar extraction. However, the immediate post-operative outcomes were found to be better mitigated when the injection was administered locally into masseter muscle.

This is a rare case of a patient who developed a relapse of dacryocystitis and maxillary sinusitis although previous dacryocystectomy. We decided to perform an external dacryocystorhinostomy to remove the scar and the residual part of the lacrimal sac combined with endoscopic sinus surgery (ESS) to solve the symptoms.

Introduction: The incidence of recurrence of OKC varied from 2.5 to 62%. Studies have linked recurrence to treatment methods and also clinical and pathological features. The aim of this study was to evaluate the 5-year recurrence and the factors associated with recurrence in odontogenic keratocysts of the jaws.

Methods: A retrospective review of records was done from the Institute's Medical Records Directory from 2010 to 2021. The following data were obtained of the lesion; age at presentation, gender, site, subsite, radiographic presentation (locularity), radiographic borders, presence or absence of satellite cysts, inflammatory infiltrate, and treatment rendered presence or absence of cortical perforation and soft-tissue extension and presence or absence of recurrence. Kaplan Meir estimator was used to evaluate recurrence rate and log rank test was used to compare the survival amongst groups. Cox regression analysis was used to evaluate the odds ratio to find out the possible factors influencing risk of recurrence. A p value of < 0.05 was considered statistically significant at 95% confidence interval.

Results: In our study cohort, 27.2% of patients had recurrence. Posterior maxillary lesions, multilocular lesions, lesions with scalloped borders, presence of soft-tissue extension and cortical perforation, presence of satellite cysts and inflammatory infiltrate and enucleation with peripheral ostectomy were significantly associated with recurrence. However, soft-tissue extension, cortical perforation, multilocular lesions and presence of satellite cysts were independent risk factors.

Conclusion: There is still debate on the best treatment modality for the management of OKCs. More studies are required to quantify the results.

Background and objective: Oral cancer surgery and the associated reconstructive procedures cause mechanical and neurological impairment of swallowing. Despite postoperative rehabilitation, functional impairment of swallowing remains a concern. This study is to investigate the potential benefits of prehabilitation with preoperative swallowing exercises to patients undergoing composite resections and compartmental tongue resections so that it results in better swallowing outcomes and improved quality of life after surgery.

Materials and methods: Sixty patients included in the study were randomized into an exercise and control group of 30 each. Patients with squamous cell carcinoma of the oral cavity undergoing composite resection or compartmental tongue resections were included, and patients with severe trismus at presentation were excluded. Patients in the exercise group were instructed on a set of six active exercises to be followed strictly for a period of at least 1 week before surgery. Preoperative swallowing exercises comprised of evidence-based exercises targeting the muscle groups involved in swallowing. Postoperative swallowing rehabilitation was the same as that of the control group. Patients were assessed after 6 months of surgery. Outcomes were assessed both subjectively and objectively. Objective assessment was done by inexpensive, novel clinical methods of repetitive saliva swallow test (RSST), water swallow test (WST) and food swallow test (FST) to and graded using dysphagia severity scale (1-7).

Results: Average oral intake scale (1-Oral solids, 2-Oral semisolids/easy to chew foods, 3-Oral liquids only and 4-Non-oral, orogastric tube dependent) assessed subjectively was significantly lower in exercise arm, and the control arm had a significantly higher OIS score. Exercise arm had higher number of patients in DSS scores of 5, 6 and 7. The control arm had a higher number of patients in DSS scores of 3 and 4. The differences between the two groups were found to be statistically significant taking into consideration the confounding factors of radiation, wound morbidity and tongue resections.

Conclusion: Preoperative swallowing exercises have shown a positive impact on postoperative swallowing ability. This is the first randomized trial to assess the effect of PSE in postoperative oral cancer patients. Our exercise protocol needs standardization, and clinical objective method of dysphagia assessment requires further validation. However, prehabilitation with PSE has the potential to improve the quality of life in oral cancer patients.

Background: Surgical excision of the tumor remains the primary choice for the treatment of head and neck cancer patients, but it often leads to facial disfigurement, which further causes mutilation in the patients. Mutilation causes shame and stigma, which imparts significant psychological strain on patients, and tends to impair their quality of life.

Objective: The present study aimed to assess the shame and stigma over long-term postoperative survival duration in head and neck cancer patients.

Methodology: Total 100 postoperative patients of head and neck cancer were recruited from the outpatient department of the host institute, and shame and stigma was assessed using the Hindi version of the shame and stigma scale.

Results: The global shame and stigma score was 22.67 ± 16.22, with the highest perceived stigma due to changes in appearance (11.94 ± 8.805), followed by impaired speech (4.490 ± 3.243), feeling of regret (3.950 ± 3.313), and feeling of stigma (4.490 ± 3.243). The shame and stigma was found to be significantly higher in maxillary cancer patients (33.22 ± 16.60), followed by larynx cancer patients (22.06 ± 13.41) and oral cancer patients (21.53 ± 16.49). Patients with stage III and stage IV of cancer were found to perceive higher shame and stigma (35.91 ± 22.23 and 27.36 ± 14.71, respectively) compared to the patients having stage I and stage II cancer (9.583 ± 9.709 and 16.44 ± 11.82, respectively). A significantly declining linear trend was found between shame and stigma and postoperative survival duration.

Conclusion: We concluded that shame and stigma act as important determinants of quality of life over long-term survival in head and neck cancer patients, and should be considered while designing psychological interventions and surgical reconstruction protocols. The present study will help clinicians to assess the mutilation among head and neck cancer patients in a better way and will help in devising new psychological strategies to manage psychological aspects associated with mutilation, which will ultimately enhance the quality of life of patients.