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1.  The Split Obturator: An Innovative Technique 
A palatal prosthesis can improve function by closing the palatal defect, preventing regurgitation, improving swallowing and speech. Although techniques have been previously described for fabrication of palatal obturator but there have not been any techniques to devise an obturator for a patient with palatal defect and that too with a quad helix orthodontic appliance overlying it. This article describes an innovative method of fabricating a palatal obturator which aims at restoring the above mentioned functions along with improving esthetics and making it cleansable, thus improving patient psychology and confidence and be a boon for them.
PMCID: PMC3682006  PMID: 24431846
Palatal obturator; Quad helix; Regurgitation; Cleansable; Psychology
2.  Pleomorphic Adenoma of Minor Salivary Gland in a 14 year Old Child 
Salivary gland tumours are rare in childhood, and almost all of them occur in parotid gland. Minor salivary gland tumours are even rarer, pleomorphic adenoma being the most frequently found tumour. Only seventeen cases of pleomorphic adenoma arising in the minor salivary gland tumour have been reported in children and adolescents. Pleomorphic adenoma of minor salivary gland represents about 45% of all the tumours of the minor salivary glands. Pleomorphic adenoma is slowly enlarging tumour indistinguishable from adenoid cystic carcinoma clinically, except for pain and ulceration, which is more common in the latter. Carcinoma arising from pleomorphic adenoma has been reported in 3% cases amongst the minor salivary gland tumours. This report presents a case of pleomorphic adenoma of minor salivary gland in a 14 year old female patient with a brief review of literature.
PMCID: PMC3681990  PMID: 24431845
Pleomorphic adenoma; Minor salivary gland tumour; Cystic degeneration
3.  A Case of Carcinoma Ex Pleomorphic Adenoma in the Buccal Mucosa: Review of the Literature 
We present a case of carcinoma ex pleomorphic adenoma on the right buccal mucosa in a 52-year-old Japanese woman. Based on the histopathology, the excised tumor was the non-invasive type, but the majority of the tumor consisted of poorly-differentiated adenocarcinoma cells. We performed proton radiation after the surgery. The patient was well, without evidence of disease, 48 months after surgery. Carcinoma ex pleomorphic adenoma in the buccal mucosa has been reported in only four cases during the past twenty years. Therefore, our case was comparatively rare.
PMCID: PMC3681991  PMID: 24431844
Carcinoma ex pleomorphic adenoma; Buccal mucosa; Proton radiation
4.  Proximity of Impacted Mandibular Third Molars to the Inferior Alveolar Canal and Its Radiographic Predictors: A Panoramic Radiographic Study 
To assess the radiographic proximity of impacted mandibular third molars to the inferior alveolar canal on panoramic radiographs. The radiographic distance between the impacted mandibular third molars and inferior alveolar canal and the reliable radiographic risk predictor signs that indicate close proximity between these two structures were evaluated.
The study comprised of 64 subjects with 68 symptomatic impacted mandibular third molars for whom panoramic radiographs were made. The radiographs were interpreted for type of impaction, radiographic distance between impacted mandibular third molars to inferior alveolar canal and presence of one or more of the seven radiographic risk predictor signs. Further, these teeth were surgically removed and the proximity was assessed based on the exposure of inferior alveolar canal/nerve which was considered as Gold standard.
The overall mean distance from the impacted mandibular third molars to inferior alveolar canal was −0.50 mm. Most of the samples (61.8 %) extended beyond the superior border of the inferior alveolar canal with a mean distance of −1.40 mm. Mesioangular impactions were found to be in the close proximity (−1.14 mm) to inferior alveolar canal than any other type. Interruption of the white line was the only statistically significant radiographic risk predictor sign p = 0.006 (< 0.05) that indicated close proximity of impacted mandibular third molars to inferior alveolar canal.
It can be concluded that panoramic radiographs are reliable in assessing the proximity of impacted mandibular third molars to inferior alveolar canal. Mesioangular impactions are more closely placed to inferior alveolar canal and interruption of the white line is the most reliable risk predictor sign on the panoramic radiographs.
PMCID: PMC3681992  PMID: 24431832
Panoramic radiographs; Inferior alveolar canal/nerve; Impacted mandibular third molars; Radiographic risk predictor sign
5.  Giant Hemangioma Presenting as a Scalp Mass Leading to a Craniofacial Deformity 
Hemangioma is the most common vascular tumor during childhood. However, cases of giant hemangiomas determining deformities in the craniofacial region are not reported frequently. Craniofacial giant hemangiomas are challenging for surgeons since they cause aesthetic and/or functional problems and may be associated with important complications such as ulcerations, infections and bleedings. The present report is aimed at describing a rare case of craniofacial asymmetry in a 30-year-old patient, secondary to an extensive mass whose growth deformed the scalp in the frontal-parietal-temporal region. The lesion was completely surgically removed with good aesthetic results, and the anatomopathological examination revealed that it was a cavernous hemangioma.
Electronic supplementary material
The online version of this article (doi:10.1007/s12663-011-0218-9) contains supplementary material, which is available to authorized users.
PMCID: PMC3681993  PMID: 24431843
Cavernous hemangiomas; Craniofacial abnormality; Hemangiomas; Surgery
6.  Coincidental Overlapping Cystic Pathological Changes: A Case against Marsupialisation 
It is relatively common to observe a solitary well defined periapical cystic change associated with decayed primary tooth displacing the underlying developing permanent tooth bud. Marsupialisation of such cysts is indicated so as to allow for eruption of the underlying tooth bud. A similar solitary well defined periapical cystic lesion involving the mixed dentition in a child was planned for enucleation. Surprisingly, during the surgical intervention two distinct separate cystic pathological changes were observed. Marsupialisation of the cystic defect with extraction of the primary tooth would have left the enlarged follicle with the developing tooth bud unaddressed. The pathological process associated with the dilated follicle would continue to progress further and may require an additional surgical intervention. The distinction between enlarged follicle and dentigerous cyst clinically is also important. Considering the size, extent and presence of the large bony cavity during the surgical intervention enucleation of both the pathological changes was performed.
PMCID: PMC3681994  PMID: 24431842
Radicular cyst; Enlarged follicle; Marsupialisation
7.  Achieving the Prediction Results by Visualized Treatment Objective Following Anterior Maxillary Segmental Osteotomy. A Retrospective Study 
This study used the manual visualized treatment objectives (VTO) as a tool to evaluate the predictive value of the computer-assisted VTO. Presurgical cephalometric tracing predictions generated by oral and maxillofacial surgeons and computer-assisted VTOs were compared with the postsurgical outcome as seen on lateral cephalometric tracings. Ten measurements of the predicted and actual postsurgical hard tissue landmarks were compared statistically. A paired Student’s t test showed that in nine of ten measurements, there were no statistically significant differences in the mean values of manual VTO (MVTO). Statistically significant differences were found in one of the four linear measurements (cant of upper lip P − 0.0001). For computer assisted (CAVTO) Student’s t test showed that in nine of ten measurements, there were no statistically significant differences in the mean values. Statistically significant differences were found in one of the four linear measurements (nasolabial angle, P  − 0.0001). From these data, it appears that both VTOs demonstrated good predictive comparative outcome, and are equally predictive, but CAVTO is precise.
PMCID: PMC3681995  PMID: 24431838
Cephalometric analysis; Quick ceph; Orthognathic treatment planner
8.  Efficacy of Colour Doppler Ultrasound in Diagnosis of Cervical Lymphadenopathy 
The purpose of the study was to evaluate the efficacy of colour doppler ultrasound (CDUS) in diagnosis of cervical lymphadenopathy.
Materials and Methods
The study group consisted of 30 patients with clinical evidence of cervical lymphadenopathy (19 patients with clinically suspected reactive/benign cervical lymphadenopathy and 11 patients with clinically suspected malignant/metastatic cervical lymphadenopathy). CDUS examinations were carried out for one lymph node (LN) in each patient and fine needle aspiration cytology of the same LN was obtained. To evaluate the efficacy of CDUS, comparison between clinical features, CDUS features and cytological features of enlarged cervical LNs were then done.
Clinical examination evaluated 54 cervical LNs. CDUS evaluation discovered an additional 55 LNs (54 + 55 = 109). Accuracy of the CDUS examination was higher than clinical evaluation. Patterns of colour doppler flow signals when correlated with cytological diagnosis showed central flow for benign nodes and peripheral flow for malignant nodes. The mean pulsatility index (PI) was 1.977 ± 0.669 in LNs involved with metastases and 0.839 ± 0.135in LNs affected by benign processes. LNs involved with metastases showed a characteristic high resistive index (RI) and a high pulsatility index than the lymph nodes affected by benign processes. The RI and PI were significantly different between LNs affected by benign versus malignant disease.
Nodal vascularity of the LNs can be used to differentiate benign from malignant lymphadenopathy. CDUS can be trusted upon as a reliable marker for the diagnosis of cervical lymphadenopathy.
PMCID: PMC3681996  PMID: 24431828
Colour doppler ultrasound; Cervical lymphadenopathy; FNAC
9.  Maxillofacial Injuries in Children: A 10 year Retrospective Study 
Fractures of facial bones in children are relatively uncommon although both children and adults are subjected to similar types of injuries. This study aims to evaluate the epidemiology of facial bone fractures among children under 14 years, their management and outcome.
Materials and Methods
This retrospective study included maxillofacial injuries treated in 112 children under 14 years admitted due to maxillofacial injuries during the period from 2001 to 2011.
Of them ten (8.93 %) were below 5 years, 44 (39.29 %) between 6 and 10 years and 58 (51.78 %) between 11 and 14 years of age. Male to female ratio was 1.8:1. Fall from a height was the most common etiology. The most common jaw involved in the fracture was the mandible. Conservative management was done in 83.04 % of cases and open reduction and internal fixation was performed in 16.96 % of cases. Five (4.46 %) cases accounted for post-operative wound infection.
Fracture of the mandible is the most common maxillofacial injury in children, most often caused by fall from a height. The osteogenic potential of the mandible in children leads to conservative management of these fractures. Opportunities for prevention of maxillofacial trauma should be taken into consideration by parents and care takers.
PMCID: PMC3681997  PMID: 24431831
Trauma; Pediatric; Maxillofacial injuries; Mandible; Non-surgical measures
10.  Immediate Non-functional Loading of Single Tooth Uniti™ Implants into Avulsed Tooth Sockets Following Ridge Augmentation in the Anterior Maxilla: A Case Series 
To assess the clinical effectiveness of immediate non-functional loading of single-tooth implant placed into avulsed tooth socket following ridge augmentation in the anterior maxilla with bioglass bone substitute and biocollagen membrane. The clinical outcome of immediate non-functional loaded implants up to 24 months after placement into avulsed tooth sockets in anterior maxilla were evaluated in 15 patients. Implants were immediately restored with acrylic resin provisional crowns. Post-operative follow-up and intraoral radiographs were obtained at 6, 12, 18 and 24 months. Survival rate, implant threads exposure immediately after placement and at 6 month interval using CT 3D reconstruction was assessed. Marginal bone loss did not extend beyond the first thread and 3D CT scan showed adequate bone mineral density with no signs of radiolucent lesion around the implant during 24 months follow-up having survival rate of 100 %. Within the limits of the present study, immediate non-functional loading of single tooth implant placed into avulsed tooth socket following augmentation with bioglass bone substitute and biocollagen membrane in the anterior maxilla is one of the viable treatment alternatives for rehabilitation of immediate loading implant.
PMCID: PMC3681998  PMID: 24431840
Single tooth implants; Ridge augmentation; Anterior maxilla; Bioglass bone substitute; Biocollagen membrane; Immediate non-functional loading; Avulsed tooth; Bioglass; 3D CT scan
11.  Botulinum Toxin Type A for the Treatment of Hyperkinetic Lines of the Face 
This study sought to determine the efficacy of Botulinum toxin A (BTA) for the treatment of hyperkinetic lines of the face. Twenty three patients who were concerned for facial wrinkles and desiring correction are presented.
This clinical study evaluated the postoperative results of 23 patients who underwent treatment for facial wrinkles with BTA. Among the patients included in the study, 20 were males and remaining 3 were females. The age of the patients ranged from 27 to 46 years (mean 34.69 years) and the treatment was done in three different sessions and divided into 3 treatment subgroups of forehead, crow’s feet, and glabellar wrinkles.
All the patients were followed up for a period of at least 6 months and graded for the response to treatment with BTA by the operator, observer and the patient independently using the facial wrinkle scale. The patient’s satisfaction to the treatment was also noted on all the follow-up visits on the satisfaction scale and the results were subjected to statistical analysis using Kappa analysis, Chi-square test and T test. The results showed that the treatment of facial hyperkinetic lines with BTA is associated with few adverse events like pain on injection, transient headache, and mild change in facial appearance in subjects with high hair line which are not serious and thus safe.
The findings of this study support the use of BTA for the treatment of hyperkinetic lines of the face although further studies with more sample size are required.
PMCID: PMC3681999  PMID: 24431836
Hyperkinetic lines; Face; Botulinum toxin A
12.  Foreign Bodies in Facial Trauma-Report of 3 Cases 
Foreign bodies embedded deep in facial tissues presents a challenge to maxillofacial surgeons. Approximately one third of all foreign bodies are missed during initial examination. After facial trauma foreign bodies like grit particles, wooden pieces, thorns, pebbles, glass particles may get embedded into deeper facial tissues which are detected only accidently either with the help of radiographs or at a later stage when patient presents with some signs & symptoms like pain, pus discharge, sinus formation etc. Trauma to maxillofacial region especially after road traffic accidents is one of major cause of embedment of foreign body, but many of these cases go unnoticed. This article contains 3 cases of foreign bodies embedded in facial tissues.
Proper initial examination of facial lacerations with thorough debridement is very essential for finding embedded foreign bodies. Foreign bodies embedded in deeper tissues are missed by surgeon eyes, so whenever in doubt radiographs must be advised to rule out presence of foreign bodies.
PMCID: PMC3682000  PMID: 24431841
Foreign body; Maxillofacial trauma; Infection; Grid particles
14.  A Comparative Study of the Effect of Prednisolone and Celecoxib on MMO (Maximum Mouth Opening) and Pain Following Removal of Impacted Mandibular Third Molars 
The purpose of this study was to compare the effects of prednisolone and celecoxib on pain and maximum mouth opening (MMO) after surgical removal of mandibular third molars.
Methods and Materials
This double-blind clinical study was conducted upon 60 subjects. These patients received 4 tablets of either 100 mg celecocxib or 5 mg prednisolone: one tablet before surgery and the rest for every 8 h post-operation. The subjects were asked to take acetaminophen codeine as rescue dose. Interincisal distance of upper and lower central teeth and pain measurements (according to Visual Analogue Scale) were taken before surgery, 24 h, 48 h and 7 days after surgery.
Average pain intensity in 24 h after surgery in patients receiving celecoxib was 3.6 ± 2.5 with significant difference to the other group (p = 0.041), but in subsequent evaluations prednisolone group reported less pain intensity, but the differences were not significant. MMO in 48 h after surgery was lower in prednisolone group (p = 0.640) and in further evaluations the groups were almost similar. Analyzing the data revealed no significant difference between groups in MMO.
According to this study there is no significant difference in the effects of prednisolone or celecoxib upon MMO, while celecoxib had better results for pain relief in 24 h after surgery in comparison to prednisolone.
PMCID: PMC3682002  PMID: 24431837
Celecoxib; Prednisolone; Pain; Maximum mouth opening; Third molar surgery
15.  Bhawsar–Karandikar Stent: An Aid to Vestibuloplasty 
The loss of teeth and their replacement by artificial denture is associated with many problems. Pre-prosthetic surgical procedures are performed to provide a better anatomic environment and to create proper supporting structures for construction of dentures. Whenever inadequate vestibular depth is present in edentulous mouth, deepening of vestibule is considered to increase the retention and stability of denture. Deepening of vestibule without any addition of the bone is termed as vestibuloplasty. This article describes the ease and convenience of vestibuloplasty followed by the use of Bhawsar-Karandikar stent to maintain the soft tissue modifications. The study yielded promising results and patient acceptance.
PMCID: PMC3682003  PMID: 24431847
Preprosthetic surgery; Bhawsar–Karandikar stent; Vestibuloplasty
16.  Comparative Evaluation of Pre-Emptive Analgesic Efficacy of Intramuscular Ketorolac Versus Tramadol Following Third Molar Surgery 
Pre-emptive analgesia aims at preventing the central nervous system from reaching a hyper-excitable state known as central sensitization, in which it responds excessively to afferent inputs. The clinical implication would be more effective pain management, thereby reducing post-operative pain and analgesic requirements. This study aimed at investigating the existence of pre-emptive analgesia and to compare the pre-emptive analgesic efficacy of im ketorolac [NSAID] versus tramadol [SYNTHETIC OPIOD] for post-operative pain management following third molar surgery. Fifty patients under the age group of 16–25 years with asymptomatic, symmetrically impacted mandibular third molars were equally divided into 2 groups and underwent third molar surgery under local anesthesia. Ketorolac 30 mg and tramadol 50 mg were used in the study group, while sodium chloride 0.9 % was used in the control group. Study parameters included pain intensity scores for 12 post-operative hours, time to 1st rescue analgesia, total number of analgesics consumed during the 5 post-operative days and patients’ self assessment of efficacy of the surgery with regardsto no pain. Statistically, the data are presented as the mean values with their standard deviations and a 95 % confidence interval [p is significant, if p < 0.05] for the mean are applicable. Incidences of adverse events like pain on injection of the study drug, local reactions, nausea and vomiting were noted. Patients in the study group significantly performed better than the control group in terms of all the parameters; while among the study group, ketorolac fared better than tramadol. All the drug related complications were mild and did not require any intervention. Pre-operative ketorolac or tramadol in comparison to placebo resulted in a significantly better post-operative pain management. However as against tramadol, ketorolac is a better choice as a pre-emptive analgesic agent for the post-operative pain management following third molar surgery.
PMCID: PMC3682004  PMID: 24431839
Third molar surgery; Ketorolac; Tramadol; Pre-emptive analgesia
17.  Extraction of Permanent Maxillary Teeth by Only Buccal Infiltration of Articaine 
The aim of this study is to demonstrate whether articaine hydrochloride administered alone as a single buccal infiltration in maxillary tooth removal, can provide favourable palatal anesthesia as compared to buccal and palatal injection of lidocaine.
Study Design
The study population consisted of 30 patients who were undergoing orthodontic treatment, and who required bilateral extraction of maxillary permanent premolars as per their orthodontic treatment plan. On the experimental side, 4 % articaine/HCl was injected into the buccal vestibule of the tooth to be extracted. On the control side, 2 % lignocaine HCl was injected both into the buccal and the palatal side of the tooth to be extracted. Following tooth extraction all patients completed a 100-mm visual analogue scale (VAS) and faces pain scale (FPS) to rate the pain on extraction.
According to the VAS and FPS scores, the pain on extraction between buccal infiltration of articaine and the routine buccal and palatal infiltration of lignocaine was statistically insignificant.
The routine use of a palatal injection for the removal of permanent maxillary premolar teeth may not be required when articaine/HCl is used as the local anesthetic.
PMCID: PMC3682005  PMID: 24431829
Articaine; Lignocaine; Tooth extraction; Maxillary tooth extraction with buccal infiltration
18.  Comparative Analysis of Osteosynthesis of Mandibular Anterior Fractures Following Open Reduction Using ‘Stainless Steel Lag Screws and Mini Plates’ 
The purpose of this study was to compare the outcome of open treatment of mandibular fracture (symphysis or parasymphysis) using lag screw or mini plate clinically as well as radiologically in young (age range 12–45 years) and healthy individuals of poor socioeconomic status.
This prospective study was conducted on 30 patients diagnosed as cases of displaced mandibular anterior fractures treated with open reduction and internal fixation. The patients were then randomly allocated to either of two groups––Group A: Two 2.5 mm stainless steel lag screws were placed in 15 patients. Group B: Two 2.5 mm stainless steel mini plates were placed in 15 patients for the fixation of fractures. Subsequent follow up was done on 2nd, 4th, 6th and 8th week postoperatively. During every follow up patient was assessed clinically for infection, malocclusion, loosening of plate/screw, sensory disturbance, plate fracture, malunion/non-union, devitalisation of associated dentoalveolar segment and masticatory efficiency. Radiographs were taken if necessary and patients were further assessed for any complaint. Pain was objectively measured using a visual analogue scale, bite force was measured using a bite force transducer at biweekly interval. The data collected was subjected to unpaired t test and paired t test for statistical analysis.
During follow up period a significant improvement in bite force was present in both the groups, with more improvement seen in the lag screw group (p < 0.01). There was a significant pain reduction present in the lag screw group (p < 0.01) and also masticatory efficiency showed a steadier improvement in lag screw group while mini plate group patients showed a tendency to masticate only food items of medium hard consistency.
The sample size is small to conclude lag screws are better than mini plates but the result of our study provides a basis for further studies done to conclude that the application of LAG SCREW is an effective, inexpensive, quick treatment modality to accelerate healing of fresh, displaced mandibular anterior fracture.
PMCID: PMC3682007  PMID: 24431830
Mandibular anterior fracture; Lag screw; Miniplates; Bite force
19.  Efficacy of PRP in the Reconstruction of Mandibular Segmental Defects Using Iliac Bone Grafts 
This retrospective study was conducted to evaluate the role of platelet-rich plasma (PRP) in the reconstruction of segmental mandibular defects using iliac bone grafts. Thirteen patients underwent reconstruction of post-resection segmental defects of the mandible using titanium reconstruction plates, cortico cancellous iliac bone graft. The patients were randomly separated into two groups. One group of the patients received a PRP graft in addition to the iliac bone graft. Post-operative dimensions of the graft were measured and compared to assess the efficacy of PRP in reconstruction of segmental defects. The post-operative follow-up radiographs confirmed consolidation of the graft in all cases and the segmental defect was obliterated. Thereby mandibular continuity was successfully achieved in all cases. Two patients in the non-PRP group developed an infection and were administered additional antibiotics. The infection was contained and the grafts survived. The use of PRP along with autogenous bone graft may be advantageous since it appeared to enhance the quantity of bone formed. Further long-term follow-up and studies are required to effectively establish the efficacy of PRP and autogenous free bone grafts in the reconstruction of bony defects.
PMCID: PMC3682008  PMID: 24431834
PRP; Mandibular reconstruction; Free graft
20.  Evaluation of Versatility and Effectiveness of Pedicled Buccal Fat Pad Used in the Reconstruction of Intra Oral Defects 
The use of buccal fat pad as a grafting source in the closure of intraoral defects has gained popularity in the last quarter of this century. Because of the ease of access and rich blood supply, its use in oral defects is an attractive concept.
The study comprised of 8 patients with oral submucous fibrosis, 1 patient with oroantral fistula, 1 patient with verrucous hyperplasia. The acquired oral defects following resection of pathology in the oral cavity, were reconstructed with pedicled buccal fat pad. The Post operative follow up at the intervals of 1st, 7th and 15th day, followed by 1st month, 2nd month and 3rd month was done.
The procedure was successful in all the patients. Healing was satisfactory with no breakdown or liquefaction necrosis post operatively. All the patients had definitive colour change at the end of 1st post operative month owing to the epithelialisation. Residual defect was present in one patient diagnosed of verrucous hyperplasia on the 1st and the 7th post operative day which subsequently healed. In 8 patients with oral submucous fibrosis post operative mouth opening was measured in and was observed to be in the range of 12–26 mm on the 1st post operative day and 34–42 mm during 3rd month post operatively.
The results of this study support the view that the use of buccal fat pad is a simple, convenient and reliable method for the reconstruction of small to medium sized intra oral defects.
PMCID: PMC3682009  PMID: 24431833
Buccal pad of fat (BPF); Oral submucours fibrosis (OSMF); General anaesthesia (GA)
21.  Factors Influencing Lingual Nerve Paraesthesia Following Third Molar Surgery: A Prospective Clinical Study 
Background and Objectives
The purpose of this prospective study was to evaluate the incidence and various risk factors influencing the sensory deficit in case of lingual nerve injury (LNI) in individuals whose impacted mandibular third molars are surgically removed under local anesthesia.
Materials and Methods
The study was based on the data collected prospectively from a random group of 100 patients who underwent surgical removal of bony impacted lower third molar in a dental hospital. Details of the patient, reason for extraction, type of impaction, method of surgery and signs and symptoms of nerve injury are recorded. Neurosensory testing was done to evaluate the LNI at 1 week, 1 months, 3 months and 6 months interval. Comparison was carried out using Chi square test. For all tests a P < 0.05 was considered significant.
The incidence of LNI was 4 % and of temporary in nature which recovered well within 6 months postoperatively. The age of the patient above 26 years, lingual flap retraction, depth of impaction (red line ≥10 mm) and duration of surgery above 30 min were the significant factors for causing LNI.
The age of the patient, depth of impaction, lingual flap retraction and longer duration of surgery are significant risk factors for LNI during mandibular third molar surgery. Greater care should be taken to avoid the morbidity and patients should be informed well ahead about the probable complications.
PMCID: PMC3682010  PMID: 24431835
Impaction; Third molar; Lingual nerve injury (LNI); Neurosensory testing
22.  Carnoy’s in Aggressive Lesions: Our Experience 
Carnoy's solution is used in the treatment of various aggressive cysts and tumors in the maxillofacial region as a chemical cauterizing agent. Its use has been extensively studied in case of odontogenic keratocysts. It is used in the management of unicystic ameloblastomas and ossifying fibromas. In our institution from 2006 to 2010 we have treated 14 cases of maxillofacial lesions using carnoy's solution. Among these cases 7 were of odontogenic keratocyst, 4 cases were of amelobalstoma and one case was of juvenile ossifying fibroma. So here we share our experience of treating these lesions with the carnoy's solution.
PMCID: PMC3589493  PMID: 24431812
Carnoy’s solution; Ameloblastoma; Odontogenic keratocyst; Juvenile; Ossifying fibroma
23.  Arched Needle Technique for Inferior Alveolar Mandibular Nerve Block 
One of the most commonly used local anesthetic techniques in dentistry is the Fischer’s technique for the inferior alveolar nerve block. Incidentally this technique also suffers the maximum failure rate of approximately 35–45%. We studied a method of inferior alveolar nerve block by injecting a local anesthetic solution into the pterygomandibular space by arching and changing the approach angle of the conventional technique and estimated its efficacy. The needle after the initial insertion is arched and inserted in a manner that it approaches the medial surface of the ramus at an angle almost perpendicular to it. The technique was applied to 100 patients for mandibular molar extraction and the anesthetic effects were assessed. A success rate of 98% was obtained.
PMCID: PMC3589494  PMID: 24431825
Inferior alveolar nerve block; Failure rate; Arched needle
24.  A Clinician’s Role in the Management of Soft Tissue Injuries of the Face: A Clinical Paper 
Injuries of the facial soft tissues may be due to road traffic accidents, industrial injuries, domestic and interpersonal violence, dog bites, human bites, war injuries etc. They may be described depending on the depth of involvement of the soft tissue and/or region since it gives the clinician the method of treatment. The soft tissue injuries must take into the underlying skeletal injury into account since these injuries if carelessly handled they leave deformed scarring in the most precious and beautiful part of the body.
Materials and Methods
Various patients reporting to the department of Oral and Maxillofacial Surgery, Narayana Dental College and hospital, Nellore were included in the study. Injuries in the various aspects of face at various anatomical areas has been presented with the mode of management.
The maxillofacial surgeon while attending these cases should avoid the need for revision by having a thorough knowledge of the anatomy, physiology of the soft tissues and treat them accordingly after following good clinical and radiological examination.
PMCID: PMC3589495  PMID: 24431809
Facial trauma; Facial injury; Soft tissue injury
25.  Efficacy of Buprenorphine Added 2 % Lignocaine 1:80000 in Postoperative Analgesia After Minor Oral Surgery 
Recent studies have demonstrated that opioid analgesia cannot be exclusively attributed to effects within central nervous system. Peripheral opioid receptors exist that can be activated by locally applied opioid agonists which mediate analgesic effects that are particularly prominent in painful inflammatory conditions. Patients who present themselves with conditions requiring minor surgery in the maxillo-facial region usually have associated ongoing inflammatory process. The aim of our study was to apply the concept of peripheral opioid analgesia in minor oral surgery and evaluate its effectiveness in managing postoperative pain. The present study was designed to evaluate the efficacy of buprenorphine added lignocaine 2 % in providing postoperative analgesia after minor oral surgery.
Materials and Methods
Hundred consenting adult patients who were scheduled to undergo various minor oral surgeries were enrolled in this double blinded study. Patients were randomly assigned into one of the two groups based on whether they received buprenorphine added 2 % lignocaine 1:80000 (Group I) or (Group II) lignocaine 2 % with adrenaline 1:80000 alone. Visual analog scale method was used for evaluation of the postoperative analgesia.
The duration of analgesia in Group I was found to be 36 ± 1.5 h and the average consumption of NSAIDs was found to be 1.86 as compared to Group II mean value of 4.4 (P < 0.0001).
Addition of small amounts of buprenorphine to 30 ml lignocaine with adrenaline 1:80000 for minor oral surgery results in significant improvement in postoperative analgesia up to 36 h and markedly reduces the need for excessive analgesic intake. Thus reducing the adverse effects associated with excessive use of NSAIDs.
PMCID: PMC3589496  PMID: 24431810
Local anesthesia; Buprenorphine added LA; Peripheral opioid analgesia

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