No abstract

IntrOductIOnSurgical extraction of impacted mandibular third molar is one of the most commonly performed day care procedure in Oral and Maxillofacial Surgery either for therapeutic or prophylactic purpose. It is often associated with complications like pain, swelling, trismus, dry socket, bleeding and infection, which are typically temporary in nature. However, the most concerning complication is temporary or permanent damage to the Inferior Alveolar Nerve (IAN) resulting in paresthesia, hypoesthesia or dysesthesia of the lower lip, teeth, gingiva and skin over the chin, which significantly affects the quality of life of the patient [1].Ahmed C et al., reports that the common risk factors for the IAN damage includes advanced age and difficult impaction but the most important one is the proximity of the root to the IAN canal [2]. The incidence of IAN injury following mandibular third molar extraction is 0.41% to 8.1% for temporary altered sensation and 0.014% to 3.6% for permanent nerve damage [3]. But the incidence increases up to 20% to 36% in high risk cases as defined by radiographic signs described by various authors [4,5] which includes alteration in the root structure (darkening, narrowing, root deflection, bifid apex or overlapping over the nerve canal) or alteration in the inferior alveolar canal features (obliteration of radio opaque line, deflection or narrowing of the inferior alveolar canal). In these cases the nerve injury may occur either due to the instrumentation or due to crushing and tearing of the nerve by the root during tooth elevation [4].Various approaches have been proposed to decrease damage to the IAN in high risk cases, which comprises coronectomy and leaving the roots behind, staged surgical removal of the third molar [6], modified coronectomy and grafting [7], orthodontic aided extrusion [8] and pericoronal ostectomy [9]. Staged tooth removal was proposed to minimize the late post-operative risk of infection of retained roots, but requires two surgical interventions and the amount of root migration is unpredictable. Modified coronectomy with grafting was advocated for restoring the periodontal health of the second molar. Orthodontic aided extrusion of the third molar is technique sensitive, time consuming, expensive and unpredictable procedure. Applied coronectomy to prevent IAN damage was first proposed by Ecuyer and Debien [10] in 1984. In spite of numerous studies supporting the effectiveness of coronectomy, the procedure remains controversial due to the possibilities of infection and other odontogenic pathology arising from the roots left behind [11]. The aim of present study was to evaluate the outcome after coronectomy of mandibular third molars in terms of complications encountered during or after the procedure, temporary or permanent IAN injury, infection rate and other associated morbidity.

Aim:The aim was to determine the morbidity or mortality associated with the blind awake intubation technique in temporomandibular ankylosis patients.Settings and Design:A total of 48 cases with radiographically and clinically confirmed cases of temporomandibular joint (TMJ) ankylosis were included in the study for evaluation of anesthetic management and its complications.Materials and Methods:Airway assessment was done with standard proforma including Look externally, evaluate 3-3-2 rule, Mallampati classification, Obstruction, Neck mobility (LEMON) score assessment in all TMJ ankylosis patients. The intubation was carried out with the standard departmental anesthetic protocol in all the patients. The preoperative difficulty assessment and postoperative outcome were recorded.Results:Blind awake intubation was done in 92% of cases, 6% of cases were intubated by fiberoptic awake intubation, and 2% patient required surgical airway. Ninety-eight percent of the patients were cooperative during the awake intubation. The frequent complications encountered during the blind awake intubation were epistaxis and sore throat.Conclusion:In an anesthetic setup, where fiberoptic intubation is not available, blind awake intubation could be considered in the anesthetic management algorithm.

Nasopalatine duct cyst is the nonodontogenic developmental cyst, frequently occurring in the midline of the anterior maxillary region. The clinical presentation of the cyst is often varied and presents a diagnostic difficulty and frequently misdiagnosed as developmental or inflammatory odontogenic cystic lesion. This paper represents a large infected nasopalatine duct cyst presenting with complete destruction of anterior palate and pyriform rim.

We are presenting a case with multiple recurring ankylosis, as the child had exhibited the clinical signs and symptoms of an ankylotic right temporomandibular joint. She was operated for the 1st time when she was 6 years old with poor compliance and was reoperated with a distraction unit when she was 10 years old. The research points out to frequent relapses in younger patients operated as they had less compliance relative to the adult ankylotic patients. Henceforth, we dealt with an aggressive approach of planning only on the resection of the mass and if the mouth opening ensues to progress with further correction of the asymmetry and the residual defect. The patient had nil mouth opening and hence was consented for tracheostomy, and fiber-optic intubation was arranged. The aggressive resection of the ankylotic mass was done and the cavity was lined with temporalis myofascial flap. This was followed by aggressive physiotherapy. The patient now has 28 mm of mouth opening and is continuing aggressive physiotherapy for the same. After 6 months of surgery, the patient is planned to undergo corrective jaw surgery for the asymmetry present.