Objectives:The objective of this study is to analyze the hard and soft-tissue profile changes as well as the upper airway changes after distraction osteogenesis (DO) using rigid external distraction device in adult cleft lip and palate (CLP) patients. The study also evaluates the stability of the surgical result.Materials and Methods:Three lateral cephalometric radiographs were taken: Predistraction (T1), postdistraction (T2), and 1 year after distractor removal (T3). The treatment changes (T1 vs. T2) and the stability (T2 vs. T3) were analyzed. The overall treatment changes after 1 year were also evaluated (T1 vs. T3). The lateral cephalograms were digitally analyzed with the help of software named Dolphin.Statistical Analysis Used:Wilcoxon Signed-Ranks test was used, and the probability value (P value) of 0.05 was considered as statistically significant level.Results:Eleven adult patients with CLP were retrospectively analyzed. After distraction, there was a significant mean maxillary advancement of 14 mm (P < 0.01) from a T1 value of 73.54 ± 10.38 to a T2 value of 88.2 ± 10.49. The lower facial height and the incisor exposure were significantly increased. The nasolabial angle had a significant improvement of 24.5° (P < 0.01) from a T1 value of 56.6 ± 21.03 to a T2 value of 81.18 ± 14.4.The upper airway was significantly improved by 3.7 mm (P < 0.01) with a T1 value of 13.5 ± 3.8 to a T2 value of 17.2 ± 3.66. After 1-year follow-up, there was a significant maxillary relapse of 3.20 mm (P < 0.05) from a T2 value of 8.29 ± 6.84 to a T3 value of 5.09 ± 5.59. However, the soft-tissue profile and upper airway remained stable.Conclusion:The clinician should have an understanding of the related hard and soft tissues as well as airway changes which may assist him when planning for maxillary advancement for CLP patients with DO. There were significant improvements immediately after distraction, but during the 1-year follow-up, some relapse was seen. This stressed on the need for overcorrection of about 35%–40% for adult CLP patients.

sequelae and improves patient comfort. Dexamethasone 4 mg given intravenously is an effective way of minimizing swelling and trismus after removal of impacted lower third molars. Submucosal hydrocortisone is effective in preventing excess swelling but its role against trismus and pain are questionable. Both modalities offer simple, safe, painless, noninvasive, and cost-effective treatment means to counteract postoperative discomfort.Keywords: Dexamethasone, Hydrocortisone, Impacted mandibular third molars.How to cite this article: Raakesh N, Ravi V, Ushass P, Painatt JM, Kumar VM, Sasikumar P, Subhash AK, Navya P. Source of support: Nil Conflict of interest: None INTRODUCTIONSurgical removal of third molars accounts for a large volume of cases in contemporary oral and maxillofacial surgical practice. It requires meticulous planning and application of surgical skills during both diagnosis and postoperative management. 1Odontectomy of mandibular third molar is generally followed by pain, trismus, and swelling. Pain is subjective and can be influenced by different factors such as age, sex, anxiety, and surgical difficulty. Pain usually begins within 3 hours after surgery and ranges in intensity from moderate to severe. This procedure can also result in significant edema and inflammation in the operative field. Corticosteroids have numerous effects on body function. The normal rate of production of hydrocortisone is 15 to 30 mg/day and it increases up to 300 mg during stress. For inflammation to be suppressed, exogenous hydrocortisone must be administered in doses exceeding the normal physiological amounts of hydrocortisone released. Several researchers have found that hydrocortisone prevents inflammation following oral surgery. Dexamethasone is a synthetic corticosteroid with much greater anti-inflammatory effect. The potency of dexamethasone is about 30 times that of natural corticosteroid.3 Postoperative swelling and edema are due to the conversion of phospholipids into arachidonic acid by ABSTRACTIntroduction: Surgical extraction of impacted mandibular third molar is a common procedure in routine maxillofacial practice. This procedure is generally followed by pain, trismus, and swelling. Various methods have been attempted to reduce these unfavorable postoperative sequelae and to improve patient comfort in postoperative period. Use of steroids is one of the commonly followed practices. In our study, we compare the efficiency of steroids given preoperatively in reducing postoperative sequelae, when given in equivalent steroid doses.

Pneumosinus dilatans describes an abnormal dilation of one or more paranasal sinuses without radiological evidence of localised bone destruction, hyperostosis or mucous membrane thickening. Dilation of mastoid air cells also occurs rarely along with involvement of paranasal sinuses. This rare combination of unknown aetiology was reported in two cases in the literature and termed ‘Pneumosinus Dilatans Multiplex’ (PSDM). It is usually asymptomatic, and is detected incidentally on plain radiography, CT or MRI. If left untreated, it can further erode the bone leading to complications such as facial asymmetry, neurological disorders and pathological fractures. The aetiology of the condition remains obscure. Various hypotheses proposed are the presence of gas-forming microorganisms, spontaneous drainage of a mucocele, the presence of a one-way valve, dysregulation of hormonal levels leading to a disturbance of osteoblastic and osteoclastic activity. This paper describes a case of PSDM possibly secondary to hormonal disturbance.