Introduction: Airway management in patients with panfacial fracture remains a challenge to anesthesiologists and surgeons. Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. In addition, submental intubation allows proper access to oronasal airways and occlusion during intraoperative management. Methods: The descriptive retrospective study was carried out and evaluated the outcomes of submental intubation in the management of panfacial fracture, complex maxillary or mandible fracture associated with nasal bone fracture and naso-orbito-ethmoid (NOE) fracture. The medical records of 23 patients who received submental endotracheal intubation were reviewed at UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal from March 2014 to December 2018. The following parameters were evaluated: mode of trauma, time required for intubation, accidental extubation, accidental perforation of the pilot balloon during its insertion, period of hospital stay, post-operative complications, such as the healing of submental scars both intraorally and extraorally. Results: The submental intubation was successfully done in all patients with minimal obvious post-operative complications. The mode of trauma for majority of cases of panfacial fracture who underwent submental intubation was road traffic accident (69.56%). The mean time required for intubation was 8.43 (±0.84) minutes. No accidental extubations occurred. Accidental perforation of the pilot balloon was seen in one patient (4.35%) during tube manipulation which was managed successfully by changing the tube. The healing of submental scars was uneventful intraorally and extraorally in almost every case. The mean period of hospital stay in patients with submental intubation was 7.95 (±1.49) days. Discussion: Submental intubation is an effective and safe method as it is not associated with complications of tracheostomy during management of panfacial fracture, NOE fracture and craniofacial fracture. In addition, it does not interfere with IMF during intraoperative period.

Fractures of the mandible occur more often than the other facial bones even though the mandible is considered to be one of the strongest and most rigid bones of the facial skeleton. 1 According to Killey and Rowe, mandibular fractures comprise between 40% and 65% of all facial fractures and angle fractures are involved in 25-33% of such fractures. 2,3 Patterns of fracture depend on multiple factors such as the size, direction, nature and surface area of the impacting force, and the biomechanical characteristics of the mandible such as bone density, mass, normal, or pathologic anatomic structures. 4,5 Huelke reported that the relationship between fracture location and the presence of a tooth-bearing area is significant. 6

Panfacial fractures are those involving the mandible, maxilla, and zygomatic complex at the same time and usually accompanying naso-orbito-ethmoid (NOE) and frontal bone fractures. When there are multiple facial fractures, involving upper & lower face, reconstruction should be approached as puzzle. It is difficult to follow an established pattern of sequencing and organizing the repair of panfacial fractures. Successful reconstructions can be achieved through a flexible approach that adheres to several key principles. The goal of treatment as with all facial fracture is to restore both the functions and pre-injury 3-dimensional facial contours. To achieve this goal, various management schemes have been proposed including “bottom to top,” “top to bottom,” “inside-out,” or “outside-in”. Nevertheless, despite aggressive management, severe post-traumatic deformities continue to appear. The correct timing of surgical intervention and use of rigid fixation allows the restoration of morphological and functional nature of face after Panfacial fractures. The aim of presenting the paper is to analyze the principles that determine the choice of method of treatment and that prevent the development of secondary deformity. DOI: http://dx.doi.org/10.3126/jucms.v2i3.11828 Journal of Universal College of Medical Sciences Vol.2(3) 2014: 41-44

Exodontia is a routine procedure in dental practice. Despite of adequate effort to perform the pro­cedure with proper technique, some mishap may happen when defective or substandard instru­ments are used. This article reports a symptomatic case of lip paresthesia since 1 month who had undergone attempted surgical extraction of third molar in remote dental hospital. On examination there was presence of retained fractured third molar with exodontia instrument tip in inferior alveolar canal and is very uncommon surgical complications and not much reported in literatures. Patient was not aware of the condition till Orthopantomogram (OPG) was done which revealed presence of approximately 1.5 cm instrument tip in inferior alveolar canal. Third molar and in­strument tip were successfully retrieved from canal under local anesthesia. Rarely, instruments breakage may occur during surgical procedures. It is the duty of every operating dental surgeon to check surgical instruments for signs of breakage and be prepared to solve a possible emergency. Retained fragments should be carefully studied prior to attempt of removal.

Introduction: Traumatic dental injury is an injury inflicted on the dentoalveolar system. It has a physical as well as a psychological impact. Despite this concern, epidemiological data regarding its prevalence is insufficient in the literature of Nepal. Hence, this study’s objective was to investigate the prevalence of traumatic dental injuries for the patients visiting Universal College of Medical Sciences, Bhairahawa, Nepal, over five years. Methods: A descriptive cross-sectional study was conducted using records from the medical record section for the patients presenting at the dental emergency outpatient department of the Universal College of Medical Sciences, Bhairahawa, Nepal, between April 2014 and April 2019. Ethical approval was taken from the Institutional Review Committee of the Universal College of Medical Sciences. Patient demographic data, type of traumatic dental injuries, and etiologies were evaluated from the record section. Results: Out of 10,080 patients registered during the study period, 793 patients (7.86%) were due to traumatic dental injury, out of which 628 (79.2%) were male, and 165 (20.8%) were female. The most vulnerable age group was 20-29 years (42.4%). Most frequently, injuries occurred in June (16%). Road traffic accidents (57.8 %) were the most common mode, and complicated crown-root fracture (23.3%) was the most common type of traumatic dental injury. Conclusions: The frequency of 7.86% of traumatic dental injury indicates that dental traumatology needs special attention for policy planning and professional training.