Objective The study aims to evaluate the efficacy of arthrocentesis in the treatment of internal derangement of the temporomandibular joint (TMJ). Study Design Thirty patients with TMJ internal derangement underwent arthrocentesis using saline. Pain using visual analog scale, maximum mouth opening, joint noises and mandible deviation were documented pre-operatively and post-operatively. Patients were followed for 1 year. Statistical analysis of pain was done by Wilcoxon signed Rank's test and dysfunction by students paired t test. Results The mean pre-operative pain was 4.8 ± 2.65 and post-operatively at 1 year was 0.27 ± 0.45 with an average decrease of 4.72 (P = 0.000). The mean maximal mouth opening pre-operatively was 29.8 ± 2.35 mm and postoperatively 41.9 ± 2.48 mm at 1 year. The mean increase in the mouth opening was 12.1 ± 3.0 mm (P = 0.000). Conclusion Arthrocentesis is simple, minimally invasive procedure with less risk of complications and significant benefits in patients with TMJ internal derangement.Internal derangement of the temporomandibular joint (TMJ) is characterized by displacement of the intra-articular disc, resulting in clicking and popping sounds. However, the displacement of the articular disc does not always cause a mechanical obstruction. These conditions may be painless or they may be associated with pain, especially during function. The most common causes are trauma, which results in an immediate displacement of the disc, or chronic parafunction, which results in degenerative changes in the articular surfaces, increased friction, and gradual disc displacement.TMJ internal derangement has always presented as therapeutic challenge to the maxillofacial surgeons. Up to 25% of the entire population has internal derangement of TMJ and usually they are treated with nonsurgical methods such as medications, physiotherapy and occlusal splints in the initial period [1]. When these methods are unsuccessful, they are often managed by surgical methods. The mainstay of surgical treatment is based on changing the morphology or position of the disc, or removal of the disc with or without replacement. There are variable reports of success with the open surgical methodologies and are associated with surgical risks and potential long term sequelae [2].New insights into the joint pathology of internal derangement were provided by the observations made during TMJ arthroscopic lysis and lavage and outcomes after such treatment. The physical action of lysis and lavage in the superior joint space, rather than disc repositioning, is believed to be responsible for the success of arthroscopic surgery [3,4]. This has led to the use of TMJ arthrocentesis as a relatively less invasive alternative to reduce the inflammation in the superior joint space and restore normal range of motion [3]. The study aims to discuss the role of arthrocentesis in the treatment of internal derangement of the TMJ and present clinical data relating to the efficacy of arthrocentesis. Materials and MethodsThis prospective clinica...

ObjectivesThe purpose of the study was to establish the role of ultrasonography in determining the involvement of specific fascial spaces in maxillofacial region and the stage of infection, in indicating the appropriate time for surgical intervention and to compare clinical and ultrasonographic findings.Material and MethodsTwenty five patients with fascial space infection in maxillofacial region were subjected to ultrasonographic examination following a detailed clinical and radiological examination. Ultrasonography guided needle aspiration was performed. Based on the findings, patients diagnosed with abscess were subjected to incision and drainage and those with cellulitis were subjected to medical line of treatment.ResultsMore than one fascial space was involved in all patients. On clinical examination 64 spaces were involved, of them 34 spaces had abscess formation and 30 spaces were in the stage of cellulitis. On ultrasonography examination, 28 spaces were reported to have abscess formation and 36 spaces were diagnosed to be in the stage of cellulitis. On comparative analysis of both clinical and ultrasonographic findings, ultrasonography was found to be sensitive in 65% of the cases and having specificity of 80%. It was registered statistically significant (P < 0.001) agreement between these two methods of assessment (kappa index = 0.814). ConclusionsUltrasonography is a quick, widely available, relatively inexpensive, and painless procedure and can be repeated as often as necessary without risk to the patient. Thus ultrasonography is a valuable diagnostic aid to the oral and maxillofacial surgeon for early and accurate diagnosis of fascial space infection, their appropriate treatment and to limit their further spread.

Primitive neuroectodermal tumor (PNET) is an aggressive round cell malignancy of presumed neural crest origin belonging to Ewing's sarcoma family of tumors. Peripheral PNET is less common in head and neck region and only eight cases of primary PNET of maxilla have been reported. We report a case of 3-year-old boy diagnosed with PNET of maxilla based on detailed radiologic, histopathologic, and immunohistochemical studies. Though the imaging features of PNET are nonspecific and definitive diagnosis is only by immunohistochemistry, PNET should be included in the differential diagnoses of fast growing soft tissue tumors of children and young adolescents. We emphasize the need for its early diagnosis and prompt management owing to its aggressive nature and high mortality rate.

To compare and assess the primary and secondary closure techniques following extraction of impacted third molars for post-operative complications. Material and Methods: In total, 30 patients ranging between 18-30 years of age and of either sex who had bilaterally impacted mandibular third molars were randomly selected. Split mouth study method was used so that the participants served as their own control. Group 1 consisted of primary closure of left mandibular impacted third molars and Group 2 consisted of secondary closure of right mandibular impacted third molars. Basement evaluations were recorded for each patient along with subjective and objective evaluations for postoperative 7 days. Data analysis was carried out by SPSS 17.0 software using Mann-Whitney U test, Wilcoxon matched-pairs test and t-test. A p-value ≤ 0.05 was assigned as statistically significant. Results: When compared to group 1, group 2 revealed statistically less pain and swelling following the secondary closure of wound from day 1 to 7. There was a significant improvement in mouth opening in Group 2 at day 1 (p=0.0005) and at day 7 (p=0.00001). Conclusion: Secondary wound closure after disimpaction of mandibular third molar results in better postoperative recovery than primary closure.

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