Background and objectives Mandibular angle fractures continue to be a common type of facial injury. The objectives in treatment are to effect rapid healing by anatomic reduction and fixation and to restore function and appearance with minimal disability and complications.Traditionally, when open techniques are utilised, the extra-oral approach is performed through a skin incision concealed in the submandibular crease. However, patients develop unsightly scars and there is a risk of injury to the marginal mandibular nerve. In comparison, the trans-oral approach, performed through an oral mucosal incision, results in minimal external scarring or injury to the marginal mandibular nerve and allows direct visualisation and confirmation of the desired occlusion during the placement of the miniplates. The basic aim of the study was to provide a treatment for the mandibular fractures which results in minimal scarring and fulfills all the functional needs of the patient. Study design Patients coming to KLES PK Hospital and MRC with mandibular angle fractures requiring open reduction and internal fixation admitted under OMFS were taken for the study. The sample size of the study was 15. In one group, the patients were treated by extra-oral approach and the other group by transbuccal approach. In patients treated by transbuccal approach, special armamentarium consisting of trocar, cannula, and cheek retractor were used; and in both the groups, semirigid fixation was done using two miniplates with around a distance of 1cm. Results Total of 15 patients were treated, 10 with transbuccal approach and 5 with submandibular approach. It has been found that both techniques fulfill the functional requirements of the patients. Patients treated with submandibular approach developed obvious unsightly scars, whereas transbuccal approach results in minimal scarring. Conclusion The results associated with clinical observations suggest that transbuccal approach is a superior and less time consuming approach than extraoral approach, but it requires special instruments, lots of skill by the operating surgeon in using the armamentarium, and a skilled assistant.

In this trial, the use of post-operative antibiotics in the open reduction and internal fixation of facial fracture was shown to confer no benefit/efficacy in reducing the chances of infection.

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...

Nevoid Basal Cell Carcinoma Syndrome (NBCCS) is a rare condition characterized by varied clinical manifestations like multiple Basal Cell Carcinomas (BCC), multiple Keratocystic Odontogenic Tumours (KCOT), palmar and/or plantar pits and ectopic calcification of the falx cerebri, which are considered as the major criteria for diagnosis. The occurrence of jaw manifestations makes it an important diagnostic problem for oral and maxillofacial surgeons and often clinicians encounter this aspect which finally leads to the diagnosis of this syndrome. This paper reports a case of NBCCS and provides an overview on the diagnosis and management of this enigmatic entity.

Objective The aim of the study is to assess the clinical and radiological factors that increase the surgical difficulty in removal of mandibular impacted 3rd molar and design a new difficulty predictive index. Methods The data was collected from 100 patients with impacted mandibular 3rd molar who presented to Department of Oral and Maxillofacial Surgery, K.L.E's Institute of Dental Sciences. Clinical and radiological parameters included in the New Index were noted. The tooth was then removed under local anesthesia and time taken for the removal was noted. The Pederson Index, New Index and time taken were co-related using kappa statistical analysis. Results The kappa agreement between Pederson Index and time taken was 66.50 % (0.2231) whereas between New Index and time was 89 % (0.7177) indicating that New Index is a better predictor of the difficulty. Conclusion The New Index is a reliable tool in predicting the difficulty in the removal of mandibular impacted third molar.