To compare the Ward’s Flap Versus Modified Ward’s flap in relation to access, healing & postoperative complications in surgical extraction of mandibular third molar impaction. Study Design: Comparative Cross Sectional. Setting: Department of Oral & Maxillofacial Surgery LUMHS Jamshoro/Hyderabad: Period: March 2017 to November 2017. Materials and Methods: The history, clinical examination and radiographs (OPG and periapical) had done by team of researchers and recorded on proforma. After selection of patient into either group (Group A=Wards Flap, Group B Modified Wards), the surgical extraction was carried out under local anesthesia. For group A, a standard full thickness mucoperiosteal flap (ward’s flap) was raised. The incision was given mesial to the impacted lower third molar. For group B, a standard full thickness mucoperiosteal flap (Modified ward’s flap) was given mesial to second molar. At the end of the surgery, the flap design used for the extraction of impacted lower third molar tooth and the duration of each operation (from the first extraction maneuver to the completion of the last suture), Pain, Swelling and Trismus13 were recorded on the proforma. Every patient was called for follow up on the 3rd day and 7th day. Results: Mean age was found 27.93 years, with range of minimum 20 years and maximum 35 years. Male were found in the majority 72.3%. Majority of the cases 51.5% were found with class B, in class A 37.5% and 10.9% were found with class C. According to the impaction position 50% cases were in class I, and 50% cases were in class II. Preoperative pain measurement was done according VAS, 71.9% patients were found with mild pain, 9.4% were with moderate pain while 18.8% patients were without pain. Modified Wards flap showed good efficacy regarding duration of third molar extraction as compare to Ward’s flap P-value 0.018. Modified ward’s flap had showed less postoperative pain as compare to ward’s flap p-value 0.022. No significant difference was found between both groups on 3rd and 7th postoperative day in Mouth opening. Conclusion: This study concluded that both ward’s flap and modified ward’s flaps showed good efficacy, while duration of surgery and postoperative pain were significantly less in the modified ward’s flaps as compare to ward’s flap. More large sample size studies are required to evaluate more accurate findings.

ABSTRACT… Objectives: To compare the efficacy of Maxillomandibular fixation screws versus Erich Arch bar in the management of mandibular fractures. Study Design: Comparative case series study. Setting: . Period: 29/03/2016 to 28/09/2016. Methodology: Forty patients of either gender with age above 18 years with mandibular fracture requiring closed reduction were included. 20 patients of Groups A, treated with Maxillomandibular fixation screws and 20 patients of Group B treated with Erich Arch bar. Mean operative time was noted. All patients were followed up on every week up to four weeks. The statistical analysis via t-test was used and P-value <0.05 was categorized as significant. Results: In MMF screw group 13(65.0%) patients were male and 7(35.0%) patients were female whereas in Arch Bar group, 15(75.0%) were male and 5(25.0%) were female. Evidence of wire stick injury was found positive in 2(10.0%) and 4(20.0%) patients among MMF screw and Arch Bar groups respectively. In MMF screw group, mean operative time was 84.20±18.04 minutes whereas in Arch Bar groups it was 121.80±13.68 minutes. The mean operative time is significantly reduced in MMF screw group as compared to Arch Bar group with p value <0.01. Conclusion: We conclude that Maxillomandibular fixation with screws was more worthwhile mode as matched to the conservative Erich arch bars for managing the mandibular fractures.

ABSTRACT… Objectives: To compare the outcome of two treatment protocols (open and closed reduction) in the management of Anterior mandible and condyle fracture in our center. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of Oral & Maxillofacial Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Hyderabad. This study was conducted from April 2017 to September 2017. Methodology: This study was consisted of total 48 patients which were equally divided into two groups Group-A(Closed Reduction that is Eyelet or Arch Bar) and Group-B(Open Reduction) having anterior mandible were included. For closed reduction technique, maxillomandibular fixation was applied for 4-6 weeks. For open reduction, fracture was fixed with miniplates after achieving the normal occlusion. Post operatively, occlusal disturbances was considered having poor occlusion and patient with maximum intercuspation was considered as good occlusion. Mouth opening more than 25mm was considered as good mouth opening. Results: In group-A 23(95.8%) patients at 3rd month were found with good occlusion. In group-B, good occlusion was found in 21(87.5%) patients at 3rd month. In group-A 22(91.7%) subjects at 3rd month were found with good range of motion and in group-B good range of motion was found in 20(83.3%) subjects at 3rd month.In group-A, mean deviation was 0.54±0.72 mm at 3rd month while in group-B, mean deviation was 1.12±1.65 mm at 3rd month. Conclusion: Open reduction with two correctly positioned plates for the stabilization of anterior mandibular and condylar fractures yielded better function compared to closed reduction.

Objectives: The purpose of the present study was to assess the outcome of two-point fixation in isolated zygomatic bone fracture. Study Design: Descriptive study. Setting: Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, LUMHS, Jamshoro/Hyderabad. Period: From 1/3/2018 to 31/8/2018. Material & Methods: Consisted of 46 patients with displaced isolated zygomatic bone fractures. All fractures were treated by reduction with transoral (Keen’s) approach & fixation was done by two point fixation with titanium miniplates. Patient was discharged from the hospital next day & advised follow-up after two weeks. Mean ± St & ard deviation was computed for qualitative variables. Diplopia was described in frequencies. Mouth opening was measured on 7th day or 1 month & measured in 1mm by metallic ruler. T-test was applied to find the P Value. Results: There were 34 male & 12 female patients. 56.5% injuries were caused by road traffic accident. Mean mouth opening at 1st week was 25.23±5.15mm & at 2nd week was 38.75±2.00 mm. At 1st week diplopia was found in 26.1% subjects while at 2nd week, diplopia was found in 10.9% subjects. There was significant difference in mean mouth opening at 1st week with 2nd week. The results also showed significant association of diplopia at 1st week with 2nd week. Conclusion: isolated zygomatic fractures can be reduced & immobilized by two-point fixation with screws & titanium mini bone plates at frontozygomatic & the zygomatic buttress area. Post-operative complications i.e. opening of mouth & diplopia were suggestively decreased afterward 15 days of treatment.

ABSTRACT… Objectives: To analyze frequency, gender, age distribution, cause of injury and type of dento alveolar injury among patients at Liaquat university hospital Hyderabad. Setting: This research done in Oral and Maxillofacial Surgery department at Liaquat University Hospital Hyderabad. Period: June 2013 to December 2014. Material and Methods: A data of 114 patients who had been suffered with dentoalveolar trauma was reviewed. Patients history including age, gender, etiology of injury, type of injury like (intrusion, extrusion, luxation, subluxation, avulsion, crown fracture, root fracture were analyzed. Results: 36 female patients and 78 male patients were affected with dentoalveolar trauma. The injury was frequent in age between 11-20 years. Mainly etiology of injury was fall in 54 cases followed by RTA in 35 cases. Intrusion of teeth was seen in 51 cases and crown fracture in 29 cases. Conclusion: The results of this study illustrate that fall is most common etiology of dentoalveolar trauma in this area. Intrusion of teeth was the most common types of dentoalveolar traumatic injury. Precautionary educational programs relating to traumatic dental injuries are required to be held in our country to reduce the number of such injuries.