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Postgraduate Papers Prize Category
POST GRADUATE PAPERS PRIZE CATEGORY
1. POSTERIOR PHARYNGEAL AIRWAY SPACE DIMENSIONS FOLLOWING MANDIBULAR SETBACK SURGERY- A CEPHALOMETRIC ASSESSMENT
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Dr. Anjali. S
Postgraduate PMS College of Dental Science and Research, Trivandrum
Introduction: Orthognathic surgery is performed for patients who exhibit malocclusion and jaw skeletal discrepancies for which orthodontic treatment alone cannot produce a harmonious occlusion and normal facial proportions. An important aspect of Orthognathic surgery is the effect that skeletal movements and changes in the position of the hyoid bone and tongue may have on the oropharyngeal airway.
Aims and objectives: The aim of the study was to assess the surface area and width of the pharyngeal airway space (PAS) after surgical setback of the mandible and to find a correlation between the amount of mandibular setback and subsequent relapse and the change in the PAS area and width and change in the positions of the tongue and hyoid bone.
Methodology: 14 patients with skeletal class III deformity who underwent mandibular setback surgery the immediate and 6 month postoperative changes to the pharyngeal airway space dimensions were analyzed using lateral cephalographs.
Results: The preoperative PAS area was 944.64 sq.mm. Immediate post operative it changed to 880.5 sq.mm. 6 month post operative 950.6 sq.mm.
Discussion: In our study the pharyngeal airway space (PAS) area decreased in all the subjects during the immediate postoperative period, ranging from 4.5% to 10.9%, which might be due to the mandibular setback. This finding was consistent with that of previous studies.
2. DICLOFENAC TRANSDERMAL PATCH AS AN ALTERNATIVE FOR ORAL TABLET - SPLITMOUTH STUDY
Dr. Ahana Mol UK
Postgraduate PMS College Of Dental sciences and Research, Trivandrum
Introduction: Management of postoperative pain is an essential part of care given to patients. Commonly we use opioid analgesics, NSAIDS to control pain in many forms. Transdermal patch is one among, which offers the advantage of sustained drug delivery with reduced incidence of systemic adverse effects due to lower plasma concentrations.
Aim: To evaluate the effectiveness of diclofenac transdermal patch over oral medication after posterior tooth extraction.
Materials and methods: Four subjects with bilateral extraction of posterior tooth were selected as per the inclusion and exclusion criteria. And divided into 2 groups- Study group and Control group. After extraction, Control group was advised to take 50mg oral diclofenac one hour after and 12 th hourly for next3days. In study group 100mg transdermal diclofenac patch was given. Postoperative assessment was done using Verbal pain score chart. Results were statistically analysed
Results: Statistical analysis proved Transdermal patch is more effective than oral tablet with less side effects.
Discussion: Even though there are different routes of administrations, oral route is considered as the most common route of administration. There were gastrointestinal side effects associated in patients receiving oral NSAIDs with first-pass metabolism. To avoid this transdermal patch can be used as an alternative and seems more effective with less complications and patients friendly.
3. BUR VERSUS ER: YAG LASER: A COMPARATIVE STUDY ON POST OPERATIVE SEQUELAE
Dr. Sneha Susan Zachariah
Postgraduate PMS College Of Dental sciences And Research, Trivandrum
Introduction: Surgical removal of impacted third molar involves the manipulation of hard tissues as well as soft tissues which leads to pain, trismus, and swelling in the post-operative period and these start off from an inflammatory process due to surgical trauma. Er: YAG lasers have shown successful ablation of hard tissues as well as soft tissues.
Aim: To compare the postoperative sequelae following surgical removal of partially impacted third molar with surgical bur and Er: YAG laser. Materials and methods:20 subjects including both genders were selected based on inclusion and exclusion criteria and alternatively arranged into laser group and surgical burgroup. Osteotomy was done
with surgical bur and Er: YAG laser for each group.
Result: Statistical analysis shows a significant reduction in pain and swelling while using laser than the surgical bur technique. We were unable to notice any significant difference in trismus, but the laser group showed a comparative increase in mouth opening
Discussion: Erbium laser surgery provides excellent field visibility, hemostasis, precision, and enhanced infection control
Conclusion: Based on the observations, pain, and swelling associated with mandibular third molar impaction were significantly lesser when bone removal was done with Er: YAG laser than that with a surgical bur. The difference observed in trismus was statistically insignificant
4. SALIVARY CORTISOL - A STRESS MARKER?
Dr. Faizal S
Postgraduate PMS College Of Dental Science And Research, Trivandrum
Introduction: Surgical removal of third molar ignites high levels of anxiety and stress. Stress activates steroid production which prepare our body to withstand these situations. Many researchers suggested that evaluation of salivary cortisol level helps to assess the variation of stress level.
Aim and objectives: Evaluation of an increase in salivary cortisol as an indicator of stress inpatient undergoing minor surgical procedure.
Materials and Methods: 30 subjects were selected randomly including both females and males as per inclusion and exclusion criteria and divided into two equal groups- the studyand control group. The study group includes the subjects who had undergone surgical removal of mandibular third molars and control group consisted of subjects where nosurgical procedures were performed. The unstimulated Saliva collected thrice from the study group and once from the control group. Each sample was labelled, frozen, stored andsend to lab. The collected sample estimated with cortisol ELISA kit and comparison of stress level was carefully analysed and recorded.
Result: There was statistically significant increase of cortisol seen in the study group compared to the control group and also within the study group from the pre-operative level to post-operative level.
Discussion: salivary cortisol is an indicator of stress and people who underwent surgical removal of molars produced high level of anxiety and stress.
5. EFFECTIVENESS OF TMJ ARTHROSCOPY IN COMPARISION TO CONSERVATIVE MANAGEMENT IN TREATING CHRONIC TEMPOROMANDIBULAR DISORDER
Dr. Vilva Karthick M
Postgraduate GDC Kottayam
Introduction:The treatment of Temporomandibular disorder (TMD) can be non-invasive, minimally invasive & invasive & depends on stage and severity of disease. This study provides better insight into effectiveness of arthroscopy with TMD.
Aim:To evaluate effectiveness of TMJ arthroscopy in comparison to conservative management in treating patients with chronic TMD reporting to Government Dental College.
Objective: To access degree of improvement of mouth opening(MO), lateral excursion and protrusion of mandible & pain score after TMJ arthroscopy in patients with chronic TMD refractive to conservative management.
Study design: Non randomised control trial - Patients within age group of 20 – 50 years with Chronic TMD. Sample size - 25
Data collection: Patients diagnosed with TMD were initially treated by conservative management if no significant improvement - undergo TMJ arthroscopy. The parameters of MO,lateral excursion, mandibular protrusion in mm and pain (VAS score) were recorded.
Discussion: The conservative management doesn’t give commendable improvement in the quality of life of the patient. In minimally invasive arthroscopic intervention - constant improvement of parameters which was statistically and clinically significant and has helped to lead a better life.
6. EVALUATION OF POSTOPERATIVE COMPLICATIONS ASSOCIATED WITH LEFORT AND ANTERIOR MAXILLARY OSTEOTOMY: A PROSPECTIVE STUDY
Dr. Athira K S
Postgraduate Mar Baselios Dental College
Introduction: Lefort AMO is a widely used treatment modality in orthognathic surgery especially in Keralite population due to prevalence of bimaxillary protrusion, literature reports complications either of LeFort l orAMO. Compications range from minor problems like dental hypersensitivity upto the loss of entire osteotomy segment by avascular necrosis.
Aims and Objectives: Study is conducted to report types and frequencies of post-operative complications associated
with combined LeFort AMO procedures for correction of vertical and anteroposterior maxillary excess.
Methods: 25 Subjects who underwent LeFort I with AMO was included in the study and followed up for 6 months postoperatively. Complications such as: neurosensory deficit, unfavorable fractures, maxillary sinusitis, vascular complications, periodontal complications, aseptic necrosis, pulpal sensibility, ophthalmic complications, non-union and relapse were assessed.
Results: The overall complication rate in our study is 4%. 96% recovery noted in 6 months. Neurosensory alterations recovery occurred within 6 months to almost preoperative sensation. Tooth sensibility recovered in 6 months postoperatively, but less than preoperative values. Maxillary sinusitis present preoperatively must be addressed prior.
Discussion: Kramer et al found that overall complication rate to be 6.4 % in a prospective study on intra and perioperative complications of LeFort I osteotomy in a series of patients. Panula et al reviewed 655 patients retrospectively and found that the most common complication is neurosensory deficit and most serious complication is intraoperative bleeding.
7. COMPARATIVE EVALUATION OF RETROMANDIBULAR APPROACH VERSUS TRANSMASSETERIC APPROACH FOR OPEN REDUCTION AND INTERNAL FIXATION OF CONDYLAR FRACTURES FOR ITS MANAGEMENT
Dr. Geethu Philo Varghese
Postgraduate Pushpagiri College Of Dental Sciences Thiruvalla Fractures of the mandibular condyle are the commonest type of fractures of the mandible with a frequency that ranges from 26% to 57%. It leads to the displacement of the condyle and loss of the height of the ramus. It has been noted that the condylar fractures are the most controversial fractures regarding their management. The decision for open reduction and fixation relies on the age of the patient, unilateral or bilateral fracture, level and displacement of the fracture, and presence of teeth. A retro mandibular approach is the most commonly used for open reduction and internal fixation. In our study we aimed to compare the complications associated with a retro andibular approach with a transmasseteric anterior parotid approach for their management. A comparative evaluation of postoperative occlusion, maximum mouth opening, range of movement, facial nerve function, visibility, convenience of plating, and time taken for exposure, fixation, and closure were studied. Incidence of complications such as wound dehiscence, wound infection, hematoma, sialocele formation, Frey’s syndrome, and hypertrophic scars were also evaluated. As there are only few studies about comparison of these approaches our study becomes relevant as it is necessary to identify the best approach with the least complications.
Keywords: Condylar fracture, transmasseteric, retromandibular
8.COMPARATIVE EVALUATION OF MIDLID AND SUBCILIARY APPROACH FOR ORBITAL FLOOR AND INFRAORBITAL RIM FRACTURE
Dr. Aiswarya RB
Postgraduate Pushpagiri College Of Dental Sciences Thiruvalla Fractures involving orbit make a considerable percentage of facial trauma (30%–40%). The floor of the orbit is made of zygomatic, maxillary, and palatine bones. Infraorbital groove, on the orbital surface of maxilla contains infraorbital nerves and vessels, is prone to get fracturedeasily in floor fractures or during surgery in this region.Approaches to infraorbital rim can be broadly classified in to transcutaneous and transconjuctival approaches consists of infraorbital,midlid or subtarsal and subciliary approaches. Each of these approaches has its advantages and disadvantages that make it more or less appealing to use depending on the patient’s age and severity of fracture. Also depends on other factors such as visibility, esthetics, postoperative scarring, complications, and operative time. Hence, there is always a dilemma to the treating surgeon, which approach to be carried out.
In this study we are compared the midlid and subciliary incisions for orbital floor and infraorbital rim fractures.
Keywords: Orbital rim fractures, subciliary and midlid incisions.
9. SQUAMOUS CELL CARCINOMA OF MANDIBLE WITH POST OPERATIVE METASTASIS TO CONTRALATERAL NECK- CASE REPORT
Dr. Anjali S Nair
Postgraduate Sree Anjaneya Institute Of Dental Sciences
Introduction:Squamous cell carcinoma is the second most common cause of skin cancer. It can also affect soft tissue, bone. Squamous cell carcinoma can spread to other parts of body like lymph nodes and lungs.
Aims: The aim is to completely remove the cancerous lesion
in a 53 year old male patient diagnosed with squamous cell carcinoma in the lower right alveolus.
Objectives: To assess the level of lymph node involvement.
Methods: Ipsilateral enlargement 0f level Ib and level II were noted. No significant nodes noted on contralateral side. CT scan reveals lesion infiltrating into the mandible. Clinically staging of the lesion to be T4N2bM0. Segmental mandibulectomy with MND (type III) was done and reconstructed with PMMC flap. Postoperative period was eventful with patient developing MI which was medically managed.
Results: Patient presented with facial flap necrosis after 1 week and was managed with wound debridement and iv antibiotics. After 2.5 months patient presented with contralateral lypmh node metastasis on level Ib and level II, inspite of the preoperative negative findings in USG and MRI of neck.
10. STEM CELL THERAPY FOR OSMF
Dr. Rony Philip
Postgraduate Azeezia College Of Dental Sciences And Research
Stem cells are master cells that have specialized capability for self-renewal, potency and capability to differentiate to many cell types. At present, the adult mesenchymal stem cells are being used in the head and neck region for orofacial regeneration and their use in the treatment of oral mucosal lesions is still in budding stages. The paper presentation will focus on the current knowledge about the role of stem cell therapies in oral mucosal lesions focusing “oral submucosa fibrosis (OSMF)’’ and could facilitate new advancements in this area.
Oral submucous fibrosis is a chronic, insidious disease with an increased risk of malignancy. Stem cells play a major role in improving signs and symptoms through neoangiogenesis, anti-inflammatory effect and fibrinolytic effect with no side effects and thereby can be a better alternative for steroid and surgical therapy.
Through further understanding of OSMF pathogenesis and related carcinogenesis, with the development of scientific research and medical level, especially in stem cells, exosomes, and other related emerging fields, it is possible to decrease the incidence, recurrence rate, and malignant transformation rate of OSMF.
11. CAT SCRATCH DISEASE WITH LYMPHADENOPATHY -A CASE REPORT
Dr. Jincy Nazar
Postgraduate Azeezia College Of Dental Sciences And Research
Cat-scratch disease (CSD) is an infrequent benign regional lymphadenitis classically associated with being scratched, bitten, or licked by cats. The causative agent is Bartonella henselae, and it affects mostly children and young adults.
The lymphadenitis usually resolves spontaneously without antibiotics in otherwise healthy patients. Imaging and serological studies in correlation with a clinical history of cat contact may facilitate the diagnosis and avoid unnecessary invasive procedures. However, the imaging features of lymphadenopathy in CSD may be confused with those of neoplasms.
Clinically a wide spectrum of differential diagnosis such as tuberculosis, Ebstein Barr virus infection, malignancies like lymphomas and metastases may be considered and should be ruled out before the treatment is decided. We report this case, as the patient presented with a very large sized lymph node in left submandibular region, giving a clinical suspicion of lymphoma.
We report a case of a 6 year boy who presented with a bosselated swelling in left side of neck measuring 8 X 7 cm in the left submandibular region and excision lymph node biopsy was done which confirmed cat scratch disease.
12. COMPARISON OF SOFT AND HARD SPLINTS IN THE SYMPTOMATIC MANAGEMENT OF TEMPOROMANDIBULAR JOINT DISORDERS.
Dr. Roshna P.K
Postgraduate Government Dental College, Kottayam
Introduction: Temporomandibular joint disorders (TMDs) embracing a variety of clinical signs and symptoms may be classified as arthrogenous, myogenous, or combined type. Splint therapy is a non-invasive management of TMDs. We hypothesized that hard splints provide better symptomatic results in the management of TMDs than soft splints based on observation.
Aim: To evaluate and compare the effectiveness of hard and soft splints in the symptomatic management of TMDs .
Methods: This study included 91 patients and randomly allocated into two groups. Group 1: hard splint group, n = 42, 10 males and 32 females; group 2: soft splint group, n = 49, 13 males and 36 females. The anamnestic and clinical dysfunction component of the modified Helkimo index was used to evaluate the outcomes at baseline (T0), first month (T1), and third month (T2).
Results and discussion: Symptoms such as clicking and pain of the joints, and muscle
pain showed improvement in both groups. Restriction and deviation of mouth opening didn’t show significant improvement in either group. Patients who underwent hard splint therapy showed an early improvement of symptoms at T1. However, there was no statistical difference between hard and soft splints at T2. Hence, both hard and soft splints were effective. However, hard splints provide an earlier reduction of symptoms.
13. ASSOCIATION BETWEEN DEGREE OF DISPLACEMENT OF ANGLE AND BODY FRACTURES OF MANDIBLE AND NEUROSENSORY CHANGES
Dr. Rathish T K
Postgraduate Government Dental College, Kottayam
Introduction: Fractures of mandible can result in damage of inferior alveolar nerve. These injuries cause paraesthesia that may or may not recover with time. Current literature lacks definite information regarding the progression and regression of neurosensory deficit mainly due to inconsistent sensory testing, lack of censored data and follow up, variable duration and scoring and different treatment techniques.
Aim: Assess the neurosensory changes with mandibular angle and body fractures, its relation with displacement and pattern of fractures.
Methods: This study is a descriptive study of 160 patients who presented with unilateral isolated angle and body fractures. Neurosensory testing were carried out immediately after trauma and after 1 week, 1 month and at 6 months. CBCT was used to measure the displacement between the fractured segments.
Results and discussion: About 62.5% were not associated with any paresthesia. At the end of 6 months only 1.9% of patients had mild neurosensory changes and 0.6% had severe changes. There is a statistically significant association between the displacement, pattern of fracture and the neurosensory change. In those fractures with displacement <4 mm the neurosensory changes recovered fully within 1 week. In those fractures with displacement > 5 mm, it took about 1 month to recover and in those cases with deficit persisting even after 1 month it did not recover after 6 months.
14. EFFECTIVENESS OF INTRA-ARTICULAR PLATELET RICH PLASMA INJECTION FOLLOWING ARTHROSCOPY FOR TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS
Dr. Vineeth John
Postgraduate Government Dental College, Kottayam
Introduction: Temporomandibular joint (TMJ) disorders are progressive painful conditions that cause joint dysfunction, joint sounds, malocclusion, and mouth opening restriction. Treatment options vary from conservative to invasive techniques. Minimally invasive surgical procedure include arthrocentesis, intraarticular drug administration and arthroscopy. TMJ arthroscopy may be finished with intraarticular injections. Platelet rich plasma (PRP) is known to be an added benefit following arthroscopy to provide better symptomatic results.
Aim: To compare the effectiveness of intra-articular PRP injection following arthroscopy and conventional arthroscopy in management of TMJ disorders.
Materials And Methods: 24 participants were enrolled in this study and divided into two equal groups. Intra-articular platelet rich plasma injection given following arthroscopy in study group and conventional arthroscopy was done for control group. Several variables were assessed between two groups which includes degree of pain, mouth opening, clicking and lateral excursion movement.
Results: The study group demonstrated a statistically significant reduction in pain and clicking, improvement in mouth opening than control group.
Discussion: In this study, group in which intra-articular PRP were used, exhibited superior efficiency compared to control group regarding majority of parameters assessed. This study provides an insight in the role of PRP in TMJ disorders and recommends it to be used as an effective and a common tool at disposal, yielding wonderful results.
15. COMPARISON BETWEEN TRANSCONJUCTIVAL AND SUBCILIARY APPROACH FOR ORBITAL FLOOR FRACTURE REPAIR
Dr. Rinsha Paul
Postgraduate Government Dental College, Kottayam
Introduction: Surgical management of blow-out fracture of orbit includes open reduction and reconstruction of orbital floor. In this study, we compare the transconjuctival and subciliary approaches in terms of access to the defect, the postoperative esthetic outcome and complications to find superior approach.
Aim and objective: To evaluate and compare the clinical outcome between preseptal transconjunctival and subciliary approaches in orbital floor fracture reconstrauction.
Methods : 20 patients with orbital floor fractures were
selected and randomly divided into 2 equal groups. In 1 group transconjunctival incision was given and in other subciliary was performed and evaluated eye fissure index(EFI), lower iris coverage(LIC), canthal tilt, scleral show, ectropion, entropion.
Results: In subciliary group there is a statistically significant difference in postop 1 month EFI, lower iris coverage, and scleral show between control and operated eye. Ectropion is noticed in 50% 1month postoperatively, and it persisted in 20% 3 months postoperatively. In transconjunctival group 1 month postop entropion was observed in 3 cases (30%). It is resolved within 3 months.
Discussion: In our study, we found that both transconjunctival and subciliary technique give adequate surgical exposure intraoperatively, transconjunctival approach has absolutely no scars, and subciliary technique has a minimum scar which is hidden in skin crease. The subciliary approach has got highest risk of lower lid retraction and ectropion.
16. EFFICACY OF INTRALESIONAL DRUG DELIVERY WITH DEXAMETHASONE USING INDWELLING CATHETER IN PEDIATRIC PATIENTS WITH CHRONIC NON BACTERIAL OSTEOMYELITIS
Dr. Shanmugapriya Ganesan
Junior Resident Government Dental College, Kottayam
Introduction: Chronic nonbacterial osteomyelitis (CNO) is a rare, autoinflammatory disorder affecting single or multiple bones in paediatric population.
Varied treatment modalities are present ranging from conservative drug management with non-steroidal antiinflammatory drugs (NSAIDs), corticosteroids (dexamethasone or methyl prednisolone), antirheumatoid drugs, anti-bone resorptive drugs (pamidronate) to surgical resection of the involved bone.
Aims and Objectives: This study aims to qualitatively analyse the demographics, clinical presentation and the efficacy of periodic local drug delivery of dexamethasone using an indwelling catheter for treatment of CNO of mandible in children.
Materials and Methods: Patients with recurrent osteomyelitis that does not respond to antibiotics were selected. The patients were planned for decortication or debridement under general anaesthesia. A nasogastric tube was inserted in the form of an indwelling catheter to provide intra-lesion access for irrigation and local drug delivery of dexamethasone twice daily for two weeks. Post-operative clinical, haematological and radio graphic assessments were done periodically at the end of two weeks, one month and three months.
Result: Intra-lesional irrigation with corticosteroid provides anti-inflammatory action reducing the swelling and pain postoperatively.
Discussion: The antiinflammatory action of the corticosteroids appears to be more effective when delivered directly into the site of interest. Localized drug delivery via an indwelling catheter is a cost effective and efficient solution to control the symptoms of CNO.
17. RECURRENCE OF OKC- THE CONUNDRUM SOLVED BY CHEMOCAUTERIZATION
Dr. Kavya Chandra
Postgraduate Government Dental College, Kottayam Introduction: Odontogenic keratocyst is a locally aggressive odontogenic cyst that deserves special attention. This pathologic entity has high recurrence rate and mandates meticulous treatment.
Aims and objectives: The study is intended to assess effectiveness of chemical cauterization (using 5-FU and carnoy’s solution) method in management of OKC. Various options are listed in the literature regarding management. It ranges from enucleation combined with adjuvant modalities to extensive resection. Among the adjuvants, chemical cauterizing agents yield excellent results in which 5 Fluorouracil and Carnoy’s solution are used mainly.
Material and methods: 10 patients were evaluated clinically and histologically. Pre and post-operative radiographs were analysed. Among 10 cases of enucleation, 5 cases where chemical cauterization was done using 5-FU and rest by carnoy’s solution were observed. Patients were on follow up and were watched for recurrence and post operative complications.
Results: No recurrence was observed during 3 year follow up. Among both, application of 5-FU had minimal nerve damage and other complications
Discussion: In most of the cases OKC was seen in posterior aspect of mandible. Most appropriate management for lesion remains controversial. The aggressive nature of the para keratinized lining was attributed to matrix metalloproteins, interleukin-1 alpha Bcl-2 and cytokeratin bringing about the mural expansion. Management by chemo cauterization treats OKC with less postoperative morbidity. As observational time period is short, elaborate time period may be required to assess emergence of recurrence.
18. TWIN FORK SHAPED MINIPLATE FOR FIXATION OF-
Dr. Angela Alex
Postgraduate Government Dental College, Kottayam
Background and objective: Fractures through the mandible at the level of the parasymphysis extending obliquely and traversing through the transitional zone to body region are relatively common. The presence of mental neurovascular bundle poses complications during reduction and fixation, and frequently results in mental nerve paraesthesia if manipulated too much.
Aim: To compare and evaluate the clinical and radiological outcomes of twinfork shaped miniplate and conventional miniplates in fracture fixation at transition zone of parasymphysis body region.
Materials and methods:40 patients with mandibular fracture at transition zone of parasymphysis body region were selected and divided in to Group A and Group B. Group A was treated with conventional miniplates and Group B was treated with twin fork shaped miniplate. Operative time and postoperative reduction of fracture in OPG were evaluated. Occlusion and neurosensory disturbance were evaluated preoperatively and postoperatively.
Results and discussion: It was noted that there is a statistically significant difference between the two groups, twinfork shaped and the conventional miniplate group in terms of operative time, occlusion and postoperative reduction of fracture segments. Twin fork shaped miniplate group had less operative time, more stable occlusion and more number of excellent fracture reduction cases and more positive neurosensory response compared to the conventional miniplate group. The above results favoured twin fork shaped miniplate in fracture fixation at transition zone of parasymphysis body region.
19. VOLUMETRIC ANALYSIS OF JAW CYST FOLLOWING DECOMPRESSION
Dr. K. Surya
Postgraduate Amrita School Of Dentistry
INTRODUCTION: Cystic decompression has been introduced as a conservative treatment of odontogenic cyst, volumetric studies on bone regeneration in cystic cavities were conducted by measuring three maximum diameters and calculating a geometrical approximated volume.
AIM: To assess the change in cyst volume following decompression of jaw cyst.
MATERIALS AND METHODS: All patients who underwent decompression therapy of jaw cyst from January 2012 to December 2020. The sample size is 40, total sites were 166. Pre and Post treatment CBCT were uploaded in In Vesalius software. Change in volume, Decompression rate of cyst, Rate of bone formation, Remodelling of nerve tissue, Proximity with anatomical structure, Improvement at various anatomical site and histology type in each jaw cyst were assessed.
RESULTS: In our study shrinkage rate was 38.7% at the end of 3rd month and was 76.9% at the end of 6th month. Shrinkage rate is more in large cystic cavity compared to small cysts. Best results of decompression at 7-8 months. Decompression was faster in younger age group. Out of all odontogenic cyst OKC reduced rapidly followed by DC, RC, CEOT and UA. Lesion involving maxilla resolves faster than mandible. DISCUSSION: Three-dimensional CT evaluation with dedicated software are useful to assess decompression effect, which is very simple to perform and is generally well-accepted by surgeons. It help us to understand the timing and modality of bone restoration after decompression.
20. EVALUATION OF INJECTABLE PLATELET RICH FIBRIN IN TRAUMATIC FACIAL SCARS -A LONGITUDINAL STUDY
Linta Sara George
Postgraduate Mar Baselios Dental College
Introduction: Facial scar is an inevitable complication following traumatic facial wounds. Our study focus on the aesthetic method of treating traumatic facial wound that would otherwise lead to ghastly scar.
Aims And Objectives: The study aims to assess facial skin healing after traumatic injury and to evaluate the effect of platelet rich fibrin in trauma scar healing.
Methods:25 patients with traumatic scars in maxillofacial region within a time period of 3-month post trauma were randomly selected for the study based on the inclusion and exclusion criteria. I-PRF obtained from centrifugation of autologous blood at 700rpm for 3 minutes was injected to the facial wound after assessing the initial scar score. Vascularity, pigmentation, pliability and height of the wound was assessed after a single i-PRF injection every 15 days for 3 months using digital photography and clinical assessment.
Results: Statistically significant change was noted in the vascularity, pigmentation, pliability of scar and height of the scar score from initial measurement to final
measurement after 3 months after the normal healing time of a facial scar
Discussion: We found that Single injection I-PRF can result in excellent changes of facial scar with promotion of angiogenesis compared to micro-needling, dermabrasion. Desai C B et al in 2013 and Hafsa G.M et al in 2018 conducted similar study and concluded that PRF-treated site showed hastened healing with early wound contracture.
21. EFFICACY OF HIGH CONDYLECTOMY AS A LONE TREATMENT MODALITY IN THE MANAGEMENT OF ACTIVE CONDYLAR HYPERPLASIA
Dr. Subiramaniyan
Postgraduate Amrita School of Dentistry.
Introduction: Mandibular condylar hyperplasia is characterized by the increased growth of condyle consequently affecting facial asymmetry and dental occlusion and may be associated with pain and dysfunction. This condition is conventionally managed by mandibular osteotomies alone or along with high condylectomy.
Aim: To assess the efficacy of high condylectomy as a lone treatment modality in the management of bone scintigraphy proven active unilateral condylar hyperplasia based on clinical and cephalometric analysis.
Materials and method: This was prospective study of 10 patients with unilateral active condylar hyperplasia and underwent high condylectomy alone between 2018-2021 at Amrita institute of medical sciences. Growth centre activity determined based on bone scintigraphy. The patients were assessed on basis of clinical measurements, photographs, PA and lateral ceph and orthopantomogram. Investigation was carried out immediate, at 6 and 12 months.
Results: In all the 10 patients, the mandibular midline moved significantly towards the facial midline. In 8 of them, it coincided with the midline. At 12 month follow-up, in almost all patients, almost similar Ramal length was achieved on both operated and unoperated side.
Discussion: Evaluation of clinical parameters revealed moderate to good improvement in facial asymmetry with deviated chin returning more or less to the midline, along with a correction in the occlusal plane tilt, thereby reducing the severity and making it amenable to smaller procedures to obtain an optimal outcome.
22. GLANDULAR ODOTOGENIC CYST - AN UNUSUAL ENTITY
Dr. Deepu Chandran
Postgraduate PMS College Of Dental Science and Research, Trivandrum
Introduction: Glandular odontogenic cyst is a rare type of cyst of the jaws, which shares histological features with that of lateral periodontal cyst, botryoid cyst, radicular cyst with mucous metaplasia, or low-grade mucoepidermoid carcinoma, making it difficult to come to a definitive diagnosis.
Case Report: 32 year old female reported with swelling in lower front teeth region Since 6 months. OPG revealed radiolucent lesion with ragged borders and <2cm lower Cortex border. Incisional biopsy and aspiration done confirming glandular odontogenic cyst. Curetting and osteotomy followed by application of Carnoy’s solution was done under GA.
Discussion: average age is 50 and Commonest site anterior region in mandibular lesion. Radiographic finding is very important in diagnosis. High rate of recurrence. Lesion should be sent for biopsy to establish diagnosis before treatment decision.
Conclusion: GOC are often misdiagnosed and treated as benign lesion. Always histopathological analysis should be done to confirm the diagnosis and preparation of a prompt treatment plan at the earliest. Adequate and early treatment of GOC is required because of its aggressive biologic behaviour and propensity for recurrence.
23. UNICYSTIC AMELOBLASTOMA: A CASE REPORT
Dr. Gopika Sasidharan
Postgraduate PMS College of Dental Science and Research, Trivandrum
Introduction: The unicystic ameloblastoma was first described by Robinson and Martinez in 1977.It is the second and far less frequent benign variant in intraosseous ameloblastoma. They comprise about 6% of the ameloblastomas.
Case Report: 10-year male patient complains of pain and swelling in lower posterior region for past 2 months. History of dull intermittent pain and increased size. On inspection, diffuse swelling extending from lower border of mandible to 3 cm lateral to corner of mouth. On palpation, it has a hard consistency. Radiographically, a large unicystic radiolucency in the left posterior aspect of mandible was noted. Histologically, it was noted to be a plexiform variant. Hence cyst enucleation and chemical cauterisation was done with Carnoy’s solution.
Discussion: Unicystic ameloblastoma is a slow growing painless intra osseous tumor. It occurs in younger population usually in the second and third decade of life and usually seen in mandibular third molar
region. Other treatments include radical and conservative surgical excision, curettage, chemical and electric cauterization, radiation therapy or a combination of above and a long term follow up is necessary.
Conclusion: Early identification and treatment of the unicystic ameloblastoma plays a major role as it has a better prognosis and early intervention can reduce the recurrence of the tumor.
24. SINUS MUCOCELE: A POST EXTRACTION SEQUELAE
Dr. Ajimsha SB
Postgraduate PMS College of Dental Science and Research, Trivandrum
Introduction: Surgical ciliated cyst (sinus mucocele) is a rare clinicopathological lesion that appears in patients who undergo maxillofacial surgery. It is a type of true epithelial lined antral cyst, may become expansile and may expand or erode the walls of the sinus.
Case Report: 37 year old male reported to the Department of OMFS with the chief complaint of swelling in the right palatal region for 2 months. History of extraction of 17 done 7 years back. Mild swelling was evident extra orally. Well-circumscribed radiolucency with a fairly radio opaque structure in the antrum, separated from the unaffected part of the sinus was noted radiographically. Preoperative computed tomographic (CT) scan showed an extensive radiolucent unilocular cystic lesion within the right maxillary sinus. Aspiration biopsy was done. Later the surgical enucleation of lesion was the cyst was done and histopathological study revealed it to be surgical ciliated cyst.
Discussion: Entrapment of the sinus membrane during the closure of wounds after surgical procedures in the maxillary sinus region would result in an inflammatory process that would stimulate the epithelial proliferation and the expansion of the cyst.
Conclusion: Surgical ciliated cyst is one of the rare sinus pathologies that have got multiple etiological factors and treatment modality is enucleation. The rationale behind this report is to emphasis even a traumatic extraction can damage the floor of the sinus and lead to the cyst formation.
25. THE TWO – THIRD’S TUMOUR: A CASE REPORT
Dr. Anitha Kurup N
Postgraduate PMS College of Dental Science and Research, Trivandrum
Introduction: Adenomatoid odontogenic tumour (AOT) is an uncommon benign odontogenic lesion that affects young patients associated with an impacted tooth, usually canine. AOT represents 3–7% of all odontogenic tumours.
Case report: A 14 year old male reported for management of missing tooth and swelling in the left maxillary region since 4 months. No associated pain or history of trauma was reported. On inspection a prominent swelling of 2 x 1.5 cm size in relation to 13 and 12 region. On palpation, a firm & bony hard swelling was present on the anterior maxilla. Radiographic investigations revealed a well localized unilocular mixed lesion of size 33.4mm x 29.7mm with buccal and lingual plate thinning and impacted 13 and 12. Surgical removal of cyst with impacted canine was done and curettage of lesion was performed.
Discussion: AOT is a wellrecognised slow growing benign tumour occurring within the tooth bearing areas of jaws. It is more frequent in females than in males with a sex ratio of 2:1, and is mainly observed during the second decade of life. The lesion is usually unilocular and radiolucent with fine calcifications (snowflake), well demarcated with smooth cortical border and often found in association with impacted teeth.
Conclusion: Even though enucleation and curettage for AOT is the most common treatment modality, accurate histological diagnosis is advisable to avoid unnecessary radical surgery.
26. INFLAMMATORY PARADENTAL CYST – A CASE REPORT
Dr. Fathima Shifa P P
Postgraduate PMS College of Dental Science and Research, Trivandrum
Introduction: Craig is credited for describing the paradental cyst in 1976.The inflammatory paradental cyst typically occur distal or buccal of partially erupted mandibular third molar with a history of pericoronitis. It is a rare cyst, which is often mimics other non-benign lesions of odontogenic and nonodontogenic origin.
Case report: An 18 year old female patient complaints of pain and swelling in lower right back region since 2 months with associated pus discharge. Radiographically a large radiolucent lesion was seen extending from distal surface of right lower third molar to subcondylar region. Following which an incisional biopsy with aspiration was done and histopathological examination revealed it to be Inflammatory Paradental cyst. Cyst enucleation was done along with the extraction of right lower third molar preserving the inferior alveolar nerve.
Discussion: Paradental cyst is a rare entity, with an incidence of 1% to 5% in all odontogenic cysts. It is often misdiagnosed as mural ameloblastoma, odontogenic keratocyst, and dentigerous cyst. Association with mandibular molars seems to be a characteristic clinical feature
of the Paradental cyst.
Conclusion: Correlating the clinical, radiographic, and histologic findings is required to obtain a final diagnosis of the Paradental cyst. Surgical removal of the tooth and the Paradental cyst has been considered the treatment of choice when the involved tooth is a third molar. Prognosis is excellent after enucleation of cyst.
27. HEAMODYNAMIC CHANGES DURING LOWER THIRD MOLAR SURGICAL REMOVAL: COMPARISION BETWEEN ARTICAINE AND LIGNOCAINE
Dr. Gopika I Manoj
Postgraduate PMS College of Dental Science and Research, Trivandrum
Introduction: Local anaesthesia forms the backbone of the pain control techniques in dentistry. Anxiety and pain during the procedure causes variation in vitals. Its effect on heamodynamic changes is still unclear. This study is to compare the heamodynamic changes caused by 2%lignocaine and 4% articaine.
Aim: To compare the hemodynamic changes during the surgical removal of lower third molar using 2% lignocaine and 4% articaine.
Materials and methods: 15 subjects were allocated into two groups for double blind study. Parameters like blood pressure, heart rate and SpO2 were monitored using pulse-oximeter and sphygmomanometer. Measurements were taken 30 mins before local anaesthesia, 2 mins after local anaesthesia, immediately after surgical procedure and one hour after the procedure.
Results: Statistical analyses shows no significant difference in haemodynamic changes between two local anesthetics except in systolic blood pressure.
Discussion: Complications of articaine were minimal. No significant difference was seen in SpO2 between articaine and lignocaine perioperative period.
Conclusion: Pain scale articaine group proved to have better local anesthetic effect than lignocaine group. Since there was no significant haemodynamic difference between the two groups, and as articaine have better local anesthetic potency, it can be used as an alternative to lignocaine.
28. GIANT PLEOMORPHIC ADENOMA OF PAROTID GLAND; AN ENIGMA TO THE SURGEON
Dr. Reshma Gafoor
Postgraduate KMCT Dental College
Salivary gland tumors comprise of less than 3% of all tumors of the head and neck region. Parotid tumours are uncommon, with the majority presenting as discrete lumps arising within the superficial portion of the gland. Pleomorphic adenoma represents 45-74% of all salivary gland tumors and 65% of them occur in the parotid gland. Conventional teaching prescribes removal of these tumours by superficial parotidectomy (SP), which encompasses facial nerve identification and en bloc removal of the superficial portion of the gland.
Owing to the close proximity of this tumor to the facial nerve, there have been various techniques for surgical management of this tumor in the literature Extracapsular dissection (ECD) is an alternative approach to the removal of such lumps involving meticulous dissection immediately outside the tumour capsule while still preserving the facial nerve and is distinct from enucleation.
Extra capsular dissection of pleomorphic adenoma is a conservative treatment modality which spares the handling of the facial nerve. This paper reports a case of extracapsular dissection of pleomorphic adenoma in the superficial lobe of parotid gland in a 50 year old male with a 1 year follow up.
29. VIRTUAL SURGICAL PLANNING AND FREE FIBULA FLAP IN MANDIBULAR RECONSTRUCTION
Dr. Anahita Ann Koruth
Postgraduate KMCT Dental College
Ameloblastoma is a tumor of the jaw that typically occurs in the third and fourth decade of life. Most ameloblastomas are multicystic, showing more aggressive behavior and a greater tendency to recur than unicystic ameloblastoma. The resection and reconstruction of ameloblastoma poses a challenge to the surgeon.
Mandibular reconstruction is one of the workhorse in head and neck reconstructive surgery, with the free fibula flap currently considered the gold standard technique.
The last two decades have seen considerable developments and a surge in popularity of virtual surgical planning (VSP). Starting with virtual performing of the surgery, the possibilities that this technology offers are enormous. Despite the high costs of this technology, it is helpful to surgeons in ablative and reconstructive surgery.
This paper reports a case of ameloblastoma of the lower jaw which was reconstructed with free fibula flap using virtual surgical planning.
Dr. Shweta Sabu
Postgraduate KMCT Dental College
Orthognathic surgery is a complex type of facial surgery that can have a profound impact on a patient's occlusal function and facial aesthetics. The best outcome of orthognathic surgery depends on surgery technique and accuracy of treatment plan.
Complex maxillofacial deformities continue to pose challenges in analysis and correction beyond modern technology. Traditional surgical planning (TSP) such as manual model surgery, the use of photographs, and twodimensional radiographs have been conventionally used at the preoperative stage of orthognathic surgery.
Virtual surgical planning (VSP) has gained popularity for preoperative orthognathic surgery planning over the last decade. VSP provides preoperative insight into the surgical intervention and the fabrication of cutting guides and surgical splints can help decrease intraoperative surgical inaccuracies.
The computer-aided surgical simulations used in VSP have offered surgeons a threedimensional (3D) facial skeleton, soft tissue, and dentition representation to facilitate virtual diagnosis and surgery. Virtual surgical planning aids in accurate midline correction, yaw correction, cant correction, differential impaction and thus enhance precision and intra operative efficiency. This paper delineates our experience in the use of virtual surgical planning in orthognathic surgery through case series of three cases and elucidates the advantages of virtual surgical planning over traditional surgical planning.
