Abstract It is well recognized that exploring a patient’s hobbies and interests is an essential component of the patch test history. It can ensure the relevant batteries are tested and explain otherwise atypical distributions or flares of rashes. We present a case of severe allergic contact dermatitis (ACD) with numerous positive patch test reactions, explained by the patient’s eclectic mix of hobbies and interests. A 53-year-old man was referred to the patch testing clinic after developing two episodes of dramatic facial swelling, followed by dry and scaly skin. He was well other than a history of psoriasis and had no known allergies. He had a desk job in a printing firm but spent his spare time creating model masks from his favourite sci-fi films, most notably ‘Alien’. Having discussed the glues and polyurethane foams used in the model-making process, he was patch tested to the British Society for Cutaneous Allergy standard, medicaments, facial, epoxy resins and isocyanates series in accordance with the International Contact Dermatitis Research Group and European Society of Contact Dermatitis guidelines. Patch test readings were performed on day 2 and day 4 and he had multiple positive patch test reactions as outlined in the Table. Diaminodiphenylmethane and hexamethylene­tetramine were both felt to be relevant to the mask-making process. Hexamethylenetetramine is used in the manufacture of formaldehyde resins and rubber, and diamino­diphenylmethane is a diamine used in the manufacture of rubber, plastics, dyes and adhesives. The Abitol and colophony reactions were initially of unknown relevance, but on further questioning the patient revealed a second hobby: reupholstering wooden record players, involving sanding of pine wood and use of polish and varnish. The propolis and fragrance allergies could have been related to personal care products, but uncovering a third pastime – caring for his pet gecko – better explained this. Bee pollen granules are advertised as ‘ideal natural supplements’ for reptiles and are commonly used as a food supplement for geckos, which are picky eaters. He was feeding his pet gecko propolis pellets and putting tree moss in its cage to create a humid environment. Reassuringly his facial rash settled and has not flared since. This case highlights the importance of taking a detailed history of interests and hobbies prior to patch testing as this information may not be volunteered by patients who are unaware of their relevance.TablePositive patch test reactionsAllergenDay 2 reactionDay 4 reactionRelevance4,4′-diaminodiphenylmethane−+CurrentHexamethylenetetramine−+CurrentColophony++++CurrentAbitol++CurrentPropolis−+CurrentTree moss++CurrentFragrance mix I++CurrentSorbitan sesquioleate−+CurrentClindamycin−+Don’t know

Abstract Tuberculous (TB) osteomyelitis of the mandible is exceedingly rare, constituting less than 2% of all skeletal tuberculosis cases. This case report describes the initial presentation of a patient with tuberculosis manifesting as swelling associated with the mandible, highlighting the importance of considering TB in the differential diagnosis of jaw swelling, especially in individuals from endemic regions. A 53-year-old male from Congo, presented with a one-month history of right-sided facial swelling, restricted mouth opening, and earache. Initial investigations, including an orthopantomogram (OPG), revealed a unilocular radiolucent lesion at the right mandibular angle, with no obvious dental pathology. A computed tomography (CT) scan showed a multi-loculated, necrotic, thick-walled collection around the right mandibular ramus, with bony destruction. Due to the degree of bone destruction, his case was discussed in the Head and Neck MDT, as osteosarcoma was suspected. Initial ultrasound-guided core biopsy was inconclusive. Repeat fine needle aspiration (FNA) aspirated pus, and cytology showed granulomas, suggesting tuberculosis. Further diagnostic testing confirmed Mycobacterium tuberculosis on a lower respiratory tract swab and FNA PCR. The patient was started on anti-TB therapy and underwent two incision and drainage (I&D) procedures for abscesses in the right buccal, deep neck, and parapharyngeal spaces. He was discharged on anti-TB medication and followed up by the respiratory team. This case underscores the importance of maintaining a high index of suspicion for TB in patients from endemic regions and highlights the need for early diagnosis and multidisciplinary management.

Postoperative pain and facial swelling are frequent complications following open reduction and internal fixation (ORIF) of mandibular angle fractures, impacting recovery and early postoperative quality of life. This study assesses the effectiveness of Kinesio taping (KT) and transdermal diclofenac patches (TDP), both individually and in combination, in managing postoperative pain and swelling. By comparing these non-invasive interventions, we aim to determine their role in enhancing patient comfort and postoperative recovery. A triple-blind randomised controlled trial was conducted at a tertiary trauma centre in rural South India, enrolling 60 patients (18-55 years) with isolated unilateral mandibular angle fractures. Patients were randomly assigned to KT + TDP, KT alone, or TDP alone and Intramuscular Diclofenac (IM-control) groups. Primary outcomes measured were postoperative swelling (measured using a 5-linetechnique), pain (10-point Visual Analog Scale), and the amount of rescue analgesics consumed, analysed using ANOVA and post hoc tests (P < 0.05). Swelling peaked on postoperative day 2, with the KT + TDP group showing significantly less swelling than other groups (P < 0.05). Pain scores were highest in the KT-only group (P = 0.00), while TDP and IM groups showed comparable pain reduction. Statistical analysis confirmed the significant differences among the groups (p < 0.05). The combination of a transdermal diclofenac patch and Kinesio tape offers the most effective relief, significantly reducing postoperative pain and swelling, indicating a synergistic effect. Integrating these non-invasive modalities into postoperative care protocols can enhance patient comfort and recovery following ORIF of mandibular angle fractures. This trial was registered in Clinical Trials Registry of India, on 29/07/2021 holding Registration number CTRI/2021/07/035272 and was registered prospectively.

Alveolar ridge defects associated with cleft lip and palate are typically repaired using alveolar bone grafting (ABG), with autologous grafting as the standard despite donor site morbidity. This study investigated outcomes of using hydroxyapatite/beta-tricalcium phosphate (HA/TCP) as a synthetic graft alternative. A retrospective cohort study identified 118 patients who underwent ABG via CPT codes and were divided into three groups: autologous Iliac Crest Bone Graft (ICBG) (N=37), ICBG + rhBMP-2 (N=65), and 15% hydroxyapatite/85% beta-Tricalcium Phosphate (HA/TCP) + rhBMP-2 (N=16). Primary outcomes included need for regrafting and % graft take, assessed via CBCT imaging. Secondary outcomes included complication rates (swelling, wound dehiscence, SSI) and perioperative data (surgery length, hospital stay). Patients who received HA/TCP + rhBMP-2 experienced similar rates of need for regrafting as the other groups. The median % graft take was higher for HA/TCP + rhBMP-2 (68.0% IQR[45.9-93.1%]) compared to ICBG (25.1% IQR[5.2-43.5%], Z = 3.16, p = 0.002) and ICBG + rhBMP-2 (44.2% IQR[24.5-63.1%], Z = 2.19, p = 0.028). Complication rates were similar across groups (dehiscence, p = 0.319; SSI, p = 0.357), except for a higher rate of post-surgical facial swelling for HA/TCP + rhBMP-2 compared to ICBG (OR = 6.8, 95% CI[1.44-32.00], p = 0.0157). HA/TCP + rhBMP-2 is a viable alternative to ABG, showing comparable success to ICBG and ICBG + rhBMP-2, with superior % graft take and no increased complication risk, aside from increased post-surgical facial swelling compared to ICBG.

Rationale:A carbuncle is a type of superficial soft-tissue infection involving hair follicles, typically starting as a furuncle. Multiple furuncles can coalesce to form a carbuncle. Methicillin-resistant Staphylococcus aureus (MRSA) is a common commensal organism on the skin and is known to cause infections, particularly in hospitalized patients or those living in nursing homes. This case report describes a patient with a right facial carbuncle complicated by co-infection with COVID-19 and drug toxicity.Patient concerns:A 73-year-old Malaysian Chinese woman with a history of chronic hypertension, diabetes mellitus, dyslipidemia, and cerebrovascular accident presented to the Emergency Department with dehydration, acute kidney injury, and a right temple carbuncle with pre-septal involvement.Diagnoses:A definitive diagnosis of the infection was made through a swab of the carbuncle pus, which was sent for microorganism culture and sensitivity testing.Interventions:At the Emergency Department, the patient was initially treated with intravenous (IV) ampicillin-sulbactam (Unasyn) 1.5 g 3 times daily. Despite this, the right facial swelling increased in size. On the fourth day of admission, IV metronidazole 500 mg 3 times daily was added, resulting in a notable reduction in swelling. Incision and drainage of the carbuncle were performed under local anesthesia, followed by daily wound dressings with diluted povidone-iodine solution. Based on blood culture and sensitivity results confirming MRSA infection, IV Unasyn and metronidazole were replaced with vancomycin 2 g initially, then adjusted to 1 g twice daily. However, vancomycin was discontinued after 3 days due to hyperkalemia, and oral Bactrim was initiated. The wound was dressed with hydrogen peroxide and povidone-iodine for their synergistic effects. The infection was effectively managed, leading to progressive wound healing.Outcomes:Complete healing of the MRSA-infected skin and soft tissue wound by secondary intention was achieved by the 7th week posthospital admission.Lessons:Localized MRSA infections of the face can be effectively managed with a combination of medical and surgical interventions. The defect in the temple area healed by secondary intention, resulting in an acceptable cosmetic outcome.

ABSTRACT Background- Ayurveda (Ayus- life or Longevity&amp; Veda – Knowledge) is a life science which has resolutions for all health difficulties. Thyroid disorders are the most frequent endocrine condition in India. One of the most prevalent endocrine disorders seen in everyday practice is hypothyroidism. Hypothyroidism is classified as Anukta Vhadhies in the Charak Samhita. The two main Doshas engaged in this Vhadhies are Vata and Kapha. Hypothyroidism is an endocrine condition caused mostly by insufficient thyroid gland stimulation or primary gland failure by the pituitary or hypothalamic glands. Hypothyroidism symptoms include fatigue, gastric discomfort, facial puffiness with edematous eyelids, slowed nail growth, put on weight, cold intolerance, mood disturbances, hoarseness of voice, decreased erotic desire, paleness, dry rough skin, dry brittle hair, alopecia, constipation, irregular menstrual cycle, muscle spasms cramps, myalgia, and so on. Case report - In this study, a female patient aged 29 years with Symptoms of hypothyroidism for 1 year was treated with Rasayana, Shaman aushadhi, and followed Pathya diet. Result-After four months of treatment, there was a considerable reduction in disease signs and symptoms, with a 60% improvement in the condition. Keywords – Ayurveda, Shaman aushadhi, Rasayana, Hypothyroidism.

This study investigates the characteristics of baseline data and the correlation between autoantibodies and clinical phenotypes in patients with systemic sclerosis (SSc) from Southwest China. A total of 346 patients diagnosed with SSc between 2021 and 2023 were included. Clinical data and laboratory data were collected to analyze the relationship between autoantibodies and clinical phenotypes. The prevalence of hypertension and osteoporosis in female patients with SSc was significantly higher than that in male patients. Anti-Scl-70 antibody was positively correlated with Raynaud phenomenon, facial or acral swelling and interstitial lung disease. Anti-Ro52 antibody is positively correlated with pulmonary hypertension. Anti-Scl-70, anti-U1-nrNP, anti-SSA, and anti-Ro52 were associated with overlap syndrome of SSc and systemic lupus erythematosus. Anti-SSA and anti-Ro52 are associated with overlap syndrome of SSc and Sjogren syndrome. Anti-Scl-70 was found to be statistically different in platelet count (PLT), C3, C4, albumin, and C-reactive protein, as was anti-U1-nRNP in hemoglobin, immunoglobulin G, C3, total triglyceride, high-density lipoprotein and low-density lipoprotein, as was anti-SSA in hemoglobin, immunoglobulin G and erythrocyte sedimentation rate, as was anti-ro52 in white blood cell count (WBC) and IgG, and anti-CENP B in PLT. Our study showed that autoantibodies anti-Scl-70 and anti-Ro52 in SSc patients were associated with the clinical phenotypes of Raynaud phenomenon, facial or acral swelling, interstitial lung disease and pulmonary hypertension.

BackgroundThis study aimed to evaluate the effect of protein intake on early wound healing following the surgical removal of impacted mandibular third molars, and to explore its associations with postoperative outcomes such as trismus, edema, pain, and oral health-related quality of life.MethodsPatients with asymptomatic impacted mandibular third molars classified as easy or medium difficulty according to the Pernambuco index were included. Dietary protein intake over the past month was assessed using a food frequency questionnaire and a 24-hour recall. Early wound healing was evaluated using the Early Wound Healing Index (EHI). Trismus was assessed by measuring maximum interincisal opening, swelling through linear facial measurements, and pain using a visual analog scale (VAS).ResultsTwenty-five patients (16 females, 9 males) aged 19–33 years (mean 23.3 ± 2.88) were analyzed. No significant differences were found between the study groups regarding age, sex, body mass index, surgical difficulty, or operation duration. Patients with high protein intake experienced a significantly greatest decrease in mouth opening on the 3rd postoperative day (p = 0.004). Facial swelling on day 3 was significantly greater in the high protein intake group compared to the low and normal intake groups (p = 0.023), while pain scores on day 1 were significantly lower (p = 0.009). Protein intake was positively associated with EHI scores on day 7, indicating improved early wound healing (p = 0.019), whereas no significant association was observed on day 1 (p = 0.081). No significant relationship was found between protein intake and OHIP-14 scores at any time point (p = 0.211, p = 0.462, and p = 0.704, respectively).ConclusionsHigher protein intake was associated with improved early wound healing and modulation of postoperative outcomes, including reduced pain severity and enhanced functional recovery following third molar surgery. These findings underscore the value of nutritional assessment and support as part of postoperative care. Further studies with larger cohorts are warranted to validate these results and clarify the underlying mechanisms.

TWIN-MIX INJECTION REDUCES POSTOPERATIVE COMPLICATIONS AFTER LOWER THIRD MOLAR REMOVAL-A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.

Eosinophilic granulomatosis with polyangiitis and facial swelling.

Clinical pathologic correlation case 3: right facial swelling after tooth extraction

An 81-year-old man with chest trauma presented with facial swelling and eyes shut due to subcutaneous emphysema. Computed tomography (CT) scans revealed extensive emphysema from the face to the pelvis, including mediastinal emphysema, fractures of the left 6th and 7th ribs, minor left pneumothorax, and slight hemothorax. Emphysema was likely caused by lung adhesions or fractured bone fragments penetrating the lung. Surgery was performed under epidural anesthesia in the right lateral decubitus position. The 6-cm incision above the fracture site allowed access to the extrapleural cavity. The lung penetration was relieved, and the fractured bones were realigned. Thoracoscopy revealed no adhesions, and two drains were placed. The patient was discharged on postoperative day nine. Although transfer to general anesthesia was considered, the surgery was successfully completed under epidural anesthesia. Epidural anesthesia may be a viable option for patients with severe subcutaneous emphysema, thereby avoiding the risks associated with positive pressure ventilation.

To investigate the clinical effect of piezosurgery combined with 45°contra-angle turbine drill in extraction of impacted mandibular wisdom teeth. A total of 146 patients with impacted wisdom teeth at the median mandibular level admitted from June 2022 to June 2024 were randomly divided into control group and experimental group, with 73 cases in each group. The wisdom teeth in the control group were simply removed using 45° contra-angle turbine drill, while those in the experimental group were removed using piezosurgery combined with 45° contra-angle turbine drill. The treatment outcomes, postoperative pain, limited swelling and incidence of postoperative complications of the two groups were compared. There was no significant difference in operation time between the two groups(P＞0.05), and the amount of blood loss in the experimental group was significantly lower than that in the control group(P＜0.05). The visual analogue scale(VAS) of pain in the experimental group was significantly lower than that of the control group on the 1st and 3rd day after surgery(P＜0.05). Immediately, 1 day and 3 days after surgery, the serum C-reactive protein (CRP) in the experimental group was significantly lower than that in the control group (P＜0.05). The score of facial swelling degree and proportion in the experimental group were significantly lower than those in the control group (P＜0.05), the reduction rate of mouth opening degree and the proportion of mouth opening restriction in the experimental group were significantly lower than those in the control group(P＜0.05). There were no significant differences in the total incidence of postoperative complications such as tongue numbness, lower lip numbness, adjacent tooth injury, dry socket and root fracture between the two groups(P＞0.05). Compared with only using 45° contra-angle turbine drill, the combination of piezosurgery for impacted mandibular wisdom teeth extraction can help reduce intraoperative bleeding, alleviate pain and swelling,improve the degree of limited mouth opening.

Factors influencing onset and course of odontogenic pediatric facial cellulitis.

3103 Background: OMX-0407 is an orally available spectrum-selective kinase inhibitor that targets key oncology-relevant tyrosine kinases and salt-inducible kinases and is being developed as a first-in-class treatment for solid tumor indications. Preclinical investigations indicate a dual mode of action by sensitizing tumor cells to immune cell induced apoptotic cell death as well as direct inhibition of tumor growth promoting kinases. Methods: This is a phase Ia/Ib dose escalation and expansion study of OMX-0407 (NCT05826600). Eligible patients for the phase Ia dose escalation part had advanced solid tumors and exhausted available therapies. Results: As of the 30 th of October 2024, 24 patients have been treated at dose levels 10 through 140 mg p. o. BID and the phase Ia part has been completed. Solid tumor histologies included melanoma, non-small cell lung cancer, sarcoma and colorectal cancer. OMX-0407 was generally well tolerated, adverse reactions were mainly gastrointestinal. Two dose limiting toxicities were observed: One case of facial swelling secondary to drug allergy at the 90 mg BID dose, and one case of fatigue at the 140 mg BID dose. One durable complete response in a patient with cutaneous angiosarcoma secondary to radiotherapy, resistant to two prior lines of chemotherapy treatment, was observed at 30 mg BID which is ongoing at 16 months (at the time of data cutoff). Pharmacodynamic analyses demonstrated phosphorylation inhibition of target kinases. A recommended phase II dose of 100 mg BID was identified. Conclusions: OMX-0407 has been well tolerated at pharmacologically and therapeutically active dose levels. One very durable response has been observed in an angiosarcoma patient at a low dose level. The phase Ib expansion part at the recommended phase II dose is currently recruiting patients with angiosarcoma and clear cell renal cell carcinoma. Clinical trial information: NCT05826600 .

Objectives: To report the “sunray” appearance on panoramic radiography as a sign of malignancy lesions of the mandible. Case Report: A 40 year old female patient came to the Hasanuddin University Dental Hospital with the main complaint of facial swelling which causes an asymmetrical appearance and hard consistency on palpation. Mucosa around the second right premolar to the third right molar is reddish with an irregular border. The patient was referred to the radiology department for panoramic radiography and MRI. The panoramic radiograph revealed a mixed radiolucent-radiopaque lesion in tooth 35 involving ramus to the coronoid process. PDL space was irregular widening at 36, 37, and 38. The "sunray” appearance was seen from the ramus extending to the coronoid process. On the MRI, a mass on the submandibular gland pushed and narrowed the sublingual, parapharyngeal, and masticator space, destroying the mandible on the left side. These radiologic findings strongly suggest a malignancy involving the jawbone. Conclusion: The findings of a mandibular malignancy in the form of a “sunray” appearance on panoramic radiography need to be confirmed with an MRI examination to determine the consistency and extent of the lesion to the surrounding tissue. A comprehensive examination is necessary to properly diagnose mandibular malignant lesions so that the most suitable treatment plan can be determined.

INTRODUCTION/BACKGROUNDThyroid disorders are among the most common endocrine diseases globally, with hypothyroidism affecting approximately 3.4% of the Malaysian population. Muscle-related symptoms, such as fatigue, cramps, and myalgia are frequently observed in hypothyroidism and usually present with mild to moderate elevations of the muscle enzymes. However, rhabdomyolysis due to hypothyroidism, particularly in the absence of other apparent causes, is rare and is more frequently associated with Hashimoto's thyroiditis. The exact mechanism remains unclear, but it is hypothesized that hypothyroidism disrupts muscle metabolism, leading to prolonged oxidative damage and subsequently rhabdomyolysis. CASEWe report a case of a 32-year-old male with no prior medical history who presented with one month of weight gain and lethargy, associated with facial puffiness for 2 weeks. He denied systemic symptoms, strenuous activity, trauma, alcohol use, or recent medications. No family history of thyroid or autoimmune disease was noted. Examination showed mild facial puffiness, no muscle weakness, and normal reflexes. Laboratory investigations revealed elevated creatinine kinase (CK) levels of 2,527 U/L (55-170), aspartate transaminase (AST) of 130.3 U/L (8-33), alanine transaminase (ALT) of 118.1 U/L (7-56) and acute kidney injury with urea 7.3 mmol/L (7-12), creatinine 182 µmol/L, and eGFR 37.6 mL/min. Thyroid function tests confirmed severe hypothyroidism with free T4 7.60 pmol/L (NR: 7.86-14.41), and TSH &gt;49.40 mIU/L (NR: 0.38-5.33) with positive thyroid peroxidase antibody, confirming Hashimoto’s thyroiditis. No other causes for rhabdomyolysis were identified and autoimmune hepatitis screening was negative. The patient was managed with aggressive intravenous hydration and levothyroxine replacement therapy, resulting in clinical and biochemical resolution. CONCLUSIONThis case underscores the importance of considering hypothyroidism in the differential diagnosis of unexplained rhabdomyolysis, especially in the absence of conventional triggers. Prompt recognition and early treatment are essential in preventing complications and ensuring optimal patient outcome.

Background: Ludwig’s angina is a rapidly progressive, potentially fatal cellulitis of the floor of the mouth and neck, often arising from odontogenic or mandibular infections. Prompt surgical intervention and appropriate antimicrobial therapy are critical for successful outcomes. Case Presentation: A 53-year-old male presented to the emergency department with severe facial swelling, trismus, dysphagia, and signs of airway compromise. Clinical and radiographic evaluation revealed an untreated, intraorally open mandibular fracture complicated with Ludwig’s angina, necessitating urgent surgical intervention. Management and Outcome: Under general anesthesia, bilateral submandibular stab incisions were made for Surgical Decompression, debridement, and irrigation with gentamicin and metronidazole, followed by placement of corrugated drains, and then ORIF of mandibular and maxillary fractures was performed. Postoperatively, the patient received intravenous antibiotics, corticosteroids, NSAIDs, and fluid support. Microbiology report revealed diphtheroids on POD-4, and Gentamicin was added to drug regimen. Drains were removed on POD-5, surgical closure of the stab incisions was done on POD-12 following the resolution of infection, and the patient was discharged. Conclusion: This case underscores the importance of early surgical intervention, multidisciplinary care, and adaptive antimicrobial strategies for managing complex facial trauma complicated by deep space infections, such as Ludwig’s angina.

Background: Leprosy, caused by Mycobacterium leprae, is a chronic infectious disease often complicated by immune-mediated reactions. Type 2 lepra reaction, or erythema nodosum leprosum (ENL), is characterized by systemic inflammatory symptoms requiring immunosuppressive therapy. Co-infection with multidrug-resistant tuberculosis (MDR-TB) further complicates management and prognosis. Case Presentation: A 35-year-old male presented with abdominal pain, loose stools, vomiting, and dusky erythematous skin lesions. He was diagnosed with lepromatous leprosy and initiated on multidrug therapy. Subsequently, he developed ENL manifesting as flared-up lesions, facial puffiness, and small joint pain, necessitating corticosteroid treatment. Two months later, he was diagnosed with MDR-TB with right-sided pleural effusion and lung collapse, which was successfully managed with a Bedaquiline-based regimen. Conclusion: This case highlights the diagnostic and therapeutic challenges posed by the coexistence of leprosy, ENL, and MDR-TB. Early recognition, multidisciplinary care, and integrated management strategies are essential for achieving favourable outcomes in such complex presentations.

Background: Chlorhexidine is usually used as a mouth disinfectant after third molar surgery however; it lacks anti-inflammatory and analgesic properties. There is a possibility that neem leaf extracts, with analgesic, anti-inflammatory properties and can serve as a disinfectant, will be a better alternative. We aimed to evaluate the effectiveness and safety of neem leaf extract in controlling postoperative complications after third molar surgeries in comparison to chlorhexidine mouthwash. Methods: This was a randomised clinical trial that enrolled patients who had impacted mandibular third molars and were randomly assigned to the control (chlorhexidine) or experimental (neem leaf extract) groups using simple randomisation method. We collected data on patients' clinical demographic, type of mouthwash, pain, facial swelling, trismus, wound healing, acute alveolar infection, localised alveolitis and adverse effects. Both descriptive and inferential statistics were performed and p-values &lt; 0.05 were considered significant. Results: 48 patients were randomly divided into control and neem groups (n = 24 each). There was no significant difference in clinical demographic characteristics between the two groups. Post-operative pain was significantly lower in the neem group at post-operative day (POD) 3 (p = 0.001) and POD 7(p = 0.001). Facial swelling reduced significantly at POD 7 in the neem group (p=0.02). There was significant decrease in trismus at POD 3(p = 0.01) and POD 7 (p = 0.004) in the neem group. Wound healing was better among those who rinsed with neem (p=0.03). Neem mouthwash did not reduce incidence of localised alveolitis (p = 0.595), acute alveolar infection (p = 0.346) and adverse effects (p = 0.257) than chlorhexidine mouthwash. Conclusion: Neem mouthwash was more effective in the control of pain, facial swelling, trismus and poor wound healing compared to chlorhexidine mouthwash but has same effect as chlorhexidine mouthwash in the control of localised alveolitis, acute alveolar infection and adverse effects.