Improvement In Mouth Opening Research Articles

Assessment of the most feasible method for the management of facial injuries in children without hampering the facial growth

Aim: To access the most feasible method for the management of facial injuries in children without hampering the facial growth. Material & Methods: The present study was conducted on 100 child patients with facial injuries attending the outpatient department of dentistry. Results: A total of 120 children were afflicted by facial injuries, the incidence being 3.24%. Among the etiological factors it was evident that fall (45.8%) was the major etiological factor. There was 100% improvement in mouth opening postoperatively treated by both the methods. Conclusion: Most of the mandibular fractures were found in the parasymphysis region. Simple fracture seems to be commonest in the mandible. Most of the mandibular and midface fractures in children were amenable to conservative therapies except a few which required surgical intervention.

Assessment between Aloe Vera Gel and Intralesional Hydrocortisone in the Management of Stage II Oral Submucous Fibrosis

Objective: To assess the effect of aloe vera gel and intralesional hydrocortisone in the management of stage II oral submucous fibrosis patients in terms of mouth opening and burning sensation. Subject and Methods: A total of 38 patients were equally divided into two groups; i.e Group A was treated with herbal antioxidant aloe vera gel, while Group B was treated with traditional intralesional hydrocortisone. Patients of stage II OSMF were diagnosed clinically on the basis of presenting symptoms. Mouth opening and burning sensations were recorded at start of treatment and postoperatively for 3 months period. All findings were recorded on proforma. Results: In both groups males were in majority as compared to females. Total of 13 males and 6 females, 14 males and 5 females were reported in Group A and B respectively (P Value 0.5190. Mean age of patients in group A was 25.19 ± 6.33, while in group B it was 28.93 ± 5.82. Significant improvement in mouth opening and burning sensation was found equally in both groups. Conclusion: Aloe vera gel applied topically and intralesional hydrocortisone are equally effective in reducing the symptoms of stage II OSMF patients. Keywords: Oral Submucous Fibrosis, Aloe Vera, Intralesional Hydrocortisone, Mouth Opening, Burning Sensation

Effectiveness of Omega-3 Fatty Acids and Spirulina as an Adjuvant Antioxidant to Corticosteroid in the Treatment of Oral Submucous Fibrosis – A Comparative Study

Introduction: Oral submucous fibrosis (OSMF) is a chronic insidious and a well-recognized potentially malignant disorder of the oral cavity. Due to its high morbidity and malignant transformation rate, relentless efforts have been made to improve effective management, despite not much improvement in the prognosis. Omega 3 polyunsaturated fatty acids have been reported to have anti-inflammatory properties. With its antioxidant, anti-inflammatory, and immunomodulating properties, Spirulina has shown promising results in the management of OSMF. This present study was conducted to compare the effectiveness of Omega-3 fatty acids and Spirulina in the management of OSMF. Aims and Objectives: To find out and compare the effectiveness of Omega-3 fatty acids and spirulina in the management of OSMF. Methods and Material: 40 OSMF patients with clinically diagnosed OSMF were selected and divided into two groups. Group A was given biweekly intralesional injections of 1.5 ml Dexamethasone in 4 mg/1 ml and Hyaluronidase 1500 IU mixed with Lignocaine 0.5 ml for six weeks and with omega-3 fatty acid capsules 1 gm three times daily for three months. Group B received similar intralesional injections but with spirulina 500 mg twice daily for three months. All the patients were followed up every month for 3 months and then after six months. Results: Both groups improved mouth opening, cheek flexibility, and VAS burning sensation except tongue protrusion (p < 0.05). When the efficacy was compared between two drugs, statistically insignificant results were found for mouth opening, tongue protrusion, cheek flexibility, and burning sensation. Conclusion: Omega 3 and Spirulina can be effective adjunctive treatment options in patients with OSMF to reduce subjective symptoms. Statistically, significant improvement was seen in both groups.

Comparison Between Mini Plate Versus Trapezoidal Plate in Management of Condylar Fracture

Objective: To compare the clinical outcomes between the Miniplates versus Trapezoidal plates in terms of pain, mouth opening and malocclusion. Methodology: A total of 34 patients were categorized into two Groups according to convenient Sampling Methods. Group A was treated with Miniplates and Group B was treated with Trapezoidal Plates. Diagnosis of condylar fracture was made through clinical examination, Orthopantomogram (OPG), P.A view of face and 3D CT scans where indicated. After surgery postoperative pain, mouth opening and malocclusion were recorded at interval of 3, 7, 14 and 21 days. Results: Mean age of the patients of group A was 30.39+10.91 years and mean age of patients of group B was 29.05+7.25 years. Males were in majority in both groups as 70.6% were in group A and 88.2% were in group B. Preoperatively most of the patients were presented with severe pain in both groups as 47.1% in group A and 52.9% in group B. Post-operative pain on day 3 was in moderate presentation in both groups, on day 7 and day 14 pain was mild in both groups and on day 21 there was no pain in either groups. Malocclusion in Group A on day 3 was in 29.4% and 11.85% in group B. At Day 21 both groups were recorded with no malocclusion. But patients treated with trapezoidal plate achieved stability earlier than those treated with miniplates. Conclusion: Trapezoidal plate has been found to be more effective. There was an improvement in mouth opening and occlusion in the immediate postoperative period. However findings were statistically insignificant. Keywords: Condylar fracture, Miniplates, Trapezoidal plates, Pain, Mouth Opening, Malocclusion

Comparative efficacy of low-level laser therapy (LLLT) to TENS and therapeutic ultrasound in management of TMDs: a systematic review & meta-analysis

ABSTRACT Objective To assess the reduction in pain, muscle tenderness, joint clicking, and improvement in mouth opening (MO) after low-level laser therapy (LLLT) compared to transcutaneous electrical nerve stimulation (TENS) and therapeutic ultrasound (US) among temporomandibular joint disorder (TMD) patients. Methods A systematic search of online sources of electronic databases was undertaken. The quality of the study was assessed using the Cochrane risk of bias assessment tool for randomized controlled trials (RCTs). Results Twelve RCTs were included in the systematic review, and 9 were included in the meta-analysis. For reduction in pain between LLLT and TENS, LLLT was found to be better than TENS, at 95% CI. LLLT was also proven to be better in reducing pain than therapeutic US, at 81% CI. Conclusion This systematic review and meta-analysis compared the effectiveness of LLLT, TENS, and therapeutic US in TMD. LLLT provided relatively more effective pain relief and improvement in MO.

Treatment of Sagittal Fracture of the Mandibular Condyle Using Resorbable-Screw Osteosynthesis

Screw osteosynthesis is advocated for the treatment of sagittal fracture of mandibular condyle (SFMC). This study aimed to explore the applicability of resorbable-screw osteosynthesis in the treatment of SFMC. A retrospective cohort study was performed in patients with SFMC treated with resorbable-screw osteosynthesis (group A) from June 2011 through June 2021. The patients who had undergone titanium-screw osteosynthesis served as the control group (group B). The primary outcome variable was fracture healing, defined as follows: 1) normal mouth opening and restoration of pretrauma occlusion; 2) without complications or discomfort of temporomandibular joint symptoms; and 3) fracture union without abnormal reactions or bone resorption in computed tomography images. The secondary outcome variable was condylar morphological changes including radiographic imaging appearance of the condyle, mandibular ramus height (MRH), anteroposterior diameter (APD), and mediolateral diameter (MLD) of the condyle, which were assessed by comparing the computed tomography images 1week after surgery with those of 3months after surgery. The collected data of the outcome variables of the 2 groups were analyzed correspondingly using Student's paired t test and Student's t test. There were 24 patients in group A and 71 patients in group B. All the patients displayed an evident improvement in mouth opening and restored pretrauma occlusion. Few patients had complications (group A, 8.33%; group B, 9.86%) and discomfort of temporomandibular joint symptoms (group A, 16.67%; group B, 15.49%). Fracture union without abnormal reactions or bone resorption was observed during the follow-up. The radiographic evaluation revealed no significant difference in the MRH, the maximum APD, and MLD of the condyles between 1week and 3months after surgery in both groups. There were no significant intergroup differences in the changes in the MRH, APD, and MLD of the condyles. Resorbable-screw osteosynthesis is a viable option for the treatment of SFMC.

Treatment efficacy using occlusal splint for anterior disc displacement without reduction of temporomandibular joint

Management of TMDs with occlusal splint is a reversible, non- invasive modality which causes minimum damage to tissues, when compared to other irreversible treatment modalities. Objectives of this study is to assess the effectiveness of flat occlusal splint in patients with anterior disc displacement without reduction by evaluating reduction in pain and improvement in mouth opening. 35 participants with mean age 35 years who does not have any systemic diseases and not undergoing treatment for ADD without reduction were selected for study. After recording pain score on VAS scale and maximum mouth opening, flat occlusal splint was fabricated for maxillary arch. Patients were advised to wear the splint for all the time except on meal times. Maximum mouth opening and pain score were again evaluated after 3 weeks. Statistical results showed that there is highly significant reduction in pain score and increase in maximum mouth opening. Mean VAS score before treatment was 7.26±0.88. After treatment with splint therapy, VAS score was reduced to 2.94±1.41. The mean value of maximum mouth opening before treatment was 23.09±4.25. After treatment with splint therapy, it was increased to 30.37±5.43. Both parameters had p value <0.001, which is highly significant statistically. Significant reduction in pain score and improvement in mouth opening noted after using flat occlusal splint in patients having ADD without reduction. However, further studies are needed on a long term basis for better results.

Comparisons between lysis and lavage, intra-articular steroid injections, and three-point subsynovial steroid injections using operative single-cannula arthroscopy — A retrospective analysis

The aim of this study is to compare the effectiveness of intra-articular and three-point sub-synovial steroid injections.In this retrospective Cohort study an OSCA lysis and lavage, intra-articular and threepoint sub-synovial steroid injections were performed and the maximal interincisinal opening (MIO), pain using 10- point visual analog scale (VAS) and quality of life (QOL) were measured one week before the procedure and 1, 3, 6, 12 months, and 2 and 3years after surgery.Sixty-five patients suffering from internal derangement refractory to conservative treatment charts were reviewed. successfully lowered pain (p value = 0.0012), and improved mouth opening (p value = 0.023), and quality of life (QoL) (p value = 0.003) for up to 6 months after surgery. OSCA with intra-articular CS injections effectively lowered pain (p value = 0.0025), and improved mouth opening (p value = 0.03) and QoL (p value = 0.004) for 12 months. In comparison, OSCA with sub-synovial steroid injections was significantly effective in lowering pain (p value = 0.000002), improving mouth opening (p value = 0.000004), and QoL (p value p = 0.000006) for the duration of the 36-month follow-up period within the limitations of the study it seems that the OSCA technique with site-specific, sub-synovial CS injections should be the preferred treatment approach when the priority is long-term success concerning pain relief, increased mouth opening and improved quality of life in Wilkes II-IV patients.

Late treatment of mandible fracture after third molar removal

Surgical management of impacted third molars is a treatment performed by dentists and its indicated for various conditions, among the indications has the prevention of mandibular fracture, but this is a factor that has been discussed and is controversial. Fractures caused by a third molar can occur, and on the other hand, the fractures after or during the management of impacted third molar are a possible complication. Surgical planning as the indication to the surgery has to be performed to avoid complications as the fracture. Thus this study aims to report a case about a mandible fracture after third molar extraction, presenting edema, pain, and restriction in mandible mobility in 01-day follow-up. A 27-year-old female was referred to the oral and maxillofacial surgery service of the Santa Casa Hospital of Araçatuba (Araçatuba, Brazil), reporting dental history of third molar removal, with immediately chief complaints. In the assessment, the patient presented edema, pain, malocclusion, and restriction in mandible mobility, and the panoramic X-ray showed a mandible fracture with displacement. The patient underwent surgery under general anesthesia to open reduction with internal fixation (ORIF) through an intraoral approach. On the follow-up, the patient showed an improvement in mouth opening and mandibular mobility without pain or infection signs. The panoramic X-Rays showed us the bone fracture healing.

Efficacy of Platysmamyocutaneous Flap in Oral Defects.

Clinicians are baffling for reconstruction of small- to medium-sized defects of the oral cavity since time immemorial, each and every flap has its own limitations, ideal flap should be pliable, easily transferrable that can result in a better restoration of form and function of oral mucosa, we have platysma for the same purpose. We aim to provide surgical technique of the superiorly-based platysma myocutaneous flap with a single neck incision in this study, as well as the flap design, results, and complications associated with age, gender, the recipient site, and the size of the defect. Study included 20 patients with oral potentially malignant disorders operated under local anaesthesia with wide local excision and reconstruction with platysma myocutaneous flap at a single tertiary care centre. The association between the variables was calculated using Chi-square tests and paired t tests. P < .05 was considered significant. Five cases of dehiscence were found at varied sites and flap viability was significantly influenced by location of skin paddle. In between anterior jugular vein and posterior external jugular vein it was 100% viable while on and posterior to the vein, had skin paddle loss. Significant improvement in mouth opening was also seen in Oral Sub-mucous Fibrosis patients. The platysma flap is a technique sensitive, and its results are promising for the reconstruction of oral defects.

ANTIHYPERTENSIVES IN ORAL SUB MUCOSAL FIBROSIS

Oral submucous brosis is a common pre-malignant condition affecting the oral mucosa with more prevalence among Indian population. Various treatment modalities have been elucidated in order to alleviate the symptoms associated with OSMF. Currently oral Anti hypertensive has been proved to have benecial result in treating OSMF because of its anti-inammatory, brinolytic, immunomodulatory and rheologic modifying property. Several categories of drugs have been used in the treatment of OSMF but their effectiveness leaves much to be desired and no treatment regimen has afforded denitive cure. While Oral administration limits the concentration of drugs in lesional tissue and increases the potential for side effects, the Intralesional injections are associated with signicant mechanical injury and non compliance on the patient’s part because of the accompanying discomfort and pain. The present study was done to evaluate the effectiveness of oral antihypertensives in the management of OSMF Very few studies across world have showed that anti hypertensive drugs showed signicant improvement in mouth opening, reduction in burning sensation. Hence anti hypertensive can be a good alternative in the management of OSMF for whom intralesional steroids or hyaluronidase are contraindicated, for those who cannot make frequent visit and to avoid pain due to injection. And most importantly anti hypertensive is cost effective and more compliant to the patient.

Protocol for Multi-Stage Treatment of Temporomandibular Joint Ankylosis in Children and Adolescents.

Treatment of temporomandibular ankylosis is challenging and frequently leads to re-ankylosis, relapse, dangerous complications and, in turn, the need for multiple operations. In this article, we present a protocol for the treatment of ankylosis of the temporomandibular joints that assumes earlier intervention with the assistance of 3D virtual surgical planning (3DVSP) and custom biomaterials for better and safer surgical outcomes. Thirty-three patients were treated due to either uni- or bilateral temporomandibular ankylosis. Twenty individuals received temporomandibular prosthesis, whereas seventeen required simultaneous 3D virtual surgical/planned orthognathic surgery as the final correction of the malocclusion. All patients exhibited statistically significant improvements in mouth opening (from 1.21 ± 0.74 cm to 3.77 ± 0.46 cm) and increased physiological functioning of the mandible. Gap arthroplasty and aggressive rehabilitation prior to temporomandibular prosthesis (TMJP) placement were preferred over costochondral autografts. The use of 3DVSP and custom biomaterials enables more precise, efficient and safe procedures to be performed in the paediatric and adolescent population requiring treatment for temporomandibular ankylosis.

Does kinesio taping reduce pain, swelling, and trismus after mandibular third molar surgery? A systematic review and meta-analysis.

The aim of this study is to provide an evidence-based conclusion regarding the effectiveness of kinesio taping (KT) in reducing postsurgical discomforts after mandibular third molar surgery and critically appraise the available literature. Eligible clinical trials evaluating patients older than 18years who were treated with any type of KT compared to no taping in which pain, swelling, or trismus scores were reported were included. An electronic literature search was carried out in the following databases to identify relevant papers up to May 30, 2021: Medline, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2.0). The effect sizes were calculated using mean difference (MD) and standardized mean difference (SMD). The heterogeneity analysis was conducted using (I2) statistic at alpha = 0.10 (PROSPERO; CRD42021252670). Nine randomized clinical trials with 444 participants were included in the qualitative analysis and eight in the quantitative analysis. The results of the meta-analysis revealed a statistically significant reduction in pain and swelling scores before the 7th postoperative day. On the 7th postoperative day, no significant difference was observed between KT and control groups in terms of pain and swelling. Additionally, KT led to an increase in patients' maximum mouth opening of more than 3mm in postoperative intervals. KT is effective in reducing postoperative pain within the first 48h after surgery and improving mouth opening during all postoperative intervals with moderate to high certainty of evidence.

Comparative Efficacy of Lag Screw and 3D Plate in Fixation of Symphysis and Parasymphysis Fractures of MandibleA Prospective Interventional Study

Introduction: Mandible is well known for its unique anatomy and is the second most prevalent facial bone to fracture followed by fracture of nasal bone. Fracture of the mandible causes deranged occlusion, trismus, mobility of fractured fragments, pain, oedema and results in functional as well as aesthetic deformity. Therefore, the fixation of mandibular fracture plays a major role in rehabilitation of the jaw. The goal of management is to restore the premorbid occlusion and function. Aim: To compare the efficacy of osteosynthesis of mandibular anterior fracture by two different methods of open reduction, i.e, titanium lag screw and titanium 3 Dimensional miniplate. Materials and Methods: This prospective interventional study was conducted in the Department of Oral and Maxillofacial Surgery of Navodaya Dental College and Hospital, Raichur, Karanataka, India from January 2019 to February 2021. A total of 10 patients with symphysis and parasymphysis fracture were included in this study and were divided into two groups, five patients for Group A (osteosynthesis by titanium lag screw fixation) and five patients for Group B (osteosynthesis by titanium 3D plate fixation) and were treated accordingly. Parameters such as occlusion, mobility of fracture segments, interincisal mouth opening, facial oedema, pain, approximation of the lower border and lingual cortex and hardware failure were assessed clinically and radiographically, and the patients were followed up for three months. Recorded data was compared and was analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Independent sample t-test was used for comparison between the groups. Chi-square test and Fisher exact test were used for qualitative data and p-value was set at 0.05. Results: There was no significant difference noted between two groups when assessed radiographically on 1st day, one and a half month later and after three months. There was no significant difference noted in occlusion as well as in pain when measured postoperatively between the groups, but lag screw fixation provided normal immediate postoperative occlusion in all the cases. A significant improvement in the postoperative mouth opening was noted with lag screw group when compared to 3 Dplates with a p-value of 0.015 when measured after a week postoperatively. When oedema was measured in transverse direction, it was statistically significantly less in 3D plates group postoperatively first day with a p-value of 0.028 and after a week with a p-value of 0.044. Oedema when measured in vertical direction revealed no statistically significant difference between two groups. Conclusion: In the present study a significant improvement in the mouth opening as well as in terms of reduction in pain and oedema was noted with lag screw osteosynthesis group. Immediate postoperative occlusion was better with titanium lag screw osteosynthesis when compared to titanium 3D plates. Based on our study we conclude that both the osteosynthesis materials provide good interfragmentary stability in the management of anterior mandibular fractures and can be used satisfactorily for the fixation of mandibular fractures.

Therapeutic Assessment of Intralesional Corticosteroids and Ultrasound Therapy in Management of Oral Submucous Fibrosis

Background: Oral submucous fibrosis (OSMF) is a premalignant condition with a chronic, debilitating, and resistant nature. Various treatment modalities have been proposed for this condition including steroid injections and surgical interventions. In literature, there are very few studies signifying the role of therapeutic ultrasound in OSMF and this still remains a hidden field which needs to be explored further. Aims and Objectives: To evaluate and compare the clinical efficacy of ultrasound therapy with and without physical exercise with intralesional injection (I/L) of 2 ml dexamethasone (4 mg/ml) + hyaluronidase 1500 IU with physical exercise in patients with OSMF. Materials and Method: A total of 30 patients with OSMF were selected irrespective of age and gender and were allocated into groups A, B and C randomly. Group A: 10 patients treated with I/L injection of dexamethasone and hyaluronidase with physical exercise. Group B: 10 patients treated with therapeutic ultrasound and soft tissue mobilization with physical exercise. Group C: 10 patients treated with therapeutic ultrasound and soft tissue mobilization without physical exercise. All the patients were evaluated weekly for 1 month and findings were compared with those at the beginning of treatment. Result: Ultrasound in combination with exercises leads to more improvement in mouth opening compared to ultrasound alone. Improvement in mouth opening of ultrasound with exercise was almost similar to intralesional injection of steroids. Conclusion: Ultrasound therapy interventions definitely show a significant improvement in the patient's condition with no reported side effects; hence it should be included in the treatment protocol for patients with OSMF.

Efficacy of topical tulsi (Ocimum sanctum) paste for the management of oral submucous fibrosis - A clinical study.

Oral submucous fibrosis (OSMF) is a chronic insidious oral potentially malignant disorder characterized by increased collagen deposition and reduced collagen degradation causing burning sensation and difficulty in mouth opening. To assess the efficacy of topical Tulsi (Ocimum sanctum) paste for the management of OSMF. Institution-based clinical trial. The study included a total of 60 OSMF patients categorized into three Groups A, B and C (20 in each) depending on the severity according to Lai DR et al. classification. The patients were advised for topical Tulsi paste application and were evaluated for the reduction in the burning sensation and improvement in mouth opening every month for 3 subsequent months using the numeric pain rating scale (NRS) and a Vernier calliper, respectively. The baseline and 3-month recordings were subjected to inter- and intra-group statistical analysis using Kruskal-Wallis analysis of variance (ANOVA), Mann-Whitney U, one-way ANOVA, Tukey's multiple post-hoc and Wilcoxon matched-pairs tests. There was a reduction in the burning sensation and improvement in the mouth opening in all three groups. The reduction in the burning sensation was statistically significant among all the groups (P < 0.05) and the NRS scores after 3 months among the three groups were not statistically significant (P > 0.05). There was a statistically significant difference (P < 0.05) in the improvement of mouth opening between Group A and B; A and C; but not between B and C. Tulsi paste showed a significant reduction in the burning sensation and improvement of the mouth opening thereby proving to be a safe and promising medicament for OSMF.

Efficacy of Fractional CO2 Laser for Improvement of Limited Mouth Opening in Systemic Sclerosis.

Systemic sclerosis is a multisystem auto-inflammatory disease-causing fibrosis in the skin and internal organs. A frequent complication of systemic sclerosis is the limited mouth opening (LMO), a difficult-to-treat condition with only a few treatment options available. The aim of this study was to evaluate the response of fractional carbon dioxide (CO2) laser resurfacing in LMO associated with systemic sclerosis. This was a hospital-based prospective study in which diagnosed cases of systemic sclerosis were taken. Patients who had significant LMO and who gave informed consent were included in the study. Fractional CO2 laser treatment was performed in the perioral area. Patients were assessed at baseline, after three and six sessions, and 3 months after the last session. Assessment was done by measurement of the interincisor distance (IID) using a ruler and calculation of the mouth handicap in systemic sclerosis (MHISS) scale. Improvement in IID occurred 3 months after the first session with a mean gain of +5 mm (range 2-7). At 6 months, a mean gain of +8.5 mm (range 7-10) in IID was observed (P < 0.001). The MHISS score decreased by a mean of 14 (range 11-17) (P < 0.001). All patients showed improvement of mouth opening, which allowed the patients to have better phonation and the patients were able to have proper dental care posttreatment in the form of brushing of teeth and other dental procedures. The adverse effects noted in these patients included erythema that resolved spontaneously or after icing posttreatment. Other adverse effects noted were stinging and burning sensations that were mild and transient. Fractional CO2 laser forms a safe, effective, and well-tolerated treatment modality for improvement of LMO in systemic sclerosis. The limitations of this study were less number of patients and no long-term follow-up.

Recurrent Botryomycosis and Management Strategy with a Follow-up of Four Years: A Case Report

Cervicofacial botryomycosis is a chronic, granulomatous suppurative infection with varied presentations in the head and neck region. Since the discovery of this entity, treatment has been elusive without evidence of complete resolution of the lesion with a long period of follow-up. Here the authors report a case of cervicofacial botryomycosis with oral manifestations in a 37-year-old male patient with a history of trauma, for whom the authors devised a treatment plan tailored to the patient's microbiological profile after culture and sensitivity testing in addition to systemic and local antibiotic therapy and heat therapy which showed drastic regression of the lesion and an improved mouth opening. The patient has been under follow-up for the past four years without signs of recurrence. Botryomycosis is an aggressive lesion where a surgery-only approach is usually futile and requires further intervention due to recurrences. The present experience suggests surgical debridement along with antibiotic and local heat therapy to be effective in managing this usually recurring lesion.

Paediatric oral caustic soda ingestion: Case series and lessons learned

Introduction: The ingestion of sodium hydroxide otherwise known as caustic soda causes devasting injuries. Oral complications include microstomia, fibrosis and trismus. We present a case series of paediatric oral caustic soda ingestion injuries and their management by the Oral Maxillofacial (OMFS) team at Royal Manchester Children’s Hospital and the lessons learnt from these cases. Methods: A total of 3 cases are presented. The patients had injuries when they were 20, 22, and 30 months old. Treatment modalities ranged from custom splinting, steroid infiltration, scar-release procedures, commissuroplasty, split thickness skin grafts and free tissue transfer. 2 patients were referred years post injury. 1 patient was referred acutely. Results: In one case a radial forearm free flap was used for reconstruction of the commissure and buccal mucosa after several failed contracture release procedures. This improved mouth opening removing reliance of PEG tube feeding. One case had severe injuries remains tracheostomy and PEG tube dependent with pending future reconstructive surgery at an older age. The final case was referred to our department early and custom splints have been used since the injury to maintain mouth opening with some success. Conclusions: Treatment of the complications of oral caustic soda ingestion in the paediatric population is challenging. The cases presented highlight that; relapse following contracture release is common and that in selected cases free tissue transfer can lead to satisfactory outcomes. We advocate early referral to an OMFS team in all cases of severe injury. Introduction: The ingestion of sodium hydroxide otherwise known as caustic soda causes devasting injuries. Oral complications include microstomia, fibrosis and trismus. We present a case series of paediatric oral caustic soda ingestion injuries and their management by the Oral Maxillofacial (OMFS) team at Royal Manchester Children’s Hospital and the lessons learnt from these cases. Methods: A total of 3 cases are presented. The patients had injuries when they were 20, 22, and 30 months old. Treatment modalities ranged from custom splinting, steroid infiltration, scar-release procedures, commissuroplasty, split thickness skin grafts and free tissue transfer. 2 patients were referred years post injury. 1 patient was referred acutely. Results: In one case a radial forearm free flap was used for reconstruction of the commissure and buccal mucosa after several failed contracture release procedures. This improved mouth opening removing reliance of PEG tube feeding. One case had severe injuries remains tracheostomy and PEG tube dependent with pending future reconstructive surgery at an older age. The final case was referred to our department early and custom splints have been used since the injury to maintain mouth opening with some success. Conclusions: Treatment of the complications of oral caustic soda ingestion in the paediatric population is challenging. The cases presented highlight that; relapse following contracture release is common and that in selected cases free tissue transfer can lead to satisfactory outcomes. We advocate early referral to an OMFS team in all cases of severe injury.

Antihypertensives in oral submucous fibrosis

Oral submucous fibrosis is a common pre-malignant condition affecting the oral mucosa with more prevalence among Indian population. Various treatment modalities have been elucidated in order to alleviate the symptoms associated with OSMF. Currently oral Anti-hypertensive has been proved to have beneficial result in treating OSMF because of its anti-inflammatory, fibrinolytic, immunomodulatory and rheologic modifying property. Several categories of drugs have been used in the treatment of OSMF but their effectiveness leaves much to be desired and no treatment regimen has afforded definitive cure. While Oral administration limits the concentration of drugs in lesional tissue and increases the potential for side effects, the Intralesional injections are associated with significant mechanical injury and noncompliance on the patient’s part because of the accompanying discomfort and pain. The present study was done to evaluate the effectiveness of oral antihypertensives in the management of OSMF. Very few studies across world have showed that anti-hypertensive drugs showed significant improvement in mouth opening, reduction in burning sensation. Hence anti-hypertensive can be a good alternative in the management of OSMF for whom intralesional steroids or hyaluronidase are contraindicated, for those who cannot make frequent visit and to avoid pain due to injection.