Interincisal Distance Research Articles

Trans-Tragal Approach for Mandibular Neck and Head Condylar Fractures.

This retrospective observational study evaluates the trans-tragal approach for the treatment of mandibular head and neck condylar fractures. From January 2009 to May 2024, 34 patients (20 males, 14 females, mean age 34 years) with 36 condylar fractures were treated using this approach. Surgical outcomes were assessed based on occlusal relationship, maximum mouth opening, and facial nerve function (House-Brackmann scale). Postoperative imaging included computed tomography scans, with follow-ups at 1, 3, 6 months, and 1 year. Complications such as wound infection, hematoma, and salivary fistula were also evaluated. Results showed satisfactory postoperative outcomes, with 32 patients maintaining normal occlusion and a mean interincisal opening distance of 40 mm. Three patients experienced complications, including temporary facial nerve numbness in one case, with complete recovery in 2 weeks, and 2 cases requiring reoperation due to condylar segment displacement. No cases of permanent facial nerve damage, salivary fistula, or tragal cartilage necrosis were observed. Aesthetic outcomes were satisfactory, with scars hidden in natural folds. The trans-tragal approach provides adequate surgical exposure to the posterior condylar region while minimizing the risk of facial nerve injury. Although the results of this study indicate favorable outcomes, further randomized controlled studies are required to validate these findings due to the non-randomized design and small sample size.

Comparison of Upper Lip Bite Test and Thyromental Distance with Other Airway (Malampatti and Inter Incisor Distance) Assessment Tests for Predicting Difficult Endotracheal Intubation

Objective: To study the ability of upper lip bite test and thyromental distance to predict difficult endotracheal intubation when compared to standard assessment tests such as Mallampati and inter incisor distance. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Anesthesiology, Pak-Emirates Military Hospital, Rawalpindi, Pakistan, Sep 2020 to Mar 2021. Methodology: We studied a total of 50 patients who reported for the administration of general anesthesia. All patients underwent evaluation with modified Mallampati test, upper lip bite test and thyromental distance test. All participants underwent subsequent intubation according to a standard protocol. The researcher documented difficult intubations. Results: We found the upper lip bite test to have a sensitivity of 75.7%, a specificity of 84.2%, and a diagnostic accuracy of 78.6%. Thyromental distance had a sensitivity, specificity, and diagnostic accuracy of 51.4%, 78.9% and 60.7%, respectively while the modified Mallampati had a sensitivity of 64.9%, 89.5%, specificity and a diagnostic accuracy of 73.2%. Conclusion: Upper lip bite test is a useful bedside assessment tool with which to predict the probability of a difficult endotracheal intubation. Height to thyromental distance ratio test is also acceptable for rapid assessment.

Pregabalin as an Effective Adjunct in Postoperative Care following Third Molar Removal

Background: The surgical removal of impacted mandibular third molar is probably the most commonly performed procedure in oral & maxillofacial surgery. This study aimed to evaluate the effectiveness of pregabalin as an adjunct to standard analgesia for managing postoperative pain, facial swelling, and trismus following mandibular third molar extraction.  Methods: A total of 136 patients undergoing bilateral extractions were included. Each patient served as their own control, receiving pregabalin with standard analgesia for one extraction and only standard analgesia for the other. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at various intervals, while facial swelling and interincisal distance (IID) were measured on Days 1, 3, 7, and 14.  Results: VAS scores were higher in the control group; however, it was not statistically significant (P = 0.000) at any time interval. % facial swelling was significantly lower in the test group on postoperative day 1[2.32(1.77- 2.95) test; 2.32 (1.82-3.60) control; P = 0.009] and day 3 [6.67 (5.17-8.44) test; 7.49 (5.77-9.43) control; P = 0.004]. However, no significant differences were seen on postoperative day 7 and day 14. Similarly, no significant differences in mouth opening measurements were found.  Conclusion: Pregabalin is effective as an adjuvant therapy in reducing pain and facial swelling after third molar surgery. However, multicenter, randomized, double- blinded studies are recommended to confirm these findings.

Open surgical approach to fractures of the mandibular condyle: surgical technique and associated complications.

This study evaluates anatomical reduction and rigid internal fixation of mandibular condyle fractures using the preauricular retroparotid approach. It also discusses advantages, deficiencies, and associated complications of the technique. This retrospective study reviewed the medical records of a total of 52 mandibular condyle fractures from 42 patients who were treated with open surgery using the preauricular retroparotid approach between January 2019 and January 2024. Preoperative and postoperative assessments included measurements of mouth opening (maximum interincisal distance), vertical mandibular movement, and facial paralysis. Moreover, the Vancouver Scar Scale (VSS) was used to evaluate scar quality at the surgical site. Descriptive statistics were used to summarize patient demographics, preoperative findings, and postoperative outcomes. Anterior open bite was the most common finding, detected in 83% of the patients before surgery. The mean mouth opening of the patients increased significantly from 29 ± 4.94 mm to 37.76 ± 2.12 mm. Vertical mandibular movement exceeding 4 cm was a finding in more than half (52.3%) of the patients. The mean VSS score, indicating scar quality, was 1.64 ± 0.70, suggesting overall good cosmetic outcomes. Plate breakage in two patients was noted as a complication during follow-up. Several surgical techniques have been described for mandibular condyle fractures, each with its own benefits and limitations.

Use of hyperboloid as an adjunct in functional jaw orthopedics – case report

Anterior open bite can be defined as a malocclusion with a negative vertical discrepancy between the incisal edges of the upper and lower anterior teeth, which do not have occlusal contacts with the antagonists and sometimes extends to the canines and, less frequently, to the premolars is one of the malocclusions with the greatest aesthetic and/or functional impairment. Anterior open bite can have several etiologies: finger sucking and/or pacifier, oral breathing, onychophagia, lip interposition, atypical swallowing, tongue interposition when uttering phonemes and anterior posture of the tongue at rest. Orofacial myofunctional disorders are present in cases of anterior open bite, generally associated with etiologies and adapt to this altered morphological condition. Regarding the anterior opening amplitude, the anterior open bite is classified as: minimum up to 1 mm, moderate between 1 and 5 mm and severe +5 mm [1]. Open bite can be classified into: maxillary, mandibular and hybrid open bite [2]. Myofunctional therapy is considered a treatment method that can increase muscle strength, cause changes in functional patterns and thus prevent deviations in craniofacial development, as it promotes new posture of structures at rest and during the performance of the functions of the stomatognathic system [3]. The hyperboloid is an instrument for increasing muscle tone and when used in chewing, it is efficient in inducing growth and remodeling. The hyperboloid fills a gap in the modern diet, with the consistency of hard, raw and dry foods [4]. Exercises with a size M hyperboloid with wire were prescribed as an initial approach. After 2 months of treatment, there was an improvement in the interincisor distance. The exercise was maintained for another 5 months. He stopped attending appointments for 2 years and 2 months. Upon his return, the results of the functional examination of swallowing, chewing, protrusion and laterality were observed, and we opted for the installation of the SN3. the hyperboloid, in this case, showed its efficiency in balancing the stomatognathic system.

Maximum mouth opening in patients with cleft lip and palate or craniofacial anomalies compared with non-affected controls: A cross-sectional study.

There are limited published data on maximum mouth opening (MMO) for children with cleft lip or palate (CLP) or craniofacial anomalies (CFA). To report MMO of patients with CLP or CFA compared with non-affected controls. Retrospective cross-sectional review of electronic medical and dental records. Patients with CLP or CFA with recorded MMO, height, and weight were included and compared with a non-affected control individuals seen during orthodontic screening. Outcome measures included MMO, recorded in millimeters of inter-incisal distance, age, height, weight, and sex. Patients with CLP or CFA (n = 376) were matched by age and body mass standardized index (BMIz) to the non-affected pool (n = 376). The affected group had a MMO of 43.14 mm (±7.1 mm) compared with the control group MMO of 48.01 mm (±7.6 mm) with a statistically significant difference of -4.86 mm (p < .0001). Specifically, MMO of the unilateral cleft group is 4.26 mm smaller than that of non-affected controls (p < .0001). MMO of the bilateral cleft group is 3.65 mm smaller than that of non-affected controls (p = 0.0063). MMO for patients with CLP was significantly smaller as compared to non-affected controls. This study helps establish MMO values for children with CLP and CFA.

Fractional Carbon Dioxide Laser for Treatment of Microstomia and Rhytids in Systemic Sclerosis Patients.

Systemic sclerosis (SSc) is an autoimmune disorder characterised by skin fibrosis leading to skin tightening and disfigurement. However, there is no definite treatment for SSc and its skin complications. Fractional carbon dioxide laser has been widely used for different cutaneous pathologies. This study aims to evaluate the benefits of CO2 laser resurfacing on microstomia and peri-oral rhytids in systemic sclerosis patients. 33 systemic sclerosis patients were enrolled. Four sessions of CO2 laser treatment were performed at an interval of four weeks. Patients were evaluated monthly. The interincisal distance (IID) measurement was used to evaluate maximal mouth opening capacity, and the mouth handicap in systemic sclerosis (MHISS) scale was used to assess the improvement after treatment. All of the participants were female with a mean age of 47.46 and a standard deviation of 7.11. The mean disease duration was 12.35. The mean total core of the MHISS scale was 25.24, and the mean IID was 48.11 millimetres before the treatment with CO2 laser. The MHISS score decreased, and patient satisfaction increased after treatment. However, observed differences in the results of IID were not statistically significant. In conclusion, it seems that the fractional carbon dioxide laser is effective in the improvement of perioral rhytids, patient satisfaction based on the MHISS score, and mouth disability in SSc patients.

Acromio-Axillo-Suprasternal Notch Index Performance in Predicting Difficult Visualization of the Larynx: An Observational Prospective Study.

Bedside screening tests for predicting difficult intubation play a crucial role in clinical practice, although their utility remains limited. This prospective observational study aimed to assess the predictive value of the Acromio-Axillo-Suprasternal Notch Index (AASI) for difficult visualization of the larynx (DVL). Following approval from the Institutional Ethics Sub-Committee (Research Protocol No.: IESC/FP/68/2023), this prospective, observational, single-center study involved a sample size of 100 consecutive adult patients, both male and female, aged 20 to 65 years. The participants were classified as American Society of Anesthesiologists (ASA) grade I or II and were scheduled for elective surgeries necessitating endotracheal intubation.Before the operation, the following factors were assessed: AASI, modified Mallampati test (MMT), sternomental distance (SMD), thyromental distance (TMD), and inter-incisor distance (IID). Larynx visualization was evaluated using the Cormack-Lehane (CL) grading system, where grades III and IV indicate difficult laryngeal visualization. Qualified anesthesiologists performed direct laryngoscopy while remaining unaware of the outcomes of the airway predictors being assessed. The main aim of the investigation was to assess the efficacy of the AASI as a means of predicting DVL. The research study's secondary goals involved evaluating the accuracy of AASI in predicting challenging airways compared to other predictors such as MMT, SMD, TMD, and IID. DVL was observed in 21% of patients, out of which 10 and 11 were males and females, respectively. The sensitivity, specificity, and area under the curve (AUC) of the AASI were observed and reported with a 95% confidence interval (CI), being 98.73% (93.2-99.9%), 71.43% (47.8-88.7%), and 0.851 (0.732-0.970), respectively. AUC analysis revealed that AASI outperformed MMT, SMD, TMD, and IID as a predictor of DVL. AASI (≥0.5) serves as an excellent predictor for DVL during direct laryngoscopy. This finding suggests the clinical utility of AASI in identifying patients who may require special consideration during intubation procedures.

Assessment of Electromyographic Changes in Masseter and Temporalis Muscles for Patients Undergoing Lower Third Molar Surgery: A Prospective Study.

Introduction Lower third molar impaction surgery is one of the most common minor oral surgical procedures done. Trismus has been one of the most common and disturbing postoperative sequelae for patients. The study aimed to evaluate the electrical activity of the masseter and temporalis muscles after mandibular third molar surgery. Materials and methods The research was conducted at Saveetha Dental College and hospitals in the Department of Oral and Maxillofacial Surgery. The study consisted of 20 individuals. The EMG (electromyography) activities of both masseter muscles in each patient were measured before the tooth extraction surgery, postoperatively after 72 hours, and after seven days. The inter-incisal distance was also measured at similar follow-up intervals. Data were analyzed using IBM Corp. Released2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp., with p-values less than 0.05 considered statistically significant. The Mann-Whitney U test was used for the comparison of electrical activity between masseter and temporalis on both the operated and non-operated sides during preoperative, postoperative, 72-hour, and postoperative seven-day periods. Results It has been found that the electrical activity of the temporalis is higher than that of the masseter muscle measured at all the intervals of the follow-up period, with statistically significant values (p=0.001). It was noted that all the patients have reduced mouth opening when compared with preoperative (mean mouth opening = 45.6 mm), postoperative 72 hours (mean mouth opening = 31.2 mm), and postoperative seven days (mean mouth opening =35.6 mm). When a comparison was done between temporalis and masseter, themasseter took longer to return to pre-operative electrical activity, which might also imply that for prolonged trismus seen in patients after lower third molar surgery, it is the masseter that is affected and needs recovery for trismus to be resolved. Conclusion Based on the results obtained, it can be concluded that there was a reduction in the electrical activity of both the masseter and temporalis post-third molar impaction surgery. It was also found that there was a reduction in mouth opening in patients who underwent lower third molar extraction surgery. Masseter muscle took longer to return to its preoperative electrical activity than temporalis muscle, implying that targeted therapies to accelerate the healing of masseter muscle may prevent prolonged trismus in patients who undergo lower third molar impaction surgery.

Sequential free fibula transfers: Quality of life and systematic review.

Successive osteoseptocutaneous fibula transfers for jaws reconstruction are rare but important options. This study contributes patient-reported and clinical outcomes, as well as systematically reviews all existing reports. All sequential fibula transfers performed by the senior author were reviewed from a prospectively managed database, including University of Washington quality of life (UWQoL). Systematic review was conducted in PubMed and Cochrane databases for similar publications. Eighteen patients (average age 51.5 years) received sequential fibulas (mean 4.7 years between reconstructions). Secondary fibulas more often had benign indications (72.2% vs. 33.3%, p = .04), most commonly osteoradionecrosis (38.9%). At a mean follow-up of 30.5 months, the average interincisal distance increased from 21.8 to 27.6 mm, and 92.3% tolerated an oral diet following the second fibula. Eight patients completed the UW-QoL before and after the second fibula, and three prior to the first fibula. Composite physical function was significantly decreased from 96.7 prefibula reconstruction to 63.3 following the first (p < .001) and 64.2 after the second fibula (p < .001). There were no differences in other domains. The systematic review yielded six articles reporting 56 patients (mean 39 months between fibulas). Secondary fibulas were performed for repeat malignancy (45%) and osteoreadionecrosis (39%), resulting in elevated tube feeding from 20% following the first to 39% following the second, but overall high quality of life in two studies. Sequential osteoseptocutaneous fibula reconstructions of jaws are often performed for benign indications such as osteoradionecrosis. Overall function and QoL are comparable with those following the first fibula transfer.

Comparative study of arthrocentesis with concentric-needle cannula with classic concentric needle: A randomized single-blind controlled clinical trial

This study aimed to assess and compare the efficacy of two distinct single-puncture techniques in temporomandibular joint (TMJ) arthrocentesis for managing disk displacement without reduction (DDwoR).Sixty patients with DDwoR were randomly and blindly assigned to two treatment groups (n = 30 each): group 1 — TMJ arthrocentesis with the classic concentric needle; and group 2 — TMJ arthrocentesis with the concentric needle-cannula system. The following variables were recorded and compared across the groups: patient's pain perception (visual analog scale — VAS, 0–10); maximal interincisal distance (MID, mm); facial edema (FE, presence or absence); and operation duration (OP, minutes).Patients in group 2 presented significantly lower values of VAS score and presence of FE (p < 0.05) when examining the data at 24 and 48 h after the arthrocentesis. They also showed an increase in MID values (p = 0.024) after 6 months. With regard to OP, no significant difference was observed between the groups.Performing a single-puncture TMJ arthrocentesis using a concentric needle-cannula system significantly reduced the patients’ pain perception, and mitigated the presence of facial edema during the immediate postoperative period (at 24 and 48 h). Furthermore, it resulted in a notable increase in the MID after 6 months.

Ultrasound-guided arthrocentesis for condylar head fracture: a technical report.

Double puncture arthrocentesis (DPA) of the temporomandibular joint (TMD) is considered an effective preservative option for managing mandibular condylar head fractures. However, the procedure is commonly performed by a traditional "blind" method using anatomical characteristics. In the present study, an ultrasonography (US) device was applied for the treatment of a case with a fractured mandibular condyle. A 79-year-old female was diagnosed right side condylar head fracture complaining pain of right TMD and reduced mouth opening range: inter-incisor distance of 20mm. Since the fracture position was high and inoperable, the decision was made to perform DPA of the TMD. The US probe was positioned parallel and slightly oblique to the major axis of the mandibular ramus. Both the posterior and anterior insertions into the joint space were performed according to the axis mentioned above, which enabled the operator to visualize the entirety of the needle. The device offered safety and ensured accuracy by providing real-time visual aid to the surgeon. The procedure provided an early increase in the inter-incisor distance (31mm) and pain relief. Hence, for the preservative treatment of mandibular condylar head fractures, based on the present study, we recommend US-guided arthrocentesis as a safe, feasible, and effective therapeutic option instead of the conventional "blind" method.

Functional and esthetic reconstruction of composite lower lip defects with a motor-innervated chimeric facial artery buccinator myomucosal-submental island flap

ObjectiveThis study aimed to assess the functional and esthetic outcomes of a chimeric innervated buccinator myomucosal-submental island flap (BMM-SIF) for large composite lower lip reconstruction. MethodsThis retrospective study included five patients who underwent lower lip tumor resection and BMM-SIF reconstruction at the Hospital of Stomatology, Sun Yat-sen University, between August 2021 and February 2023. Lip function was evaluated using water leakage, cheek puffing tests, and superficial electromyography. Lip appearance was observed using photographs and evaluated through subjective interviews. Donor-site conditions, including facial symmetry and mouth opening, were monitored. ResultsAll the BMM-SIFs survived. Drooling was the main complication observed shortly after surgery. The water leakage test showed complete oral competence for liquid holding in the 7th month; however, moderate air leakage was present in two patients. Electromyography revealed myoelectric signals from the innervated buccinator at the recipient site. Facial expression and food intake were typically managed. The shape and projection of the vermilion were harmonious and satisfactory for each patient. Neither microstomia nor mouth opening limitation was observed, with an average inter-incisor distance of 37.25±4.4 mm. ConclusionChimeric motor-innervated BMM-SIF effectively reconstructed large full-thickness lower-lip defects with satisfactory functional and esthetic outcomes.

Delayed Commissuroplasty Increases Interincisal Distance in Buccogingival Cancer Patients Treated with Free Flap Reconstruction of the Oral Commissure.

Oral cavity cancers requiring excision of the oral commissure and free flap reconstruction often requires commissuroplasty to manage oral incontinence. We aimed to evaluate the implications of primary versus delayed commissuroplasty on drooling, and interincisal distance outcomes in this cohort. A retrospective query of head and neck cancer patients operated by a single surgeon from 2017 to 2020 was performed. Patients were included if they underwent free flap reconstruction of the oral commissure, had an immediate or delayed commissuroplasty, and had 2 years of follow-up data including Thomas-Stonell and Greenberg drooling rating scales and interincisal distance measurements. Thirty-five patients were included in the review. Twelve patients received immediate commissuroplasty and 23 patients had delayed commissuroplasty. Interincisal distance was similar at baseline, although significantly varied between immediate and delayed commissuroplasty groups at 1 month and 2 years postoperative. Drooling scores were significantly elevated in the group treated with delayed commissuroplasty, but eventually normalized after staged surgery and follow-up. Patients treated with adjunct radiation therapy had lower interincisal distance than patients who did not have radiation. Delayed commissuroplasty increased interincisal distance and normalize drooling in patients who required full-thickness excision of the buccal mucosa and oral commissure and free tissue reconstruction. The presented data can help to educate patients on expected postoperative outcomes and likely advocates for a second-stage procedure after completion of adjunct radiotherapy to achieve optimal commissural placement and oral competence.

Use of platelet-rich plasma isolated or in combination in osteoarthritis of the temporomandibular joint: a systematic review

Introduction: Temporomandibular joint osteoarthritis (TMJ-OA) is a common disease in the oral and maxillofacial regions and is the most serious type. Among temporomandibular disorders, TMJ-OA accounts for 18% to 85% of all cases. The use of platelet-rich plasma (PRP) has been highlighted, as well as in combination with other types of treatments such as hyaluronic acid, arthrocentesis, and corticosteroids. Objective: to highlight the main clinical outcomes of the treatment of osteoarthritis of the temporomandibular joint through the injectable use of platelet-rich plasma, alone or in combination with other types of treatment. Methods: The research and development of the work were carried out from December 2023 to February 2024 in the databases Scopus, PubMed, Science Direct, and Scielo, using scientific articles from 2013 to 2023, following the PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was based on the Cochrane instrument (Funnel Plot). Results and Conclusion: A total of 178 studies were found that were subjected to eligibility analysis. The final sample had 45 eligible studies and 31 studies were described in the systematic review. Most studies showed homogeneity in their results, with X2 =66.7% &gt;50%, with p&lt;0.05. The symmetric funnel plot did not suggest a risk of bias among studies with a small sample size. The results showed that platelet-rich plasma performed better than hyaluronic acid in the treatment of osteoarthritis of the temporomandibular joint during longterm follow-up in terms of reducing pain and increasing interincisal distance. Combined injection of hyaluronic acid and platelet-rich plasma after arthrocentesis is more effective than hyaluronic acid or platelet-rich plasma alone in the treatment of osteoarthritis of the temporomandibular joint, as well as platelet-rich plasma with hyaluronic acid after arthrocentesis showed significant clinical efficacy long-term concerning pain relief. Furthermore, it was found that intra-articular injections of platelet-rich plasma reduced pain on palpation of the temporomandibular joint more effectively compared to hyaluronic acid and corticosteroids. Platelet-rich plasma injection can significantly improve pain, mouth opening, abnormal joint sound, and jaw function in patients with temporomandibular joint osteoarthritis, and has a good repair effect on condylar bone defects. Furthermore, platelet-rich plasma injection combined with physical therapy can effectively control medium and long-term pain in patients.

A single-centre retrospective 10-year experience of the rhombic 3D condylar fracture plate for open reduction and internal fixation of condylar neck and base fractures

Fractures of the mandibular condyle account for a significant proportion of mandibular fractures. The specific functional loads require particular specifications for the implant design used for open reduction and internal fixation of such fractures. The clinical and radiographic outcomes in patients treated using a single rhombic 3D condylar fracture plate for open reduction and internal fixation at a single institution, and who fulfilled the inclusion and exclusion criteria, are presented.The primary outcome variables were: occlusion, maximum interincisal distance and mandibular excursion at 1, 3, and 6 months postoperatively, and radiographic measurements for mandibular height and gonion angle.In total, 263 patients were included, of whom 173 (65.8%) were male and 90 (34.2%) female. The mean age was 40.4 ± 18.9 years. There was satisfactory occlusion in 98.9% of patients at the 6-month follow-up, and a significant improvement in all parameters for mandibular excursion (p < 0.001), with a reduced ramus height and an increase in the gonion angle on the fractured side.Excellent clinical and radiographic results were achieved using the rhombic-shaped implant, deeming it appropriate for the osteosynthesis of mandibular condyle fractures.

Longitudinal outcomes of trismus release with free-flap reconstruction in primary and secondary oral submucous fibrosis-related trismus

Oral submucous fibrosis is a global health concern associated with betel quid use and results in trismus, which can be either primary or secondary in origin. Severe cases often require trismus release with free-flap reconstruction. This study examined longitudinal outcome trends following trismus release and compared the outcomes of patients with primary and secondary oral submucous fibrosis-related trismus. We conducted a retrospective cohort study by including patients who underwent trismus release between 2013 and 2022. All procedures were performed by a single surgical team to ensure technique standardisation. We measured the maximum mouth opening, the interincisal distance, perioperatively and 1, 2, 3, 4, 6 and 12 monthspost-operatively. Data were analysed using generalised estimating equations. A total of 35 patients were included in the study, 17 with primary and 18 with secondary oral submucous fibrosis-related trismus. Initially, patients with primary oral submucous fibrosis-related trismus had greater interincisal distance gains than those with secondary oral submucous fibrosis-related trismus (p=0.015 and p=0.025 at 3 and 4months post-operatively, respectively). However, after 12months, this initial advantage faded, with comparable interincisal distance improvements in patients with primary and secondary disease, despite the more complex surgical procedures required in secondary cases. Surgeons should carefully consider the benefits of trismus release procedures for patients with secondary oral submucous fibrosis-related trismus by recognising the changes in post-operative outcomes.

Amplification, Resistance, and Kinetics of the Jaw Stretching Device (ARK-JSD): analysis of the force variation and implications for trismus therapy

PurposeJaw-stretching devices, including the Amplification, Resistance, and Kinetics of the Jaw (ARK-JSD), are an effective option for treating trismus after head and neck cancer (HNC) treatment. The force, however, that is applied to the patient’s jaw is unknown.MethodsTen ARK-JSD devices were constructed for each of the levels of resistance (total of 30 samples). Each sample was tested using a Universal Testing Machine (UTM).ResultsThe easy, medium, and hard ARK-JSD had a mean maximum force of 12.3, 21.0, and 32.7 Newtons (N) at a mean interincisal distance (IID) of 8.0 mm, 13.0 mm, and 16.0 mm, respectively. The force varied by 6.9 N for the easy and 24.1 N for the hard ARK-JSD. Fatigue analysis demonstrated up to 5.5 N loss of force over 10 weeks.ConclusionThe ARK-JSD is a low-cost trismus device that can force between 12.3 and 32.7 N. The variation in resistance may impact efficacy. Understanding this variation will assist clinicians and patients using the ARK-JSD for trismus therapy.

Efficacy of Hydrocortisone, Povidone-Iodine, and Normal Saline as an Irrigating Solution During Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Trial.

Background The surgical removal of mandibular third molars is one of the most common procedures in dentistry. Researchers have extensively studied the treatment of postoperative sequelae such as pain, edema, trismus, and alveolar osteitis throughout the past six decades. Many approaches have been used to address clinical difficulties after third molar surgery, including various flap designs and irrigating solutions.The aim of this study was to compare the effects of three irrigating solutions, hydrocortisone, povidone-iodine, and normal saline, on pain, trismus, and edema following surgical removal of the impacted mandibular third molar. Methodology The study involved 105 participants who required surgical extraction of mandibular third molars. The patients' ages ranged from 18 to 40 years, and they fulfilled the inclusion criteria. Using a simple random sampling technique, they were divided into three groups (group 1: hydrocortisone, group 2: povidone-iodine, group 3:normal saline). The parameters evaluated were edema, pain, and trismus on the second and seventh postoperative days. All data were input into Microsoft Excel (Microsoft® Corp., Redmond, USA) worksheets and analyzed using Stata17.0 (StataCorp LLC, College Station, USA). The visual analog scale (VAS) score was used to measure postoperative pain, and postoperative swelling was measured using linear measurements from four fixed anatomical points and compared to preoperative values. To assess trismus, the inter-incisal distance was measured in millimeters with a caliper. A p-value of <0.01 was considered statistically significant. Results The mean VAS score for pain in group 1 was lower than the other two groups. The effect of group 1 was significant on the second postoperative day but insignificant on the seventh postoperative day for swelling. The effect of all three groups on trismus was significant on the second and seventh days. Conclusions Hydrocortisone as an irrigating solution showed promising results in managing postoperative swelling in the first 48 hours, but its effect gradually declined by the seventh postoperative day. Additionally, it was effective in controlling postoperative pain and trismus. This suggests that utilizing hydrocortisone as an irrigating solution, compared to povidone-iodine, has been proven to be a significantly effective option in reducing postoperative pain, edema, and trismus resulting from the surgical removal of impacted teeth.

The benefits of performing temporomandibular joint arthrocentesis with catheters and a vacuum pump: A randomized control trial

This study aims to compare the effectiveness of two different techniques of double puncture arthrocentesis with and without the addition of catheters and a vacuum pump for management of temporomandibular joint (TMJ) disc displacement without reduction (DDWOR). A total of 48 patients with DDWOR were randomly and blindly allocated into two treatment groups (N = 24): Group 1, TMJ arthrocentesis with the addition of catheters and a vacuum pump to the second needle; Group 2, TMJ arthrocentesis without any addition device. The following variables were registered and compared between groups: patient's pain perception (visual analogue scale [VAS; 0–10]); maximal interincisal distance [MID; mm]; joint effusion (JE, presence or absence); facial edema (FE; presence or absence); and the operation duration (OP; minutes). Patients in Group 1 presented with significantly lower VAS scores (p < 0.001) and presence of FE (p = 0.03) in the post-operative period, also an increase in MID values (p = 0.026), and a reduction in JE (p = 0.022) after 3 months. Besides that, in this group, the procedure was performed significantly faster (p < 0.001). Performing arthrocentesis with the addition of a vacuum pump makes the procedure faster and yields better results in terms of pain, facial swelling, mouth opening and joint effusion.