Interincisal Distance Research Articles

Comparative Study of Mouth Exercise Program and with Combination of Ultrasound Therapy in Temporomandibular Disorder

Introduction: Temporomandibular disorders (TMDs) are multifactorial, with several clinical presentations. The treatment is extensive and diverse, involving several therapies. Objectives: To evaluate and compare the combination of ultrasound therapy and mouth exercise with a mouth exercise program alone on pain and pain-free maximum mouth opening (inter-incisal distance) in TMD patients. Materials and Methods: A total of 30 patients who were clinically diagnosed with TMDs were equally divided into two groups. VAS score and pain-free mouth opening were recorded before and during the treatment for four weeks in all the patients. Results: Statistical analysis revealed a mean difference of 0.33 ± 0.09, 0.47 ± 0.01 in the VAS score in ultrasound with physiotherapy and physiotherapy alone. The pre- and post-treatment change in mean mouth opening (MMO) was 2.60 ± 0.21, 0.30 ± 0.87 in ultrasound with physiotherapy group and 0.27 ± 0.23, 0.20 ± 0.03 in the physiotherapy group alone, respectively. These differences in VAS score and mouth opening were statistically significant (P < 0.05). Conclusion: Both treatment modalities were effective in giving symptomatic relief, but ultrasound therapy with mouth exercises outstands showed better results in reducing pain and improving joint function.

A novel therapeutic approach for reducing postoperative inflammatory complications after impacted mandibular third molar removal.

Background:This study was designed to compare effect of combined use of dexamethasone and honey versus each agent alone in controlling complications associated with removal of impacted mandibular third molar.Methods:This randomized clinical study included patients suffering from impacted mandibular wisdom teeth. Patients were divided randomly into 4 groups. Group I, control, group II, received dexamethasone injection preoperatively, group III, received honey locally in the wound after extraction, and group IV, received dexamethasone injection preoperatively and topical honey application. All patients were evaluated preoperatively and postoperatively to assess facial edema, interincisal distance, pain, and total analgesic dose used.Results:Significant edema developed in group I than other groups and improved significantly in group II and III on seventh postoperative day, and tenth postoperative day in group I. Insignificant edema developed in group IV. Significant decrease in interincisal distance occurred in all groups on third postoperative day that improved significantly on seventh postoperative days in all groups except group I, it improved on tenth postoperative day. Pain was significantly minimum in group IV than other groups and its maximum degree was in group I.Conclusion:Both dexamethasone and honey are an effective way of minimizing swelling, pain, and trismus after removal of impacted lower third molars. Both agents either alone or in combination provide simple, safe, painless, and cost-effective method to eliminate postoperative discomfort. However, dexamethasone or honey can decrease complications related to surgical extraction of mandibular third molar, the simultaneous application of both agents is more effective method in this regard.

Bromelain vs trypsin-chymotrypsin in management of complications following surgical removal of mandibular third molar

Surgical removal of third molars is still the most common routine surgical procedure done by oral and maxillofacial surgeons which is usually associated with postoperative sequelae. In order to avoid or minimize post-surgical complications such as swelling, pain and trismus, patients are advised to use proteolytic enzyme and NSAID’s along with routine antibiotics. 50 patients who have bilateral symmetrical impacted mandibular third molars were included in the study. Post operatively, all patients were given antibiotics and analgesics for 5 days. Patients were given bromelain for 5 days after the procedure on one side and trypsin-chymotrypsin for 5 days on the other side with an interval of 21 days between the two procedures. Patients were recalled on day 1, day 3 and day 7 for assessment of post- operative trismus, pain and swelling based on measuring inter-incisal distance, visual analogue scale and, facial reference points. Data was gathered and statistical assessment was done using SPSS software by using descriptive statistics and chi square test. The conclusion drawn from the study was that bromelain has a significant effect on swelling, mouth opening and pain after surgical removal of impacted third molar than chymotrypsin. We suggest its usage in reduction of swelling and pain post operatively after surgical removal of third molar. However further studies with larger sample size and randomizations are required to confirm the same.

Trismus after partial maxillectomy and radiotherapy: Free flap reconstruction versus prosthetic obturation

ObjectivePartial maxillectomy and postoperative radiotherapy are both risk factors associated with trismus. This retrospective study aimed to evaluate the incidence and severity of trismus in patients following partial maxillectomy with or without postoperative radiotherapy and to compare free flap reconstruction and prosthetic obturation. MethodsA retrospective review of 40 oral cancer patients who underwent partial maxillectomy with or without postoperative radiotherapy was performed. Maximum interincisal distance recorded at least 6 months after surgery was classified according to a revised subjective-objective management-analytical (SOMA) scale and compared between the free flap reconstruction group (n = 12) and the prosthetic obturation group (n = 28). ResultsTrismus was observed in 16/40 (40%) patients, and severe trismus was observed in 4/40 (10%) patients. Although no significant difference in trismus grade was observed between the free flap reconstruction and prosthetic obturation groups, both severe trismus and radiation-induced osteonecrosis were only seen in the prosthetic obturation group with postoperative radiotherapy. ConclusionFree flap reconstruction was preferable to prosthetic obturation to avoid severe trismus and radiation-induced osteonecrosis in patients who underwent both partial maxillectomy and postoperative radiotherapy.

To determine the efficacy of colchicine as a monotherapy in Oral Submucous Fibrosis (OSMF) Patients

Introduction: Oral submucous fibrosis (OSMF) is a potentially malignant disorder of oral mucosa affecting mainly population in South and Southeast Asia. Oral submucous fibrosis (OSMF) condition results in scars, fibrosis of the tissues, and develops precancerous lesions in some long-term individuals most frequently affecting the buccal mucosa. This study is aimed to determine the effectiveness of colchicine in the management of OSMF along with examination of clinical conditions such as burning sensation, buccal mucosal flexibility, interincisal distance, and protrusion of tongue. Materials and Methodology: Group A: Study participants who were getting treatment with 0.5 mg colchicine tablets twice daily for 3 months. Group B: Treatment with intralesional injection of 2 mL dexamethasone, hyaluronidase 1,500 IU with 2 mL lignocaine twice a week for 4–6 weeks. Periodic reassessment of all the participants on certain selected parameters was done after 3 and 6 months. All the data obtained were subjected to statistical analysis at the end of the study. The statistical analysis was performed by using the SPSS 17.0 version for Windows (Chicago, IL, USA).

A predictive nomogram for trismus after radiotherapy for head and neck cancer

BackgroundThe aim of this study is to develop a prediction model for trismus (maximal interincisal distance equal to or less than 35 mm) based on a multivariable analysis of dosimetric and clinical factors. MethodsThe maximum inter-incisal opening (MIO) of hean and neck cancer (HNC) patients who underwent radiotherapy (RT) ± concurrent chemotherapy with radical intent, was prospectively measured prior to RT (baseline) and 6 months post-RT. The outcome variable is trismus. The potential risk factors (clinical and dosimetric) were first screened by univariate analysis and then by multivariate analysis. At the end of this process, we used the features identified as relevant, to fit a logistic regression model and calculate the probability of observed trismus during the 6-month follow-up after RT. ResultsOne hundred and four consecutive patients were included (mean age 63 years, range 25–87), 68 males, 36 females. In the univariate analysis, the MIO at baseline, as an independent variable, and several Vdoses of different masticatory structures were found as significant. Additionally, using a bivariate model, a feature selection process was performed. Finally, we considered as best performing model the MIO at baseline and V42 at masseter muscles. The area under curve (AUC) of Receiver Operating Characteristic (ROC) curve value was 0.8255 (95% CI 0.74–0.9). The Hosmer and Lemeshow goodness-of-fit test, used to calibrate our model, was not-significant. ConclusionsA prediction nomogram was developed to assess trismus risk in planning process. An external validation of the model is required to apply it for current clinical use.

Predicting difficult intubation in apparently normal subjects

One of the major problems faced by health care professionals is the prediction of airway difficulties in apparently healthy subjects. Failed endotracheal intubation is a well-known reason for increased morbidity of patients including brain damage or even death. This study is focused on parameters used for prior determination of airway for predicting difficult intubation in healthy Indian populations. This study was done on 500 healthy individuals. Neck parameters were measured including inter-incisal distance, neck circumference, thyro-mental distance and sterno-mental distance. Mallampati classification and mandibular protrusion test were also carried out. Statistical analysis was done using SPSS software (V.25). MC class 3 and 4 percentages were higher in males in comparison to females. Mandibular protrusion test grade A and B percentage was higher in females while class C percentage was higher in males. The comparison of baseline values of the neck parameters (inter-incisal distance, neck circumference, thyro-mental distance and sterno-mental distance) was statistically significant (<0.05) in both genders. The purpose of the study is to find out the baseline values of parameters involved in assessing methods for difficult intubation in healthy Indian population.

Double-Puncture Versus Single-Puncture Arthrocentesis: A Randomized Controlled Trial with 3 Years of Follow-Up.

To compare the clinical effectiveness of conventional double-puncture vs single-puncture type 2 arthrocentesis for management of temporomandibular joint (TMJ) disc displacement without reduction (DDWOR) after 3 years of follow-up. A total of 26 patients with DDWOR were randomly and blindly allocated into two treatment groups (n = 13 each): group 1 = conventional double-puncture arthrocentesis; group 2 = single-puncture type 2 arthrocentesis. Data on gender, side of painful joint complaint, age (years), duration of joint pain (months), maximum interincisal distance (MID, mm), and pain intensity (self-reported with a 0-10 visual analog scale [VAS]) were collected. VAS scores and MID were measured before (baseline) and 3 years after (final) the arthrocentesis. Twenty-three patients completed the study (group 1, n = 11; group 2, n = 12). Both techniques resulted in significantly reduced VAS scores and increased MID (P = .001) after the 3 years of follow-up; however, there were no statistically significant differences between techniques (P > 0.05). The two arthrocentesis methods tested were both effective in reducing VAS scores and increasing MID in patients with DDWOR.

Comparison of intraarticular injection of platelet-rich plasma following arthrocentesis, with sodium hyaluronate and conventional arthrocentesis for management of internal derangement of temporomandibular joint

Aim:The aim of the study is to compare the efficacy of platelet-rich plasma (PRP) for the management of internal derangement of temporomandibular joint (TMJ).Settings and Design:Thirty-three patients were selected from the pool of patients visiting the department of oral and maxillofacial surgery. Simple randomization was done.Subjects and Methods:Patients with anterior disc displacement without reduction (DDWOR) were indicated for arthrocentesis. Group A patients are treated with PRP, Group B patients with sodium hyaluronate following arthrocentesis, and Group C patients were treated with arthrocentesis alone. Postoperative pain and maximal incisal opening are the primary outcomes evaluated.Statistical Analysis Used:The collected data were analyzed with IBM. SPSS statistics software 23.0 version and the one-way ANOVA with Tukey's post hoc test were used.Results:The mean age is 33 years, with female predominance. The statistical significant differences (P < 0.05) in pain and MIO between the 3 groups at the end of 3rdweek, 4thweek, and 3rd month postoperatively are seen in PRP group comparative to other groups.Conclusions:Our study has concluded that the intraarticular injection of PRP is an effective management for anterior DDWOR of TMJ than intraarticular injection of sodium hyaluronate and arthrocentesis in, reducing the pain and improving the interincisal distance in patients with DDWOR, thus providing a rapid recovery and improved quality of life.

Assessment of predictors for difficult intubation and laryngoscopy in adult elective surgical patients at Tikur Anbessa Specialized Hospital, Ethiopia: A cross-sectional study

BackgroundGeneral anesthesia is not without morbidity. One of the well-known life-threatening events associated with general anesthesia is difficult airway which can happen during induction of anesthesia while attempting to insert the endotracheal tube with the aid of a laryngoscope. Difficult intubation, inadequate ventilation, and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. ObjectiveThe main objective of this study was to assess the magnitude and predictors for difficult laryngoscopy and intubation among surgical patients who underwent elective surgery under general anesthesia with endotracheal intubation at Tikur Anbessa Specialized Hospital from February 1 to March 30, 2019. Materials &methodAn institutional based cross sectional study was conducted from February 1 to March 30, 2019 on patients who underwent elective surgery under general anesthesia with endotracheal intubation. Data on socio-demographic characteristics, preanesthetic airway assessment and laryngoscopic view were collected. Data were analyzed by SPSS Version 20.0. Chi- square test, binary logistic regression and multivariate analysis were performed. Tables and texts were used to present data. A p value less than 0.05 was considered as statistically significant. ResultsThe magnitude of difficult laryngoscopy, difficult intubation, and failed intubation were 12.2%, 6.1%, and 0.67%, respectively. Upper Lip Bite Test (ULBT) had a higher sensitivity (90.2%) and negative predictive value of 85.3%. Mallampati had a sensitivity of 45.8% and negative predictive value of 86% in predicting difficult laryngoscopy. Mallampati grade, thyromental distance and ratio of height to thyromental distance (HRTMD) have also showed greater sensitivity (69.6%, 58.3% and 47.8%, respectively) when compared to other tests in predicting difficult intubation. Mallampati class, upper lip bite test (ULBT) and inter-incisor distance (IID) are independent predictors for difficult laryngoscopy (p < 0.05). Furthermore, Mallampati class, Thyromental distance and ratio of height to thyromental distance (HRTMD) are identified as independent predictors of difficult intubation (p < 0.001). Conclusionand recommendation: Mallampati class, Thyromental distance and Ratio of height to Thyromental distance (HRTMD) can predict the probability of difficult endotracheal intubation in adult patients. Whereas, Mallampati class and upper lip bite test (ULBT) predicts higher probability for difficult laryngoscopy.

Evaluation of the potential denture covering area in buccal shelf with intraoral scanner

Background/purposeThe characteristic of soft tissue changes in buccal shelf area during function is unclear. This study aimed for evaluating the potential denture covering area in buccal shelf area in different ranges of mouth opening by a digital approach. Materials and methodsNineteen qualified dentate participants were enrolled. An intraoral scanner was used to record soft tissue in buccal shelf area in different ranges of mandibular opening, which were maximum intercuspation, 10 mm, 20 mm, and 30 mm of interincisal distance. The experiment was performed by two examiners. The common area of each range was generated within the clinically acceptable denture adaptation range, which was represented as the potential denture covering area. Data were statistically analyzed using descriptive statistic, one-way repeated measure ANOVA, intraclass correlation coefficient (ICC), and the Pearson correlation test. ResultsTrends of the mean distance of the potential denture covering area increased from the frenum area to the second premolar and the first molar area then decreased in the second molar area, along with the ranges of mouth opening increased. The distance in the second molar area had drastic percentage changes during the mouth opening. The mean distances changed significantly when the mouth opening increased (P < 0.001). All ICC values of intra-, inter-rater reliability indicated good to excellent reliability. The correlation between the results from two examiners was strong (P < 0.001). ConclusionThe characteristic of the denture covering area posteriorly to the first molar area is inversely proportional in length to ranges of mouth opening.

Association between Successful Palpation of the Cricothyroid Membrane and the 3-3-2 Rule for Predicting Difficult Airway in Female Patients Undergoing Non-Neck Surgery: A Prospective Observational Cohort Study.

Background: Prediction of difficult airway is important for airway management in patients undergoing surgery. The assessment of airway structures and establishment of protective airway strategies are essential to improve patient safety. However, the association between successful palpation of the cricothyroid membrane and airway predictions has not been fully elucidated in patients undergoing surgery. We investigated this in female patients undergoing non-neck surgery. Methods: A total of 68 female patients were enrolled in this prospective observational cohort study between January 2021 and June 2021 at Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea. Exclusion criteria were male patients and those with neck pathology or neck surgery. The assessment of difficult airway was performed before the induction of anesthesia and was defined by one of the following conditions: inter-incisor distance < 3 fingerbreadths, hyoid-to-mental distance < 3 fingerbreadths, and thyroid-to-hyoid distance < 2 fingerbreadths (the “3-3-2 rule”). The accuracy of palpable identification of the cricothyroid membrane was confirmed by ultrasonography (US). The patients were divided into the non-difficult airway (NDA) group (n = 30) and the difficult airway (DA) group (n = 30). Results: The two groups were comparable in terms of age, but the DA group had higher body mass index (BMI). In airway assessment, 9 patients showed inter-incisor distance < 3 fingerbreadths, 3 patients showed hyoid-to-mental distance < 3 fingerbreadths, and 24 patients showed thyroid-to-hyoid distance < 2 fingerbreadths in the DA group. The rate of successful palpation of the cricothyroid membrane was higher in the patients without than in those with difficult airway variables. Conclusions: Patients with a positive 3-3-2 rule showed a poor palpability of cricothyroid membrane.

Clinical Assessment of Efficacy of Omega 3 in Oral Submucous Fibrosis Patients - A Randomized Controlled Trial.

Background:Oral submucous fibrosis (OSMF) is a chronic, potentially malignant condition affecting the oral cavity. Omega 3 has shown innumerable health benefits in yesteryears. So, the aim of the study was to evaluate the efficacy of Omega 3 in the medical management of this disease. Methods:A randomized controlled trial was designed and 48 clinically confirmed patients of OSMF (24 in each group) completed the study. Patients of both the groups were given biweekly intralesional injections of dexamethasone 1.5ml, hyaluronidase 1500 IU mixed with lignocaine for 6 weeks. Additionally, group A received a placebo (lactose capsule) for 3 months while group B received 1gm of omega 3 (flaxseed oil) three times daily continuously for 3 months. Patients were followed every month for 3 months and then, after 6 months and one year. Results:During the first two months, improvement was observed in both the groups independently but intergroup comparison showed no significant difference. However, after 3 months statistically significant (p<0.05) improvement among all three clinical parameters i.e. inter-incisal distance (mean improvement in group A = 3.79±1.07mm and group B = 6.58±1.24mm, p=0.019), tongue protrusion (mean improvement in group A = 1.87±1.54mm and group B = 4.62±1.78mm, p=0.044) and cheek flexibility (mean improvement in group A = 2.08±1.38mm and group B = 3.50±1.84mm, p=0.035) was observed in group B when compared to group A. In contrast, statistically significant improvement in burning sensation was observed after one month itself in group B when compared to group A (mean drop in group A = 2.5±0.78 points and group B = 6.0±1.144 points, p<0.05). Conclusion:Omega 3 in conjunction with intralesional injections is an effective therapy when compared to intralesional injections alone in treatment of patients with OSMF (grade II and III) with no side effects.

The use of mandibular nerve block in unilateral mandibular fracture to evaluate the mouth opening for assessment of airway.

Background:Facial area is one of the most frequently injured area of the body, accounting for 23–97% of all facial fractures. Treatments under general anesthesia as those for maxillofacial fractures or infections is a highly complicated and a major challenging task in trismus associated patients. The main culprit in trismus is the increase muscle tone of masticatory muscles which are supplied via the mandibular nerve, blocking which could help increase the mouth opening thus, changing the whole of airway management.Material and Method:A prospective study was done on 50 patients of ASA grade I-II with unilateral mandibular fracture with trismus posted for maxillofacial surgery. Mandibular nerve block was given via extraoral approach with 5 ml of 0.5% bupivacaine using peripheral nerve stimulator to determine the difference in Pre block and Post block mouth opening and the VAS score at 2, 5, 10, 15, 20, 25, and 30 minutes.Results:The Interincisor distance measured Pre block was 1.20 ± 0.32 mm and was significantly increased after 5 mins onwards from the block (P < 0.005). The VAS score determined Pre block was 5.14 ± 1.37 which significantly decreased just 2 minutes after the application of block (P < 0.005).Conclusion:Mandibular nerve block decreases the pain and will aid in the decision making by an anesthetist regarding airway management as it helps in increasing the inter incisor distance significantly. Moreover, given the feasibility and effectiveness of the block it could be included in standard of care protocol for mandibular fracture patients.

English

BACKGROUND Mouth opening is an important clinical parameter in our daily clinical practice. Mouth opening and its adequacy is an important factor in the treatment and follow up of the common conditions involving head and neck. Normal mouth opening has been defined as the inter-incisal distance at the maximal mouth opening. The purpose of this study was to determine the normal range of maximal mouth opening in the young adult Kumaoni population between the age of 20-40 years. METHODS The study was undertaken in the institutional hospital, Almora. A total of randomly selected 200 subjects between the age group of 20-40 years representing a sample of dentate adults was included for the study. The sample was stratified into four groups according to age followed by gender stratification. The age groups were classified as 21-25 years (Group 1), 26-30 years (Group 2), 31-35 years (Group 3), and 36-40 years (Group 4). Each group comprised 50 patients (25 males and 25 females). All particulars of patients, relevant clinical history and examination findings were recorded in the clinical proforma after taking proper informed consent. The mouth opening was measured using a standardized protocol with a calibrated ruler, and the findings were recorded in millimetres. RESULTS The mean MMO for males was 51.85 mm [standard deviation (SD) ± 2.59]. The range was 48–56 mm. The mean MMO for females was 49.82 mm (SD ± 2.32). The range was 46–56 mm. In the age group of 21-25 years, the mean MMO was 50.14 (SD ± 2.53) mm. The mean value for males was 50.80 (SD ± 2.67) mm and for females was 49.48 (SD ± 2.25). In the age group of 26-30 years, the mean MMO was 50.20 (SD ± 2.54) mm. The mean for males was 51.16 (SD ± 2.52) mm and for females was 49.24 (SD ± 2.22). In the age group of 31-35 years, the mean MMO was 51.56 (SD ± 2.62) mm. The mean for males was 52.28 (SD ± 2.66) mm and for females was 50.60 (SD ± 2.44). In the age group of 36-40 years, the mean MMO was 50.83 (SD ± 2.66) mm. The mean for males was 53.56 (SD ± 2.62) mm and for females was 49.82 (SD ± 2.32). CONCLUSIONS The mean maximum mouth opening for male participants was 51.85 mm (SD 2.59) (Range: 48-56 mm). The mean maximal mouth opening for female participants was 49.82 mm (SD 2.32) (Range: 46–56 mm). The maximum mouth opening was observed to decrease with age. The mouth opening of females was also observed to be lesser than the males from the corresponding age groups. KEY WORDS Maximum Mouth Opening, MMO, Trismus, Oral Cavity, Jaw, TMJ, Kumaon

Modified Blair Approach for the Treatment of Mandibular Condyle Fractures.

Purpose:The management of fractures of the condyle of the mandible has been a topic of debate and still no consensus exists in the literature about the most appropriate approach. The objective of this study was to evaluate the efficacy and safety of the modified Blair approach for the open reduction and internal fixation of mandibular condyle fractures.Methods:A retrospective study was conducted on 18 patients with 20 mandibular condyle fractures from 2014 to 2020. All patients were treated surgically using the modified Blair approach. Postoperative occlusion status and mouth opening were assessed for treatment outcomes. Also, the rate of complications such as facial nerve paralysis, wound infection, hematoma, salivary fistula, Frey syndrome, and greater auricular nerve paraeesthesia evaluated.Results:Seventeen out of 18 patients (94.4%) achieved their original pretraumatic occlusion after the surgery. One patient (5.5%) had postoperative occlusal interference due to premature dental contact. The maximal postoperative interincisal distance was measured with a range between 33 and 41 mm (mean 37.6 mm). One patient (5.6%) had transient facial nerve palsy. Also, salivary fistula developed in 1 (5.6%) patient in the postoperative period.Conclusion:The results of this study revealed that the modified Blair approach provides satisfactory clinical outcomes with low complication rates and may offer an alternative, safe, and effective method for open reduction and internal fixation of mandibular condyle fracture.

Diagnostic Efficacy and Clinical Value of Ultrasonography in Difficult Airway Assessment: Based on a Prospective Cohort Study.

Diagnostic Efficacy and Clinical Value of Ultrasonography in Difficult Airway Assessment: Based on a Prospective Cohort Study.

Radiological versus Traditional Parameters for Airway Assessment: A Comparison.

Background:The incidence of difficult tracheal intubation includes not only difficult and failed intubation but also difficult laryngoscopy (DL) and difficult mask ventilation.Aim:The study was done to compare the sonographic assessment of tongue thickness (TT) and condylar mobility with traditional airway assessment scores for prediction of difficult intubation (DI).Settings and Design:This experimental, randomized prospective study was conducted in the Department of Anaesthesia, Himalayan Institute of Medical Sciences, Dehradun.Materials and Methods:After obtaining approval from the Institutional Ethical and Research Committee, this study was conducted in the Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun. After obtaining written and informed consent, 385 subjects of either sex between 18 and 60 years of age, undergoing various elective surgeries under general anesthesia with endotracheal intubation, were selected. The number of attempts at intubation, the need for alternative DI approaches, and invasive airway access or cancellation of the procedure due to inability to secure the airway were noted.Statistical Analysis Used:Data analysis was done using SPSS 20.0. Categorical data were assessed by Chi-square test, while independent t-test/Mann–Whitney test was used to determine the association between continuous data.Results:Age, inter-incisor distance (IID), body mass index (BMI), and Mallampati score were positively correlated with TT. BMI (kg.m−2) >26.0, modified Mallampati scoring >2, IID ≤5 cm, TT >6 cm, and condylar mobility >10 mm were significantly more among subjects with DL and difficult tracheal intubation.Conclusion:Ultrasonography can be used in elective settings to rule out any possibility of difficult airway and to prevent airway-related complications.

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.

Correlation between predictors of difficult mask ventilation and its grading using a risk score

Background: Maintenance of airway patency and oxygenation are the main objectives of face mask ventilation. Preoperative prediction can reduce the incidence of unanticipated difficult mask ventilation (DMV). Aim of Study: The aim of this study was to evaluate the correlation between predictors of DMV and its grading using a risk score. Study Setting and Design: This was an observational study approved by the Institutional Ethics Committee in a tertiary care hospital between 2020 and 2021. Patients and Methods: A total of 110 adult patients scheduled for elective surgery under general anaesthesia were studied. A detailed preoperative airway assessment was done to identify and risk score for seven standard predictors of DMV (male gender, age >55 years, body mass index ≥30 kg/m2, obstructive sleep apnoea [STOP-BANG score], edentulous state, modified Mallampati class and presence of beard). The risk score was correlated with the grading of mask ventilation in the operation theatre performed using the four-point scale as described by Han et al. Results: A statistically significant association was found with standard predictors such as male gender, obstructive sleep apnoea (STOP-BANG score) and the total preoperative risk score with the grading of mask ventilation (P < 0.05 for all). Additional risk factors found statistically significant were interincisor distance, thyromental distance, neck circumference, receding mandible, mandibular jaw protrusion, restricted neck movements, buck teeth and submucosal fibrosis. Conclusion: Prediction of DMV with preoperative risk score can lead to better anticipation of difficult airway management. Appropriate anticipatory airway management could potentially decrease the incidence of failed ventilation and resultant hypoxia.