Maximum Interincisal Distance Research Articles

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.

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.

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.

Kinematics of the jaw following total temporomandibular joint replacement surgery

Total temporomandibular joint (TMJ) replacement surgery aims to improve mandibular function, reduce pain and enhance quality of life in patients suffering from end-stage TMJ disorders. Traditional post-operative jaw evaluation is carried out using measurement of maximum interincisal opening distance; however, this can correlate poorly to joint function. The present study aimed to evaluate three-dimensional (3D) jaw motion during border movements and chewing in unilateral total TMJ replacement patients and healthy controls. Motion analysis experiments were performed on six unilateral total TMJ replacement patients and ten age-matched healthy controls. Subject-specific motion tracking plates worn by each participant were registered to CT scans of each participant’s skull and mandible to enable anatomical mandibular kinematics measurement using an optoelectronic system. Participants performed 15 repetitions of maximal opening, protrusion, lateral excursions, and chewing cycles. Total TMJ replacement patients had significantly smaller incisal displacements at maximum mouth opening relative to the controls (median difference: 7.1 mm, p = 0.002) and decreased anterior translation of the prosthetic condyle (median difference: 10.5 mm, p = 0.002). When TMJ replacement subjects chewed using their contralateral molars, there was a significant increase in inferior condylar translation of the non-working condyle (median difference: 9.7 mm, p = 0.016). This study found that unilateral total TMJ replacement surgery was associated with mouth opening capacity within the range of healthy individuals, but reduced anterior movement of the prosthetic condyle and restricted protrusion and lateral excursions. The results provide future direction for prosthetic TMJ design to enhance postsurgical implant functionality and improve long-term clinical outcomes for prosthesis recipients.

Comparative Study of Injection Triamcinolone and Hyaluronidase Combination with Injection Platelet Rich Plasma (PRP) in Management of Oral Submucous Fibrosis (OSMF).

This study aimed to compare the results of injection triamcinolone and hyaluronidase combination with injection Platelet Rich Plasma (PRP) in management of Oral Submucous Fibrosis (OSMF). Present study was carried out in randomly divided two groups of 30 patients each of OSMF who all are presented with chief complain of reduced mouth opening. Group A patients were given 1ml of injection triamcinolone and hyaluronidase combination. Group B patients received 1ml of injection Platelet Rich Plasma. Both injections were given intralesionally once a week for 6weeks. Results of ANOVA shows significant better results in improving mouth opening in group B patients receiving injection Platelet Rich Plasma as a treatment. In Group A, patients shows improvement in Maximum interincisal distance (MIID) of mean 6.51 ± 1.02mm as compared to the patients in group B shows improvement in MIID of mean 9.53 ± 1.06mm (p value < 0.05). Treatment of OSMF with injection Platelet Rich Plasma is a novel method and found to be more efficient than treatmentwith injection triamcinolone and hyaluronidase combination.

Preoperative Submucosal Dexamethasone Injection for Minimizing Postoperative Pain, Trismus, and Oedema Associated with Impacted Mandibular Third Molar Surgery

Aim: Is To evaluate the relative ability of 4mg dose of preoperative Dexamethasone, administered submucosally, to reduce the postoperative pain, swelling and trismus after third molar surgery.&#x0D; Methods: The total 40 patient required surgical removal of a single mandibular third molar were included and divided into two groups, The experimental group (20 cases) received intraoperative submucosal injection of 4 mg Dexamethasone buccally around the tooth at three points after the onset of anesthesia and the control group (20 cases) received no drugs. The maximum interincisal distance and facial contours were measured at baseline and at post-surgery days 2 and 7. The measurement of pain was done using visual analog scale (VAS).&#x0D; Results: There was a statistically significant reduction in the severity of postoperative edema in the experimental group by the second postoperative day. While both groups saw a reduction in discomfort and trismus, there were no statistically significant differences between them.&#x0D; Conclusion: The findings support submucosal injection of Dexamethasone (4 mg) to decrease postoperative edema. Low-dose Dexamethasone injection at the surgical site enhances drug concentration at the injury site without loss owing to diffusion or excretion. The submucosal technique was significantly effective in reduction of postoperative swelling and trismus.

Evaluation of Efficacy of Ultrasound Therapy as an Adjuvant in Management of Myofascial Pain: A Randomized Clinical Trial

Aims: To determine ultrasound therapy as an effective adjuvant for the management of myofascial pain involving masticatory muscles.&#x0D; Study Design: Randomized clinical trial study.&#x0D; Place and Duration of Study: Department of oral medicine and radiology, Narayana dental college and hospital between March 2021 to November 2022.&#x0D; Methodology: We included 30 patients (20 females and 10 males; age group &gt;18 years) clinically diagnosed with Myofascial pain who were randomly assigned into two groups each comprising of 15 patients. Group A patients received ultrasound therapy along with tizanidine 2mg twice a day for 14 days while group B patients received tizanidine alone. All the patients were evaluated for maximum inter-incisal distance, tenderness of muscles of mastication on palpation, pain while chewing, and pain during mandibular movements at baseline, 7th and 14th day.&#x0D; Results: A significant pain reduction and improvement in mouth opening was found in both the groups. However, patients who received both tizanidine and ultrasound therapy had greater relief compared to other group from 7th day to 14th day and the results were statistically significant.&#x0D; Conclusion: No side effects were observed in Group A during or after ultrasound therapy. As it is a non-invasive therapeutic modality and offers good patient compliance, ultrasound therapy can be used as an effective therapeutic adjuvant for the management of myofascial pain.

Temporomandibular Joint Gape Angles in Normal and Painful Domestic Felines.

The purpose of this study was to determine and compare the gape angles (temporomandibular joint range of motion with mouth opening) of conscious and anesthetized domestic felines and to compare gape angles with and without evidence of oral pain. This prospective study evaluated the gape angle of 58 domestic felines. The cats were grouped into painful (n = 33) and nonpainful cohorts (n = 25) and gape angles were compared during conscious and anesthetized conditions. Gape angles were determined based on measurements of the maximal interincisal distance and lengths of the mandible and maxilla followed by calculation of the law of cosines. The mean feline gape angle (standard deviation) was determined to be 45.3° (8.6°) and 50.8° (6.2°) for conscious and anesthetized felines respectively. There was no significant difference between painful and non-painful feline gape angles during conscious (P = .613) or anesthetized (P = .605) evaluations. There was a significant difference between anesthetized and conscious gape angles (P < .001) for both painful and non-painful cohorts. This study determined the standardized, normal feline temporomandibular joint (TMJ) gape angle in both conscious and anesthetized states. This study suggests that the feline gape angle is not a useful indicator of oral pain. By determining the feline gape angle, which was previously unknown, further evaluation of its utility as a non-invasive clinical parameter for evaluation of restrictive TMJ motions as well as its use for serial evaluations may be pursued.

Management of Oral Sub Mucous Fibrosis Using Three Different Flaps: Superficial Temporal, Nasolabial Flap, Buccal Fat Pad Flap Along with Active Physiotherapy- A Comparative Study.

To assess the efficacy of different flaps along with active physiotherapy for comprehensive management of OSMF. A total of 33 patients of oral submucous fibrosis were admitted and surgically treated. All patients were diagnosed with bilateral oral submucous fibrosis of buccal mucosa. All the patients had advanced oral sub mucous fibrosis with interincisal distance less than 20mm. Eleven patients were treated with buccal pad of fat, eleven with nasolabial flap and eleven patients were treated with temporo-parietal fascia flap. Physiotherapy was started from the 5th postoperative day and the patients were followed regularly for one year to measure maximum interincisal distance. There was a significant corelation between post-operative mouth opening and regular physiotherapy, exercise and quitting of the habit irrespective of type of reconstruction flap used. On the basis of the result obtained from this study, significant improvement in mouth opening was seen in patients who performed aggressive physiotherapy irrespective of the flap used. Thus we conclude along with the surgical treatment, post-operative physiotherapy and cessation of habit are of equal importance for good prognosis in OSMF patients.

Assessment of Inter-Incisal Distance among the Bachelor Level Students of a Tertiary Care Centre of Nepal

INTRODUCTION: The inter-incisal distance at maximum mouth opening has been referred to as normal mouth opening. Variations in the inter-incisal distance exists among different age groups, sex, gender, race and ethnicity. The mean inter-incisal distance is required during the treatment of maxillofacial fractures, temporomandibular joint disorders, oral malignancies, reconstructed mouth anomalies, and craniofacial syndromes. The aim of this study was to determine the maximal inter-incisal distance among bachelor level students of tertiary care center of Nepal. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among the 320 bachelor level students of Chitwan Medical College. Convenience sampling method was used. Sex and ethnicity of the patient were recorded. Inter-incisal distance was measured in all the participants with the help of tongue depressor. The data were entered in Microsoft Excel 2019 and later transported to Statistical Package for Social Science (SPSS) version 16 for the statistical analysis. Descriptive statistical analysis was done. RESULTS: In this study among the 320 participants 131 (40.9 %) were male and 189 (59.1 %) were female. The mean age was 22.34 ± 2.02 years. The mean inter-incisal distance of male and female was 48.69 ± 6.92 mm and 46.51 ± 6.24 mm respectively. The mean inter-incisal distance was maximum in Muslims who had inter-incisal length ie.51.24± 3.54 mm, followed by Buddhists 48.86± 5.89 mm. CONCLUSIONS: This study concluded that the mean inter-incisal distance of male was more than that of female. On the basis of religion, Muslim students had maximum inter-incisal length followed by Buddhists, Hindus and Christians. On basis of ethnicity this study documented the maximum inter incisal distance in Chhetris and minimum in Newars.

Comparison of Pain and Mouth Opening in Primary versus Secondary Closure after Surgical Removal of Impacted Mandibular Third Molar

Aim: To compare pain score and trismus in primary and secondary closure of surgical wound after removal of impacted mandibular third molar. Study design: Randomized controlled trial. Place and duration of study: Bacha Khan Medical Complex, Gajju Khan Medical College, Shah Mansoor Swabi Pakistan from 1stMay 2020 to 30thJune 2021. Methodology: Fifty patients were divided into two groups i-e group A (Primary closure) and group B (secondary closure). Demographic data (name, age, gender and contact number) was recorded. Pre-operative mouth opening was measured as maximum interincisal distance in millimetres. Pre-operative variables were again re-evaluated on 3rd post-operative day for pain on Visual analogue scale (VAS 0-10) and for mouth opening. Results: Thirty one (62%) patients were males and 19(38%) were females. Overall mean pain score was 2.48±1.90 on visual analogue scale (VAS). Mean age was 30.24±7.64 years while mean post-operative interincisal distance was 43.5±4.717 mm. The difference between Group A and B for both mouth opening ((P=0.03; 95% CI = 0.135, 0.434) and pain (P=0.006; 95% CI = 0.426, 2.453) were statistically significant. Conclusion: When intra operative parameters of impaction difficulty are the same, secondary closure ensures minimal morbidity of pain and trismus as compared to primary wound closure. Keywords: Flap closure; Primary closure; Secondary closure; Impacted third molar

Patient-Reported and Dosimetric Determinants of Trismus after Chemoradiation with Proton Beam for Nasopharyngeal Carcinoma: A Prospective Study

<h3>Purpose/Objective(s)</h3> Trismus after radiation therapy for head and neck cancer is common. Yet, prospective efforts investigating patient reported outcomes with dosimetric predictors are lacking. <h3>Materials/Methods</h3> We conducted a prospective, phase II clinical trial of adult patients with biopsy proven, stage IIB-IVB nasopharyngeal cancer treated with concurrent proton-based chemoradiotherapy (cisplatin 100 mg/m2 q 3week), followed by adjuvant cisplatin and 5-fluorouracil. Trismus was assessed in a multifactorial fashion. Objective trismus was defined as a decrease in maximal inter-incisal distance (MID) of >20%, relative to baseline. Patient-reported trismus was assessed using trismus domain of the EORTC QLQ H&N35 questionnaire. The relationship between radiation dose to the muscles of mastication/temporomandibular joint (TMJ) and the development of trismus was evaluated using Cox regression. <h3>Results</h3> Between 2006-2011, 24 patients were enrolled. Median age was 48 years old. Median follow-up was 3.0 years. 63% of patients had stage III/IV disease. The mean doses to the lateral pterygoids, medial pterygoids, suprahyoids, infrahyoids, masseters, temporalis, and TMJs was 54, 51, 16, 46, 14, 12, and 32 Gy RBE, respectively. Eleven patients developed objective trismus. The median decrease in MID at 24 months was 6mm (range 1-19mm, IQR 5-11mm). Nine patients developed patient-reported trismus. Association of presence vs absence of patient-reported trismus and decline in 2y MID was seen (median 10mm vs 5mm, p=.03). Dose (per Gy increase) to the lateral pterygoids was associated with patient-reported trismus (HR 1.16, 95% CI 1.01-1.33, p=.04) and magnitude of decline in 2y MID (β=0.48mm, 95% CI 0.01-0.96mm, p=.045) but not objective trismus (HR 1.07, 95% CI 0.96-1.19, p=.25). Dose (per Gy increase) to TMJs was associated with patient-reported trismus (HR 1.14, 95% CI 1.02-1.26, p=.02), objective trismus (HR 1.12, 95% CI 1.01-1.25, p=.04) and magnitude of decline in 2y MID (β =0.53mm, 95% CI 0.12-0.95mm, p=.01). Patients with patient-reported trismus had higher mean dose to TMJ (36 vs 30 Gy, p=0.01) and lateral pterygoids (57 vs 52 Gy, p=0.03) than those who did not. <h3>Conclusion</h3> In this prospective study incorporating a homogeneous patient population and treatment regimen, the development of patient-reported trismus after chemoradiation with proton beam was associated with increase in mean dose to the lateral pterygoids and TMJ and decline in 2y MID. Delineation and avoidance of these structures seems prudent.

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.

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.

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.

Evaluation of effect of submucosal administration of depomedrol in management of postoperative sequelae in mandibular fractures: A randomized clinical trial study.

Introduction:The mandible is a commonly fractured bone in the face, a fact related to its prominent and exposed position. Open reduction and internal fixation (ORIF) of mandibular fractures has been associated with trauma to the surgical site and the surrounding tissues.Purpose:The purpose of this study is to evaluate the effects of immediate postoperative submucosal depomedrol administration on postoperative pain, edema, and trismus after ORIF for mandibular fractures.Materials and Methods:We conducted a prospective, randomized, controlled, double-blind study of forty patients who required ORIF for mandibular fractures under general anesthesia. The patients were divided into two groups, an experimental group who received immediate postoperative submucosal 40 mg of depomedrol injection through the surgical incision site, and a control group who did not receive any drug. Pain was assessed using a Visual Analog Scale score and the frequency of analgesic consumption at various postoperative intervals. The maximum interincisal distance and facial measurements were compared before surgery and at 24, 48, 72 h, and 7 days after surgery.Results:Statistical analysis of the data indicated a significant decrease in edema, trismus, and pain in the depomedrol group. No clinically apparent infection, disturbance of wound healing, or other corticosteroid-related complications were noted.Conclusion:The results of our study suggest that submucosal administration of depomedrol injection after ORIF for mandibular fractures is effective in reducing postoperative pain, edema, and trismus.

Comparison of Two Different Doses of Dexamethasone to Control Swelling and Trismus following Mandibular Third Molar Surgery

Introduction: Third molar surgery is one of the most common procedures performed by dental surgeons in clinical practice, where postoperative sequelae like pain, trismus, and swelling are often encountered. Thus, in this study, we compared medications employed to reduce such complications. Objective: To compare the effect of two different doses (4 and 8 mg) of dexamethasone in the control of swelling and trismus after the surgical extraction of mandibular impacted third molars. Methods: An experimental study consisted of twenty-seven (27) healthy adult patients of both genders with bilateral impacted lower third molars, where surgical extraction was indicated, 4 mg and 8 mg of dexamethasone were given orally to the patients 1 hour before the surgical procedure at both the surgeries. The swelling was recorded by measuring the length of 3 facial planes using a measuring tape. Trismus was evaluated by measuring the maximum interincisal distance. Recording of facial swelling and maximum interincisal distance was done preoperatively and on the 1st and 2nd days postoperatively. Results: Based on statistical analysis (Independent T-test), the results showed a difference in the measurements of the degree of swelling and trismus of the treated sample. 8 mg of dexamethasone promoted a greater reduction of symptoms than 4mg of dexamethasone though there was no statistically significant (p-value &gt;0.05) difference between the two doses. Conclusions: 8 milligrams of the dexamethasone had better effectiveness than 4 milligrams of the dexamethasone in reducing the degree of swelling and trismus. Keywords: Dexamethasone; impacted third molars; swelling; trismus.

Comparison of anthropometric and conic beam computed tomography measurements of patients with and without difficult intubation risk according to modified mallampati score: New markers for difficult intubation.

The aim of this study was to compare the anthropometric and cone beam computed tomography (CBCT) measurements taken from risk-free and risky groups by using the modified Mallampati score (MMS). A total of 176 volunteers between the ages of 18 and 65 in four different MMS classes were included in the study. The patients in classes MMS I and MMS II were accepted as risk-free and the patients in classes MMS III and MMS IV were accepted as risky for intubation. The Mann-Whitney U test was performed on the data to compare the anthropometric and radiological measurements taken from the risk-free and risky groups. A receiver operating characteristic (ROC) analysis was applied to the parameters that had a statistically significant difference. According to the analysis results, statistically significant differences were found in the neck circumference (NC), maximum interincisal distance (MID), thyromental distance (TMD) and sternomental distance (SMD) of the anthropometric measurements of men and women between the risk-free and risky groups (P < 0.05). In terms of CBCT measurements, the thickness of the tongue (TT), distance between the uvula and posterior wall of pharynx (U-Ph), distance between posterior nasal spine and nasopharynx (Snp-Nph) and length of the epiglottis (LE) were found to have statistically significant differences between the risk-free and risky groups of men and women (P < 0.05). The NC, MID, TMD and SMD anthropometric measurements and TT, U-Ph, Snp-Nph and LE radiologic measurements were found to support MMS, which is one of the most widely used bedside intubation prediction tests. In addition to the inclusion of CBCT for intubation prediction, U-Ph and Snp-Nph radiologic measurements were added as difficult intubation markers.

A Comparative Evaluation of Effectiveness of InGaAsP Laser and Therapeutic Ultrasound Administration Before the Induction of Muscle Fatigue on Healthy Young Individuals

Background: Muscle fatigue or the inability to maintain muscle strength is a protective mechanism to prevent muscle injury. Phototherapy or low-level laser therapy (LLLT) and therapeutic ultrasound are non-invasive and non-pharmacological forms of treatment modalities that have demonstrated effective and affirmative results when used to prevent muscle fatigue. Aim: The study evaluated the effect of phototherapy and therapeutic ultrasound in reducing muscle fatigue when administered before the induction of fatigue. Methodology: The study design was a blind, randomized, and sham-controlled clinical trial on laser and therapeutic ultrasound. The study sample consisted of 100 healthy young participants randomly allocated to four different groups of lasers, sham laser, therapeutic ultrasound, and sham ultrasound. All the individuals were subjected to clinical examination to record the bite force by the bite force dynamometer, maximum interincisal distance (MID) by using digital vernier calipers, and muscle fatigue by using EMG Retrainer's Device. The laser and therapeutic ultrasound were given on the masseter and anterior temporalis muscle on both sides and both sham groups were submitted to the same procedure but with the devices in the switch-off mode. All the individuals were instructed to chew two pieces of gum (one on each side) for 6 min to induce muscle fatigue and MID, the bite force and muscle fatigue were re-evaluated. Results: Statistically significant improvement was observed between the pre-and post-bite force, MID, and muscle fatigue in both the laser and Therapeutic ultrasound group as compared to the sham control groups with the P-value equal to 0.000. No, statistically significant difference was observed in the improvement of the muscle fatigue when both the treatment groups, i.e., laser and therapeutic ultrasound were compared with a P value &gt;0.05. Conclusion: Muscle fatigue can be effectively reduced if any one of the physical modalities, either laser or therapeutic ultrasound is administered before the long-duration treatments; enabling administration of treatment comfortably and effectively in one appointment.

The Outcome of Temporomandibular Joint Disc Repositioning with Retrodiscal Contracture

Statement of the Problem: One of the common surgical procedure for management of mechanical interferences in TMJ is disc repositioning procedure. Disc repositioning for TMJ internal derangement is established procedure with variable success and means of fixation. The purpose of this study is to assess the outcome of using temporomandibular joint (TMJ) arthroscopy disc repositioning with retrodiscal contracture as a minimally invasive surgical treatment for TMJ internal derangement (ID). Materials and Methods: 25 patients, were treated in the period from 2015-‌ 2017. All patients were evaluated for changes in preoperative versus postoperative clinical assessment through visual analog scale score (VAS), maximum interincisal opening distance, Joint loading Sign, joint noise and pain, muscle pain, diet and medication intake. Methods of Data Analysis: All patients were followed up for 1 year after treatment. Statistical analyses included the Student t test and Chi square test to determine if there were significant differences in preoperative and postoperative assessments. Results: 25 patients (32 TMJ), the mean age was 39 years; 21 were female and 4 male. 13 classified as Wilkes II, 19 as Wilkes III. The success rate was 72% based on improvement of joint pain. The study showed statistically significant improvement in all outcome variables except muscle pain. Conclusion: Clinical outcome data presented show that TMJ arthroscopy disc repositioning with retrodiscal contracture is an effective, predictable surgical treatment. The present study further specifies Wilkes II, early III TMD patients as the most successful category of patients for such procedure.