Maximal Interincisal Mouth Opening Research Articles

The reliability and validity of the juvenile idiopathic arthritis magnetic resonance scoring system for temporomandibular joints

In children with juvenile idiopathic arthritis (JIA), the temporomandibular joint (TMJ) can be involved. To prevent TMJ damage due to inflammation, early recognition is important, for which contrast-enhanced magnetic resonance imaging (MRI) is the gold standard. In this study, the interobserver reliability and construct validity of the Juvenile Idiopathic Arthritis Magnetic Resonance Scoring System for Temporomandibular Joints (JAMRIS-TMJ) was assessed. Two radiologists independently examined 38 MRIs using the JAMRIS-TMJ scoring system. Inter-observer reliability was assessed by Cohen's (weighted) kappa (κ), 95% confidence intervals (CIs) and absolute agreement (%). Construct validity was assessed by correlation between the JAMRIS-TMJ items and TMJ involvement, active maximum interincisal mouth opening (AMIO), and anterior maximum voluntary bite force (AMVBF). The interobserver reliability for the JAMRIS-TMJ items varied from poor to good (κ = 0.18–0.61). Joint enhancement had the highest reliability (κ = 0.61). Correlations were found between TMJ involvement, AMIO, and the JAMRIS-TMJ items, although variation between radiologists and TMJ side existed. No correlation was found between AMVBF and the JAMRIS-TMJ items for both radiologists. The strongest correlations were found between most of the JAMRIS-TMJ items and AMIO. Our findings support the utility of AMIO as a clinical measure of TMJ status in children with JIA.

Intra-Articular Injection of Adipose-Derived Stromal Vascular Fraction in Osteoarthritic Temporomandibular Joints: Study Design of a Randomized Controlled Clinical Trial.

Temporomandibular joint (TMJ) osteoarthritis is a degenerative disease of the TMJ. It is characterized by progressive degradation of the extracellular matrix components of articular cartilage, with secondary inflammatory components leading to pain in the temporomandibular region and reduced mouth opening. Current treatments do not halt disease progression, hence the need for new therapies to reduce inflammation and, consequently, improve symptoms. The aim of our randomized controlled clinical trial protocol is to investigate the efficacy of adjuvant intra-articular injections of autologous tissue-like stromal vascular fraction (tSVF), compared to arthrocentesis alone, in reducing pain and improving mouth opening in TMJ osteoarthritis patients. The primary endpoint analysis will consist of the visual analogue scale (VAS) for pain. The secondary endpoint analyses will include maximal interincisal mouth opening measurements; assessment of oral health and mandibular function based on the oral health impact profile (OHIP) questionnaire and mandibular functional impairment questionnaire (MFIQ); complications during the follow up; synovial cytokine analysis at baseline and after 26 weeks; and nucleated cells and tSVF (immuno)histochemistry analyses of the intervention group. Our randomized clinical trial protocol will be applied to evaluate the efficacy of a new promising tSVF injection therapy for TMJ osteoarthritis. The safety of intra-articular injections of tSVF has been proven for knee osteoarthritis. However, since a tSVF injection is considered a heterologous application of cell therapy, the regulatory requirements are strict, which makes medical ethical approval challenging.

Persistent myogenic temporomandibular disorders: Are navigation-guided botulinum toxin-A injections into the lateral pterygoid muscles effective?

BackgroundBotulinum toxin has proven effective in treating persistent myogenous temporomandibular disorders (M-TMDs) unresponsive to conservative therapies. While the usual injection sites are the masseter and temporalis muscles, the deeper lateral pterygoid muscle (LPM) is often overlooked due to its difficulty of access and the risk of local complications. This study aims to evaluate the effectiveness of botulinum toxin-A injections (BTX-A) in the LPM with MR-guided navigation of patients with persistent M-TMDs. MethodsThis retrospective study enrolled 34 patients suffering from M-TMDs despite conservative therapies with a total of 51 injection sessions. All of them were treated by BTX-A injections in the LPM using MR-guided navigation, masseter and temporalis with clinical guidance. The effectiveness of the treatment was evaluated with measures of maximum pain-intensity scores of breakthrough and background pain, maximal interincisal mouth opening (MIO), and the presence of joint sounds. The assessment was conducted before injections, and subsequently, at 1 and 3 months postoperatively. Adverse events and perception of improvement with the treatment were also reported for each injection sessions. ResultsBTX-A injections in the LPM significantly improved pain scores intensity with a reduction of 65 % and 49 % respectively at the 1- and 3-month follow-ups, with peak effectiveness at 1 month. This study showed also a statistically significant improvement in mean MIO at 3 months post-injection and a decrease in joint sounds with persistence in 9,7 % of cases at 3-month follow-up compared to 41,2 % at baseline. No significant adverse events were observed. Patients treated with BTX-A injections in the LPM had a subjective complete improvement in their perception of treatment efficacy in 63 % of cases at the end of the follow-up period. ConclusionsThis study reports clinical experience on the use of MR-guided navigation to perform accurate, reliable, and safe BTX-A injections in the LPM. Although our results appear to be encouraging regarding symptom improvement of patients suffering from persistent M-TMDs, this approach may not be feasible as a primary standard procedure for managing M-TMDs. Further research is necessary to explore potential reproducible, safe, and cost-effective alternatives to enhance the accessibility of the LPM in clinical practice.

Identifying the Best Reduction Point for Zygomatic Arch Fractures Using Surface Markers

This study aimed to describe a straightforward and efficient surgical technique for identifying the ideal point of reduction in isolated zygomatic arch fractures using preoperative radiopaque markers. In addition, a retrospective review of patient outcomes associated with this technique was conducted. The collected data encompassed demographics, injury side, mechanism of injury, time of injury, and classification of the isolated arch fracture. Measured outcomes included radiographic anatomic reduction, clinical facial symmetry, surgical operating time, and maximum interincisal mouth opening. Descriptive statistics were computed for each study variable. A total of 12 patients (10 males and 2 females) with an average age of 39.25 years (range: 26–60 y) were included in the study. The mechanisms of injury comprised road traffic accidents (6 patients, 50%), sports-related injuries (2 patients, 16.7%), occupational injuries (2 patients, 16.7%), and falls (2 patients, 16.7%). On average, patients presented 3 days after the injury (range: 1–14 d). The fracture classification according to Reyes and colleagues categorized 10 patients (83.3%) as type 4 and 2 patients (16.7%) as type 2. Coronoid impingement was observed in half of the patients (50%). The average surgical time was 15.4 minutes (range: 12–19 min). All patients exhibited optimal radiographic anatomic reduction, clinical facial symmetry, and maximum interincisal opening. In conclusion, this study demonstrates that the described technique is a simple and effective method for identifying the optimal reduction point in isolated zygomatic arch fractures.

Clinically Established Temporomandibular Involvement in Adults With Juvenile Idiopathic Arthritis.

To study clinical variables defining temporomandibular function in adults with juvenile idiopathic arthritis (JIA) and healthy controls. In this cross-sectional study, the temporomandibular joint (TMJ) screening protocol, mandibular range of motion (MROM), and anterior maximum voluntary bite force (AMVBF) were compared between adults with JIA and healthy controls. Unadjusted and adjusted models with corrections for sex and disease duration were constructed for active maximum interincisal mouth opening (AMIO) and AMVBF. A total of 100 adults with JIA and 59 healthy adults were included in this study. In adults with JIA, 56% had clinically established TMJ involvement. AMIO was the MROM variable most reduced by TMJ involvement; AMIO was 8.8 mm (95% CI -11.40 to -6.12; P < 0.001) less in adults with JIA with TMJ involvement compared to JIA without TMJ involvement. No differences of AMIO were found between healthy adults and adults with JIA without TMJ involvement (-2.52, 95% CI -5.13 to 0.10; P = 0.06). Male sex was associated with a higher AMIO, and disease duration was associated with a decreased AMIO. Collinearity between the subtype prebiologic era and disease duration was found. AMVBF did not differ between adults with JIA and healthy adults. The high prevalence of clinically established TMJ involvement in adults with JIA indicates the need for awareness of TMJ problems in adults with JIA. TMJ involvement negatively influenced AMIO and should therefore be part of the TMJ screening in adults with JIA. AMVBF seems to have less utility for TMJ screening in adult populations.

Efficacy of Arthrocentesis and Anterior Repositioning Splints in Treatment of Internal Derangement of TMJ: A Prospective Clinical Study.

The aim of this study is to assess the efficacy of double puncture arthrocentesis and anterior repositioning splints in the treatment of internal derangement of temporomandibular joint. 35 patients with mean age of 36.6 years±10.2 years diagnosed with unilateral TMD who fell into Wilkes stage 2 and disc displacement with reduction with intermittent locking described by RDC/TMD were treated with Nitzan's double puncture arthrocentesis and were given a anterior repositioning hard splint. The parameters following parameters were assessed at intervals of 1 week, 2 weeks, 1 month, 3 months and 6 months: pain, maximum inter-incisal mouth opening, Joint noise/click. Statistically significant (p < 0.001) improvements were seen at all recorded intervals in all observed parameters. Simultaneous arthrocentesis and anterior repositioning splint therapy is effective in alleviating pain and improving mouth opening without discomfort in patients with unilateral painful TMD showing disc displacement with reduction with intermittent locking.

Atmospheric Plasma Lingual Frenectomy Followed by Post Operative Tongue Exercises: A Case Series.

The lingual frenulum is a submucosal component significantly involved in the mobility of the tongue. In the case of short lingual frenulum, different surgical approaches have been proposed. Atmospheric plasma is a thermal technique of vaporization or sublimation of the superficial tissues, without going deep, and the resulting fine carbonized layer avoids bleeding. The aim of the present investigation was to evaluate the effectiveness of atmospheric plasma (voltaic arc dermabrasion) for the frenectomy of a short lingual frenulum. A total of 30 patients with an age range between 6-11 years old and a class III/IV Kotlow's ankyloglossia classification were included in the study. The Kotlow's free-tongue, maximal interincisal mouth opening (MIO, mm) and interincisal mouth opening with tongue tip to maxillary incisive papillae at roof of mouth (MOTTIP, mm) were calculated at the baseline, immediately postoperatively (T0), at one week (T1), one month (T2) and two months (T3). A significant increase of Kotlow's measurements, MOTTIP and MIO were detected when comparing the baseline and the T0 (p &lt; 0.05). No significant difference was detected between the T0, T1 and T2 (p &gt; 0.05). The atmospheric plasma demonstrated a very minimal invasive approach for frenectomy, without important or fibrotic complications and with very low recurrence rates.

Effectiveness of the Platelet Rich Fibrin with Suture and without Suture on Postoperative Complications Following Removal of Lower Third Molars

Background: The removal of impacted 3rd molar is a traumatic surgical procedure that may lead to some postoperative sequelae such as pain, swelling, and trismus. The aim of this study was to evaluate the effects of PRF with suture, and without suture, on post-operative complications after removal of 3rd molars.Patients and Materials: This study enrolled 60 patients with partially impacted lower third molars at three centers; Postgraduate Clinic- Department of Oral and maxillofacial Surgery/College of Dentistry/ University of Sulaimani, Private Dental and Maxillofacial Clinic, and Maxillofacial Unit of Kalar General Hospital from November of 2021 till April of 2022. They were randomly allocated into 3 groups of 20 patients each. Group Ӏ was managed by PRF with suture, group ӀӀ was managed by PRF without suture and group ӀII was left without PRF and without suture. Pain, swelling, and maximum interincisal mouth opening were evaluated after the procedure at 1st, 3rd and 7th post-operative days.Results: In terms of pain (p=0.06), trismus (p=0.71), and swelling (p=0.05), there were no statistically significant differences between the study groups and the control group. In contrast to the control group, the values of the three parameters connected to the study groups were lower. In the group of PRF with suture, Visual Analogue Scale (VAS) pain scores on the 3rd and 7th days were significantly (P=0.008 and P=0.038, respectively) less than other groups. Regarding swelling and trismus, there was no significant correlation (P&gt;0.05) between groups.Conclusions: Application of PRF with and without suture had no significant effects on postoperative complications such as pain, swelling, and trismus following removal of partially impacted third molars.

Open vs Closed Management of Condylar Fracture Our Experience of 100 Cases in a Suburban Tertiary Care Hospital.

Retrospective Observational Study. Mandibular condyle fractures are distinctive among maxillofacial injuries in which they disrupt mandibular function in a way that other traumatic injuries do not. Condylar fractures can be treated using either the conservative (closed reduction and immobilisation) or surgical (open reduction and internal fixation) approaches. Both of these modalities of treatment have advantages and disadvantages, as well as indications and contraindications. The purpose of this study is to compile and compare our experience in the management of condylar fractures through open and closed reduction. The present retrospective analysis included a total 100 patients of condylar fractures in patients > 18years of age who were randomly divided into nonsurgical and surgical group based on Edward Ellies criteria. In the present study, the outcomes of conservative vs surgical management of condylar fractures were discussed in terms of seven parameters, including the maximal inter-incisal mouth opening, protrusive and lateral excursive movements of the mandible, status of occlusion, deviation of mandible during mouth opening, temporo-mandibular disorders and facial nerve paralysis which were measured and evaluated pre- and post-operatively at different intervals of time. Follow-up period was for 6months. It was noted that the main cause of condylar fracture was trauma with a male predilection with an average age of 32.6 ± 1.2years. Subcondylar fracture was the commonest type of condylar fracture that we encountered. 33.3% of the patients had restricted mouth opening and 57% of the patients had deranged occlusion. 37% of the patients were treated surgically and 48.6% of these fractures were approached using peri-angular approach. More patients had an increased mouth opening and a stable occlusion at the 6months follow-up when compared to that of the 2month follow up. From the above study we can conclude that the treatment plan should be patient specific and follow the algorithm for a particular type of fracture. We endorse the same based on our experience in treating condylar fractures over the last 5years. The art of decision making solely depends on the surgeon's expertise in managing condylar fractures.

Trismus among Preclinical Students in a Medical College: A Descriptive Cross-sectional Study.

Trismus is a condition of reduced mouth opening due to tonic constrictions of the muscles of mastication. Trismus greatly affects health-related quality of life and thus daily life activities. The aim of this study was to find out the prevalence of trismus among preclinical students in a medical college at a tertiary care teaching hospital. A descriptive cross-sectional study was conducted in a medical college from 10th July 2021 to 10th December 2021 for a period of five months. Ethical clearance was obtained from the Institutional Research Committee (Reference number: 0311202004). A total of 315 preclinical students studying at a medical college were included in the current study. Convenience sampling method was used. Point estimate and 99% Confidence Interval were calculated. Among 315 students, trismus was seen in 14 (4.44%) (1.45-7.43, 95% Confidence Interval) . The clicking sound on the right side of the temporomandibular joint was found to be in 6 (42.86%), on the left side was 5 (35.71%) and that of both sides of the temporomandibular joint was 1 (7.14%) among the 14 students with trismus. The mean maximal interincisal mouth opening was found to be 33.4±0.46 mm in students having trismus. The prevalence of trismus was found to be similar to the other studies performed in similar settings among preclinical students in a medical college. Awareness on mouth opening exercises and timely management can help reduce trismus. prevalence; temporomandibular joint; trismus.

Prognostic criteria for the management of temporomandibular disorders using arthrocentesis with normal saline and arthrocentesis with normal saline and platelet-rich plasma.

Temporomandibular joint disorders (TMDs) are ailments affecting the jaws and allied structures, resulting in many pathologies (TMJ hypermobility, internal disc derangement, bone changes, degenerative disorders, and ankylosis). Pain, clicking or crepitus, restricted range of motion, deranged jaw function, and deflected or deviated mouth opening and closing are the commonly observed manifestations in TMDs. Internal derangement refers to an aberrant relation of the articular disc to the condyle and fossa, respectively. Conventional therapies highlight the role of non-invasive conservative treatment strategies, namely joint unloading, anti-inflammatory drugs, and physiotherapy. Current literature has emphasized the use of corticosteroids and platelet-rich plasma (PRP) as treatment strategies in TMDs. This study aimed to evaluate whether intra-articular injection of PRP after normal saline lavage in TMJ minimizes the symptoms of TMDs, as compared to injection of normal saline. Thirty patients with TMD according to research diagnostic criteria (RDC) were selected. One group received arthrocentesis with normal saline, and the other group received arthrocentesis with PRP injection. The patients were assessed for pain, maximum inter-incisal mouth opening, bite force, and TMJ sounds. TMDs treated by PRP injection had slightly better results. More studies are required to substantiate the outcome. Injections of PRP were more effective in reducing the symptoms than arthrocentesis with normal saline.

Growth curves for mandibular range of motion and maximum voluntary bite force in healthy children.

Mandibular range of motion and bite force are indispensable variables for the evaluation of mandibular function. There are a variety of medical and dental conditions that can negatively affect mandibular function. Values for mandibular range of motion (i.e., active and passive maximum interincisal mouth opening, protrusion, and laterotrusion) and anterior maximum voluntary bite force (AMVBF) in healthy children and adolescents can help in recognizing temporomandibular dysfunction. In this longitudinal study, 169 healthy children aged 6–18 years were included. They were examined at four time points over 1 year. Mixed model analysis was performed to produce growth curves of mandibular range of motion and AMVBF. Average active maximum interincisal mouth opening was significantly higher in boys with 50.0 mm compared to 47.8 mm in girls. Boys also had a significantly higher AMVBF than girls with an average of 169.0 N versus 140.0 N, respectively. Growth curves of active and passive maximum interincisal mouth opening showed an increase with age, albeit levelling off through puberty. The growth curves of AMVBF in girls reach a plateau phase at ages 12–14 years, after which the curve descends; in boys, the AMVBF tended to increase up to 18 years of age, although a slow‐down after 14 years of age was noted.

Comparative Assessment of Clinical and Quality of Life Outcomes in Mandibular Angle Fractures Treated with Standard and Three-Dimensional Mini-Plates.

To undertake a multidimensional comparative assessment of the standard and three dimensional (3D) mini-plates in managing isolated mandibular angle fractures (MAFs). Thirty-six subjects were divided equally into two groups. Group A underwent fixation with a standard 2mm miniplate, while group B with 2mm 3D mini-plates. Evaluations were done preoperatively (T0), postoperatively at one week (T1), one month (T2) and three months (T3). Maximal inter-incisal mouth opening (MIO) and mean bite force (MBF) at the central incisors, right and left molars were calculated. Postoperative complications and Quality of life (QoL) outcomes were evaluated using the short form Oral Health Impact Profile (OHIP-14). Mean operative time was almost similar for both groups. Although mean MIO improved significantly from T1 to T3 in both groups, intergroup comparison of MIO was not significant. The MBF values were significantly higher in group B on the right and left molars at T2 and T3. Although significant improvement in OHIP-14 scores was seen from T2 to T3 in both the groups, intergroup comparison of OHIP was not significant. 3D plates demonstrated similar clinical and QoL outcomes compared to the standard mini-plates.

A five-year review of the OMX temporomandibular prosthetic total joint replacement system.

The aim of this study was to undertake a 5-year review of the OMX temporomandibular prosthetic total joint replacement system (OMX-TMJ). Data was collected from patients who had an OMX-TMJ implanted between May 2015 and November 2020 at Epworth-Freemasons and St. Vincent's hospitals in Melbourne, Australia. The data points included patient demographics, primary diagnosis, and clinical outcomes in terms of visual analogue scale (VAS) for pain, maximum inter-incisal mouth opening, and complication events. There were 206 OMX-TMJ devices implanted in 151 patients over the 5-year study period. The vast majority were female patients (n = 137, 90.7%) with a mean age of 44.8years (range 20-76years) at the time of surgery. Most patients presented with primary (idiopathic) osteoarthritis (119 joints-57.8%) that failed to respond to conservative measures. Based on a mean follow-up period of 36months (range 12months to 73months), the average mouth opening improved from 30.8mm pre-surgery to an average of 39.1mm following OMX-TMJ surgery (p < 0.05). Joint pain (VAS: 0-10) significantly improved from 6.14 pre-surgery to 0.87 following OMX-TMJ surgery (p < 0.001). Twenty-one patients (13.9%) experienced device-related complications which resulted in explantation of 7 (3.4%) OMX-TMJ devices over the 5-year period. This study shows that the OMX-TMJ prosthetic total joint replacement system is a reasonably safe, versatile, and reliable implant that effectively improves mandibular opening and reduces joint pain across a broad range of end-stage TMJ disorders.

Prevalence of Trismus and Its Impact on Oral Health-Related Quality of Life in Patients Treated for Oral Squamous Cell Carcinoma.

Oral squamous cell carcinoma, one of the most common malignancies, has a poor prognosis due to impairment in oral functions secondary to treatment. Trismus one of the major causes of impairment of oral function. The present study investigated the prevalence of trismus and its impact on oral health-related quality of life (OHRQoL) in patients treated for oral squamous cell carcinoma (OSCC). The maximum inter-incisal mouth opening of hundred OSCC patients was recorded at post-treatment and 3 months post-treatment. OHRQoL questionnaire (OHIP-14) was intervened to assess the OHRQoL of patients post-treatment and 3 months follow-up, with emphasis on correlation with grades of trismus. The prevalence of trismus was 16% pre-treatment, 72% post-treatment, and 62% at 3 months after treatment. The overall OHIP-14 scores indicated that patients with trismus reported greater impairment of OHRQoL than those without trismus at the end of treatment and 3 months follow-up. At the end of treatment, patients with severe trismus demonstrated a higher mean OHIP-14 score (23.47 ±3.34) than those with moderate (17.72 ±2.83) and mild trismus (12.66 ±3.84) with statistically significant differences (p<0.001). Equivalent results were obtained at 3 months follow-up period. Patients with trismus suffer greater impairment of OHRQoL. The findings demand the need of identifying risk factors for developing trismus and early institution of newer/modified treatment approaches for better OHRQoL in OSCC survivors.

Efficacy of hypertonic dextrose injection (prolotherapy) in temporomandibular joint dysfunction: a systematic review and meta-analysis

Hypertonic dextrose prolotherapy (DPT) has been reported to be effective for temporomandibular disorders (TMDs) in clinical trials but its overall efficacy is uncertain. To conduct a systematic review with meta-analysis of randomized controlled trials (RCTs) to synthesize evidence on the effectiveness of DPT for TMDs. Eleven electronic databases were searched from their inception to October, 2020. The primary outcome of interest was pain intensity. Secondary outcomes included maximum inter-incisal mouth opening (MIO) and disability score. Studies were graded by “Cochrane risk of bias 2” tool; if data could be pooled, a meta-analysis was performed. Ten RCTs (n = 336) with some to high risk of bias were included. In a meta-analysis of 5 RCTs, DPT was significantly superior to placebo injections in reducing TMJ pain at 12 weeks, with moderate effect size and low heterogeneity (Standardized Mean Difference: − 0.76; 95% CI − 1.19 to − 0.32, I2 = 0%). No statistically significant differences were detected for changes in MIO and functional scores. In this systematic review and meta-analysis, evidence from low to moderate quality studies show that DPT conferred a large positive effect which met criteria for clinical relevance in the treatment of TMJ pain, compared with placebo injections.Protocol registration at PROSPERO: CRD42020214305.

Unilateral Condylar Fracture with Review of Treatment Modalities in 30 Cases - An Evaluative Study.

Introduction:The treatment of subcondylar mandible fractures is a topic of debate and can be variable even though these fractures are commonly seen. The present study aimed at evaluation of various treatment modalities for unilateral condylar fracture in adults.Materials and Methods:Thirty patients with unilateral condylar fractures between the age of 18 and 60 years were evaluated. Treatment protocol included closed reduction for 15 patients and open reduction for 15 patients.Results:Assessment was done functionally for maximum interincisal mouth opening, deviation on maximum interincisal mouth opening, occlusion and facial nerve function, and radiologically for ramus height shortening. In general, there were no statistically significant differences between closed and open methods.Discussion:Both the treatment options for condylar fractures of the mandible yielded acceptable results. Closed treatment appears to be a safe and appropriate modality for most unilateral condylar fractures. Although the open group, in general, showed similar outcomes, this treatment should be reserved for limited indications. The present study has confirmed that both treatment options can yield acceptable results. On clinical examination, there was no significant difference in mouth opening measures, the incidence of occlusal disturbances or in the degree of pain perception.

Comparative evaluation of the efficacy of gabapentin and gabapentin in combination with nortriptyline in the management of pain-related temporomandibular disorders

Background: Temporomandibular disorders (TMDs) are considered the most common orofacial pain conditions of nonodontogenic origin. The current perspective regarding TMD is multidimensional. If the pain becomes chronic, it can have a great impact on the social and emotional behavior of the patient. Materials and Methods: A total of 40 patients between the age groups of 18 and 45 years were included in the study. These patients were divided into two groups comprising 20 patients each. Group I was prescribed gabapentin and was advised to take the medicine twice daily. Group II was prescribed gabapentin along with nortryptyline twice daily. Patients in each group were evaluated at the end of every week using a visual analog scale (VAS) score for pain, maximum interincisal mouth opening, and several muscle tenderness sites for 3 weeks, and a comparison was made. Results: The age range in group I was 19–45 years, whereas in group II it was 18–45 years with a P value of 0.711. Female predominance was observed in both groups as 65% of patients were females in group I and 60% were females in group II and P value obtained was 0.74. VAS score decreased more rapidly in group II than group I. The P value obtained was <0.001 at the end of the third week. Comfortable moth opening shows a more effective increase in group II than group I. The P value (0.003) shows significance at the end of the third week. The mean number of muscle tenderness sites at the end of 3 weeks in group I and group II reduced to 1.15 and 0.40, respectively. Conclusion: The combination therapy of gabapentin with nortryptyline was found to be more effective than gabapentin alone.

Effects of Local Application of Platelet Rich Fibrin on Postoperative Sequelae after Surgical Removal of Impacted Lower Third Molars.

Objectives: The goal of this research was to evaluate the effects of Platelet Rich Fibrin (PRF) in reducing post-surgical complications as pain, swelling, and trismus after surgical extraction of impacted lower third molars. Methods: A total of 44 patients who fulfilled the inclusion criteria were chosen to take part in this research. Postoperative pain was assessed using a numerical rating scale (NRS). Facial swelling was measured by a modification of tape measure method. To assess trismus, the maximal interincisal mouth opening was measured by using a digital caliper scale (electronic vernier). Results: In the Platelet Rich Fibrin PRF group; the results showed a significant difference of levels of pain experienced (NRS) in the 1st postoperative day in comparison to the control group. In regard to post-operative swelling; a significant decrease in the 3rd postoperative day was observed in comparison to the control group. With regard to trismus; no significant differences between groups regarding interincisal mouth opening was noticed. Conclusions: The application of PRF reduces the severity of the immediate postoperative sequelaes.

The Retromandibular Transparotid Approach for Reduction and Internal Fixation of Mandibular Condylar Fractures.

Introduction:The retromandibular transparotid approach is most useful for condylar and subcondylar fractures and provides the best access to the joint and ascending ramus. The study aims at evaluating the ease of access and outcomes encountered on using the retromandibular transparotid approach to access the fracture site for the open reduction and internal fixation (ORIF) of condylar and sub-condylar fractures.Materials and Methods:An observational clinical study was carried out among 10 patients with unilateral and bilateral condylar fracture requiring ORIF. Maximal interincisal mouth opening, facial swelling, occlusal discrepancy, facial nerve injury, scar formation, and acceptability and complications including wound dehiscence, infection, and sialocele/salivary fistula were assessed and measured preoperatively and postoperatively.Results:There was a notable improvement in mouth opening and facial nerve weakness. Postoperative intermaxillary fixation was done with selective patients who had a discrepancy in their occlusion. Preoperatively, swelling was present in four patients (40%) out of 10 patients studied. There was no incidence of sialocele/salivary fistula in any of the cases studied.Conclusion:Retromandibular transparotid incision is technique sensitive and thorough knowledge about the retromandibular area is must for good results and minimal morbidity. The cosmetic results are good in this approach, as well as the facial nerve injury were less in this without any permanent damages.