Reduced Mouth Opening Research Articles

Vascular Pedicle Ossification After Jaw Reconstruction With Fibular Free Flap.

Ossification of vascular pedicle in free fibular flap for jaw reconstruction was a rare complication. The aim of our study is to evaluate its consequence and propose our clinical experience with surgical management and outcomes of this complication. Our study includes patients who underwent jaw reconstruction with free fibular flap from Jan 2017 to Dec 2021. Patients were included only they had at least one computed tomography scan in follow-up period. Among 112 cases included in our study, 3 cases were observed of abnormal ossification along vascular pedicle who underwent maxilla (two patients) or mandibular (one patient) resection. Two patients who received maxilla resection present a progressive reduction in mouth opening after surgery, and CT scans showed calcified tissue around pedicle. Surgical revision was performed in one patient. Our experience show that periosteum preserves its osteogenic capability which allows the possibility of new bone formation along the vascular pedicle. Another important factor is mechanical stress. From our experience, it was necessary to remove periosteum from vascular pedicle only when mechanical stress of vascular pedicle were high, in order to avoid complication of vascular pedicle calcification. Surgical excision of calcification may be necessary only with clinical symptom. We believe this study could aid in understanding of pedicle ossification and contribute towards prevention and treatment of pedicle ossification.

Assessing Prevalence and Characteristics of Oro-bulbar Involvement in Children and Adults with SMA Type 2 and 3 Using a Multimodal Approach

Bulbar and jaw muscles are impaired in patients with Spinal Muscular Atrophy (SMA) but the assessment of their severity and progression are limited by the lack of age-appropriate and disease-specific measures. We investigated mastication and swallowing in children and adults with SMA, sitters and walkers. In a 2-year multicentre cross-sectional prospective study, lip and tongue strength (Iowa Oral Performance Instrument), chewing and swallowing (Test of Masticating and Swallowing Solids), active mouth opening (aMMO) were compared to age-appropriate normative data. The perceived burden of oro-bulbar involvement (SMA-Health Index) was recorded. 78 patients were included, 45 children (median age 7.4 years),22 adults (median age 26.8 years) on nusinersen and 11 untreated (median age 32.7 years). Forty-three percent children had reduced mouth opening, 50% had prolonged total time to eat. These issues were more prominent in sitters than in walkers (p = 0.019, p = 0.014). Sixty-six percent needed increased swallows for bolus clearance. Nusinersen treated adults had median aMMO, tongue strength and total time at TOMASS values within normal range (z score: −1.40, −1.22, −1.32, respectively) whereas untreated adults had reduced aMMO (z score: −2.68) and tongue strength (z score: −2.20). Only a minority of children (2/17) and treated adults (5/21) reported burden in swallowing or mastication compared to all untreated adults (5/5). After 16 months, mastication and swallowing were stable in treated children and adults, whether sitters or walkers. The reported multimodal approach to assess oro-bulbar functions demonstrate that swallowing and mastication are impaired in SMA despite patients’ perception. These results suggest a trend towards stabilization of oro-bulbar function in patients on long-term treatment with nusinersen.

FitJaw Mobile, a virtual reality device applied to dentistry: An analysis based on two patient treatments

Statement of problemVirtual reality (VR) has improved significantly in the last decade and has been applied to different fields, including medicine, dentistry, and physiotherapy. VR has been used for the innovative treatment of painful conditions, especially when traditional exercise therapies were unsuccessful because of patient noncompliance. PurposeThe purpose of this study was to analyze the use of VR as an aid when using exercises to manage temporomandibular disorders (TMDs). Material and methodsTwo White women diagnosed with TMDs of muscular origin (one with muscular pain and the other with reduced mouth opening) were referred to the Department of Prosthodontics of the University of Seville, where they were enrolled in an exercise program using the VR software program FitJaw Mobile. Both had been treated the previous year with an occlusal device for TMD of muscular origin, but their symptoms had not improved. ResultsFor both patients, the functional movement limitation and the chronic pain improved noticeably. ConclusionsThe use of VR when doing jaw exercises can improve outcomes and compliance.

Restriction of Mouth Opening, Reduction in Pressure Pain Thresholds and Activation of Myofascial Trigger Points in Mandibular and Cervical Regions after Root Canal Therapy: A Quasi-Experimental Study

Background: In daily clinical practice, patients often refer temporomandibular or cervical complaints after different oral procedures, especially in lengthy procedures that can result in iatrogenic postures or trauma that can affect the temporomandibular joint (TMJ). This study aimed to evaluate the clinical and functional changes of the temporomandibular joint (TMJ) and cervical region immediately after a session of root canal therapy. Methods: Twenty-nine subjects who received a session of root canal therapy were included. Clinical assessments included mouth opening, cervical mobility, pain intensity, pressure pain thresholds (PPTs), and myofascial trigger points (MTrPs) of the jaw and neck muscles. Results: After the intervention, a significant reduction in mouth opening (41.90 mm; SD = 6.21) was observed compared to baseline (46.28 mm; SD = 6.17) (p < 0.001). A significant reduction in PPTs and cervical mobility (p < 0.05), and an increase in MTrPs (p = 0.002–0.026) were demonstrated after the intervention. Conclusions: A session of root canal therapy can produce an immediate significant reduction in mouth opening, PPTs, and cervical mobility, and an increase in MTrPs. The risk can be higher if there is a previous TMJ limitation.

Clinical Pattern and Prevalence of Oral Cancer in Patient Suffering with Oral Submucous Fibrosis: An Institutional Experience

Introduction: Oral submucous fibrosis (OSMF) is a potentially malignant disorder which occurs due to dysregulation of collagen metabolism. It is also known as Atrophica idiopathica mucosae oris and is characterized by a burning sensation in the oral cavity, reduced mouth opening, burning sensation, and decreased tongue movement. Clinically there is blanching of oral mucosa due to the deposition of excessive collagen fibers. Aims: This study aims to estimate the prevalence of oral cancer in a cohort of patients suffering from OSMF and to understand the clinical pattern of oral cancer in these patients. Materials and Methods: It was a unicentric cross-sectional study conducted between January 2022 and January 2023. The study was conducted on 630 patients with clinical presentation of OSMF. Informed consent was obtained from the patient before the start of the study. Results: Data obtained were tabulated and Statistical Package for Social Sciences version 22 was used for analysis. Of 630 subjects, 176 subjects (27.83%) had oral cancer with OSMF. The most common site of the oral cancer was found to be buccal mucosa that was followed by lateral border of the tongue and retromolar trigone. Conclusion: OSMF is a potentially malignant disorder and use of areca nut with smokeless tobacco is the main cause. The use of areca nut and smokeless tobacco must be regularized.

Role of Dynamic 3 Tesla MRI in the Evaluation of Temporomandibular Joint Dysfunction.

The internal derangement of the temporomandibular joint (TMJ) is the most common type of dysfunction. Internal derangement can be divided into anterior and posterior disc displacement. Anterior disc displacement is the most common type, which is further classified into anterior disc displacement with reduction (ADDWR) and without reduction (ADDWoR). Temporomandibular joint dysfunction (TMD) symptoms are pain, reduced mouth opening, and joint sound. The main aim of this study was to correlate the clinical findings and magnetic resonance imaging (MRI) diagnosis of TMD in symptomatic and asymptomatic TMJs. This prospective observational study was conducted in a tertiary care hospital on a 3T Philips Achieva MRI machine with 16-array channel coils after obtaining approval from the institutional ethical committee. A total of 60 TMJs of 30 patients were included in the study. After the clinical examination of each patient, an MRI of both right and left TMJs was done. In patients with unilateral TMD, the asymptomatic side was used as the asymptomatic joint, and the affected side as the symptomatic joint. Asymptomatic patients without any symptoms of TMD were used as controls for bilateral TMD cases. MRI with high-resolution specific serial sections was obtained in both open- and closed-mouth positions. A p-value of <0.05 was considered a statistically significant agreement between clinical and MRI diagnoses of internal derangement. Out of a total of 30 clinically asymptomatic TMJs, only 23 were normal on MRI. On MRI, 26 TMJs showed ADDWRand 11 showed ADDWoR. The most common shape of the disc was biconcave and the displacement was anterior in symptomatic joints. The most common type of articular eminence shape was sigmoid in ADDWR and flattened in ADDWoR. Agreement between clinical and MRI diagnosis in this study was 87.5% (p < 0.001). The study concluded substantial agreement between clinical and MRI diagnosis of TMJ internal dysfunction and suggests that the diagnosis of the internal dysfunction can be made clinically but the exact position, shape, and type of disc displacement can be assessed precisely with the help of MRI.

Ultrasonographic evaluation of masseter muscle thickness in chronic areca nut/ tobacco chewers and oral submucous fibrosis patients

The benign increase in the size of the masseter muscle is referred to as masseter muscle hypertrophy (MMH). It may affect unilaterally or bilaterally. Frequent and prolonged chewing of areca nut, betel quid, and tobacco exerts undue pressure on muscles of mastication. This may lead to hypertrophy of masticatory muscles, especially the masseter. The objective of the study is to evaluate the difference in cross-sectional thickness of masseter muscle at rest and at maximum clenching position using USG in chronic areca nut/tobacco chewers, OSMF patients, and the control group.The study included 20 chronic areca nut/tobacco chewers and 18 OSMF consecutive patients. The control group comprised of 42 age, sex, and body mass index-matched healthy individuals. Ultrasonographic measurements were performed in all the subjects in both contracted and relaxed states. Intergroup comparison of ultrasonographic cross-sectional thickness was done using ANOVA with post hoc.Masseter muscle thickness significantly increased in chronic chewers in both relaxed &amp; contracted states bilaterally when compared to OSMF &amp; control group. Muscle thickness decreased in the OSMF group compared to controls.In patients with chronic chewing habits without OSMF, due to prolonged chewing muscle thickness increased whereas, in OSMF patients, reduction in mouth opening leads to a decrease in bite force and consequent atrophy of muscle.

Arthrogryposis multiplex congenita with maxillofacial involvement: a case report

BackgroundArthrogryposis multiplex congenita is a rare condition that mainly involves the lower limbs, characterized by severe joint deformity and contracture, muscular atrophy, and functional impairment. Its clinical manifestations are heterogenous and may involve the maxillofacial district as well.Case presentationThis case report describes a 20-year-old patient with arthrogryposis multiplex congenita with skeletal crossbite, facial asymmetry, reduced mouth opening and absence of lateral mandibular movement on the left side. After clinical evaluation, the following exams were required: postero-anterior cephalometric tracing, head and neck electromyography, computerized axiography, computed tomography scan, and maxillofacial magnetic resonance imaging. Orthognathodontic evaluation indicated skeletal asymmetry, reduced condylar movements on the left side and abnormally low electromyography activity of the masticatory muscles on the left side. Computed tomography and magnetic resonance imaging revealed unilateral left mandibular hypoplasia, hypotrophy, and fatty infiltration of masticatory muscles on the left side, as well as immobility of the left condyle during mouth opening, and hypoplasia of the left articular disk, which was however not displaced. Surgery was not indicated and conservative orthognathodontic treatment with function generating bite was suggested to balance the occlusal plane, as well as stretching exercises.ConclusionsA rare case of arthrogryposis multiplex congenita with maxillofacial involvement illustrates that a patient-centred, multidisciplinary approach with accurate diagnosis is required to formulate the best treatment plan. Because of the considerable damage to the masticatory muscles, conservative orthognathodontic therapy may be the best treatment option.

Oral Rehabilitation of Segmental Mandibulectomy with Extensive Fibrosis- A Daunting Obstacle for the Maxillofacial Prosthodontist

The fifth most frequent malignancy worldwide is head and neck cancer. Following surgical removal of lesions of the oral cavity, mandibular resection can result in undesirable effects, such as altered mandibular movements, disfigurement, dysphagia, impaired speech, and deviation of the mandible in the direction of the resected site. After a marginal or segmental mandibulectomy, prompt rehabilitation is preferred since aesthetic and functional deficiencies impair a patient’s quality of life. The contribution of maxillofacial prosthodontists safeguards the prosthetic viability, driven by a prosthetic proposed plan. Maxillofacial prosthodontists should be included from the start, and they play a crucial and directing role in this procedure. This article specifies the treatment of a 52-yearold male patient with extensive fibrosis who had a reduced mouth opening as a result of right side segmental mandibulectomy. The mandible was difficult to manipulate into occlusion due to considerable fibrosis that had formed over time, thus a guiding flange prosthesis was not employed in this case. To address the patient’s inability to chew food, a double occlusion table was designed using the remaining maxillary teeth. A 3-month follow-up was performed, as well as the Oral Health Impact Profile-14 (OHIP-14) was done prior to and following the treatment.

Mast cell expression in oral submucous fibrosis: A systematic review and metanalysis.

Oral submucous fibrosis (OSMF) is a chronic disorder associated with reduced mouth opening, burning sensation and listed as potentially malignant disorder. The role of mast cells in initiation and progression of this condition has been debated in last few years. It is imperative to understand the definitive role of mast cells and subsequently identify a possible cost-efficient treatment modality for OSMF. This review aimed to study the role of mast cells in OSMF by framing a research question that assessed the mast cell count (MCC), their degranulation and immunohistochemical analyses. We performed a comprehensive search of PubMed, EBSCOhost and general Google search that conceded 26 studies from which 15 articles were finalized for the review. The individual study syntheses revealed increased MCC in OSMF as compared to controls. Also, there was decreased MCC with the progression of OSMF. However, the metanalysis showed high level of heterogeneity as three studies out of eight studies found reduced MCC in disease when compared with controls. There is definite increase in mast cell in OSMF although the cell count falls with the advancement of OSMF. This increases the scope for further research to identify exact mechanism by which mast cells contribute to fibrosis and conduct the drug trials that can inhibit the mechanism. Key words:Oral submucous fibrosis, mast cell count, degranulated mast cells, stages of OSMF.Oral submucous fibrosis, mast cell count, degranulated mast cells, stages of OSMF.

Awake video laryngoscopy aided intubation as an alternative to awake fiberoptic intubation in a patient with difficult airway.

Dear Editor, We are reporting the airway management of a 75-year-old male patient diagnosed with recurrent basal cell carcinoma (BCC) nose who had undergone multiple resections and facial reconstructive surgeries. He was posted for excision of recurrent BCC. On examination, his mouth had a fish-mouth appearance with restricted opening of approximately 4 cm. He had no nose, was edentulous with restricted tongue protrusion, and had a Mallampati score of 4. The patient had no other comorbidities and the investigations were within normal limits. After 6 h of fasting, the patient was taken up for surgery. The anesthetic plan was awake intubation followed by induction of general anesthesia (GA) and controlled ventilation. Fiberoptic bronchoscope (FOB) was unavailable and mask ventilation was seemingly impossible due to deformed facial contours. So, we planned to perform an initial awake check laryngoscopy under topical anesthesia. Following intravenous glycopyrrolate 0.2 mg, topicalization of oral cavity was done with 10% lignocaine spray. Then awake check laryngoscopy was performed with C MAC videolaryngoscope using D blade and we were able to visualize the glottic opening. Transtracheal block was given with 4 mL of 4% lignocaine, and then, under videolaryngoscopic visualization, a soft gum elastic bougie was introduced into the trachea. A 7.0mm internal diameter flexometallic endotracheal tube (ETT) was then railroaded over the bougie [Figure 1]. After observing regular end-tidal carbon dioxide waveforms, the patient was induced with propofol, paralyzed with vecuronium, and ETT was fixed at 21 cm at the left angle of the mouth. Fentanyl was used as an analgesic and anesthesia was maintained with isoflurane in an air–oxygen mixture. The intraoperative period was uneventful and the patient was extubated when fully awake after reversing neuromuscular blockade.Figure 1: Patient after intubationThough awake fiberoptic intubation (AFOI) is considered the gold standard for securing the airway in difficult airway patients, it may not be available always. Awake check laryngoscopy is helpful to plan mode of induction and intubation in difficult airway patients. Induction of GA in such patients is considered safe only if glottis could be visualized during check laryngoscopy. If FOB was available, oral AFOI would have been the ideal technique for our patient. Securing airway in patients with anticipated difficult airway in the absence of FOB could be accomplished by use of intubating laryngeal mask airway[1]or I gel,[2,3]a few among the many techniques described. We preferred intubation over supraglottic airway devices as they are bulkier than ETT and in the presence of reduced mouth opening, it would have further limited the surgical access for excision of the tumor at the mouth. Recent research has shown that videolaryngoscopes provide similar success rates and faster intubation times when compared with FOB-aided intubations in awake patients having difficult airways.[4,5]Optimal topicalization of the oral cavity, oropharynx, and the structures near the glottis as well as proper counseling of the patient are important for a successful outcome of this technique. We conclude that awake videolaryngoscopy followed by the introduction of soft gum elastic bougie into the trachea and railroading ETT over it is a safe alternative to AFOI during unavailability of FOB, provided the patient has adequate mouth opening. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Lingual frenulum length: A prospecting link to craniofacial morphology in adults.

The aim of this study was to evaluate the correlation of the length of the lingual frenulum with the craniofacial morphology in adults. The study comprised a total of 144 subjects, aged 18 to 28 years, divided into 3 groups (48 in each group), based on ANB angle i.e., Skeletal Class I, Skeletal Class II & Skeletal Class III. To measure the length of the lingual frenulum direct and indirect methods were used. A Lingual frenulum ruler was used for direct measurement and the differences between the maximum mouth opening reduction (MMOR) with and without the tip of the tongue touching the incisive papilla measurement were taken for the indirect method. A lateral cephalogram was collected from each subject and a cephalometric analysis was done to assess craniofacial morphology. Statistical analysis was done by ANOVA and the significance of the mean difference between (inter) the groups was done by Tukey's HSD (honestly significant difference) post hoc test after ascertaining normality by Shapiro-Wilk's test and homogeneity of variance between groups by Levene's test. The lingual frenulum length and maximum mouth opening reduction were significantly increased in the Skeletal Class III subjects with a statistically significant value of P < 0.001 when compared with the Skeletal Class I and Skeletal Class II subjects. A balance in the teeth positioning is maintained by orofacial musculature and any disturbance which occurs in this, results in malocclusion. Malocclusion can result in a long lingual frenulum that pushes the mandibular anterior forwards. Hence, the malocclusion and lingual frenulum length relationship are essential to eliminate the erratic forces and to attain excellent results, following the elimination of malocclusion.

Management of trismus using novel physiotherapy appliance: A case series

Trismus refers to the restriction of the range of movements of the jaw commonly referred to as “lockjaw”. We report case series of trismus in patients who came with chief complaint of reduced mouth opening and pain with various aetiologies. These patients were successfully treated by Shekar’s physiotherapy appliance. Thus, this novel oral physiotherapy appliance is simple, easy to use, custom made and perhaps be employed as an effective method to treat trismus.

Bilateral resorption of mandibular angle in patient with systematic sclerosis - a case report

Progressive systemic sclerosis (PSS) is chronic autoimmune disease affecting a connective tissue. The symptoms of PSS in orofacial area are: restricted mouth opening, xerostomia, facial asymmetry and problems with oral hygiene. Radiographic images can show specific features like bone resorption, especially in mandibular region or periodontal ligament space widening. The aim of this study was to present the case of 56-year-old woman with characteristic scleroderma-related changes visible on panoramic radiograph. The patient diagnosed with severe systemic sclerosis was referred by dermatologist to general dentist. The woman experienced tightening of facial skin, xerostomia and reduced mouth opening which caused problems with daily oral hygiene and dental treatment. General dentist referred the patient to the Department of Dental and Maxillofacial Radiodiagnostics of Medical University of Lublin for the panoramic X-ray. One of the main findings was bilateral resorption of mandibular angles. Localization of the bone resorption in patients with scleroderma is related to attachements of masticatory muscles. Dentists and general doctors should be aware that some of the maxillofacial manifestations of systematic scleroderma can be visible on panoramic radiographs.

Low-concentration Povidone-iodine and Normal Saline as Irrigant on Reducing Postoperative Complications after the Third-molar Surgery: A Comparative Study

This study was conducted to compare the efficacy of using 0.5 mg/mL povidone-iodine solution as an irrigant and coolant in reducing postoperative sequelae like swelling, trismus, and pain with the conventional normal saline irrigation during the surgical removal of the impacted lower third molar. The research was conducted out toward the MES Dental College in Perinthalmanna, Kerala, in the Department of Oral and Maxillofacial Surgery. After mandibular third-molar surgical removal, researchers studied 60 individuals, 30 of whom had normal saline irrigation (group I), and 30 of whom received 0.05% povidone-iodine irrigation (group II). The postoperative discomforts were measured on the second and seventh days after surgery, respectively. After that, the data were analyzed using SPSS. The data analysis considered p-values less than 0.05 to be significant. At the second postoperative visit, patients in the povidone-iodine group reported much less pain, swelling, and reduced mouth opening than those in the normal saline group. But on the seventh postoperative day, there was not much difference between either group. Following the surgical removal of teeth, it was revealed that povidone-iodine solution (0.5 mg/mL) was more effective as irrigation and cooling aid than regular saline solution. Low-concentrated povidone-iodine is a better option in dentistry as irrigant.

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.

Oral and dental late effects in long-term survivors of childhood embryonal brain tumors

PurposeTo investigate oral and dental late effects in survivors of childhood brain tumors medulloblastoma (MB) and central nervous system supratentorial primitive neuroectodermal tumor (CNS-PNET).MethodsThis cross-sectional study assessed oral and dental late effects in MB/CNS-PNET survivors treated before 20 years of age, and with a minimum of 2 years since treatment. Participants went through an oral and radiographic examination. We assessed oral status using the decayed-missing-filled index (DMFT), oral dryness, maximum mouth opening (MMO), fungal infection, and registration of dental developmental disturbances (DDD) in the form of hypodontia, microdontia, and enamel hypoplasia.ResultsThe 46 participants’ mean age at enrolment was 27 ± 12.8 years and at treatment 8.5 ± 5.2 years, and the mean time since treatment was 18.9 ± 12 years. Over a third (35%) of survivors had reduced mouth opening (mean 29.3 ± 5.6 mm (range 16–35)). A significantly lower MMO was found in individuals treated ≤ 5 years compared to survivors treated > 5 years (p = 0.021). One or more DDD were registered in 30.4% of the survivors, with a significantly higher prevalence in individuals treated ≤ 5 years (p < 0.001). Hypodontia was the most prevalent type of DDD. There was no difference in DMFT score in relation to age at treatment. Oral dryness was not frequently reported or observed in these survivors.ConclusionSurvivors of childhood MB/CNS-PNET are at risk of oral and dental late effects including reduced mouth opening and DDD. The risk is highest in survivors treated before the age of 5.

A nonsurgical approach in management of burns induced microstomia: a review

Burns of head and neck region causes skin contracture which will result in microstomia and loss of skin flaccidity. The prevention and management of microstomia contracture is an important aspect of facial burn. The goal of microstomia repair include the reconstruction of orbicularis sphincter for adequate lip functioning, obtaining lip symmetry and well positioned scar and adequate mouth opening. The standard treatment for the prevention and management of contracture includes compression therapy, grafting, mouth splinting, scar massage, excercise, patient education. These types of maxillofacial prosthetic appliances may be indicated, in conjunction with or without surgery these appliances can be use to improve the reduced mouth opening caused by burns or other traumatic injuries With proper education and motivation of operator and the patient use of these appliances will not only improve the reduced mouth opening but also improve form, function, esthetics, and also enhance the patient’s quality of life.

Prognostic determinants in severe odontogenic space infections: a single-center retrospective analysis.

Odontogenic space infections are a common presentation in oral and maxillofacial surgery units worldwide. Multiple patient and treatment dependent variables may be used predict the outcomes of the disease process. This study was aimed at a retrospective evaluation of significant predictors of prognosis in terms of length of hospital stay and the need for re-exploration in cases of odontogenic space infections. Patients who underwent incision and drainage of odontogenic space infections were identified from the hospital records of the Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, Karnataka, India. The variables assessed included Diabetic status, pyrexia on admission, topical rubefacient agent application, hot fomentation, recent tooth extraction, trismus, dysphagia or dyspnea on presentation, white blood cell count, number of spaces involved, antibiotics used, organisms isolated, severity of the infection and the anesthesia technique used (local anesthesia [LA], conscious sedation or general anesthesia). The sample consisted of 259 patients (110 male, 159 female) with a mean age of 41±16.9 years. Space infections were preceded by tooth extractions in 53 (20%) cases, rubefacient balm application in 130 (40%) and hot fomentation in 58 (22%) cases. Trismus was noted in 140 patients with an average mouth opening of 21±10.3 mm. Dyspnea and dysphagia were noted in 55 (21%) and 96 (37%) patients each. Sixty-six patients were diabetic. The average length of hospital stay was 5.8±3 days and re-exploration was required in 75 (29%) patients. Significant predictors of hospital stay were severity (P<0.001), number of spaces affected (P<0.001), hot fomentation (P=0.04), trismus (P<0.001), dysphagia (P<0.001) and dyspnea (P<0.001). Predictors of re-exploration are an increased primary surgery under LA (P<0.001), white blood cell count (P<0.001), rubefacient balm application (P=0.045), dysphagia (P<0.001), dyspnea (P=0.018), and reduced mouth opening (P<0.001). No significant correlation between diabetes and length of hospital stay or the need for re-exploration were found in this study. Poorer outcomes can be predicted based on the severity of the infection, the number of spaces involved, an increased white blood cell count as well as clinical signs and symptoms like trismus, dysphagia and dyspnea. Hot fomentation and Rubefacient agent application were identified as significant determinants of poor prognosis in this study. The presence of these indicators warrants a more aggressive approach towards management of space infections.

Are there difficulty variables in maxillary third molar surgery? A prospective observational cohort study.

The main aim of the present study was to assess which factors were related to surgical difficulty in maxillary third molar extraction. Intra- and postoperative complications were also evaluated. A prospective observational cohort study was performed on out-patients who underwent impacted maxillary third molar extraction. Principal component analysis and multiple linear regression were used to assess the correlation among variables as well as the influence of different preoperative variables on surgical difficulty, suture duration and risk of intraoperative complications. Eighty-six teeth were extracted. There was a positive correlation between pre- and postoperative evaluations and surgery duration. Available space for surgical access in the upper fornix, second molar contact, crown palatal position, depth of the elevation point and surgeon's seniority had a significant effect on the overall difficulty index. Risk of intraoperative complications increased considerably as the percentage of reduction of maximum mouth opening increased (2.03±0.98) as well as in cases in which ostectomy and tooth sectioning were performed (7.02±2.68). The surgeon's seniority was associated with a decreased risk of intraoperative complications (-1.52±0.72). Surgeons were able to predict the difficulty of surgery only to a limited extent. The percentage of maximum mouth opening reduction with an object in the fornix, crown palatal position, and contact with the second molar were found to be related to surgical difficulty.