This article focuses on the different imaging modalities used to evaluate acute mandibular fractures and explores important concepts relating to their diagnosis, investigation, and treatment. Significant focus will be given to exploring general management principles, considerations regarding first-line imaging, and recent technological advancement. Computed tomography (CT) is the preferred method when attempting to identify acute mandibular fractures, particularly in trauma patients, and has very high specificity and sensitivity. Multidetector CT now represents the standard of care, enabling fast scan times, reduced artifact, accurate reconstructed views, and three-dimensional (3D) reconstructions. Cone-beam CT is a newer advanced imaging modality that is increasingly being used worldwide, particularly in the ambulatory and intraoperative setting. It produces high-resolution images with submillimeter isotropic voxels, 3D and multiplanar reconstruction, and low radiation dose, however is less widely available and more expensive. Ultrasound is a valuable method in identifying a fracture in unstable patients, but is limited in its ability to detect nondisplaced fractures. Magnetic resonance imaging is useful in determining the presence of soft-tissue injury. CT angiography is invaluable in the assessment of potential vascular injury in condylar fracture dislocations.

The cephalometric norms for orthognathic surgery (COGS analysis) are the standard benchmark in cephalometrics for any orthognathic surgical diagnosis and treatment planning. Since the introduction of cephalometrics by Broadbent, numerous studies have been conducted to establish craniofacial norms of different ethnicities. Most of these studies, however, determined craniofacial norms for Caucasian people and may not be applicable to other ethnic groups due to differences in their facial appearance. Therefore, it is essential to study and compare the existing cephalometric parameters between Caucasians and Indians to validate their application during the treatment planning of the orthognathic surgery. This review focuses on studying the cephalometric norms for the North Indian (NI) population and establishing the COGS analysis for the population of North India. The objective is to determine the cephalometric parameters of Angle's dental and skeletal Class I faces for the NI population. The following databases were searched for the present study -PubMed, Ovid MEDLINE, and EMBASE. The initial inclusion criteria comprised studies written in English and quoting cephalometric norms in Indian population. The time period of publications was not determined. The quality features evaluated were sample description, variables analyzed, and how cephalometric standards were evaluated. Initially, 49 articles were retrieved. After removal of the duplicated records and assessing for the eligibility, four articles met the inclusion criteria. These four articles were included in the systematic review. The NI people are characterized by having small cranial base, short facial height, protrusive chin, and more inclination of mandibular incisors in comparison with Caucasians. Due to limited research on the Central Indian cephalometric norms, the Caucasian norms are still referred for the diagnosis and treatment planning of orthognathic surgery for NI population.

Mucormycosis is a modern-day lifestyle disease that has burst into the health-care scenario. It is an opportunistic fungal infection that proliferates into the immunocompromised host by invasion of the fungus into the paranasal sinuses, thereby invading the palate, maxilla, and orbit. Left untreated it invades the cranial components such as cavernous sinus, skull base, and brain. Mucormycosis invades blood vessels, making these infections highly angioinvasive. We reviewed 45 cases of mucormycois of the head-and-neck region from 2010 to 2020 on the basis of electronic search peer-reviewed journals in Medline (PubMed) database. Presenting symptoms, risk factors, history of extraction, and treatment were tabulated and the data were analyzed. The mean age of patients was 53.8 years. 73.93% of patients had diabetes mellitus, 13.63% of patients had no immunocompromised state, and 8.74% of patients had other medical disorders. About 34.78% of cases had a history of extraction prior to manifestation of symptoms. Mucormycosis remains difficult to treat disease with a high mortality rate. At present, the triad of clinician's awareness, appropriate antifungal therapy, and aggressive surgical intervention represents treatment protocols against the disease.

Postoperative nausea and vomiting (PONV) is considered to be the most unpleasant experience associated with surgery and is believed to be one of the most common reasons for poor patient satisfaction in the postoperative period. It also results in prolonged hospitalization and increased use of resources such as intravenous fluids and drug supplements along with prolonged medical attention, all of which have psychological and financial implications. In addition to this, PONV can result in aspiration, laryngospasm, dehydration, electrolyte disturbances, gastric bleeding, increased intracranial pressure, increased intraocular pressure, and wound dehiscence particularly when the surgical intervention is performed through an intraoral approach. It is a well-known fact that there are many etiological factors as well as predisposing factors for PONV. Hence, this review is intended to evaluate as an individual factor what the role was played by the anesthetic agents used for GA in the incidence of PONV.

Introduction: Treatment of Medication-related osteonecrosis of the jaw (MRONJ) is challenging. The aim of this study was to assess the effect of topical phenytoin on the healing process of MRONJ after debridement. Materials and Methods: In this study, patients with stage II of MRONJ were randomly allocated to two groups: Group 1 received debridement of the necrotic bone, with additional 5% topical phenytoin + tetracycline. Patients in group 2 underwent debridement and the involved area was primarily closed. Patients were evaluated after 1 (T1), 6 (T2), and 12 (T3) months. The presence of wound dehiscence (stage 0: No dehiscence, stage 1: Less than 10 mm dehiscence, stage 2: More than 10 mm dehiscence) and infection (presence or absence of pus and sinus tract) was evaluated. At the 12-month follow-up (T3), the number of patients who were asymptomatic for 3 months was documented in each group. Results: Twenty patients completed the study protocol (10 patients in each group). At T1 and T3, a significant difference was noted in the stage of healing between the two groups (P < 0.05). At T3, nine patients in group 1 and four patients in group 2 were symptom-free for 3 months. (P = 0.03). Conclusion: These results demonstrated that debridement combined with topical administration of phenytoin and tetracycline improved the healing process and relapse rate after treatment in stage II of MRONJ patients.

Background: The aim of the study is to compare intubating conditions and hemodynamic changes during awake fiber-optic intubation (AFOI) using midazolam and fentanyl versus dexmedetomidine in cases of difficult airway. Materials and Methods: A randomized prospective study was conducted in the department of oral and maxillofacial surgery, with a total of 60 patients, 18–55 years of age, ASA class I–II, of either sex with anticipated difficult airway planned for elective surgery. They were divided into two groups; group I patients received 1 μg/kg of dexmedetomidine and then an infusion of 0.5 to 0.7 μg/kg/hr of dexmedetomidine, whereas group II patients received 1 μg/kg of intra-venous (iv) fentanyl and 0.05 mg/kg of iv midazolam with additional doses of 0.02 mg/kg to achieve a Ramsay Sedation Scale score of ≥2. The ease of placement of the fiber-optic scope and the endotracheal tube and the patient's reaction to placement of the fiber-optic scope were assessed on a scale of 1–4 and were recorded as endoscopist satisfaction score and patient discomfort score, respectively. Results: The endoscopy time ranged from 2.66 ± 1.00 (group I) to 3.90 ± 0.96 (group II) minutes and was found to be statistically significant (p < 0.05). Also, the patient discomfort score was recorded during endoscopy (1–4) and ranged from 1.3 ± 0.53 (group I) and 2.33 ± 0.66 (group II) and was found to be statistically significant (p value < 0.05). Patients undergoing the procedure who received dexmedetomidine were thus more comfortable than those who received fentanyl and midazolam combination. Conclusion: Dexmedetomidine provided better intubating conditions, patient tolerance, higher endoscopist satisfaction, and reduced hemodynamic responses compared to fentanyl and midazolam combinations. Also, the major advantage of dexmeditomidine for preservation of airway with a lesser degree of respiratory depression allows for safer use of AFOI in cases of difficult airway.

Background: Aldehyde dehydrogenase 1A1 (ALDH1A1) is a key aldehyde dehydrogenase (ALDH) isozyme, related to the cancer stem cells which are responsible for initiating tumor growth, progression, and recurrence. High expression of ALDH1A1 has been reported in several tumor types in humans and its expression is associated with poor prognosis. The aim of this study was to assess the expression of the ALDH1A1 in oral squamous cell carcinoma (SCC) and its correlation with various clinicopathological parameters. Materials and Methods: ALDH1A1 expression was analyzed by using immunohistochemistry on paraffin blocks of 112 cases of primary oral SCC and their corresponding 68 lymph nodes with metastatic deposits. ALDH1A1 expression was also correlated with various clinicopathological parameters. Statistical analysis was done with statistical analysis software, the Statistical Package for the Social Sciences version 21.0. Results: High ALDH1A1 expression was observed in 31.2% of cases of primary oral SCC as compared to 73.5% in lymph node metastasis. A statistically significant difference (P = 0.04) was observed in high TNM stages (68.6%) of the tumor as compared to low TNM stages (31.4%). However, histopathological grades of tumor showed nonsignificant correlation with ALDH1A1 expression (P = 0.093). 40.2% of patients were expired at the end of the study, and the rate of mortality was significantly higher (P = 0.01) in patients with high ALDH1A1 expression as compared to low expression (60.0% vs. 31.2%). Conclusion: High ALDH1A1 expression was associated with higher TNM tumor stage and high nodal stage. It was also associated with high mortality rate which validates it as a marker of invasiveness and poor prognosis in oral SCC.

Objectives: The objective of the study was to examine the feasibility of bi-paddled pectoralis major myocutaneous (PMMC) flap reconstruction in patient undergoing full thickness composite resection. Materials and Methods: Inclusion criteria: The subjects chosen were patients with clinically T4A squamous cell carcinoma of buccal mucosa, lower alveolus, and maxilla in with skin involvement. Patients required a full-thickness composite resection of intraoral lesion, bone (mandibular segment and/or maxilla), and overlying involved skin and had modified radical neck dissection. Exclusion criteria: Patients not requiring full thickness composite resection including skin. Patients were observed postoperatively for early and late postoperative complications, starting of oral feeding, post-operative trismus, and dysphagia during subsequent follow-up and cosmetic outcome. Results: Overall, the complication rate was 33.8% out of which only 7.8% required major re-surgery with second flap reconstruction. This is comparable with other large series of PMMC flap. Clavien-Dindo Grade I complications were seen in 9.5%, Grade II in 69.7%, Grade IIIA in 13.4%, and Grade IIIB in 7.45% of patients. Full-thickness partial flap necrosis included necrosis of either the external or the internal skin paddle. There were 15 cases – 6.5% of full thickness external paddle necrosis. These were mostly in patients with bite composite resections and having a larger random fasciocutaneous distal component of the flap without underlying muscle. Furthermore, 40% of these patients were females. In females, the flap necrosis comprised 4 of the 12 patients (33.33%). Conclusion: Pectoralis major mycocutaneous flap has been a boon to reconstruction of the oral cavity post its inception. In case of locally advanced squamous cell carcinomas of the oral cavity, in many instances, there is a clinically significant cervical lymph nodal spread vessels post mandating a comprehensive lymph node dissection. PMMC flap provides a robust well vascularized muscular cover to the cervical vessels poststernocleidomastoid excision.

Aim and Objective : Our study was an observational and evolutional to analyze the significance of orbital volume calculation in predicting the probability or tendency of developing late enopthalmous on patients with unilateral orbital fracture with or without associated midface injury reported to our hospital. Materials and Methods: The subjects in our study included fifteen patients between18 and 60years. They were treated surgically and conservatively. Patients were exposed to series of examination from the day of injury or reporting for a consecutive period of up to six months following injury. CT was taken prior to treatment following management to evaluate the volume change in orbit. Its correlation and significance to treatment outcome were analyzed using MIMICS software by Materialise by comparing injured orbit to opposite side normal eye. Result: Conclusive of clinical examination and summary of statistical analysis patients were categorized into three groups: Low (with volume change of less than 2%), Medium (volume change between 2 to 20%) and High (volume change more than 20%) by comparing fractured orbit to uninjured orbit and a statistically significant mean value of 27.7 ± 2.6 cu.mm for fractures eye and 25.9 ± 2.6 cu.mm for normal eye was found (P ≤≤ 0.05). Conclusion: Orbital volume can be considered as useful criteria in evaluation of patients with orbital fracture. Evaluation and follow up in correlation with resultant volume assessment provide a better indicator for assessment of prognosis and enopthalmous. Unlike other methods for volume assessment MIMICS software by Materialise provide a better method and it can be incorporated to working station in hospital. Every CT assessment in orbital trauma should include orbital volume as a parameter and this software is easy and user-friendly software that does not require its technical knowledge for application.

Objective: The objective of the study is to evaluate the morphology of the symphyseal region of adult skeletal Class II and Class III malocclusion as compared with Skeletal Class I subjects. Materials and Methods: The symphyseal width and height were evaluated using data from 80 lateral cephalograms of the age range of 18 years to 25 years. Average growing Skeletal Class II (n = 30) and Class III (n = 20) subjects were used as a comparison group. Average growing normal occlusion samples (n = 30) were used as controls. Results: Alveolar height was similar in all groups. The width of the symphyseal region including basal width, the width of the cervical region of the lower central incisor at the cementoenamel junction, and symphysis width were found to be similar in all groups. There is no significant difference in gonial angle in both Class II and III groups as compared to control. Articular angle showed no significant difference. Mandibular incisor dentoalveolar height (L1-AH) was found to be significantly higher in the Class II group (P < 0.05). Conclusions: There are no definite morphological differences in the symphyseal region between average grower Class I, Class II, and Class III skeletal malocclusions except mandibular incisor dentoalveolar height (L1-AH) and incisor mandibular plane angle which is higher whereas ramus length and body length which is lesser in Class II group as compared with controls. Width of the cervical region of the lower central incisor at the cementoenamel junction (Id-Id') and incisor mandibular plane angle was lower than control in Class III subjects.

Introduction: Morphometric studies of the auricle find its place in many areas, such as esthetics, forensic medicine, biology, anthropology, mythology, arts, and acupuncture. Aims and Objective: This study aims at establishing the anatomical variations in the auricular dimensions in North Indian population. The objectives of this study were to measure auricle height in males and females, to measure auricle width in both sexes, to measure lobular height (LH) in both sexes, to measure lobular width (LW) in both sexes, to calculate the auricle index in both sexes, and to calculate lobular index in both sexes. Materials and Methods: This study was conducted on 130 subjects (78 males and 52 females), in the age group of 18–25 years, without history of genetic disorders, injuries, or any disease of the auricle. Results: The average length of the auricle was 6.28 cm (right) and 6.23 cm (left), and the average width was 3.21 cm (right) and 3.28 cm (left). The average height of the lobule was 1.76 cm and 1.77 cm on the right and left sides, respectively, while the lobule width was 1.90 cm on the right side and 2.01 cm on the left side. Conclusion: Total right auricle height and total auricle width of both the right and left ears are more in males as compared to females, and the difference between both the sides was significant. Both right- and left-side LH and LW were higher in males as compared to females.

Introduction: The midface with multiple bones and cavities is vulnerable to fractures more commonly. Midface is one of the most frequently injured areas of the body, accounting for 23%–97% of all facial fractures. The classic LeFort type of fractures are uncommon nowadays and a more common picture is more severe forms primarily due to the high-speed vehicles that are a major cause of these fractures. It, therefore, has become imperative to determine the commonly occurring patterns of fractures in this area in the present time for a better insight into diagnosis and treatment plans. The aim of this article was to determine fracture patterns in midface trauma to ease the treatment planning in such a scenario. Materials and Methods: This prospective study included 114 patients who reported to a tertiary hospital during a 4-year period and were diagnosed with suspected midface fractures. The etiology and pattern of fractures of midface were assessed based on history, clinical examination, and imaging data. The diagnosis of a fracture was based on the clinical history, signs and symptoms, manual examination, and correct interpretation of radiographs and computed tomography. Midface fractures were recorded as LeFort I, II, III, dentoalveolar, palatal, zygomatic complex fracture, nasal bones, naso-orbital-ethmoidal complex, and orbital and zygomatic arch fractures. Etiological factors were classified as road traffic accidents (RTAs), fall, assault, and sports injuries. Results: During the 4-year period, a total of 114 patients were included. Patients' ages ranged from 17 to 68 years, with 102 males and 12 females. The most common fracture in this study was found to be zygomatic complex fractures (52%), and RTA was identified as the main cause of fracture in this study (79.2%). Conclusion: The midface fractures are more common in males due to the propensity of males to use two-wheelers more than females. The prominence of the zygoma makes it more vulnerable to fractures than rest of the bones in the midface. Increased speed of vehicles and lack of discipline in following traffic rules have resulted in RTA, being the biggest etiological factor in midface injuries.

Background: Titanium allergy is a main reason for failure of dental implant. Hence, newer implant biomaterials have emerged such as zirconia and carbon or glass fiber reinforced poly-ether-ether-ketone (CFR-PEEK)-based materials. The aim of the present study was to compare the stress pattern in bone surrounding implant with CFR-PEEK and commercially pure titanium implant. Materials and Methods: Three-dimensional formal model of mandibular first molar partsubstituting with implant supported crown was generated. Implant with dimensions of 10 mm length and 4.3 mm diameter was used in this study. Finite element models of CFR-PEEK and commercially pure titanium implant assemblies were generated. A 100 Newton (N) force was implemented along the long axis and obliquely at 30° to the long axis of implant. Von Mises pressures generated in the bone surrounding implant were analyzed using ANSYS workbench 16.0 and other finite element software. Results: Similar stress distribution was detected in bone surrounding implant with CFR-PEEK implant and commercially pure titanium implant assembly under 100 N force applied vertically and obliquely. Conclusion: PEEK reinforced with carbon or glass fiber implants can be a viable alternative in individuals who are more of esthetic concern and who demonstrate allergy to metallic implants.

Purpose: The behavior of trigeminocardiac reflex (TCR) is limited to few case reports only in maxillofacial surgery, especially for temporomandibular joint (TMJ) ankylosis cases. The present study aims to find out the incidence of bradycardia due to TCR during intraoperative forceful mouth opening in TMJ ankylosis patients. Materials and Methods: A prospective, unicentric observational study was conducted selecting those patients who were planned for osteoarthrectomy with interpositional gap arthroplasty under general anesthesia. Sixty cases of TMJ ankylosis were randomly selected from December 2018 to-03-2020. Predictor variables were patient age, gender, and type of ankylosis, and outcome variables were pulse rate, mean arterial blood pressure (MABP), and oxygen saturation level (SPO₂). Data were recorded at baseline and during intraoperative mouth opening via heister jaw stretcher. A Chi-square test was used for testing the association between variables. P values were considered statistically significant at <0.05. Results: The sample size of 60 subjects has been divided into two age groups (10–19) years and (20–40) years. The mean standard deviation age of the patients was 18.32 ± 6.81 years. About 63.3% were male. Out of 60 cases, 14 patients developed bradycardia. The frequency of bradycardia was found 23.3%. According to logistic regression analysis, age and type of ankylosis were the significant predictors of bradycardia. Conclusion: We conclude that bradycardia due to TCR in TMJ ankylosis patients is not an uncommon entity. Incidences are more prevalent in the age group of 10–19 years and type IV bony ankylosis. Male had a high incidence of bradycardia though P value was nonsignificant.

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

Introduction: The most commonly performed surgical procedure in most oral and maxillofacial surgery practices is the removal of third molars. Postoperative pain is considered a form of acute pain due to surgical trauma with an inflammatory reaction. Materials and Methods: One hundred and fifty patients were included in the study which were divided into GROUP-A, B, and C-50 patients each; those who underwent third molar removal under local anesthesia. Local anesthesia was obtained by inferior alveolar, lingual, long buccal, posterior superior alveolar, and greater palatal nerve block injections after first complain of pain, all patients were prescribed analgesics (Ketorolac-10 mg), (Tramadol-50 mg), (Flupirtine-100 mg), and antibiotics co-amoxiclav-625 mg) T. D. S in all the three groups A, B, C, respectively, for 5 days and the timing noted in the patients assessment sheet. The statistical analysis was done using SPSS Version 15.0 statistical analysis software. Results: The flupirtine group has early onset and also had minimum side effects. All the groups showed similar trend in change in pain score from 3 h. P. O to different time intervals. It was observed the pain score increased significantly till 6 h. Post operative a decreased trend was found at 24 h, 48 h, 78 h, after 6 h. and this change was found to be statistically significant for all three groups. Conclusion: Flupirtine had faster onset and comparable pain management profile as compared to tramadol, it also had minimum side effects, hence the use of flupirtine might be recommended for postoperative pain management in cases undergoing third molar surgery.

Background: Mucogingival surgery is performed to resolve the problems arising due to high frenum attachment and shallow vestibular depth (VD). The surgical procedures are mainly indicated to prevent gingival recession and for esthetic reasons. The aim of this study was to compare the degree of vascularization in the treatment of mucogingival problems by both microsurgical and macrosurgical techniques. Materials and Methods: Forty-two participants with aberrant frenum and shallow VD were randomly selected for frenectomy, frenotomy, and vestibular deepening either by a microsurgical (test) or macrosurgical (control) approach. Fluorescein angiography was performed at 1, 7, and 14 days after the surgical procedures. In addition, patient's satisfaction scores were recorded postoperatively. Results: Angiographic evaluation at test site revealed a statistically significant vascularization at 1, 7, and 14 days after the surgical procedure when compared to control sites. Probing pocket depth(PPD) in both the groups in vestibular deepening procedure decreased from 1 month to 6 months, but the reduction was insignificant. There was significant reduction in VD in both the groups over a period of 6 months. Microsurgical approach in all three procedures was superior in terms of patient satisfaction than macrosurgical approach. Mean surgical time spent in vestibular deepening and frenectomy procedures was highly significant in micro group as compared to the macro group. Conclusion: This clinical study indicates that microsurgical approach improved the percentage of vascularization and patient satisfaction compared with macrosurgical approach.

Background: After the clinical introduction of ultrasound scalpel in recent years, piezosurgery has become competitive with conventional instruments in orthognathic procedures to reduce the operative and postoperative complications reported to occur in association with these surgeries. Aims: The aim of this prospective clinical study was to compare intraoperative and postoperative outcomes of both piezoelectric device and the traditional bur technique in orthognathic surgery. Intraoperative bleeding time, operative time, postoperative swelling, and neurological impairment were evaluated. Materials and Methods: In this study, a split-mouth technique was applied on ten patients requiring orthognathic surgery. To make the osteotomy cuts, on the one side, piezo-osteotome was used, and on the other side, conventional osteotomy bur was used. Results: Duration of osteotomy was found to be greater with piezo osteotomy compared to bur osteotomy. Mild bleeding was observed with piezosurgery. Postoperative swelling was greater on the side of piezosurgery compared to the bur side. Altered neurosensory activity was found to be equal on the 1^st day postoperatively, but the piezo side recovered faster compared to the bur side in the 1^st month after surgery. Conclusion: Piezoelectric device offers better advantages over the conventional bur in orthognathic surgery and hence can be considered an alternative to the bur in some orthognathic procedures.

Objective: The objective is to evaluate the efficacy of prophylactic single intravenous dose of palonosetron in the management of postoperative nausea and vomiting (PONV) following oral and maxillofacial surgical interventions performed through an intraoral approach under general anesthesia (GA). Materials and Methods: A prospective study was conducted on 100 subjects who underwent intraoral surgical procedures for the management of maxillofacial trauma, pathology, dentofacial anomalies, and deformities under GA. All subjects received a prophylactic single intravenous dose of 0.075 mg palonosetron along with premedication. Predisposing factors for PONV such as patient age, gender, Apfel risk score, history of motion sickness, smoking, type of procedure, and administration of postoperative opioids were taken into consideration. All the patients were monitored for PONV for the 1^st 24 h postoperatively (PO). First, at an interval of 30 min for 1^st 4 h and then at every 2 h interval for next 8 h followed by monitoring every 6 h interval till 24 h. Time and frequency of rescue medication were noted. Results: Seventy-nine percentage subjects did not have PONV. 15% subjects had a single episode of vomiting PO which could be attributed to multiple intra oral surgical sites performed as well as longer duration of exposure to anesthetic agents in addition to providing opioid analgesics for the management of postoperative pain. Only 6% subjects needed rescue antiemetic drug. Palonosetron did not show any significant changes in cardiac status and serum profile. Conclusion: Palonosetron is effective in the management of PONV for maxillofacial surgical procedures performed through an intraoral approach under GA.

Introduction: Sloth bear, a native species of Indian subcontinent, has a population estimate of 1200–1500 in Jharkhand. Human habitats in proximity to forest reserve cause frequent human–bear interactions and thus bear attack injuries. Face is the most common site affected. This is a prospective study performed to evaluate the incidence and pattern of maxillofacial trauma after bear attack and the outcome of the treatment provided to them. Materials and Methods: Patients with bear attack injuries reporting to the outpatient department were recruited for the study. The incidence was recorded in terms of time, month, and site. Details of maxillofacial wounds and fractures were noted. The variables used to analyze the outcome of the treatment were ugly scar, facial asymmetry (eyelid, nose, cheek, and lips), facial nerve paralysis, loss of vision, and alopecia. Results: Majority of the cases were reported in April and March. Victims were from Ranchi 4 (26.6%), Gumla 3 (20%), Lohardaga 2 (13.3%), Latehar 2 (13.3%), Simdega 1 (6.6%), Ramgarh 1 (6.6%), Khunti 1 (6.6%), and West Singhbhum 1 (6.6%) districts of Jharkhand. Zygoma (10) was the most affected fractured bone, followed by frontal (9) and mandible (6). Minor ugly scar was found in 14 (93.3%) of the patients, postoperative facial deformity in 12 (80%), unilateral facial paralysis in 2 (13.3%), and alopecia patch in the scalp in 1 (13.3%). Conclusion: Spring and early summer are the breeding seasons of sloth bears in Jharkhand. Mahua petal which attracts the wild bear falls from trees during these months causing such human attacks. Loss of vision describes the mutilating nature of bear attack.

Many aggressive non-endodontic radiolucent lesions show very similar clinical and radiographical features to periapical lesions of endodontic origin. Since the treatments of endodontic and non-endodontic lesions differ markedly, a precise diagnosis is imperative. Thus, the present study aimed at presenting a clinical case on the diagnosis and management of a Langerhans cell histiocytosis (LCH) lesion mimicking a periapical lesion of endodontic origin. A 51-year-old male patient was referred to a private dental office due to slight pain from the region of tooth 36. Although no sign of prosthetic or endodontic failure was noted, radiographical examination revealed a radiolucent image with poorly defined borders associated with the periapical region of the tooth. Apicoectomy and bone curettage were then performed and, given the clinical and laboratory features, the definitive diagnosis of solitary eosinophilic granuloma was made. The surgical treatment was sufficient for the remission of the symptoms, and recurrence was not observed. Given the current case, dentists should be aware of LCH lesions as they may mimic endodontic periapical pathoses, leading to misdiagnosis and therapeutic complications. Moreover, alveolar bone lesions may be the first or only sign of LCH in many cases.

This study aims to evaluate the success of the morpho-functional restoration of a tooth with subgingival carious lesion using the modified replantation technique, which entails the rotation of the element of 180° on its axis. This study has a follow-up of 16 months. A 68-year-old man comes to rehabilitate the esthetic and the functionality of element 1.2, affected by destructive carious process extended below the gingival margin. At the clinical and radiological examination, the possibility of a conservative approach is excluded due to the total lack of healthy dental tissue to construct the ferula. It is executed the technique of modified intentional replantation, followed by a rehabilitative phase. After 16 months of follow-up, it can be appreciated the stability of the hard and soft tissue, the lack of pathological probing or symptomatology, and radiographically there is no evidence of bone or root resorption. The modified intentional replantation can be a valid alternative to the surgical lengthening of the clinical crown, to the orthodontic extrusion or to the surgical extrusion. This variation allows obtaining an apical stop during the replanting phase, which contributes to the stabilization of the element. Due to the short follow-up examination from us, further studies are necessary.

Schwannomas are rare benign tumors arising from Schwann cells of the nerve sheath. Although the head-and-neck region accounts for a large percentage of extracranial schwannomas, those located within the orbit are infrequent. This paper presents an extremely rare case of orbital schwannoma arising from the terminal branch of abducens nerve in a 37-year-old female. The lesion presented as a large intraconal mass causing proptosis and weakness to abduct the left eye. Imaging showed a well-defined, solid-cystic lesion, measuring 2.7 cm and displacing the lateral rectus muscle laterally and the optic nerve medially. A multidisciplinary approach was used for the surgical management of the tumor. Access was attained through lateral rim osteotomy. Histopathological evaluation was diagnostic for schwannoma. A search of English literature revealed only five previously published cases of abducens nerve schwannomas. A review of these cases has also been discussed along with the present report.

Tongue reconstruction can be simple to complex depending on the size of the defect. Reconstruction of medium-to-large size defect is technically demanding to achieve better esthetic and functional outcome. There are various options in the reconstruction of tongue defect when it comes to the type of flap. Any type of flap has its own advantages and disadvantages. Local flaps seem to be the best option, as it avoids secondary donor site morbidity and has similar tissue characteristics as native tissue, therefore provides better esthetic and functional results. This case report illustrates a case of tongue reconstruction that was performed with the help of tongue base island flap after wide local excision of verrucous carcinoma, which provided us with excellent results.

Trigeminocardiac reflex (TCR) is a cascade of physiological response secondary to the stimulation of any of the sensory divisions of the trigeminal nerve, which is the largest cranial nerve and provides sensory supply to the face, scalp, mucosa of the nose, and mouth. This response usually presents as a triad including bradycardia, apnea, and gastric motility changes. On the another side, transient loss of consciousness or vasovagal syncope, a well-known phenomenon in dentomaxillofacial surgery with its pathophysiology fully elucidated, is thought to be mediated by TCR and sometimes termed as dentocardiac reflex. Thus, it is imperative to know about TCR and its association with routine dental and maxillofacial surgery procedures. It can potentially happen during any minor or major oral surgical procedures ranging from simple third molar extractions, soft tissue surgeries, root canal treatments, or management of maxillofacial fractures. This paper presents two case reports demonstrating TCR which presented during maxillary third molar extraction and author(s) own experience in managing the same.

Ameloblastomas are tumors arising from the odontogenic epithelium. Ninety cases of desmoplastic ameloblastoma have been reported so far in the literature, out of which only five cases with mucous cell differentiation have been reported. We are presenting a case of 24-year-old female having a chief complaint of a painless swelling on the left side of the face for 7 months. After radiological, histopathological findings lesion was diagnosed with unicystic ameloblastoma which was treated by segmental resection. The purpose of this article is to present a case of desmoplastic ameloblastoma that has occurred in an unusual site and has unique histopathological features.