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Betancourt C, Sanabria A. Post-thyroidectomy bilateral cervical plexus block relieves pain: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:3765-3778. [PMID: 38709322 DOI: 10.1007/s00405-024-08626-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/18/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To assess the effectiveness of bilateral superficial cervical plexus block (BSCPB) in treating post-thyroidectomy pain. METHODS MEDLINE, Embase, Google Scholar, LILACS, and the Cochrane Central Register of Controlled Trials, were extensively searched. The search period extended from 1968 until December 2022. Randomized controlled trials comparing BSCPB to placebo, no block in patients with thyroidectomy for benign or malignant thyroid disease were included. Outcomes were pain in the first 24 h after surgery. Analgesic rescue, period before the first rescue dosage, and 24-h opioid usage were secondary outcomes. The RoB 2 instrument was used to evaluate the risk of bias. RESULTS 34 of 354 studies were eligible. There were 2,519 patients. BSCPB reduced the intensity of pain postoperatively [SMD: - 1.17 (95% CI: - 1.54 to - 0.81)] and in the first 24 h [- 0.62 (95%: 0.91 to 0.33)]. A considerable delay for the first opioid dose, rescue analgesics, and postoperative opioid usage was also found. CONCLUSION BSCPB's 24-h analgesic efficacy minimizes the requirement for rescue analgesia, postoperative opioid intake, and rescue analgesia start time. The choice of anesthetic and different application methods might affect its effectiveness.
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Affiliation(s)
- Carlos Betancourt
- Head and Neck Service, Hospital Alma Mater, Medellín, Colombia
- CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Alvaro Sanabria
- Head and Neck Service, Hospital Alma Mater, Medellín, Colombia.
- CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia.
- Department of Surgery, School of Medicine, Universidad de Antioquia, Cra. 51d #62-29, Medellín, Colombia.
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Sellami M, Zouche I, Ben Ayed M, Bouhali M, Ben Ayed K, Ktata S, Hammami B, Chaabouni MA, Charfeddine I. Ketamine infiltration improves analgesia after thyroid surgery. F1000Res 2023; 12:206. [PMID: 38314321 PMCID: PMC10835105 DOI: 10.12688/f1000research.127562.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 02/06/2024] Open
Abstract
Background: Postoperative pain increases the risk of postoperative complications and may predispose patients to chronic post-surgical pain. This study aims to evaluate the impact of ketamine wound infiltration versus placebo at the end of thyroid surgery on postoperative pain and analgesic requirements. Methods: In this randomized controlled trial, we prospectively studied patients who underwent thyroid surgery. Patients were randomized into two groups: group S, where local infiltration was performed using 10 ml of a physiological saline solution; and group K, where 10 ml of a solution containing 2 mg/kg ketamine was infiltrated. Standardized thyroidectomies were performed in the 2 groups. Pain perception was measured using a visual analog scale (VAS) every 10 minutes in the post-anesthetic care unit (PACU) for 2 hours and thereafter every 6 hours during the first 24 hours. The opioid requirement in the PACU was evaluated. A comparison between the 2 groups was carried out. Results: Postoperatively, the mean VAS was higher in group S compared to group K during all PACU stay periods and the first 24 hours. Pain scores during swallowing were significantly lower for group K in the PACU at 0, 10, and 20 minutes. The mean morphine consumption in the PACU was 0.71 mg and 0 mg respectively in group S and group K (p=0.03). The incidence of nausea and vomiting was similar in both groups. Conclusions: Ketamine wound infiltration is an efficient modality to reduce postoperative opioid consumption compared to a placebo after thyroid surgery.
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Affiliation(s)
- Moncef Sellami
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imen Zouche
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mariam Ben Ayed
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Maroua Bouhali
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Khadija Ben Ayed
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Salma Ktata
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Boutheina Hammami
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mohamed Amine Chaabouni
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Ilhem Charfeddine
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
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Gau TP, Wu SH, Huang JM, Lu WL, Huang TY, Lu IC, Wu CW. Multimodal Analgesia with Local Wound Infiltration and Intravenous Parecoxib for Thyroidectomy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050855. [PMID: 37241087 DOI: 10.3390/medicina59050855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
Background and objective: Adequate postoperative pain control is an important component to enhance recovery. Multimodal analgesia with various pain control techniques has been widely used to alleviate postoperative pain. The use of either wound infiltration or a superficial cervical plexus block has been reported to be effective for pain management after thyroid surgery. The present study evaluated the effect of multimodal analgesia using lidocaine wound infiltration combined with intravenous parecoxib for patients monitored after thyroidectomy. Materials and Methods: A total of 101 patients with a multimodal analgesia protocol being monitored after thyroidectomy were enrolled. After the induction of anesthesia, multimodal analgesia was performed through wound infiltration of 1% lidocaine and epinephrine at a ratio of 1:200,000 (5 μg/mL) combined 40 mg intravenous parecoxib before skin excision. Patients were divided into two groups for this retrospective analysis based on the injection dose of lidocaine they received. Patients in Group I (the control, n = 52) received a 5 mL injection solution, while those in Group II (the study, n = 49) received a 10 mL dosage in a time-sequential manner, in accordance with a previous clinical trial. The primary outcome was measuring postoperative pain intensity at rest, as well as during motion and coughing, which was measured at the postoperative anesthetic care unit (PACU) and on the first day after the operation (POD 1) in the ward. Pain intensity was assessed using a numerical rating scale (NRS). The secondary outcomes were postoperative adverse events including anesthetic-related side effects, as well as airway and pulmonary complications. Results: Most of the patients reported no pain or mild pain during the observation period. The patients in Group II had a lower pain intensity during motion than Group I (NRS 1.47 ± 0.89 vs. 1.85 ± 0.96, p = 0.043) when measured at the postoperative anesthetic care unit. Pain intensity during coughing was also significantly lower in the study group than in the control group (NRS 1.61 ± 0.95 vs. 1.96 ± 0.79, p = 0.049) when measured at the postoperative anesthetic care unit. There were no severe adverse events in either of the groups. Only one patient (1.9%) in Group I experienced temporary vocal palsy. Conclusions: The use of lidocaine with an equal volume of intravenous parecoxib provided comparable analgesia with minimal adverse events when monitoring thyroidectomy.
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Affiliation(s)
- Tz-Ping Gau
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Information Management, National Sun Yat-sen University, Kaohsiung 804, Taiwan
| | - Sheng-Hua Wu
- Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jui-Mei Huang
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wen-Ling Lu
- Department of Anesthesiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
| | - Tzu-Yen Huang
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - I-Cheng Lu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Anesthesiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
| | - Che-Wei Wu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Mohammed GS, Mazy AM, El-Ebahnasawy NS, Mohammed MN. Efficacy of superficial cervical plexus block versus cervical retrolaminar block both combined with auriculotemporal nerve block in parotid surgeries. Ann Med Surg (Lond) 2022; 75:103445. [PMID: 35386783 PMCID: PMC8977931 DOI: 10.1016/j.amsu.2022.103445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Regional techniques in parotid surgeries include superficial cervical plexus block (SCPB) and auriculotemporal nerve (ATN) block, which can be used as an anesthetic technique for awake parotidectomy. This study aimed to evaluate the efficacy of cervical retrolaminar block (RLB) as an alternative to SCPB both, used in combination with auriculotemporal nerve (ATN) block, in parotid surgery. Material and methods A total of 40 patients undergoing parotid surgery were prospectively randomized into either the SCPB group (n = 20) or the cervical RLB group (n = 20) using 20 ml of 0.25% bupivacaine plus 5 mcg\mL epinephrine. Both were combined with ATN block using 5 ml of 0.25% bupivacaine plus 5 mcg\mL epinephrine. Results The time to first request for analgesia was longer in the RLB group than the SCPB group. Total intra operative fentanyl consumption and post-operative pethidine consumption in the first 24h were lower in group RLB. All patients (n = 20) in the SCPB group required rescue analgesia using pethidine, while only 40% of patients required pethidine in the RLB group. Visual analog scale was lower in the RLB group from 2 to 24-h post-operatively, but it was associated with hypotension and longer block technique time occurred with RLB than SCPB. There was no significant difference in side effects except for 20% Horner's syndrome in the SCPB group. Conclusion Cervical RLB is more effective analgesic technique than SCPB, as the cervical RLB showed longer time to first analgesic request, lower intraoperative anesthetic consumption, lower total post-operative pethidine consumption and lower VAS. A study on 40 patient undergoing elective parotid surgery of 2 groups; Cervical retrolaminar block or SCPB. Cervical retrolaminar block more effective than SCBP. Cervical retrolaminar block is alternative Technique to paravertebral block. No significant difference between the two study groups according to complications.
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Affiliation(s)
- Ghada S. Mohammed
- Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Corresponding author. Department of Anesthesiology, Faculty of Medicine, Mansoura University, El Gomhouria St, Dakahlia, Governorate, 35516, Egypt.
| | - Alaa M. Mazy
- Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nahla S. El-Ebahnasawy
- Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed N. Mohammed
- Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Superiority of non-opioid postoperative pain management after thyroid and parathyroid operations: A systematic review and meta-analysis. Surg Oncol 2022; 41:101731. [DOI: 10.1016/j.suronc.2022.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022]
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Deepika V, Ahuja V, Thapa D, Gombar S, Gupta N. Evaluation of analgesic efficacy of superficial cervical plexus block in patients undergoing modified radical mastoidectomy: A randomised controlled trial. Indian J Anaesth 2021; 65:S115-S120. [PMID: 34703056 PMCID: PMC8500200 DOI: 10.4103/ija.ija_339_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/26/2021] [Accepted: 07/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: Intravenous analgesics and local infiltration are used for postoperative analgesia in patients undergoing mastoidectomy. No randomised controlled trial (RCT) has so far determined response rates of pain reduction after ultrasound-guided superficial cervical plexus block (SCPB) in adult patients undergoing modified radical mastoidectomy. Methods: This double-blind RCT was conducted in 30 adult patients of the American Society of Anesthesiologists (ASA) grade I/II undergoing modified radical mastoidectomy. The primary outcome was a reduction in the visual analogue scale (VAS) score. Secondary outcomes were postoperative diclofenac consumption, haemodynamics, and occurrence of any adverse events. All patients received general anaesthesia. At the end of the surgery, patients were randomised to either Group ‘Block’ (n = 15) ultrasound guided SCPB with 5 mL ropivacaine 0.5% or Group ‘No block’ (n = 15). All patients received intravenous (IV) paracetamol 1 g every 6 hourly and rescue analgesic IV diclofenac 75 mg if VAS score >4. Results: Patients in Group ‘Block’ reported lower VAS score at rest versus Group ‘No block’ at 1 h postoperatively (P = 0.012). VAS score on movement was lower in patients of Group ‘Block’ compared to Group ‘No block’ at 1 h (P = 0.010), 4 h (P = 0.035), 8 h (P = 0.027), and 12 h (*P = 0.003) postoperatively. Diclofenac consumption was lower in patients of Group ‘Block’ (P = 0.041). No adverse effects were reported. Conclusion: Postoperative ultrasound-guided SCPB produced higher response rates in terms of reduction in VAS score in patients undergoing modified radical mastoidectomy.
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Affiliation(s)
- Vijaya Deepika
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Vanita Ahuja
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Deepak Thapa
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Satinder Gombar
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Nitin Gupta
- Department of Otolaryngology, Government Medical College and Hospital, Chandigarh, India
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Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review. J Clin Med 2021; 10:jcm10204659. [PMID: 34682777 PMCID: PMC8537195 DOI: 10.3390/jcm10204659] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/03/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022] Open
Abstract
Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.
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Perioperative pain management for thyroid and parathyroid surgery: A systematic review. Am J Surg 2021; 223:641-651. [PMID: 34256931 DOI: 10.1016/j.amjsurg.2021.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/21/2021] [Accepted: 06/27/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION A growing body of evidence suggests that surgeons have historically over-prescribed opioid pain medications following thyroid and parathyroid surgery, thereby potentially contributing to the current US opioid epidemic. We reviewed the evidence supporting multimodal methods of pain control after cervical endocrine surgery. METHODS Fifty-one randomized clinical trials, 9 prospective cohort studies, 7 retrospective studies/reviews, and 1 survey regarding pain management for cervical endocrine surgery were include. RESULTS Most studies reported in-hospital pain scores and opioid consumption. Data on pain scores following discharge were limited. In several studies, the interventional dose was much greater than what is commonly used clinically. CONCLUSION Several evidence-based, non-opioid interventions can be incorporated into a standardized pain management protocol following cervical endocrine surgery. Little is known regarding the effects of these interventions on post-discharge pain scores and patient quality of life during recovery.
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Kende P, Wadewale M, Mathai P, Landge J, Desai H, Nimma V. Role of Superficial Cervical Plexus Nerve Block as an Adjuvant to Local Anesthesia in the Maxillofacial Surgical Practice. J Oral Maxillofac Surg 2021; 79:2247-2256. [PMID: 34153248 DOI: 10.1016/j.joms.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Infiltration techniques are used as an adjuvant to regional anesthesia. In this study, we evaluated the efficacy of the superficial cervical plexus nerve block, as an alternative to local infiltration techniques; in the management of mandibular fractures and peri-mandibular space infections. METHODS A prospective randomized controlled trial was conducted on 24 patients having either mandibular fractures or peri-mandibular space infections; and were scheduled for surgery under regional anesthesia (eg, inferior alveolar nerve block, long buccal nerve block). The control group involved delivering a combination of regional anesthesia along with local infiltration. The experimental group received regional anesthesia with a superficial cervical plexus nerve block. The following parameters were studied: pain, onset and duration of anesthesia, time interval until first analgesic request, pulse rate and blood pressure [at different time intervals]. RESULTS Intergroup comparison was done using unpaired t-test. Intragroup comparison was done using repeated measures ANOVA (for >2 observations), followed by a post hoc test. The superficial cervical plexus nerve block group showed highly statistically significant (P < .01) improvement in terms of intra-operative pain at 30 minutes, duration of anesthesia, intraoperative anesthetic requirement, time interval until first analgesic request and intraoperative diastolic blood pressure at 10 minutes. CONCLUSION It can be concluded that the combination of a regional anesthesia technique with a superficial cervical plexus nerve block is an alternative and safe technique for patients undergoing surgery for mandible fractures and perimandibular space infections, with clear advantages over local infiltration.
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Affiliation(s)
- Prajwalit Kende
- Head of Department, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai
| | - Maroti Wadewale
- Resident, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai.
| | - Paul Mathai
- Ex-Assistant Professor, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai
| | - Jayant Landge
- Associate Professor, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai
| | - Harsh Desai
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai
| | - Vijayalaxmi Nimma
- Assistant professor, Department of Oral Medicine and Radiology, Government Dental College and Hospital, Mumbai
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