Is it better to bend wires occlusally or apically during placement of arch bars for intermaxillary fixation?

Efficacy of Enhanced Recovery after Surgery (ERAS) protocol in maxillofacial trauma: A randomized controlled trial

INTRODUCTION

Enhanced Recovery after surgery (ERAS) guidelines have been formulated in the literature for various different specialties but none is present for maxillofacial trauma patients. Hence, we have formulated ERAS protocol for maxillofacial trauma (ERAS-MT) patients and compared with the patients receiving the standard traditional care for post trauma outcomes.

METHODOLOGY

A randomized controlled trial included 74 patients divided into two groups: Group 1 (ERAS group:37 patients) and Group II (Control group:37 patients). ERAS group were intervened according to the formulated ERAS protocol based on the previous literature and the control group received the standard of care. The both groups were compared for various post trauma outcomes.

RESULTS

Baseline demographic data was non-significant between both the groups. There was significant decrease in pre-operative IV fluid use and total number of IV analgesics used till 72 h as well as in the immediate post operative period in the ERAS group(p = 0.001). ERAS group started oral feeds within 6 h and they were significantly compliant for oral carbohydrates in the pre-operative phase(p = 0.001). PONV episodes, swelling and infections were insignificantly less in the ERAS group(p > 0.05), however a significant difference was seen throat pain and decreased anxiety as well as Oral Hygiene Index(p = 0.001). At two weeks, a significant difference was seen in overall patient's satisfaction and cost analysis in the ERAS group (p = 0.001).

CONCLUSION

Our study suggested that ERAS protocol was associated with shorter hospital stay, early recovery with better overall satisfaction of the patients, lesser post-operative complications and significantly decreased cost analysis.

Compare the Efficacy of Open Reduction and Internal Fixation of Mandibular Fractures With and Without Use of Intra-Operative Inter-Maxillary Fixation

Mandible fractures are regularly encountered by maxillofacial surgeons and various treatment protocols are available for the management of these fractures. The aim of study compares the efficacy of open reduction and internal fixation of mandibular fractures with and without use of intra-operative inter-maxillary fixation. Twenty patients between age group ranging l8-65 years who reported with single mandibular fracture in Dental college in India, during Oct 2012-March 2015 were the study subjects. These patients were divided into two groups. In one group fracture reduction was done by using inter-maxillary fixation and miniplate fixation was done. In other group fracture reduction was done manually and then fractured fragments were held in position by the assistant and miniplate fixation was done. Post-operatively patients were evaluated for occlusion, bone alignment and soft tissue/hard tissue infection at 1st, 4th, 8th, 12th weeks in both the groups. Statistics done by using Spearman's Rank correlation coefficient and Mann-Whitney U test. It was observed thatthere was no statistically significant difference seen in both the groups in terms of post-operative occlusion, radiological alignment and soft/hard tissue infection. Statistically significant difference was seen when the mean operating time was compared. The Group A showed mean difference of 35.50 min more time than Group B. The results of our study suggested that, use of intra-operative IMF does not show any advantages in terms of post-operative occlusion, bone alignment and soft/hard tissue infection. We have concluded from the study that the increased intra-operative time for the placement of IMF increases the cost of the surgery in regard to equipment and theatre time. There is no benefit in terms of radiographic and clinical outcome. Hence use of intra-operative IMF can be avoided for ORIF of single mandibular fracture.