Comparative Evaluation of Preemptive Analgesia of Dextromethorphan and Ibuprofen in Third Molar Surgeries

Introduction:

Postoperative pain following third molar removal is one of the most common and unpleasant complications encountered in routine surgical practice. Various methods have been advocated to minimize the postoperative pain: preemptive analgesia is one of those found to be effective.

Objective:

The aim of this study was to compare the preemptive analgesic efficacy of Dextromethorphan (DM) and Ibuprofen in the third molar surgeries.

Material and Methods:

Thirty-six patients reporting to our institution were included in the study. Patients were randomized into three groups of 12 patients each to receive either DM 30 mg, ibuprofen 100 mg, or placebo in the form of multivitamin syrup, 90 min before the procedure. The difficulty of removal of the teeth was assessed using Campbell difficulty score. The study objectives were to evaluate the time elapsed since surgery after which the patient took their first dose of aceclofenac, to evaluate the postoperative pain using visual analog scale score, and to record the number of aceclofenac tablets consumed postoperatively.

Results:

The results of the study revealed that preemptive DM was significantly better than ibuprofen and placebo in the duration of time that elapsed before the patients consumed their first analgesic postoperatively. Preemptive DM also reduced the total number of aceclofenac tablets consumed on the day of surgery and on the 1^st postoperative day, but the difference was not statistically significant. Between the two drugs, DM is better suited for providing preemptive analgesia. No side effects at a dose of 30 mg of DM were noted in any of the patients.

Conclusion:

DM premedication is a viable preemptive analgesic in reducing postoperative pain.

Facial Nerve Injury in Temporomandibular Joint Approaches

Facial paralysis can be a devastating consequence resulting from blunt and penetrating trauma to the head and neck, as well as surgical injury, either accidental or due to involvement by tumor. In addition, the etiology can be attributed to a variety of other causes, ranging from infectious to metabolic, and is frequently idiopathic in nature. The incidence of facial nerve injury during temporomandibular joint (TMJ) surgeries varies among surgeons. There are many factors that could contribute to the injury of the temporal and zygomatic branches of the facial nerve. These nerves lie in a confluence of superficial fascia, temporalis fascia, and periosteum and may be injured by any dissection technique that attempts to violate the integrity of these regions. Excessive or heavy-handed retraction causes compression and/or stretching of nerve fibers resulting in neuropraxia. The facial nerve then enters the parotid gland, where the main trunk branches into the upper and lower divisions at the pes anserinus. The nerve further divides into five main branches: the temporal, zygomatic, buccal, marginal mandibular, and cervical. The temporal branch lies within the superficial muscular aponeurotic system at the level of the zygomatic arch. In this paper, we evaluate the facial nerve function based on the House–Brackmann grading index after the preauricular approach for the treatment of condylar fractures, pathologies, and TMJ ankylosis cases. The nerve functional regeneration postfacial nerve injury has been evaluated and reported in this retrospective study.

Management of Non-Hodgkin's Lymphoma in Maxillofacial Region with Chemotherapy

Malignant lymphomas form a heterogeneous group of neoplasms of the lymphoid tissue with different clinical courses, depending on the treatment and prognosis. Lymphoma is a malignant neoplasm of the lymphoid tissue; it is broadly classified into Hodgkin lymphoma (HL) and Non-HL (NHL) depending on the presence or absence of the Reed–Sternberg cells. The main types of lymphomas are (1) HL and (2) NHL. This case report describes about primary NHL involving the mandible. Chemotherapy was advised by the oncologist, and a total of 14 cycles were suggested at the gap of every 2 weeks. The treatment regimen followed was classical Cyclophosphamide hydrodaunorubicin oncovin Prednisolone (CHOP) therapy. NHL can be managed by chemotherapy, radiotherapy, and surgery in various combinations. NHL arising in bone is best treated by chemotherapy and may not require radiotherapy. Survival and prognosis are excellent in localized disease, whereas disseminated disease seems less favorable.

Complications of using laryngeal mask airway during anaesthesia in patients undergoing major ear surgery

Use of the laryngoscope and tracheal tube during general anaesthesia results in many complications such as sore throat, cough, vocal cord paralysis, compulsory injection of muscle relaxants for tube insertion and risky emergence of anaesthesia. This study investigated the use of laryngeal mask airway (LMA) as a safe and complication-free device in patients undergoing ear surgery. This is a retrospective cross-sectional study on a population comprising patients from 3 to 70 years of age who have undergone major ear surgery, in Amir Alam Hospital, from 1999 to 2006. Laryngeal mask airway replaced the tracheal tube in all patients. Of the 2000 patients who underwent major ear surgery with general anaesthesia using LMA, 246 (12.3%) developed haemodynamic instability. A significant relationship was observed between age and haemodynamic instability (p value = 0.03); 14.9% of these patients were aged between 16 and 40 years and 20% were aged > 60 years. No relationship was observed between the occurrence of this complication and duration of surgery (p value = 0.2). Furthermore, no significant relationship was observed between sex and haemodynamic instability. In conclusion, considering the low rate of complications with laryngeal mask airway, replacing tracheal tube with this device in major ear surgery will lead to a noticeable decrease in associated complications.