Etiology, Pattern, Treatment and Outcome of Maxillofacial Fractures at Dhulikhel Hospital

Background Maxillo-Facial region is one of the prominent parts of human body and is more vulnerable to injury when any form of trauma is encountered. Injury to this region can result in fractures and pattern of fractures often depends upon the mechanism of injury as well as direction of impact. Objective To determine the etiology, pattern, treatment, and outcome of maxillofacial fractures presenting to Dhulikhel hospital. Method The records of all the patients with maxillofacial injuries presenting to the department of oral and maxillofacial surgery of dhulikhel hospital between period of December 2012 to November 2019 were included in the study. The data regarding age, sex and etiology were recorded. The etiologies were classified as Motor vehicle accidents (MVA), interpersonal violence, fall injuries, sports related injuries, occupational hazards, gunshot injuries and animal attacks and others. Similarly, the pattern of fractures was recorded according to classification by anatomical site. The types of treatment performed was also recorded. Treatment outcome in the form of any postoperative complications were recorded. Result Out of 1366 patients with maxillofacial injuries, 378(27.7%) patients had fracture of maxillofacial region. The most common etiology was motor vehicle accidents (53.7%) followed by fall injury (31.2%). Zygomatico-maxillary complex was the most common type of fracture (27.9%). Open reduction and internal fixation were the most common form of treatment provided (85.4%) and post-operative complications were minimal (5.0%). Conclusion Motor vehicle accidents still remain the most common cause of maxillofacial fractures. Midface fractures are more common than mandible fracture. The present study provides an insight into changing etiology and pattern of maxillofacial fractures and open reduction and internal fixation remains the most favored treatment of maxillofacial fractures with minimum complications.

Clinicopathological Analysis of Oral Lesions - A hospital based retrospective study

Background Proper diagnosis plays a key role that determines treatment and prognosis of the disease. To give appropriate clinical diagnosis, clinicians must be well aware of the presentation and demographic information of the lesion including the rare ones. Histopathology is still considered as gold standard in diagnostic pathology but final diagnosis becomes difficult unless detailed clinical and radiological descriptions are given. Hence an interdisciplinary approach is needed which requires correlation between both clinical and pathological details. Objective To analyze the clinicopathological details of all the oral lesions diagnosed in Dhulikhel hospital within the period of two years and to assess the concordance between clinical and histopathological diagnosis of these lesions. Method Laboratory record file of all the oral lesions diagnosed between January 2016 to December 2017 were retrieved from the department archives and the data were collected. The extracted data were analyzed using SPSS version 23.0. Result A total of 237 cases were analysed in the present study. Odontogenic cysts were the most common category followed by benign lesions. However considering the individual lesion, mucocele was the commonest lesion followed by squamous cell carcinoma. Total concordance between clinical and histopathologic diagnosis was found in 56.5% cases. The most clinicopathological agreement was seen for benign lesions followed by malignant lesions. Conclusion Mucocele and oral squamous cell carcinoma are the two most common lesions found among the patients visiting our hospital. The cases of oral squamous cell carcinoma are on a rise with each subsequent year. At present, though it is the second most common entity, it can be hypothesized that it may be higher up on the list. Therefore, oral healthcare awareness is paramount and this may be one of the best ways to reduce the oral cancer incidence rates and lowering the healthcare management burden.

A Large Dermoid Cyst in the Floor of the Mouth

The dermoid cyst in the floor of mouth is considered to bea rare condition which comprises only 1.6 to 6.5% of all body dermoid cysts. Dermoid cyst in the floor of mouth may be congenital or acquired. The congenital form results from defective embryonic development and the acquired form may be due to traumatic or iatrogenic causes; and as a result of the occlusion of a sebaceous gland duct. We report an unusual case of huge dermoid cyst in the floor of the mouth in a 12 year old male who presented with progressively increasing swelling below his tongue and reviewed the relevant literature.

Juvenile Ossifying Fibroma of Maxilla

Ossifying fibroma (OF) is a rare, benign, non-odontogenic tumor of the jaw which comes under the group of fibro-osseous lesions. Ossifying fibromas of the mandible are more common than in the maxillary region. Juvenile ossifying fibroma has been distinguished from conventional ossifying fibroma on the basis of patient's age, site predilection, and clinical behavior. The lesion should be differentiated from other fibro-osseous lesions as its management varies from surgical enucleation to complete resection. Present report describes the case of juvenile ossifying fibroma of anterior maxillary region in a 7 year old male patient, with a detailed description of clinical, radiographic, histopathologic features, and its surgical management.

Comparative Study to Determine the efficacy of Zinc Oxide Eugenol and Alveogyl in Treatment of Dry Socket

Background Dry socket is one of the most common complications following permanent tooth extraction, especially mandibular third molar. Management remains controversial and different authors have shown different results with the use of zinc oxide eugenol and AlveogylTM, some preferring AlveogylTM over zinc oxide eugenol. Objective To determine the incidence, possible risk factors and compare the effectiveness of two most commonly used agents (Zinc oxide eugenol and AlveogylTM) for management of dry socket. Method Dry socket patients were randomly divided into two groups. Various risk factors were recorded through proper history. After thorough irrigation with normal saline, zinc oxide eugenol paste mixed with cotton pellet was placed in one group whereas AlveogylTM was placed in another group. Intensity of pain was recorded on visual analogue scale of Zero to ten. Pain score was recorded at the time of diagnosis, thirty and sixty minutes after placement of medication and on second, fifth, seventh and tenth day. The medication was changed every day until the pain subsided. The data were collected and analyzed using SPPS software (version 20). Result Incidence of dry socket was 4.70%, more common in males (59.09%). It was more common after extraction mandibular third molar. Initial and final pain relief on visual analogue scale was better with use of zinc oxide eugenol. Conclusion Zinc oxide Eugenol paste is more effective in management of dry socket for early as well as final pain relief compared to AlveogylTM.

Incidence and Pattern of Impaction of Mandibular Third Molars : A Single Institutional Experience in Nepal

Background Impacted teeth are those that have erupted or are partially erupted and will not assume a normal arch relationship with opposing and adjacent teeth and tissues. Objective To evaluate the incidence and pattern of mandibular impacted third molars in patients of Dhulikhel Hospital. Method A retrospective study was conducted from March 2016 to November 2016 and reviewed 581 orthopantomograms and clinical records of patients who presented to the Department of Oral and Maxillofacial Surgery. The angulation of impaction was measured using Winter's classification and the level and position of impacted third molar was recorded using Pell and Gregory classification system. The etiology for extraction was recorded from previous clinical records. Result In this study, incidence of impaction was more prevalent in females. The most common pattern of impaction was mesioangular followed by horizontal, vertical, distoangular and others. The most common cause of extraction was caries in the third molar. There was no significant difference between the pattern of impaction in the right and left sides of the mandible. Conclusion Classifications of impacted mandibular third molars can be effectively used to predict the surgical difficulty and to evaluate the risk of postoperative complications. Therefore, this study highlights the importance of evaluation of pattern, type and class of impaction in Nepalese population giving a high clinical significance.

Retrospective Study to Determine Stability of Mandibular Setback Surgery using Bilateral Sagittal Split Osteotomy Technique

Background Bilateral sagittal split osteototomy of mandible is one of the most commonly performed orthognathic surgical procedure performed in the mandible. According to hierarchy of stability, mandibular setback procedure is considered to be relatively unstable procedure and chances of relapse are higher. Objective We conducted this study to determine the skeletal stability of mandibular setback procedure using bilateral sagittal split osteotomy technique in Nepalese population. Method Lateral cephalograms of 14 patients who underwent mandibular setback using bilateral saggital split osteotomy were taken pre-operatively (P1), immediate postoperatively (P2) and eight months to one year post-operatively (P3). Cephalometric tracing was done for all the cephalograms. Various parameters of Burstone's hard and soft tissue, Steiner's and McNamara analysis were used in the study to determine angular and linear changes following surgery. After tracing the cephalograms, changes between P1- P2, P1-P3 and P2-P3 were calculated. Mean difference in changes between P1-P2, P1-P3 and P2-P3 were compared using paired t test. P value less than 0.05 was considered to be significant. Data analysis was done using SPSS software version 20. Result Mean setback at Pogonion was 3.03 mm whereas at point B were 4.64 mm. Relapse at Pogonion was 0.03 mm and relapse at point B were 0.02 mm. Mean change in point A-Nasion-point B angle was 5.1 degrees whereas mean changes in NA-Pogonion angle were 4.69 degrees. Conclusion There were significant changes in angular as well as horizontal parameters at P2 but there were no significant changes in those parameters at P3. This is a preliminary study that we have carried out at our institution with smaller sample size thus we recommend a study with larger sample size and long term follow up.

Clinico-histopathological Survey of Head and Neck Cancer at Tertiary Health Care Centre -Dhulikhel Hospital

Background Head and neck is one of the most prevalent site for cancers along with lungs, cervix, breast and stomach. Hospital based cancer registries required for effective evaluation of diagnosis and management of cancer is inadequate in Nepal. Cancer registry system established by WHO is acquired by seven major hospitals in our country. However, data from tertiary health care centres like ours remain undocumented. Objective The objective of this study is to perform retrospective analysis of clinicohistopathological types of head and neck lesions which were eventually diagnosed as cancer in Dhulikel Hospital, a tertiary health care centre of Central East Nepal. Method Data regarding head and neck lesions diagnosed as cancer (January 2001- December 2014) were extracted from the archives of Department of General Pathology. These cases were categorised according to demographic profile, site of cancer and histological diagnosis. Result A total of 240 cases matched the inclusion criteria and were selected for this study. Male: Female ratio of 1.3:1 with a mean age of 52 years (52.82±1.8) was found. Two hundred and two (84.16%) patients were diagnosed with carcinoma, 31 (15%) with lymphoma, 3 (1.25%) with melanoma, 2(0.83%) with small round cell tumor and 2 (0.83%) with sarcoma. The most common histological types of carcinoma seen were Squamous cell carcinoma (138 cases; 57.5%) followed by papillary carcinoma (26 cases; 10.8%). Among the lymphomas Non-Hodgkin's lymphoma (21 cases; 8.75%) was the most predominant type. The most common site of presentation was oral cavity (60 cases; 25%) followed by skin (36 cases; 15%), thyroid (32 cases; 13.33%) and oesophagus (27 cases; 11.25%). Metastasis to cervical lymph node was found in 39 cases (16.25%). Conclusion Based on these finding, it was observed that Squamous cell carcinoma was the most common type followed by different epithelial and mesenchymal malignancies in head and neck region. The results revealed by this study will provide useful information for planning the health care policies about cancer in Nepal and will be more effective and helpful to the patients of remote areas.

Prevalence of dry socket following extraction of permanent teeth at Kathmandu University Teaching Hospital (KUTH), Dhulikhel, Kavre,Nepal: a study

BACKGROUND

One of the most common postoperative complications following the extraction of permanent teeth is a condition known as dry socket. Although the aetiology of dry socket is debated, it is probably multifactoral, and its pathogenesis remains unknown.

OBJECTIVES

The aim of the study was to evaluate incidence of dry socket following extraction of permanent teeth at dental out-patient department (OPD) of Dhulikhel hospital, Kathmandu university teaching hospital (KUTH), Kavre, Nepal.

MATERIALS AND METHODS

Retrospective reviews of records of total 1860 no of patients were studied who underwent extraction of permanent teeth for various reasons since January 2007 to December 2008 period. There were 873(47%) male patients and 987 (53%) female patients. Information regarding indications for extraction, extracted tooth status, onset of symptoms, relevant findings of the examining clinician, interval between presentation, management given, and its outcome were retrieved and analysed.

RESULTS

A total 1860 no of patients were studied who underwent extraction of total 2640 number of permanent teeth for various reasons. A total of 103 (3.9%) extractions were complicated by dry socket in patients aged 11 to 80 years with female predominance (54.4%).

CONCLUSION

The etiology of dry socket is multifactorial and ultimately it is the host's healing potential which determines the severity and duration of the condition. The incidence of dry socket was found as 3.9% in this study. The incidence was higher in female patients (54.4%) and in mandibular teeth extraction cases (68.93%).

Versatility of orthognathic surgery in the management of maxillofacial deformities

Orthognathic surgery is a surgical procedure which is widely practiced throughout world for the correction of various maxillofacial deformities. The procedure for correction of a particular deformity will be done after proper evaluation, which includes cephalometric and dental model analysis and photographs. The patient undergoes pre surgical orthodontic correction for the dental compensation after which the surgery is planned.

The Sos1 and Sos2 Ras-specific exchange factors: differences in placental expression and signaling properties

Targeted disruption of both alleles of mouse sos1, which encodes a Ras-specific exchange factor, conferred mid-gestational embryonic lethality that was secondary to impaired placental development and was associated with very low placental ERK activity. The trophoblastic layers of sos1(-/-) embryos were poorly developed, correlating with high sos1 expression in wild-type trophoblasts. A sos1(-/-) cell line, which expressed readily detectable levels of the closely related Sos2 protein, formed complexes between Sos2, epidermal growth factor receptor (EGFR) and Shc efficiently, gave normal Ras.GTP and ERK responses when treated with EGF for < or =10 min and was transformed readily by activated Ras. However, the sos1(-/-) cells were resistant to transformation by v-Src or by overexpressed EGFR and continuous EGF treatment, unlike sos1(+/-) or wild-type cells. This correlated with Sos2 binding less efficiently than Sos1 to EGFR and Shc in cells treated with EGF for > or =90 min or to v-Src and Shc in v-Src-expressing cells, and with less ERK activity. We conclude that Sos1 participates in both short- and long-term signaling, while Sos2-dependent signals are predominantly short-term.

The pattern of tooth loss due to dental caries and periodontal disease among patients attending dental department (OPD), Dhulikhel Hospital, Kathmandu University Teaching Hospital (KUTH), Nepal

Aims and objectives: The aim of this study was to investigate the type of tooth usually associated with extraction due to caries or periodontal disease and its relation to age at which these were lost, among patients attending dental surgery outpatient clinic, Dhulikhel Hospital, Kathmandu University Teaching Hospital (KUTH). Materials and methods: A total no of 626 patients (male-299 and female-327) attending at outpatient clinic, in the department of Dentistry, Dhulikhel Hospital were taken in over a period of six months. The details about the permanent teeth to be extracted regarding each tooth type, including age and sex of the patient, type of tooth extracted, cause of extraction were collected, causes other than dental caries and periodontal disease were excluded. Results: The highest proportion of extraction due to caries occurred between 21-30 years of age, while that of periodontal disease was between 51-60 years of age. More than 80% of teeth lost were from below 40 years of age group. Mandibular first molar was by far the most frequently extracted tooth due to dental caries followed by maxillary first molar. Maxillary teeth were lost more than mandibular teeth due to periodontal disease. Conclusion: Dental caries and periodontal disease are the two most important factors for extraction or removal of tooth. In this study dental caries is the major cause for loosing tooth among young group of people. Key words: dental caries, periodontal disease, extraction    doi: 10.3126/kumj.v7i1.1767       Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 59-62