Comparison of 'sutureless' Transconjunctival and Subciliary Approach for Treatment of Infraorbital Rim Fractures: a Clinical Study

PURPOSE

The aim of the study is to compare subciliary incision and 'sutureless' transconjunctival incision in the treatment of infraorbital rim fractures.

MATERIALS AND METHOD

In this prospective study, 40 patients with fractures of the infraorbital rim were selected and divided into 2 groups using random sampling technique. Group A patients were treated using 'sutureless' transconjunctival technique and group B patients were treated using subciliary approach. The following parameters were compared a) time taken, intraoperative ease of access, exposure achieved; b) clinical outcome and postoperative complications; c) Aesthetic outcome at intervals of 15 days, 1 month and 3 months.

RESULTS

Total time taken for completion of surgery was lesser in group A patients. The presence of subconjunctival ecchymosis (at 1 month interval) and neurological deficit was found to be statistically significant (P<0.05) in the 'subciliary' group of patients. The transconjunctival approach showed better esthetic results and fewer post-operative complications.

CONCLUSION

The subciliary approach gives good exposure of the infra-orbital rim and is better suited to reduce extensively displaced fractures of the infra-orbital rim. The transconjunctival approach is comparatively faster, gives better esthetic results and fewer post-operative complications but is technique sensitive and requires an additional lateral canthotomy in cases where more exposure is needed.

An unusual complication of late onset allergic contact dermatitis to povidone iodine in oral & maxillofacial surgery - a report of 2 cases

BACKGROUND

Povidone iodine (PVP-I) is a chemical complex of polyvinylpyrrolidone (also known as povidone or PVP) and elemental iodine. Iodine containing compounds are widely and commonly used as antiseptics and disinfectants. They are available in various forms like aqueous solution, tincture, aerosol, ointment, or foam. Skin irritation to them is due to the oxidative effects of iodine. Because of the low free iodine concentration in povidone-iodine, skin irritation is less frequent from short contact (1).

CASE

We report two cases, both with no history of allergy to any drugs, who developed an allergic reaction 24 hours after the usage of povidone iodine as a pre-operative antiseptic to prepare (scrub) the lower third of face before surgical removal of third molars. This case report was granted an exemption by the ethical committee of our institution review board. The Helsinki declaration doesn't apply to this case presentation.

CONCLUSIONS

PVP-1 is the most commonly used antiseptic scrubbing solution prior to most surgeries. However, allergic contact dermatitis due to PVP-I has not been extensively documented or reported and hence under evaluated, compared to other commonly encountered allergens. There is almost general agreement to the proposition that PVP-I is a very rare sensitizer (2,3) though there are some conflicting reports on the matter. However, sometimes when prolonged skin contact with PVP-I occurs when used as a pre-operative antiseptic agent, it can cause allergic dermatitis (4,5). Does this finding make pre-operative testing for allergies to PVP-1 necessary in all patients? A point to ponder.