Hereditary gingival fibromatosis is a rare disorder characterized by various degrees of attached gingival overgrowth. Gingival fibromatosis usually develops as an isolated disorder but can be one feature of a syndrome. A case of a 17-year-old female who presented with a generalized severe gingival overgrowth, involving the maxillary and mandibular arches and covering almost the whole dentition. Excess gingival tissue was removed by conventional gingivectomy under local anesthesia. The postoperative course was uneventful and the patient's appearance improved considerably. Good esthetic result was achieved without recurrence of the gingival overgrowth. After treatment, regular recall visits are necessary in order to evaluate oral hygiene, and the stability of the periodontal treatment.
Ankyloglossia is an uncommon congenital oral anomaly that can cause difficulty with breast-feeding and speech articulation. For many years, the subject of ankyloglossia has been controversial with practitioners of many specialties having widely different views regarding its significance and management. This study is about a series of five cases of ankyloglossia subjected to surgical correction by frenectomy procedure. Three cases were treated with electrocautery, one case with diode laser and one case with conventional scalpel technique. 1 week and 1 month post-operative follow-ups were done and healing was compared with the available literature. Manipulation of tissues was better in laser and electrocautery techniques when compared with scalpel. Post-operative complication of swelling and pain was seen in scalpel technique whereas it was largely uneventful in other techniques. Though, there was no difference in healing at the end of first month clinically, scalpel technique has shown better results in organization of muscle fibers. This clinical study indicates that laser and electrocautery treatment used for frenectomy operations provides better patient perception in terms of postoperative pain and function than that obtained by the scalpel technique. Considering the above advantages, when used correctly, the laser and electrocautery offers a safe, effective, acceptable and impressive alternative for frenectomy operations.
Dehiscence of the sternum is a serious and potentially devastating complication. The purpose of this prospective study was to determine whether a prophylactic sternal weave would decreased the incidence of noninfective sternal dehiscence, compared to routine sternal closure, in a high-risk group. Between 2000 and 2007, 200 patients undergoing median sternotomy for cardiac surgery, with one or more risk factors including New York Heart Association functional class III/IV, chronic obstructive pulmonary disease, osteoporosis, obesity, and off-midline sternotomy, were randomly assigned to group A (sternal weave closure, 100 patients) or group B (routine sternal wire closure, 100 patients). No patient in either group with a single risk factor had sternal dehiscence. The incidence of noninfective sternal dehiscence was significantly less in group A than group B in patients with 2 or more risk factors (2.5% vs. 12.5%). Routine sternal closure is sufficient in patients with a single risk factor, whereas a prophylactic sternal weave should be carried out in all patients with 2 or more risk factors, to decrease postoperative morbidity.
Several additives have been combined with local anaesthetics for intravenous regional anaesthesia to improve block quality, analgesia and to decrease tourniquet pain. Magnesium sulphate is one potential additive. This prospective, randomised, double-blinded study was conducted in 30 ASA physical status I or II patients undergoing upper limb surgery under tourniquet. In group L, patients received intravenous regional anaesthesia with lignocaine alone (9 ml of 2% lignocaine diluted with normal saline to total volume of 36 ml). Patients in group M received intravenous regional anaesthesia with lignocaine plus magnesium sulphate (6 ml of 25% magnesium sulphate plus 9 ml of 2% lignocaine diluted with normal saline to total volume of 36 ml). Assessment was by observing the response to injection of drug; sensory and motor block and tourniquet pain. The mean time of onset of sensory block was 12.40 and 3.47 minutes in groups L and M respectively (P <0.001). The average times of onset of motor block in groups L and M were 17 and six minutes respectively (P <0.001). Of the patients in group M, 66.7% reported moderate to severe pain while the drug was being injected, compared to 20% in group L (P=0.011). There was a statistically significant difference in visual analogue scale for tourniquet pain at 10 and 30 minutes after tourniquet inflation (lower in group M). These findings indicate that magnesium sulphate added as an adjuvant to lignocaine hastens the onset of sensory and motor block and decreases tourniquet pain. However, there is increased incidence of transient pain on injection if magnesium sulphate is added.
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