1.
"Signs and Symptoms Tell All"-Pseudoaneurysm as a Cause of Postoperative Bleeding after Orthognathic Surgery-Report of a Case and a Systematic Review of Literature
Kumar A, Kaur A, Singh M, Rattan V, Rai S
Journal of maxillofacial and oral surgery. 2021;20(3):345-355
Abstract
PURPOSE Pseudoaneurysms are one of the rare complications that can be encountered after the orthognathic surgery. We are presenting a new case of pseudoaneurysm of bilateral sphenopalatine artery after Bijaw Surgery in a young male and a systematic review of all the cases in the literature emphasizing on signs and symptoms, epistaxis or bleeding episodes and treatment outcomes. METHODS A systematic research strategy was planned according to the PRISMA guidelines, and articles were taken from 1986 to September, 2019. A total of 899 articles were selected for screening, out of which only 26 articles met our inclusion and exclusion criteria. These were included in the study for qualitative analysis. RESULTS Most PAs were associated with Lefort I osteotomy (69.7%), followed by sagittal split osteotomy (24.24%). Average intraoperative blood was 635 ml. Maximum number of episodes of epistaxis/swelling or bleeding occurred in second week. Mean bleeding episodes were 2.58 ± 0.996. The arteries commonly affected were internal maxillary artery (42%), sphenopalatine artery (27.27%), facial artery (15.15%), descending palatine artery (12.12%), internal carotid artery (9.09%) and infraorbital artery (3.03%). Embolization was treatment of choice in 81.81% cases. CONCLUSION If a patient has recurrent epistaxis or swelling after orthognathic surgery, it is advisable to go for diagnostic imaging like angiography without any delay. In recent times, advanced techniques and expertise are readily available for early diagnosis and management of pseudoaneurysm.
2.
Comparative evaluation of coronally advanced flap using amniotic membrane and platelet-rich fibrin membrane in gingival recession: an 18-month clinical study
Rehan M, Khatri M, Bansal M, Puri K, Kumar A
Contemporary Clinical Dentistry. 2018;9((2)):188-194.
Abstract
Background: An amnion membrane is a placenta-derived tissue that consists of numerous growth factors, proteins, and stem cell reserves which help in accelerated wound healing and regeneration. Platelet-rich fibrin (PRF) also releases growth factors after activation from the platelets and gets trapped within fibrin matrix which has been shown to stimulate the mitogenic response in the periosteum for bone repair and regeneration during normal wound healing. This preliminary, controlled, randomized clinical trial with an 18-month follow-up was aimed to evaluate the effectiveness of coronally advanced flap (CAF) with either PRF membrane or bioresorbable amniotic membrane (AM) in treatment of localized gingival recession defects. Materials and Methods: Sixteen healthy adult patients presenting with Miller Class I recession defects were treated surgically with CAF along with AM (Group I) or PRF (Group II) for coverage of the recession defects. For all patients, plaque index, gingival index, bleeding on probing, clinical attachment level, depth of recession, width of recession, width of attached gingiva, and gingival thickness were evaluated at 6 months and 18 months postoperatively. Statistical analysis was done using paired t-test, repeated measure analysis of variance test, Bonferroni test for intragroup comparison and unpaired t-test for intergroup comparison. Results: The results showed statistically nonsignificant (P < 0.01) difference in all clinical parameters at the 6- and 18-month follow-ups in both groups. Gingival recession in both PRF and amnion group when evaluated individually, significantly reduced from baseline to 6 months (P = 0.000) and from baseline to 18 months (P = 0.000). However, the mean value from 6 months to 18 months was statistically nonsignificant. Conclusion: The present study demonstrated that both CAF + PRF and CAF + AM are equally effective in providing clinically significant outcomes with respect to root coverage with AM showing the better percentage of root coverage as compared to PRF.
3.
Patient-centered microsurgical management of gingival recession using coronally advanced flap with either platelet-rich fibrin or connective tissue graft: a comparative analysis
Kumar A, Bains VK, Jhingran R, Srivastava R, Madan R, Rizvi I
Contemporary Clinical Dentistry. 2017;8((2)):293-304.
Abstract
PURPOSE To evaluate autologous platelet-rich fibrin (PRF) and autogenous connective tissue graft (CTG) in gingival recession defects in conjunction with coronally advanced flap (CAF) using a microsurgical technique. MATERIALS AND METHODS Forty-five Class I and II recession defects were randomly equally (n = 15) divided into three groups: Group I sites treated with CAF with PRF, Group II sites treated with CAF with CTG, and Group III sites treated with CAF alone using microsurgical approach. Parameters recorded were vertical gingival recession (VGR) and horizontal gingival recession (HGR), % complete root coverage (CRC), patient comfort score (PCS), patient esthetic score (PES), and hypersensitivity score (HS) at 10 days, 3 months, and 6 months. RESULTS CAF surgery alone and in combination with PRF or CTG are effective procedures to cover denuded roots with mean VGR values of 1.26 +/- 0.70 mm (74.4%), 1.26 +/- 0.59 mm (58%), and 1.06 +/- 0.79 mm (53.3%) for Groups I, II, and III, respectively. In terms of CRC achieved at 6 months, results showed that 100% CRC was obtained in 60% sites of Group I, 20% sites of Group II, and 27% sites of Group III. Patient response and acceptance for surgical treatment modality in terms of PCS and PES were highest for Group I (PRF and CAF) followed by Group III and Group II, and there was decrease in HS for Group I (PRF and CAF) while no significant changes in HS were observed for Group II and Group III. At the end of 6 months follow-up, there was a significant increase in gingival thickness measurements using transgingival probing in Group II, whereas nonsignificant changes were observed in Group I and Group III. CONCLUSIONS A long-term multicenter randomized controlled clinical study may be necessary to evaluate the clinical outcome for autologous PRF in comparison to CTG and CAF alone.