Facial asymmetry involving extensive maxillofacial skeletal discrepancy presents a complex surgical challenge. This case report presents a comprehensive surgical solution for a 35-year-old woman with pronounced facial asymmetry due to unilateral mandibular hypoplasia. The patient was treated using a surgery-only orthognathic approach combined with adjunctive facial contouring and revision genioplasty. The surgical plan included Le Fort I osteotomy and a combination of sagittal split and vertical ramus mandibular osteotomies, supplemented by reduction malarplasty, reduction mandibular anguloplasty, buccal fat pad removal, and revision genioplasty following liquid silicone extraction with genial muscle realignment. The patient’s preexisting stable occlusion allowed for the omission of orthodontics, aligning with her primary aesthetic concerns. Postoperative assessments over 12 months demonstrated stable occlusion, enhanced facial symmetry, and high patient satisfaction. This case supports that, in carefully selected patients, a surgery-only orthognathic approach combined with targeted facial contouring can provide efficient, predictable, and aesthetically favorable correction of complex facial asymmetry.

The high success rate of dental treatment is dependent on the cooperation of pediatric patients during procedures. Dental treatment often causes pain, particularly in children. The factors in providing treatment to pediatric patients include the characteristics and location of the tooth, profoundness of the anesthesia including the type of local anesthetic, and cooperation of the patient. Previous studies have examined several techniques to successfully achieve profound pulpal anesthesia in maxillary permanent teeth. The dentist should select the injection technique to be used based on patient needs. In children, either buccal with palatal injections or buccal with intra-septal injections may be used to anesthetize the permanent maxillary first molar. Buccal with palatal injections are commonly used prior to routine maxillary dental procedures. Currently, there are only a few studies on the employment of buccal with intra-septal injections to anesthetize permanent maxillary first molars in pediatric patients. This review will focus on efficacy of buccal with palatal versus buccal with intra-septal pulpal anesthesia of the permanent maxillary first molars in pediatric patients and aim to determine which technique should be used during routine dental procedures.

BACKGROUND: Every patient who undergoes mandibular third molar surgery is concerned about post-operative pain. Indeed, previous researchers have used various methods to treat such pain. This study aimed to assess the effectiveness of sublingual injection of dexamethasone (8 mg) to treat post-operative pain after mandibular third molar surgery. METHOD: This was a randomized, double-blind, split-mouth, clinical trial, involving 48 healthy patients who required surgical removal of two mandibular third molars with similar bilateral positions. All operations were performed by the same experienced surgeon. The patients were randomized into a study group (8 mg dexamethasone injection) and a placebo group (normal saline injection). Both interventions were injected into the sublingual space immediately after local anesthesia, 30 min before the first incision. The study group received an 8 mg dexamethasone injection, while the placebo group received a normal saline injection. The wash period between the patients' two operations was 3 to 4 weeks. Pain was assessed by recording the number of analgesic tablets (rescue drug) consumed, as well as by noting the patients' responses to the visual analog scale (VAS) on the first, second, and third days after surgery. RESULTS: The study group differed significantly from the placebo group in terms of VAS score and analgesic consumption. CONCLUSION: Dexamethasone (8 mg), injected sublingually, significantly eased post-operative pain after surgical removal of the mandibular third molar.
Administration, Sublingual ; Anesthesia, Local ; Dexamethasone* ; Humans ; Methods ; Molar, Third* ; Pain, Postoperative ; Tablets ; Tooth, Impacted ; Visual Analog Scale

BACKGROUND: No study has compared lidocaine with articaine, each at a concentration of 4% and combined with epinephrine. The purpose of this study was to compare the effectiveness of 4% lidocaine with that of 4% articaine, with a concentration of 1:100,000 epinephrine added to each, in an inferior alveolar nerve block for surgery on impacted lower third molars. METHOD: This study was conducted at the Faculty of Dentistry, Mahidol University in Bangkok, Thailand. The randomized, single-blind, comparative split-mouth study was carried out in patients with symmetrically impacted lower third molars, as identified on panoramic radiographs. Each patient underwent surgery for the removal of the lower third molars by the same surgeon under local anesthesia at two separate visits, 3 weeks apart. The onset and duration of local anesthesia, intra-operative pain, surgical duration, and number of additional anesthetics administered were recorded. RESULTS: The subjective and objective onset of action for the local anesthetics showed statistically significant differences (P < 0.05). However, the intra-operative pain, surgical duration, duration of local anesthesia, and number of additional anesthetics administered did not show statistically significant differences. CONCLUSION: The use of 4% articaine for the inferior alveolar nerve block was clinically more effective in the onset of subjective and objective anesthesia as compared with the use of 4% lidocaine. Based on the pain scores from the visual analogue scale, 4% lidocaine provided more analgesia during the procedure, and patients noted less intra-operative pain than with 4% articaine; however, the difference was not clinically significant.
Analgesia ; Anesthesia ; Anesthesia, Local ; Anesthetics ; Anesthetics, Local ; Carticaine* ; Dentistry ; Epinephrine ; Humans ; Lidocaine* ; Mandibular Nerve* ; Methods ; Molar, Third* ; Nerve Block ; Thailand ; Visual Analog Scale

BACKGROUND: Dental fear is usually associated with hemodynamic changes. Fear of pain during the surgical removal of a lower impacted third molar might cause patients anxiety, thereby leading to avoidance of any future dental therapy. This study aimed to determine the effect of experiencing a surgical impacted-tooth removal on the pain perception-related anxiety and hemodynamic status. METHODS: Twenty-seven healthy patients aged 15–30 years (mean age, 24 years), for whom surgical removal of bilateral lower third molars was advised, were included. This prospective, randomized, controlled, split-mouth study involved operations on both sides of the mandibular arch, with a 1-month washout period in between. Blood pressure and heart rate were measured before the surgical procedure, during and after the injection, preoperatively, and postoperatively. Pain perception was evaluated using a 100-mm visual analog scale during the injection, preoperatively, and postoperatively after the numbness disappeared. Differences in the blood pressure, heart rate, and pain perception between the two appointments were analyzed using the paired t-test. For all statistical analyses, SPSS version 11.5 was used. RESULTS: The mean pain perception values during the injection and preoperatively showed no significant differences between the two appointments (P > 0.05); however, significant differences in the blood pressure and heart rate were noted before the surgical procedure; preoperatively, the blood pressure alone showed a significant difference (P < 0.05). CONCLUSIONS: There was a significant decrease in the blood pressure and heart rate preoperatively; hence, experiencing a surgical impacted-tooth removal can reduce the subsequent preoperative anxiety in healthy patients.
Anxiety* ; Appointments and Schedules ; Blood Pressure ; Dental Anxiety ; Heart Rate ; Hemodynamics* ; Humans ; Hypesthesia ; Molar, Third ; Pain Perception ; Prospective Studies ; Visual Analog Scale