Relevance of Predictors in Difficult Intubation for Patients Undergoing Maxillofacial Surgery

Objective: To determine a clinically useful variable for predicting difficult tracheal intubation in patients with seemingly normal airways. Material and Methods: In our study we had included 68 patients from September 2011 to September 2013 who needed tracheal intubation for elective maxillofacial surgery. An airway assessment test was conducted on each patient prior to general anaesthesia, with respect to mouth opening, sternomental distance, thyromental distance, oropharyngeal (Mallampati) classification and ability to protrude the mandible. After induction of anaesthesia, the laryngeal view during laryngoscopy was graded and then the ability to intubate was assessed. Results: Incidence of difficult intubation occurred in 8 (11.76%) cases out of 68 patients. Airway test that was significant for predicting difficult tracheal intubation was SMD of less than 12.5 cm, TMD of less than 6 cm, a score according to Mallampati et al. of greater than III, protrusion of mandible position B and position C and IIG less than 3 cm with sensitivity of 87.5%, 62.5%, 62.5%, 25% and 50%, respectively. Conclusion: Our study concluded that sternomental distance had the highest sensitivity of 87.5% which was statistically significant

Prevalence and Sex Distribution of Temporomandibular Disorder and Their Association with Anxiety and Depression in Indian Medical University Students

Objectives: The term TMD refers to a group of disorders characterized by pain in the temporomandibular joint and associated structures. The aim of this study was designed to evaluate prevalence, severity and sex distribution of sign and symptoms of TMD and to evaluate their relation with anxiety and depression among the students. Material and Methods: A total of 1000 university students were enrolled in the study (550 females;450 males), with ages ranged between 18 and 28 years. Helkimo anamnestic index (Ai) and clinical dysfunction index (Di) were used to determine symptoms and signs respectively. For the association of TMD with anxiety and depression, HAD (Hospital Anxiety and Depression) scale was used. Results showed that prevalence of one or more symptoms of TMD was 27.7%, while the prevalence of one or more signs of TMD was 64.4% which was mild in severity. Mild anamnestic symptoms (AiI) were found in 19.8% and severe symptoms (AiII) were found in 7.6%, while mild clinical sign (DiI), moderate clinical (DiII) and severe clinical sign (DiIII) were found in 49.7%, 12.2% and 2.4% respectively. Statistically there was no gender difference in these two scales. Regarding the association between TMD with anxiety and depression, 206 of the 311 students (66.2%) with TMD symptoms also had signs of anxiety and depression (P < 0.001). Conclusion: These findings confirmed that students had high prevalence of TMD which was significantly associated with anxiety and depression.

Assessment of Relationship between Pain and Anxiety Following Dental Extraction—A Prospective Study

Objective—Anxiety and expected dental pain are the main reasons for avoiding any dental treatment by general population. In this study, we aimed to evaluate the various factors which can in-crease the anxiety and its association with pain perception of patients following dental extraction. Material and Methods—We had included 100 patients in our study who were undergoing orthodontic treatment and required extraction of either 34 or 44. Pain and anxiety levels after extraction were assessed with a visual analog scale (VAS) and an anxiety questionnaire consisting of eleven questions. Results—The mean VAS score for the entire study group was 16.23 ± 1.28 with statistically significant differences between genders, and was high in females and no statistically significant differences between different age groups. The mean anxiety score was 10.64 ± 3.12. This was significantly higher in women (P = 0.005), but there was no statistically significant differences between different age groups. There was a statistically significant correlation between VAS and total anxiety score (P < 0.001) as well as each question, except for question number 4, 8 and 9 in men. Conclusion—Although most patients had experienced limited pain, there was a significant gender difference in pain and anxiety level. They were anxious because they expected pain, women being more anxious than men. The most provoking factor for anxiety and pain while going for extraction in females was “being seated in dental chair”, while in men the most provoking factor was “uncertainty about proper numbness before extraction”.