Comparison of Upper Lip Bite Test with Modified Mallampati Score in Predicting Difficult Intubation

Background and Aims: Identifying a patient with a difficult airway is important in planning anaesthetic management so that endotracheal intubation can be achieved safely. This study aims to compare modified Mallampati score with Upper Lip Bite Test to predict difficult intubation using intubation difficulty scale. Materials and methods: A prospective study was carried on 104 patients, both sexes aged between 18 to 60 years scheduled for elective surgeries under general anaesthesia fulfilling inclusion and exclusion criteria. Patient airway was evaluated by MMT and ULBT preoperatively. Predictors of difficult endotracheal intubation were assigned to MMT class III and IV, ULBT class III. After premedication and induction laryngoscopy was performed. After successful intubation Intubation difficulty score was noted down based on the sum of seven assessing parameters. A score >5 was considered difficult intubation. Results: The incidence of difficult intubation in the study was 10.6% (i.e. 11 out of 104 patients). In this study ULBT had a higher sensitivity (90.9% v/s 18.20%), specificity (95.7% v/s 75.3%) PPV (71.4% v/s 8%) and NPV (98.9% v/s 88.6%) than that of MMT Conclusion: Upper lip bite test is better at predicting difficult intubation with higher accuracy when compared to Modified Mallampati test. Both the tests are good predictors of easy intubation. Keywords: Upper Lip Bite Test (ULBT), Modified Mallampati test (MMT), Intubation Difficulty scale (IDS), airway assessment. Difficult intubation prediction, Difficult airway

Evaluation of Lip Morphology and Nasolabial Angle in Non-Syndromic Cleft Lip and/Palate and Non-Cleft Individuals

Objective: To investigate the variation between the non-syndromic cleft lip and/or palate (NSCLP) and non-cleft (NC) subjects in relation to the lip morphology (LM) and nasolabial angle (NLA). Materials and Methods: Lateral cephalogram (Late. Ceph.) of 123 individuals (92 NSCLP [29 = bilateral cleft lip and palate (BCLP), 41 = unilateral cleft lip and palate (UCLP), 9 = unilateral cleft lip and alveolus (UCLA), 13 = unilateral cleft lip (UCL)], and 31 NC) who did not undergo any orthodontic treatment were investigated. By WebCeph, an artificial intelligence- (A.I.) driven software, 2 (two) parameters of LM, namely upper lip to E line (LM-1) and lower lip to E line (LM-2), and NLA analysis was carried out for each individual. Multiple tests were carried out for statistical analysis. Results: The mean ± SD observed for LM-1, LM-2, and NLA for NC individuals were 1.56 ± 2.98, 0.49 ± 3.51, and 97.20 ± 16.10, respectively. On the other hand, the mean ± SD of LM-1, LM-2, and NLA for NSCLP individuals were 4.55 ± 4.23, 1.68 ± 2.82, and 82.02 ± 14.66, respectively. No significant variation was observed with respect to gender and side. NSCLP (different types) and NC individuals showed significant disparities in LM-1 and NLA. Conclusion: It can be concluded that parameters of lip morphology such as LM-1, LM-2, and NLA vary among NSCLP and NC individuals.

Comparison of Two Protocols for the Treatment of Class 2 Malocclusion

Purpose: The purpose of this study was to compare the outcomes of the treatment with the twin block and modified twin block appliances in growing patients with Class 2 malocclusion. Materials and Methods: A cephalometric analysis was performed in 51 patients. The twin block sample consisted of 23 patients, 10-girls and 13-boys (mean age 10.46±0.71 years at the start of treatment, T1, and 12.84±0.78 years at the end of active treatment, T2). The modified twin block sample consisted of 28 patients, 18 girls and 15 boys (mean age 11.78±0.91 years at T1, and 13.32±0.56 years at T2). The twin block activators were used during the day, except for eating time, and the modified ones were used only at night. Duration of the treatment was 16-20 months. The changes from T2 to T1 and the differences between the groups were compared with the analysis of variance. Results: SNB angle in the twin block group showed 1.25±1.39 degrees change and in the modified twin block group, it exhibited 3.69±1.01 degrees change. Overjet in the group with twin block decreased 4.58±1.59 mm, and in the group with modified twin block it decreased 4.43±1.41 mm. In the modified twin block group, there was more retrusion of upper incisors in comparison with the twin block group. Accordingly, under the effect of modified twin block, retrusion of the upper lip was observed. Conclusion: Through modifying the twin block appliance, it is possible to ensure the comfort of the patients by reducing the daily usage, to reposition the mandibula forward and to correct overjet and sagittal dento-skeletal relationships without increasing facial height and to improve positions of upper incisors and lips.

GRANULOMA PIOGÊNICO EM LÁBIO SUPERIOR: RELATO DE CASO

This article is based at the diagnosis of pyogenic granuloma, which is characterized as a benign simple hyperplastic tumor and has an inflammatory reactive component that increases in size as a connective tissue reaction, forming a repair tissue as a protective mechanism. Clinically, pyogenic granuloma is seen as a red or purplish lesion (similar to the adjacent mucosa), too vascular, with a sessile or pedunculated base, with slow growth, reaching a size that rarely exceeds 2,5 cm, the surface of which can be rough or smooth. It occurs more frequently in adulthood, with a predominance in females (mainly during pregnancy), between the second and seventh life's decades. This aim of this paper is to report a case of pyogenic granuloma on the upper lip of a patient at the FAESA's Dental Clinic.

Labial Repositioning Using Print Manufactured Polymethylmethacrylate- (PMMA-) Based Cement for Gummy Smile

Treating patients with excessive gingival display (EGD) to provide them with a pleasant smile is a challenge to periodontists. A gummy smile can be due to excessive vertical bone growth, dentoalveolar extrusion, short upper lip, upper lip hyperactivity, or altered passive eruption (APE). In addition, many patients have a lack of lip support due to marked depression of the anterior process of the maxilla. In these cases, lip repositioning using polymethylmethacrylate (PMMA) cement could be performed. This article describes a case of EGD with subnasal depression. In the clinical examination, the presence of a marked subnasal depression was found, in which the upper lip lodged during a spontaneous smile. In addition to this, gingival exposure extending from the maxillary molar on one side of the mouth to the one on the opposite side was also found during the spontaneous smile. Therefore, the periodontal surgical intervention proposed consisted of performing a procedure to fill the subnasal depression with PMMA cement. This article describes a digital approach to plan the use of PMMA cement in lip repositioning in a patient with gummy smile and subnasal depression. The patient reported no postoperative complications. Six months after the surgery, the patient revealed a more harmonious smile than before, with reduction in the gingival exposure and new adequate support for and repositioning of the upper lip.

A COMPARATIVE STUDY OF MODIFIED MALLAMPATI CLASSIFICATION WITH NECK CIRCUMFERENCE ALONG WITH UPPER LIP BITE TEST IN MORBIDLY OBESE PATIENTS

INTRODUCTION: Anaesthesia in morbidly obese patients can present many challenges. The overriding concern of most anaesthesiologists is airway management, as obese patients have been thought to be at greater risk of difcult airway and/or difcult intubation, when compared with the general population. The term 'difcult airway' has been dened by the American Society of Anaesthesiologists (ASA) taskforce as the clinical situation in which a conventionally trained anaesthesiologist experiences problems with mask ventilation or tracheal intubation or both. AIMS AND OBJECTIVES- To assess the positive predictive value,sensitivity and specicity of MMPC, NC along with ULBT and compare it with Cormack Lehane grading intraoperatively. MATERIALS AND METHOD- Preoperative airway assessment of 200 patients posted for surgery under general anaesthesia was carried out to evaluate the usefulness of multiple screening tests in predicting the ease or difculty of laryngoscopy in obese patients undergoing laparoscopic bariatric surgery. Modied Mallampati test grade III or IV, Upper Lip Bite test grade III, Neck Circumference >40cm were considered as predictors of difcult laryngoscopy. Laryngoscopy was considered difcult if the view on laryngoscopy was Cormack and Lehane grade III or IV. The results were evaluated on the basis of sensitivity, specicity, positive and negative predictive value and accuracy of these tests. RESULT- Group A (ULBT+MMPC) identied 65% of the patients with difcult intubation (sensitivity of 92.86 % & specicity of 33.3 %), whereas Group B (ULBT+NC) identied 75% of the patients with difcult airway (sensitivity 93.75% & specicity of 25%). Pearson Correlation analysis was applied to know the correlation between the various tests and the Cormack Lehane Classication, both the groups had p value of 0.001 , which was highly signicant. CONCLUSION-When multiple predictors are taken into consideration there was a considerable reduction in false negatives with signicant improvement in accuracy of test and hence prediction of difcult laryngoscopy was made easy. Application of multiple predictors in combination can reduce the frequency of unanticipated difculty and unnecessary interventions related to over prediction of airway difculty.

Determination of Maxillary Incisal Edge Position using Canine Visibility as a Guide – An In vivo Study

Purpose: To evaluate the reliability of the visibility of the central incisor & the canine for the cervico incisal positioning of anterior maxillary teeth related to age & sex while the upper lip was in repose in dentate patients & the development of rehabilitation recommendations for edentulous individuals with regard to the location of the maxillary incisal edge Methodology: 308 subjects [152 Males & 156 Females] belonging to the age of 30 to 59 years were selected using a simple stratified random technique. There were three age and sex groups: Group I was 30 to 39 years old, Group II was 40 to 49 years old, and Group III was 50 to 59 years old. The vertical distances (in mm) between the lower border of the upper lip and the right maxillary central incisal edge and canine tip were measured and recorded using adhesive tape marked with millimetres. A single examiner recorded all the measurements and the values were tabulated and subjected to statistical analysis. Results: Men in Groups I and II had maxillary central incisor exposure ranging from +6 to -1mm, whereas males in Group III had exposure ranging from +5 to -2mm. There was an exposure range of +6 to -2 mm in females in Group I, +7 to -2 mm in Group II, and +5 to -2 mm in Group III for the central incisors. While the canine exposure in Group I and II and Group III ranged from +2 to -4mm in females, the exposure ranged from +3 to -3mm in men of all ages. In all groups, females had statistically significant (P0.05) more central incisor and canine exposure than men. Conclusions: The canine visibility was less variable in all the age groups and in both males and females in comparison to the central incisor. When restoring edentulous individuals, the average canine exposure dimension can be employed for cervico-incisal location of the anterior maxillary teeth.

Nevus pigmentado de junção

This paper presents besides concept and classification of Pigmented Nevus, a case report of a patient with Junctional Pigmented Nevus, localized in the internal mucous of let upper lip. The patient is a 26 years old black woman.