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PATIENTS DIARY Date:-

Name:- Age:-
Gender:- Sex:-
Address:-
Phone no:-


Surgery 1

Tooth extraction no :- X-ray picture:-


MOUTH OPENING
Mouth opening before surgery:-
Mouth opening on 2
nd
day(in mm):-
Mouth opening on 7
th
day(in mm):-






FACIAL SWELLING (2
nd
day)
a)The distance (mm) between the lateral corner of the eye and the angle of
the mandible._______
b) The distance (mm) between the tragus and the outer corner of the
mouth._______
c) The distance (mm) between the tragus and the soft tissue pogonion.______

FACIAL SWELLING (7
nd
day)
a)The distance (mm) between the lateral corner of the eye and the angle of
the mandible._______
b) The distance (mm) between the tragus and the outer corner of the
mouth._______
c) The distance (mm) between the tragus and the soft tissue pogonion.______

Difference between the swelling on 2
nd
post-operative day and
7
th
postoperative day (in mm):________.









VAS SCALE


0 hrs:-
30 min:-
1 hr:-
12hr:-
24hr:-
48hr:-

Time of first perception of pain:-________(hh:mm)

Duration of surgery after anesthetic administration:- ________

Efficacy of piroxicam (Likert scale):-
Excellent Very Good Good Fair Poor




Rescue medication if required:-
Time :-_______ Amount:-_______

Any adverse reactions noted:-

-Notes-






Surgery 2

Tooth extraction no :-

MOUTH OPENING
Mouth opening before surgery:-
Mouth opening on 2
nd
day(in mm):-
Mouth opening on 7
th
day(in mm):-






FACIAL SWELLING (2
nd
day)
a)The distance (mm) between the lateral corner of the eye and the angle of
the mandible._______
b) The distance (mm) between the tragus and the outer corner of the
mouth._______
c) The distance (mm) between the tragus and the soft tissue pogonion.______

FACIAL SWELLING (7
nd
day)
a)The distance (mm) between the lateral corner of the eye and the angle of
the mandible._______
b) The distance (mm) between the tragus and the outer corner of the
mouth._______
c) The distance (mm) between the tragus and the soft tissue pogonion.____


Difference between the swelling on 2
nd
post-operative day and
7
th
postoperative day (in mm):________.







VAS SCALE


0 hrs:-
30 min:-
1 hr:-
12hr:-
24hr:-
48hr:-

Time of first perception of pain:-________(hh:mm)



Duration of surgery after anesthetic administration:- ________









Efficacy of piroxicam (Likert scale):-
Excellent Very Good Good Fair Poor

Rescue medication if required:-
Time :-_______ Amount:-_______


Any adverse reactions noted:-


-Notes-