Multidisciplinary management of temporomandibular joint ankylosis in an adult: journey from arthroplasty to oral rehabilitation.

Ankylosis of the temporomandibular joint is a debilitating condition resulting in progressive trismus and facial disfigurement. Common trigger factors include paediatric mandibular trauma, middle ear infection or traumatic childbirth. Although diminishing in incidence among urban population, it is still prevalent in the underprivileged world. Substandard child safety norms, delayed presentation, lack of access to specialties like maxillofacial surgery in rural areas and absence of follow-up contribute to ankylosis. Afflictions in ankylosis are multipronged, involving aesthetic, functional, psychological and nutritional implications to name a few. The damage this pathology causes to the young mind and their morale is humongous. Although well documented, a complete presentation of cases with follow-up till oral and myofascial rehabilitation is seldom reported. This paper describes multidisciplinary management of a young female patient with temporomandibular joint ankylosis. Staged management commencing from interpositional arthroplasty until dental restoration with a 2-year follow-up is presented in this paper.

Submental intubation.

MacInnis and Baig modified Altemirs' original technique for sub-mental intubation. Instead of a lateral entry, they described a central entry just anterior to the sub-mental crease that does not carry the risk of damage to the lingual nerves, submandibular ducts and sublingual glands. We describe here our experience with this modified sub-mental intubation that also allows the operating surgeon to provide for a correct midline and optimal esthetics in case of panfacial trauma.

Intra-oral Plastic Pressure Dressing: A Technical Note.

Post-operative swelling in the maxillofacial region is a common finding, especially in the cheek region. There is abundance of soft tissue and lack of any anatomical barrier to inhibit the swelling in the cheek region. External pressure dressing is the most commonly followed norm along with steroids. This protocol usually is insufficient to counter the swelling. In our Technical note we are describing a technique of use of intra-oral plastic sheet pressure dressing along with the conventional treatment protocol. The use of intra-oral plastic sheet is a cheap, safe, readily available in the OR and effective method of compression dressing.

Penetrating skull injury with six inch fence rod.

In this study we are describing an unusual case of the boundary fence (6 inch long) penetrating through the skull vault and lodging into the middle cranial fossa. A 10 years old male child fell onto his house fence while playing on the terrace. The metal fence penetrated through the scalp, parietal bone, midbrain and the midface, fracturing the parietal and the midfacial bones. CT-scans were obtained to view the trajectory and the position of the fence. The amount of midbrain injury was also accessed. The degree of morbidity vis-à-vis the type of injury was surprisingly low. Safe access to the fence was made through a bicoronal incision and modified bifrontal craniectomy to retrieve the lodged portion of the fence. These kind of penetrating injuries are rare considering the thickness of the vault. Proper preoperative planning and team approach is required for the safe surgical removal of the objects.