Management of Persistent Diplopia and Epiphora in Mismanaged Orbital Blowout Fracture - A Case Report.

ABSTRACT: A 31-year-old male with a history of right zygomaticomaxillary complex (ZMC) fracture presented with aesthetic concerns, continuous tearing, and double vision. The patient had undergone multiple surgeries post accident, resulting in an asymmetrical cheek bulge, persistent diplopia, and epiphora. Investigations revealed abnormal placement of an orbital mesh and damage to the lacrimal sac. A surgical plan was devised to remove the plates, reposition the muscles, secure the floor, correct the epiphora, and provide the desired aesthetics. The surgery involved removal of the mesh and a long plate, refracturing of the zygoma, approximation and securing of the fractured zygoma with plates, and creation of an osteum on the lateral wall of the nose. Post-operatively, the patient's healing was uneventful and he was satisfied with the outcome. This case underscores the importance of a proper surgical technique and patient-centered care in managing complex facial fractures.

Decannulation Dilemmas - Timing Tracheostomy Tube Removal in Children with Craniofacial Deformities - A Retrospective Study.

Introduction: Tracheostomy decannulation in children with craniofacial deformities poses challenges due to airway obstruction and the developing brain. This study aimed to compare decannulation outcomes based on age at tracheostomy and duration of cannulation so as to identify the best time for decannulation for children with long-term tracheostomy. Methods: This retrospective study included 12 children at a single centre who underwent decannulation after prolonged tracheostomy for craniofacial deformities. Data on demographics, clinical features, decannulation process and outcomes were collected. Children were divided into two groups: ≤6 years (n = 7) and >6 years (n = 5) at tracheostomy insertion. Results: All children underwent successful decannulation without immediate complications. One case of mild tracheomalacia and one of subglottic stenosis were treated pre-decannulation. Children ≤6 years demonstrated better post-operative adaptation in swallowing and speaking compared to the >6 years group. Notably, early and prolonged tracheostomy in the ≤6 years group was associated with easier adaptation post-decannulation. Social interaction was another challenge, particularly for the >6 years group. Discussion: The timing and duration of tracheostomy significantly impacts post-decannulation adaptation, likely due to factors such as neuroplasticity, muscle memory and psychological adjustment. This emphasises the need for comprehensive care, especially for older children. Early tracheostomy in children may allow them to adapt speech and swallowing skills, easing post-decannulation regain of skills. Conversely, older children with fully developed skills may struggle to relearn them after tracheostomy and decannulation. Age at tracheostomy and duration of cannulation influences decannulation outcomes in children with craniofacial deformities. Further research is crucial to develop targeted interventions for better post-operative care, particularly for older children.

Maxillomandibular Fusion Along with Fusion of Dorsal Surface of the Tongue to the Hard Palate-A Case Report.

RATIONALE: This case report presents a rare combination of congenital anomalies in an otherwise healthy male infant born at 36 weeks. The infant was diagnosed with congenital maxillomandibular synechia, ectrodactyly, and ankyloglossia superior syndrome (ASS). PATIENT CONCERNS: Inability to open the mouth completely, feeding challenges, and a cleft palate. The infant was stabilized through successful positive pressure ventilation via a face mask at birth and enteral feeding was initiated via a feeding gastrostomy. EXAMINATION: Diagnostic tests revealed a midline palatal cleft, hypoplastic jaws, persistent metopic suture, and a bony fusion at the midline. TREATMENT: Sectioning of the bony spur along the midline and achieving a mouth opening of 2 cm post-manipulation. The patient is under follow-up, with future treatment plans including cleft palate correction at 12 months and potential frontomandibular and lower jaw advancement depending on growth trajectories. TAKEAWAY LESSONS: This case underscores the complexity of managing multiple congenital anomalies and the need for individualized treatment plans.

Median mandibular cleft in SAMS syndrome - A rare case report.

Rationale: SAMS syndrome is a rare genetic disorder characterized by midline facial clefting, skeletal anomalies, and other defects. Salient Features: Among the craniofacial manifestations of SAMS syndrome is the presence of a median mandibular cleft (MMC). MMC is a rare occurrence and in this syndrome, it poses a complex challenge for both functional and aesthetic reasons. Patient. Findings: This rare case report describes the successful correction of an MMC in an 18-month-old child diagnosed with SAMS syndrome. Treatment: This report describes the presentation, diagnosis and treatment. The surgical intervention involved a meticulous, single stage, osseous reconstruction. The mechanism of MMC in SAMS syndrome is discussed. Outcomes: Early intervention for MMC in SAMS syndrome patients can offer promising outcomes.

'Frozen eye' - Post blowout fracture surgical correction - A case report.

The Rationale: "Frozen Eye" is a very uncommon sequel after treatment of orbital blowout fractures requiring implant placement. Patient Concerns: The implant may faultily impinge on the ocular and extra-ocular muscle(s), causing the abnormality in the movement of the eye. Diagnosis: We present a 56-year-old male whose ocular implant impinged on muscle, causing "frozen eye" and had an infected implant. Treatment Outcomes: The same was removed and surgically corrected. The manuscript describes the details and discusses the possible mechanism that led to the "Frozen Eye".

Modified Placement of C-flap in Unilateral Cleft Lip Repair to Avoid Alar Base Scar - A Retrospective Study.

Introduction: In spite of several techniques, Millard's approach for the correction of cleft lip still is widely used. Although versatile, it has certain drawbacks including scar contraction, short lip and notching. A modification of the 'C' arm helps to address this drawback. The purpose of this study was to describe the qualitative and quantitative outcomes of the author's modification of Millard's C flap. Materials and Methods: Archival photographic records of cleft lip repairs and post-operative photos of cases treated by author were screened. Anthropometric measurements of the height and width of the lip, the height of the vermilion and the width of the alar base were considered. The outcome was quantified by comparing the ratio of each feature between the cleft and normal sides. The quality of cleft lip repair was assessed using the Steffensen criteria. Appropriate statistical tests were performed. Results: In all, 233 cases with a mean age of 4.46 ± 0.91 years and 106 (45.5%) males formed the study group. The mean lip height ratio was 0.936 ± 0.04, the mean lip width ratio was 0.938 ± 0.037, the mean vermillion height ratio was 0.9433 ± 0.35 while the mean alar base width ratio was 0.932 ± 0.35. The physical parameter ratios' mean difference between the normal side and the cleft side was below 0.06 mm. Discussion: The mechanism behind the drawback of the classical Millard's technique is discussed and compared with present modification. The authors' modification shows that modified Millard's technique produces better aesthetic outcomes.

Rare case of granular cell tumour at 16 years - A case report.

Rationale: Granular cell tumours (GCTs) of the tongue are a rare, soft tissue pathological entity at young ages. This case report aims to present one such case. Patient Concerns: A 16-year-old female patient sought treatment for a small, slow-growing, painless nodule in the dorsum of the tongue since six months. She underwent successful orthodontic treatment in recent past and is in the retention phase. Diagnosis: Excisional biopsy revealed the lesion to be a GCT under histopathology. Treatment: The patient was treated for an abnormal, small, slow-growing, painless nodule in the dorsum of the tongue. Outcomes: The patient had satisfactory esthetics and early diagnosis. The active intervention dispelled the confusion about the role of trauma and orthodontics appliance in the etiology of GCT in this particular case to the patient. Take-away Lessons: GCT can occur at any age. Early diagnosis and corrective surgery would help to avoid late complications.

Rigid versus Resorbable Plate Fixation in Fronto-Orbital Advancement in Unicoronal Stenosis - A Retrospective Study.

Introduction: Rigid plating fixation (RPF) and resorbable plating systems (RPS) advanced the field of reconstruction in craniomaxillofacial region. However, their performance in patients, particularly the effect on bone remodeling at site of hardware placement is not much documented. This manuscript aims to compare the performance of RPF and RPS in a cohort using a retrospective audit of case records. Methods: Archival records were searched for patients who had undergone cranial metal-RPF or RPS or combination for the correction of craniofacial deformities following inclusion-exclusion criteria. From records, data of the quality and quantity of bone formed along the site of plate fixation as compared with the adjacent site, accommodating or facilitating brain growth, and persistence of bone deformity at the site of hardware placement were collected at the end of the follow-up period. A total of 128 sites from 18 individuals (6 with exclusive metal-RPF and 12 with RPS) mean age of 7.45 ± 7.28 (Median 4; IQR of 8.88;2.6-11.5) who underwent cranial bone remodeling surgery formed the study group. Results: There was a statistically significant difference between the RPF and PRS system at the fronto-orbital suture (P = 0.002) and coronal suture (P = 0.036) with bone quality and quantity. Discussion: The RPF system was rigid but had a set of issues, while RPS has advantages and limitations. The qualitative difference in between the two systems is different. Due to inherent dissimilarity, the two systems cannot be interchanged and due diligence has to be exercised while deciding on the system. More prospective studies are needed to validate the findings.