Bilateral temporomandibular joint reconstructions with stock alloplastic prostheses on a distracted mandible - A case report.

Background: The management of patients with a triad of temporomandibular joint (TMJ) ankylosis, retrognathia, and obstructive sleep apnea (OSA) has long been a matter of debate. Even though consensus favors distraction osteogenesis (DO) in the 1st phase of treatment to relieve the OSA, various treatment approaches for TMJ reconstruction after ankylosis release have been put forth. Most of the reconstructive modality has been focused on autogenous materials or customized TMJ prostheses after mandibular distraction.Case Presentation: The authors present a case of a patient with the triad of TMJ ankylosis, retrognathia, and OSA who underwent DO for correction of his OSA. This was followed by bilateral TMJ reconstruction with stock alloplastic prostheses on the distracted mandible, along with genioplasty to correct retrogenia.Conclusion: In this case, stock TMJ total joint prostheses were used successfully to treat bilateral TMJ ankylosis following previous surgery for mandibular distraction.

Hardware Removal in Maxillofacial Trauma: A Retrospective Study.

BACKGROUND: Miniplates are commonly used for the fixation of maxillofacial fracture segments. Removal of the hardware is controversial. A retrospective study of medical records was performed to observe the reasons for plate removal. MATERIALS AND METHODS: A 10-year retrospective study of medical records was performed. Demographics, type of fracture, location, type of miniplate used, the time gap between the insertion and removal, and causes of hardware removal were assessed. RESULTS: About 1472 patients had undergone internal fixation for the facial fractures. Stainless steel miniplate was used in 489 patients, and titanium was used in 983 patients. Out of the 42 cases, 22 cases involved the removal of titanium hardware and 20 patients involved the removal of stainless steel hardware. Infection/osteomyelitis was the main cause of hardware removal. The maximum amount of hardware failure was in the mandible. 78.6% of hardware removal was performed in males. CONCLUSION: Based on our study, routine removal of titanium miniplates can be performed in children to avoid growth disturbances, not indicated in adult patients unless symptomatic.

The Influence of the Suture-less Anterior Releasing Incision in a Triangular Flap Design on Postoperative Healing Following Surgical Removal of Impacted Mandibular Third Molars.

OBJECTIVES: The objective of this study was to determine the effect of suture-less anterior releasing incisions on postoperative wound healing following surgical removal of impacted mandibular third molars. MATERIALS AND METHODS: A total of 112 patients were included in the study. Group 1 had 56 patients in which the anterior releasing incision was not sutured postoperatively, and group 2 had 56 patients, in whom the anterior releasing incision was sutured. The two groups were compared in terms of pain, swelling, and trismus at 1 day, 3 days, and 7 days postoperatively. The Univariate Type III Repeated-Measures ANOVA Assuming Sphericity was used to compare the two modes of treatments at different time points. The periodontal healing distal to the second molar was assessed on the first day and at 2 months following the surgical intervention. The independent t test was used to compare the periodontal healing between the two groups at two time points. RESULTS: No significant difference was observed between the two groups for pain and trismus (P > 0.05). However, the swelling was significantly greater in group 2 as compared to group 1 (P < 0.001). Periodontal healing was better in group 2, which showed lower periodontal probing depth distal to the mandibular second molar, compared to group 1 (P < 0.05). CONCLUSION: Suture-less anterior releasing incision decreases the postoperative swelling and edema, but the periodontal healing was poor when compared to the sutured anterior releasing incision cases. The type of closure technique did not have any significant influence on pain and trismus.

Posttraumatic stress disorder among patients with oral and maxillofacial trauma in a South Indian population.

AIM: To determine the incidence and severity of Post-Traumatic Stress Disorder (PTSD) in maxillofacial trauma patients and to assess the predisposing factors. METHODS AND RESULTS: Post-Traumatic Stress Disorder (PTSD) was assessed as per the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. The PTSD checklist for DSM-5 (PCL-5), was used initially to screen patients for PTSD for a provisional diagnosis. These provisionally diagnosed patients were then subjected to a structured interview by a Clinician Administered PTSD Scale for DSM-5 (CAPS-5). The PTSD status outcome of PCL-5 and CAPS-5 were correlated. PTSD was compared among patients with different types of facial fractures/injuries and also compared based on their anatomic location. The reliability of PCL-5 scale in relation to the structured CAPS-5 was assessed and the specificity was found to be 71.4%. Patients with both aesthetic and functional deformity exhibited greater severity of injury and showed higher incidence of PTSD with higher conversion rate from the 1st month to 3rd month. The frequency of PTSD in deformities with higher severity like zygomaticomaxillary complex injuries was found to be statistically significant. CONCLUSION: A high incidence of PTSD is associated with maxillofacial trauma and early detection is essential.

The influence of the mandibular gonial angle on the occurrence of mandibular angle fracture.

BACKGROUND/AIMS: Angle fractures represent the largest percentage of mandibular fractures. They pose as a unique entity because of their codependent morphological dynamic factors, rendering the understanding of the mechanism, and treatment challenging. The aim of this study was to analyze the association between the mandibular gonial angle and the risk of mandibular angle fracture while highlighting its clinical relevance. MATERIALS AND METHODS: A retrospective analysis of radiographs of patients treated for mandibular fractures was done. The factors studied were as follows: the presence of a high gonial angle and an impacted third molar. The outcome was mandibular angle fracture. The gonial angle was measured using Planmeca Digital Software 3.7.0.R. Status of the third molar was also noted. Data obtained were analyzed using SPSS 22 (IBM Corp, Armonk, NY). RESULTS: The sample comprised 70 mandibular fractures (32 angle fractures and 38 non-angle fractures). The mean gonial angle in the angle fracture group was 128.5 ± 5.4º which was 10.2° larger than in the non-angle group (mean 118.5 ± 4.4º; P = 0.0001). Patients with a high gonial angle were 8.7 times more likely to sustain an angle fracture than those with normal or low gonial angles. A statistically significant relationship between the presence of impacted third molar and patients sustaining mandibular angle fractures was noted (P = 0.0001). CONCLUSION: Subjects with a high gonial angle and an impacted third molar are at an increased risk for mandibular angle fracture due to direct and indirect morphological factors.

Chronic recurrent osteomyelitis: A surgeon's enigma.

BACKGROUND: Chronic recurrent forms of osteomyelitis of the mandible with their morbid clinical course have long been considered a challenge to maxillofacial surgeons in terms of both diagnosis and treatment. Various classifications and treatments have been established through the ages to define and manage the inflammatory symptoms occurring in adults and children. This paper discusses two such entities occurring in an adult and a child, highlighting the diagnostic and treatment challenges of recurrent osteomyelitis. METHODS: A thorough workup which included clinical, radiographic, blood investigations was done, followed by administration of antibiotics and anti-inflammatory with or without surgical debridement/adjuvant therapies. Correlation of our findings and treatment plan was done with evidence-based literature and practice. RESULTS: Complete resolution of symptoms with radiographic evidence was achieved in both the cases. In the recurrence period, long-term steroids, NSAIDs, antibiotics resulted in better outcomes. CONCLUSION: The evidence-based protocol for osteomyelitis stresses on short inpatient stays predicated on efficient literature. Thorough clinical and radiographic evaluation with aggressive medical management and surgical intervention when necessary can result in longer symptom-free periods. Thus understanding the disease, recurrence pattern and response to therapy is essential.

A linguoverted impacted tooth with orocutaneous fistula - a rare case report.

The orocutaneous fistulous tract of odontogenic origin is often a diagnostic challenge, due to its rare manifestation and absence of dental signs and symptoms. The odontogenic cutaneous fistula is often misdiagnosed as a superficial skin lesion of non-odontogenic origin delaying the treatment. The diagnosis and treatment must be precise and swift to improve the clinical outcome and minimize the complications. This article presents a rare case of odontogenic keratocyst involving a linguoverted impacted third molar presenting as orocutaneous fistula. The patient was initially treated with empirical antibiotic therapy with no resolution of the cutaneous fistula and thickening of the skin around the sinus opening resulting in cosmetic deformity. Once the fistula was attributed to the underlying odontogenic cyst, treatment was done by cyst enucleation along with the extraction of tooth and fistula excision. The purpose of the paper is to emphasize the importance of early and accurate diagnosis and prompt management of the orocutaneous fistula due to the odontogenic origin.

Concomitant Temporomandibular Joint Ankylosis and Maxillomandibular Fusion in a Child with Klippel- Feil Syndrome: A Case Report.

Klippel-Feil syndrome (KFS) is classically characterized by fusion of any of the two of seven cervical vertebrae. It is identified by the presence of a triad of clinical signs including short neck, limitation of head and neck movements and low posterior hairline. Unusual bony malformations leading to facial asymmetry is the most common oral manifestation associated with KFS. Such maxillomandibular fusion can also result in restricted mouth opening in children. It's a challenge to provide complete rehabilitation in such children. This paper presents a report of a type II KFS with both maxillomandibular fusion and temporomandibular joint ankylosis which led to the limited mouth opening in a six-year-old child. Also, the child showed an inadequate development of speech, facial asymmetry and compromised oral health owing to the restricted mouth opening. After thorough investigations, surgery was done which restored limited mouth opening which led to normalizing of speech and oral health.

A Modified Peri-Angular Approach for Exposure of Condylar Fractures.

PURPOSE: To describe a modified peri-angular approach to address subcondylar and condylar neck fractures. MATERIALS AND METHODS: A modified peri-angular incision is used to approach a fractured condyle through the anteroparotid transmasseteric approach. RESULTS: In the authors' experience, this method provides quick and clean exposure to the fractured condylar base and neck fractures for open reduction and internal fixation. CONCLUSION: Although the peri-angular approach has been discussed in the literature, the authors' modification lessens the chance of complications, such as marginal nerve injury and parotid fistula formation, because the nerve is visualized and kept isolated throughout.

Rare case of giant unicystic ameloblastoma: Luminal variant.

OBJECTIVE AND IMPORTANCE: Ameloblastoma is a locally aggressive benign tumor, commonly occurring in the mandible. While giant ameloblastoma of multicystic or plexiform variant have been reported, the authors report a rare case of giant unicystic ameloblastoma of luminal variant, which was treated by compartmental resection and planned for delayed reconstruction. CLINICAL PRESENTATION: A 46 year old male patient reported to the oral surgery out-patient department with a swelling of the left side mandible region of 2 years duration. He had undergone ayurvedic treatment for the same with no improvement. The size of the lesion on presenting was approximately 9 × 12 cm. INTERVENTION: Compartmental resection with plan for secondary reconstruction, after adequate follow up period. CONCLUSION: While conservative management is being explored as a treatment option for unicystic ameloblastoma, resection is still the standard of care regardless of the histopathological subtype for giant lesions.

Pernicious Effects of Toe Sucking Habit in Children.

Digit sucking is common nonnutritive sucking habit in childhood. However it is unusual to find toe sucking habit in children. We report a case of a seven-year-old child sucking great toe of the left foot. The child was referred by her paediatrician for dental evaluation due to her complaint of recurrent episodes of pyrexia. A dental evaluation was warranted as no particular system contributed to such recurrent episodes of fever in this child. Although dental examination did not reveal any cause for recurrent episodes of pyrexia, as a part of routine history taking we discovered that this child indulges frequently in sucking the great toe of her left foot since infancy. Any nonnutritive sucking habit is considered deleterious; this habit also caused significant effect on the child's dentofacial structures, sucked toe, and her general health. Hence the treatment plan was formulated for immediate cessation of habit. Appropriate interception of habit and timely orthodontic intervention led to not only early interception of cross-bite but also decrease in pyrexial episodes. This case report describes the pernicious effects of toe sucking habit and its relevance to recurrent pyrexia in children.

Our Experience in the Management of Traumatic Wound Myiasis: Report of 3 Cases and Review of the Literature.

Compromised health and hygiene can lead to many complications and one among them is traumatic wound myiasis. Myiasis is the invasion of living tissues by larvae of flies. Three cases of traumatic orofacial wound myiasis and treatment strategies followed for the management of them are reported in this paper.

Fabrication of a surgical splint in an emergency situation: a clinical report.

Fractures involving pediatric jaws most often require a splint to prevent the fragments from being displaced; however, impression making presents a challenge. This article describes the fabrication of a surgical splint over an ideal cast, which is subsequently refitted with a tissue conditioner onto the patient's jaw. The highlight of this technique is the elimination of an impression procedure, thereby reducing clinical and laboratory time and easing pain in the child.

Current perspectives in intra operative airway management in maxillofacial trauma.

OBJECTIVE: Maxillofacial trauma presents a complex problem due to the disruption of normal anatomy. In such cases, we anticipate a difficult oral intubation that may hinder intraoperative IMF. Nasal and skull base fractures do not advocate use of nasotracheal intubation. Hence, other anesthetic techniques should be considered in management of maxillofacial trauma patients with occlusal derangement and nasal deformity. This study evaluates the indications and outcomes of anesthetic management by retromolar, nasal, submental intubation and tracheostomy. METHODOLOGY: Of the 49 maxillofacial trauma cases reviewed, that required intraoperative IMF, 32 underwent nasal intubation, 9 patients had tracheostomy, 5 patients utilized submental approach and 3 underwent retromolar intubation. RESULTS: Among patients who underwent nasal intubation, eight cases needed fiberoptic assistance. In retromolar approach, though no complication was encountered, constant monitoring was mandatory to avoid risk of tube displacement. Consequently, submental intubation required a surgical procedure which could result in a cosmetically acceptable scar. Though invasive, tracheostomy has its benefits for long term ventilation. CONCLUSION: Intubation of any form performed in a maxillofacial trauma patient is complex and requires both sound judgement and considerable experience.