Factors Influencing Outcome of Orbital Floor Reconstruction.

Introduction Orbital floor fractures are routinely encountered in facial trauma. Many factors influence the final outcome of the orbital floor surgery, time interval and the extent of other facial bone fractures are the two factors which can significantly influence the postoperative outcome following orbital floor reconstruction. Our study aims to find the ideal time for intervention and the association of other factors in the final outcome of orbital floor reconstruction. Methods A retrospective and prospective cohort study of patients who were operated at Pondicherry Institute of Medical Sciences for orbital floor fractures, between 2011 January and 2017 July. All the data were entered on an Excel work sheet and statistically analyzed. Results In our study 8 patients (8/29, 27.58%) had diplopia prior to surgery, 5 patients (5/29, 17.24%) had complete recovery following surgery and 3 patients (3/29, 10.34%) had persistence of diplopia postoperatively. Patients with diplopia operated prior to 7 days were found to have significant improvement in postoperative diplopia. Patients with 5 or more facial fractures were found to have persistence of diplopia, infraorbital numbness, and enophthalmos postoperatively. Conclusion Our study suggests that early intervention, before 7 days improves the outcome in patients with diplopia and provides a better result postoperatively. In our study preoperative diplopia and infraorbital numbness and postoperative persistence of enophthalmos, diplopia, and paresthesia were found more in patients with 5 or more facial bone fractures. Our study suggests a poor postoperative outcome when 5 or more facial bones are fractured.

Assessment of temporomandibular joint dysfunction in condylar fracture of the mandible using the Helkimo index.

INTRODUCTION: Condylar fractures of the mandible are functionally important fractures as the condyle of the mandible being a part of the temporomandibular joint (TMJ) and can lead to TMJ dysfunction if not properly treated. MATERIALS AND METHODS: This was a cross-sectional study of a total of 33 treated patients with fracture of the mandibular condyle who underwent examination as per the Helkimo index. Their dysfunction was quantified and clinicoepidemiological characteristics were assessed. It was found that majority of our patients were young males involved in a two-wheeler accident. All patients underwent intermaxillary fixation as the minimum treatment and 30% underwent open reduction and internal fixation in addition. RESULTS: There was no statistically significant association between the degree of clinical dysfunction and factors such as age, mechanism of injury, type of condyle fracture, presence of other mandible fractures, and surgical procedure. However, dislocation of the mandibular condyle was found to be a negative prognostic factor and all these patients had some degree of dysfunction. CONCLUSION: The overall prevalence of TMJ dysfunction according to the Helkimo index was 90%. About 61% of patients had mild dysfunction (Di1) and 30% had moderate dysfunction (Di2). None of the patients had severe dysfunction. To conclude, the Helkimo index is a simple, effective, inexpensive, reliable screening index to assess TMJ dysfunction in condylar fractures of mandible.

An unusual foreign body in the infratemporal fossa.

Infratemporal fossa injuries are uncommon and often go undetected presenting later with complications. We present a case of an infratemporal fossa penetrating injury with a ball point spring following a vehicular accident. Post-traumatic trismus even following supposedly trivial injury in the area should raise suspicion of possible injury in this location.

Complex Traumatic Facial Degloving Injury.

By definition, degloving is detachment of skin and subcutaneous tissue, most often affecting the limbs and extremities and occasionally the scalp. Degloving generally occurs from high-energy trauma. This paper describes a patient of traumatic facial degloving injury. This is an extremely rare condition, as the patient survived despite the risk of imminent death. This patient report addresses the decisions made regarding the emergency management, prevention of necrosis and infection by surgical debridement, and timely repair of the vital soft tissue structures that guided the management.

Insulin injection site dystrophic calcification with fat necrosis: a case report of an uncommon adverse effect.

We report a case of an uncommon adverse effect of insulin injection resulting in hard subcutaneous swelling in the lower abdomen of a 47-year-oldfemale with type 1 diabetes. Extensive dystrophic calcification and fat necrosis was revealed on histopathological examination.

Temporary ectopic testicular replantation, refabrication and orthotopic transfer.

Bilateral traumatic castration if left untreated can result in permanent sexual, social and psychological maladjustments. We hereby report a novel procedure of temporary ectopic replantation of a traumatically avulsed testis on the forearm with refabrication and subsequent successful orthotopic microsurgical transfer to the perineum. The significance of this replantation is related to the refabrication of a long pedicle for subsequent reattachment to the perineum. This would not have been possible but for the ectopic replantation.

Case report of orbital lymphoma associated with polycystic disease: a coincidence?

The most common known extra renal malignancy associated with polycystic kidney disease (PKD) is of pancreatic origin. Here we report a case of orbital lymphoma in a patient with PKD. This might just be a co-incidence or there might be some genetic interaction.