Management of a case of osteoma of coronoid: A rare case report.

Coronoid process osteoma is an extremely unusual and slow growing tumor which causes functional limitations of the temporomandibular joint. Till december 2014 only 7 cases have been reported worldwide. This case report is about a 40 year old male patient with osteoma of left coronoid process. Treatment plan constitutes of surgical resection of the mass and post operative physiotherapy.

Role of platelet rich fibrin and platelet rich plasma in wound healing of extracted third molar sockets: a comparative study.

AIMS AND OBJECTIVES: This prospective study was done to evaluate and compare the utility and effectiveness of platelet rich fibrin (PRF) with that of platelet rich plasma (PRP) on soft tissue healing and bone tissue healing of extracted third molar sockets. MATERIALS AND METHODS: This study included split mouths of 20 patients who underwent bilateral extraction of impacted third molars. During the same appointment, following which PRF and PRP were prepared from patients' autologous blood and placed in right and left extracted sockets, respectively. The data for soft tissue healing were recorded at end of 1 week, using healing index of Landry et al. and the data for bone tissue healing were recorded at the end of 4 months using digitalized orthopantomogram images on Adobe Photoshop CS; which was then compared between the two sites of the same patient. RESULTS: The mean values of soft tissue healing collected at 1 week post-operative, for PRF group were significantly higher as compared to PRP group. And the mean values of bone density collected at the end of fourth month post-operative, for PRF group were also significantly higher as compared to PRP group. Both tests showed p value of 0.00. CONCLUSION: PRF is significantly better in promoting soft tissue healing and also faster regeneration of bone after third molar extraction, in comparison with PRP. This could be attributed to simpler preparation protocols of PRF over PRP and the ability of PRF to release growth factors in a controlled way.

Massive ossifying fibroma of mandible.

Ossifying fibroma is a benign bone neoplasm often considered to be a type of fibro-osseous lesion. Its origin is believed to be from periodontal membrane, and it shows more predilection toward females. Mandible is more commonly affected than maxilla. This bone tumor consists of highly cellular, fibrous tissue that contains varying amounts of calcified tissue-resembling bone, cementum, or both. Radiographically, the lesions are either completely radiolucent or mixed, depending on the amount of calcification, or are completely radiopaque and surrounded by a radiolucent rim. Ossifying fibroma requires radical surgery, because of the tendency for recurrence and possibility of malignant transformation. Here, we have presented a case of massive ossifying fibroma of mandible in an 80-year-old female.

Detection of Bacterial Flora in Orofacial Space Infections and Their Antibiotic Sensitivity Profile.

INTRODUCTION: Most odontogenic infections arise as a sequel of pulp necrosis caused by caries, trauma, periodontitis, etc. They range from periapical abscesses to superficial and deep infections in neck. Some resolve with little consequence and some lead to severe infections of head and neck region. The purpose of this study was to identify microbial flora present in orofacial space infection of odontogenic origin and thereby provide better perspective in management of odontogenic infection. MATERIALS AND METHODS: Twenty-six patients with space infection of odontogenic origin were selected irrespective of their age and gender. Pus samples were collected and processed in the microbiology laboratory for the growth of anaerobic and aerobic bacteria and antibiotic sensitivity profile. RESULTS: Demographic profile of the patients showed that male patients were more commonly involved and most patients fell in to the third and fourth decade of age groups. Most common site of involvement was submandibular space. Alpha hemolytic streptococci were the frequent aerobic bacterial isolate and among anaerobes, anaerobic streptococci followed by bacteroids were the major pathogens. Clindamycin, Gentamycin, Linezolid, Imipenam were the most effective antibiotics. 20 % of the aerobes were resistant to penicillin. CONCLUSION: Streptococcus species are still the commonest pathogen in orofacial infections of odontogenic origin. Administration of amoxicillin clavulanic acid combination and metronidazole followed by surgical drainage of abscess and extraction of infected teeth, yielded satisfactory resolution of infection.

Biomechanical and finite element analysis of mandibular vertical ramus marginal resection designs.

This study aims to know the post-surgical Von Mises stress of the mandible after two different vertical ramus marginal resection designs, analyze the results, compare with stress pattern of normal adult mandible without simulation and infer regarding the better of the two. Three groups of 3D finite element models of human adult mandibles were created. Group I (control)-normal mandible. Group II: Mandible with a quadrilateral vertical ramus marginal resection simulated. Group III: Mandible with an arc shaped vertical ramus marginal resection simulated. Finite element analysis (FEA) models were subjected to a point load of 475 N over right and left first molars, along with masticatory loads of masseter, medial pterygoid, anterior belly of digastric and temporalis loads in varying combinations (with and without bilateral temporalis and without right temporalis). The models were analyzed to infer the overall Von Mises stress in (a) the mandible (b) the sigmoid notch (c) postero-inferior resection corners. Results of our present study provides scientific evidence for the common practice of using arc form for marginal resection of vertical ramus of mandible whenever executed. Scientific evidence behind the concept of marginal resection of horizontal ramus is available but only scanty biomechanical evidence using finite element method (FEM) is available behind the same when performed in the vertical ramus, as magnitude and direction of loads in this region vary when compared to the horizontal ramus. The results ratify that incorporating arc shaped design pattern and removal of ipsilateral temporalis load by removal of coronoid, an area prone to stress concentration on loading, significantly decreases the post surgical Von Mises stress and hence would reduce the progressive micro-damage of the mandible after marginal resections of the vertical ramus of mandible.

Finite Element Analysis: A Maxillofacial Surgeon's Perspective.

The science of finite element analysis (FEA) is purely a mathematical way of solving complex problems in the universe. In medical field, this is an innovation in biomedical research and development, as it gives easier mathematical solution to biological problems. This article deals with the understanding of various basic material properties of bone like Young's modulus, yield strength, Bulk modulus, shear modulus, Poisson's ratio and density from a maxillofacial surgeon's perspective. Basic concepts in FEA, its application, advantages, disadvantages, and limitations in the field of maxillofacial surgery have been discussed. The importance of surgical fraternity to be in coordination with evolving technologies has been emphasized for the future of evidence based practice of oral and maxillofacial surgery.

The versatility of temporalis myofascial flap in maxillo-facial reconstruction: a clinical study.

OBJECTIVES: This clinical study was conducted in the department of Oral & Maxillofacial Surgery, at our institute, to study the versatility of temporalis myofascial flap in maxillofacial reconstruction. METHODS: The study group comprised of 20 patients, both male and female patients between the age group of 6 years and 60 years underwent surgery under general anesthesia and temporalis myofascial flap was used for reconstruction of various types of maxillofacial defects including maxillectomy defects arising as a result of ablative surgery for tumors and treatment of aggressive cysts, as an interposing material in TMJ ankylosis surgery and facial reanimation in cases of long standing facial nerve paralysis. Following surgery the cases were evaluated for clinical parameters weekly for first post-operative month followed by monthly review for a minimum period of one and maximum of three years from January 2003 to June 2006. RESULTS: Temporalis myofascial flap fared well in 16 out of 20 cases (80%), in remaining four cases (20%) three reported back with reankylosis, and in one case of facial reanimation flap breakdown occurred due to infection leading to failure of the procedure. CONCLUSION: The temporalis myofascial flap is a versatile option for reconstruction of moderate to large sized maxillofacial defects, the muscle can provide abundant viable and vascular tissue, with minimal to no functional morbidity or esthetic deformity at the donor site.

Comparison of circummandibular wiring with resorbable bone plates in pediatric mandibular fractures.

Pediatric patients present a unique challenge to maxillofacial surgeons in terms of their treatment planning as well as in their functional and nutritional needs which are different from that of adult patients. Early literature has advocated conservative closed management of pediatric fractures to prevent complications. However recent advances in maxillofacial surgery has enabled us to use biodegradable plates and screws, which overcomes the limitations of metallic plates. We present a comparison of two cases of parasymphysis fracture treated with circum-mandibular wiring and biodegradable plate fixation their outcome in terms of fracture healing and functional stability.

Central schwannoma of mandible.

Intraoral schwannomas are uncommon and intraosseous ones are even rarer. The intrabony lesions account for less than 1% of the central neoplasms.According to the literature, there have been reports of 44 cases of intrabony neurilemmomas that occurred in either of the jaws. In theis case report. we report a case of central schwannoma of the mandible in a 23-year-old female, who presented with a swelling involving the right body of the mandible. Radiographs revealed a well defined, unilocular radiolucency with bicortical expansion. Histopathology and immunohistochemistry confirmed the diagnosis of schwannoma arising from right inferior alveolar nerve. The lesion was treated by segmental resection and reconstructed with autogenous iliac bone graft.

A comparative evaluation of rhytidectomy versus retromandibular approach for Open Reduction and Internal Fixation (ORIF) of mandibular condylar fractures.

OBJECTIVE: This clinical study was carried out on thirty patients who underwent open reduction and internal fixation for condylar fractures via rhytidectomy/retromandibular approach were evaluated. METHODS: Group I (rhytidectomy approach) were compared and evaluated clinically and radiologically with Group II (retromandibular approach) for the following parameters like surgical access, duration of surgery, anatomic reduction assessment with relevant radiographs, occlusal discrepancies, need for post operative IMF, facial nerve morbidity, other post operative complications and scarring. RESULTS: There was a statistically significant difference between the two groups in the duration of surgery which was found to be significantly lesser for group II than group I. Access was better in group I. Scar was well camouflaged in patients of Group I when compared to group II. CONCLUSION: The rhytidectomy (Face-lift) incision which we have used in our study has all the advantages of the retromandibular approach with an added advantage of a less conspicuous scar and a wider exposure of the fracture site. The only disadvantage is the added time required for the closure which is not a concern as the aesthetic outcome of this technique is superior to the other approaches.

A comparison between 2.0-mm standard and 2.0-mm locking miniplates in the management of mandibular fractures.

PURPOSE: The purpose of this clinical study was to compare effectiveness of 2.0-mm locking miniplates and screws with 2.0-mm standard miniplates and screws in treating mandible fractures. PATIENTS AND METHODS: A randomized prospective study comprising of 40 samples, where 20 patients (group 1) were treated with locking plates and 20 patients (group 2) were treated with standard miniplates. All the cases were evaluated for the type of fracture, need for the Intermaxillary Fixation (IMF) and its duration, duration of surgery, anatomic reduction, paresthesia / neurosensory changes, occlusal discrepancies, infection at the fracture site and any need for the removal of the plates and screws. RESULTS: In our study Road Traffic Accidents (RTA) accounted for the majority of patients 30 (70%). RTA was more prevalent (52.5%) in 21-30 age group, with assault being more common (67%) in 25-35 years. There was a significant difference between group 1 and 2 in postoperative occlusal discrepancy and need for IMF (p=0.008). There was no significant difference in complication rates between group 1 and group 2 patients. CONCLUSION: Locking plate/screw system proved to be more rigid than conventional plate/ screw system, thereby reducing the need and duration of IMF. However there was no significant difference in complication rates.

A study on coronal incision for treating zygomatic complex fractures.

OBJECTIVE: To study the value of coronal incisions for treating zygomatic complex fractures and evaluate the advantages, indications and complications associated with it. METHOD: In this prospective study, 12 patients were randomly selected regardless of age, sex requiring open reduction and internal fixation of communited zygomatic complex fractures with or without other associated fractures of the midface. Patients were all treated by coronal approach for open reduction and internal fixation of fracture of the zygomatic complex. Other local incisions were used if required. RESULTS: In all cases postoperative complications were relatively minor except in one case were the temporal branch of facial nerve weakness persisted at 3 months. Whereas 5 cases reported with slight weakness of the temporal branch of the facial nerve which resolved at the end of 3 months. The time taken for exposure of the fracture site via the coronal incision had a mean of 28.7 minutes. There were no cases of flap infection and just 1 case of stitch abscess reported. The same case later reported with a hypertrophic scar formation of greater than 0.5cm at 3months. In all other cases scar formation was negligible and well hidden within the hairline. There were no reported cases of paraesthesia at the operated site or hollowing of the temporal fossa. CONCLUSION: The coronal incision provides excellent access to the zygomatic arch and zygomatic complex, aiding in good anatomical reduction and also has the added advantage of the scar hidden in the hairline. It also has disadvantages like long operating time, risk of facial nerve injury, scarring in patients with male pattern baldness, paraesthesia of operated site etc. Therefore the incision should be judiciously used and not overused and indications strictly applied.

Use of a modified epidural catheter for analgesia after iliac crest bone procurement.

BACKGROUND AND OBJECTIVES: Autogenous bone grafting is the gold standard procedure for various maxillofacial defects which needs surgical correction and anterior iliac crest is the most common site of harvest. Immediate postoperative pain at the harvested site is a major morbidity associated with it. The aim of the study was to assess the immediate postoperative pain control at the iliac crest graft harvested site by placing an epidural catheter in the incision wound and continuously infiltrating bupivacaine 0.25% at regular intervals. MATERIALS AND METHODS: Twenty patients requiring autogenous bone grafting for large maxillofacial defects were chosen for the study. They were divided randomly into two groups of ten each. Group 1 patients were placed with epidural catheter in the incision wound at iliac crest harvested site and group 2 patients did not receive epidural catheter. Continuous infiltration of long acting amide local anesthetic (Bupivacaine) was given to group 1 patients on the postoperative day. Both group 1 & group 2 patients received parenteral analgesic Diclofenac sodium 75mg intramuscularly. Pain at the iliac crest and maxillofacial area was assessed by VAS scale. Also the time of ambulation of the patient was noted. These variables were compared statistically. RESULTS: The observed findings were statistically analyzed. Group 1 patients showed significant pain relief at the graft harvested site as compared to group 2 patients. Also the patients in group 1 were ambulated early as compared to group 2 patients. INTERPRETATION AND CONCLUSION: It was concluded that by placing epidural catheter at the incision wound and continuously infiltrating with bupivacaine 0.25% at iliac crest harvested site at regular intervals effectively controls the immediate acute pain postoperatively and the patient can be ambulated and brought back to normal routine early.