Treatment Effect of Combined Surgical Maxillary Expansion and Mandibular Setback in Skeletal Class III.

The purpose of this case report is to describe and discuss a combined surgical and orthodontic technique for the management of transverse maxillary deficiency and mandibular prognathism in the treatment of skeletal Class III malocclusion in a mature patient. Skeletal Class III malocclusion can present with maxillary deficiency or retrognathism, mandibular excess or prognathism, or a combination. The maxillary arch is narrow and often requires expansion. A 25-year-old patient presented with a constricted maxilla, a skeletal Class III malocclusion with a large mandible, Angle's Class III malocclusion, retroclined lower incisors, proclined upper incisors, crowding of maxillary and mandibular teeth, and bilateral posterior crossbite. The case report shows that an adult patient with Class III malocclusion (constricted maxilla and large mandible) can be treated with rapid maxillary expansion accompanied by bilateral maxillary osteotomies, followed by a reduction bilateral sagittal split osteotomy (BSSO). As the patient was 25 years old with a bilateral crossbite, a surgically assisted rapid maxillary expansion procedure was performed. As the diastema space was available at the end of expansion, it proved to be beneficial for the presurgical decompensation of Class III, thus creating a negative overjet, followed by which a BSSO setback was done.

Pediatric Facial Fractures: A 10-year Study.

AIMS AND OBJECTIVES: The aim of the study is to retrospectively analyse the incidence of facial fractures along with age, gender predilection, etiology, commonest site, associated dental injuries and any complications of paediatric patients operated in Craniofacial unit of SDM college of dental sciences and hospital. MATERIALS AND METHODS: This retrospective study was conducted at the department of OMFS, SDM College of Dental Sciences, Dharwad from January 2003-December 2013. All the patients below 15 years of age were included in the study. Data were recorded for the cause of injury, age and gender distribution, frequency and type of injury, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, complications, concomitant injuries and different treatment protocols. RESULTS: A total of 68 cases of paediatric fracture were treated during these 10 years. Boys were commonly injured than girls with a ratio of 2.9:1, the commonest cause of trauma was fall (59 %), mandible was the commonest bone to be fractured (83 %), treatment protocols were dependant on the age, region and type of fracture but in most of the cases closed reduction was the choice of treatment, dental injuries were seen in 26 % patients and the commonest injury was avulsion. CONCLUSION: This study was done not only to analyse the different types of facial fractures and the pattern of fracture of paediatric cases admitted at this centre, but also to act as a contributional data which will help us to take preventive measures to avoid such injuries and make the appropriate treatment plan and execute it to achieve the pre-injury status of form and function.

Accuracy of palpation, ultrasonography, and computed tomography in the evaluation of metastatic cervical lymph nodes in head and neck cancer.

INTRODUCTION: India accounts for the majority of oral cancer cases occurring worldwide. The metastasis of oral cancer to the regional lymph nodes and distant sites determines the prognosis and the survival rate of this disease. OBJECTIVES: The aim and objectives of this study were to evaluate the accuracy of preoperative clinical methods such as palpation, ultrasonography (USG), and computed tomography (CT) in comparison with postoperative histopathological findings in determination of metastatic cervical lymph nodes and also to assess whether combining these techniques increases the specificity and sensitivity of lymph node metastasis in oral squamous cell carcinoma (SCC). METHODOLOGY: Totally, 26 consecutive biopsy proven cases of oral SCC were included, and the nodal status was evaluated by palpation, CT and ultrasound (US) and confirmed by histopathological examination. The results were presented in terms of sensitivity, specificity, predictive values, accuracy, and P value. RESULTS: Palpation, USG, and CT findings were compared with histopathologic findings by Fisher's exact test and the "P" value for palpation, US and CT were 0.003, 0.000, 0.000, respectively, which are statistically significant. CONCLUSION: US examination combined with CT gives a better assessment of the neck for nodal metastasis.

Aggressive nodular fascitis of the mandible in a child: a rare case report.

Nodular fascitis is a benign, reactive, fiboproliferative lesion that is thought to represent an over exuberant reaction to injury or inflammation. Its histological picture is very similar to fibro sarcoma. An accurate diagnosis is imperative to avoid unnecessary aggressive treatment. It occurs most commonly in upper extremities, and rarely in the maxillofacial region. We present a case of aggressive intraosseous nodular fascitis of the mandible involving the vital structures in the neck in a 10 year old boy.

Carcinoma of buccal mucosa: A site specific clinical audit.

BACKGROUND: Carcinoma of buccal mucosa is the most common cancer of the oral cavity in India. Treatment of oral cancer poses unique reconstructive challenges, owing to the dynamic architecture of the oral cavity. Despite current progress in various treatment modalities, over the past 50 years survival rates have not improved drastically. Although, philosophy on treatment of buccal mucosa carcinoma remains well-established, due to the relative paucity of reported data, retrospective reviews of institutional experiences are of prime importance. This study provides a detailed insight on this site specific cancer of the oral cavity in the Indian population. AIM: The aim of this study is to analyze our experience with the management of carcinoma of buccal mucosa; associated clinical presentation, outcomes and prognostic factors. SETTINGS AND DESIGN: A retrospective chart review was performed of all cases of primary buccal mucosa carcinoma treated surgically between years 2008 and 2012 in SDM Craniofacial Unit, Karnataka, India. MATERIALS AND METHODS: All cases were analyzed based on patient characteristics, clinical presentation, surgical and adjuvant therapy rendered and treatment outcomes. A retrospective chart review was carried out using the hospital's data base for the same. STATISTICAL ANALYSIS USED: Kaplan-Meier methods were used for analyzing disease free survival (DFS). Univariate analysis of prognostic factors was performed with log rank test. RESULTS: The significant variables in univariate analysis were: Overall stage, T-stage (T1/T2 vs. T3/T4) and nodal status (N0 vs. N+). We found that staging, tumor size and nodal status were significant prognostic factors for DFS. CONCLUSION: The strong influence of overall disease stage, tumor size, nodal status, final histopathological report and habits of tobacco/betel quid chewing, on prognosis; emphasizes the importance of early diagnosis and prevention of carcinoma of buccal mucosa in the Indian population.

Oral eumycetoma of infancy: a rare presentation and a brief review.

Mycetoma is a chronic granulomatous infection of skin and subcutaneous tissue, which may involve bone. The disease is caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Both types of organism are important soil saprophytes, and therefore infection is normally acquired by traumatic inoculation of the skin by contaminated material. Clinically, mycetomas are characterized by tumefaction, draining sinuses and discharging grains. The grains are aggregates of fungal hyphae or bacterial filaments, and grain size, colour and consistency provide the initial clue to the causative organism. To our knowledge, this probably is the first case report of oral eumycetoma of infancy. Review of literature shows only ten cases of eumycetoma involving the head and neck, including the present case. Histological examinations of the biopsies were the cornerstone in the diagnosis of mycetoma. The distinction between eumycetoma and actinomycetoma is essential for treatment. Direct microscopic examination of the grain and histopathological examination, using histochemical staining will distinguish between the two. Treatment consists of long courses of antifungals and antibacterials agents, often combined with surgery.

Peripheral calcifying epithelial odontogenic tumor - Case report.

The calcifying epithelial odontogenic tumor (CEOT), Pindborg tumor is a benign, slow growing, but locally invasive neoplasm. It is known to have a common intraosseous variant and a very rare extraosseous variant. We report an unusual case of an extraosseous variant of CEOT of unusual large size and maxillary anterior location, the treatment was planned considering the clinical, radiological and histological features. Though peripheral types are less aggressive and had no recurrence, in our case regular follow up is required considering the aggressiveness of the lesion and its proximity to important adjacent structures.

Radiographic assessment of influence of cleft width and canine position on alveolar bone graft success: a retro-prospective study.

PURPOSE: To evaluate the effect of cleft width and the pre-surgical position of the permanent cuspid, on the success of secondary alveolar bone grafts, using preoperative and post-operative radiographs. METHODOLOGY: A total of 20 cases treated with secondary alveolar bone grafting for alveolar clefts were included in the study. Pre-surgical maxillary occlusal radiograph was used to determine the cleft width. Canine position was assessed by marking 6 points on a pre-surgical intra oral periapical radiograph. Alveolar bone contour and the success of bone grafts were determined using 11 points marked on post-operative periapical radiographs taken after a minimum follow-up of 6 months. RESULTS: Linear regression analysis of pre-operative cleft width and pre-operative position of the permanent cuspid were carried out on the bone graft success which was determined using post-surgical periapical radiographs. P < 0.05 was set. The results obtained had weak correlations and were statistically not significant. CONCLUSION: We concluded that the success of the alveolar bone graft has minimal or no relation to the pre-operative width of the cleft or the position of the permanent cuspid at the time of grafting.

Assessment of masticatory function using bite force measurements in patients treated for mandibular fractures.

Bite force measurements are excellent criteria for assessment of masticatory efficiency. The purpose of this study was to assess the effect of mandibular fractures on the bite forces of patients treated for such fractures. Patients who were surgically treated for isolated mandibular fractures in the Department of Oral and Maxillofacial Surgery from January 2006 to December 2007 were included in the study. Patients were asked to bite on a bite force transducer on the first, fourth, sixth, and ninth postoperative weeks. The bite force values were compared with those of age, sex, and weight-matched controls. A total of 60 patients were included in the study. It was found that maximum bite forces in patients were significantly less than in controls for several weeks after surgery. After the ninth postoperative week, the maximum bite force measured < 65% the normal in patients with isolated angle fractures and > 80% the normal in patients with isolated parasymphysis fractures. The same values reduced to < 60% in patients with fractures of angle and parasymphysis and < 70% in patients with fractures of parasymphysis and condylar complex. An inverse relationship was found between the bite force values and the number of fractures of the mandible. We also found lower bite forces and longer period for normalization in patients who had fractures in those regions of the mandible which are more significantly associated with the masticatory apparatus for example angle or condyle of the mandible.

Epidermal inclusion cyst of the mandible after extraction of a third molar: case report.

Epidermal inclusion cysts of the head and neck are rare. We report the case of a non-traumatic epidermal inclusion cyst in the submandibular region, with both intraosseous and extraosseous components, which communicated with the socket of a third molar extracted 12 years previously.

Osteomyelitis of maxilla in poorly controlled diabetics in a rural Indian population.

OBJECTIVES: To retrospectively analyze all patients who were diagnosed with Osteomyelitis of jaws in our unit. STUDY DESIGN: 31 patients with Osteomyelitis of jaws were analyzed retrospectively from 2002 to 2008 at the Department of Oral & Maxillofacial Surgery, S.D.M College of dental sciences and hospital, Dharwad, India. Parameters considered were age, gender, jaws involved, clinical features, surgical management & complications. RESULTS: Of the 31 patients, maxilla was involved in 16 patients and mandible was involved in the remaining 15. 11 out of the 16 patients with maxillary osteomyelitis were immuno-compromised. The predominant etiology noted was odontogenic infection. With the treatment protocol we have adopted, all our patients showed satisfactory resolution of the condition by 6 weeks. CONCLUSION: Incidence of maxillary osteomyelitis & their association with diabetes mellitus was higher in our series compared to others. The cause for this high incidence was analyzed in our study. Based on our results we conclude that a conservative surgical method with an attempt to preserve vital bone and an appropriate antibiotic therapy with the correction of the underlying medical problems is adequate to treat Osteomyelitis of jaws.

Inflammatory pseudotumor of maxillary sinus: Mimicking as an aggressive malignancy.

Inflammatory pseudotumor is a rare entity in the head and neck region. Clinically it behaves as an aggressive lesion with extensive destruction but considered to be a benign reactive process. Because of its extensive involvement and infiltrative nature, it is confused as a malignancy. Most of them respond very well to corticosteroid and surgical excision.

Non-syndromic recurrent multiple odontogenic keratocysts: a case report.

Odontogenic keratocysts (OKCs) are one of the most frequent features of nevoid basal cell carcinoma syndrome (NBS). It is linked with mutation in the PTCH gene. Partial expression of the gene may result in occurrence of only multiple recurring OKC. Our patient presented with nine cysts with multiple recurrences over a period of 11 years without any other manifestation of the syndrome.

Cyclic neutropenia in a cleft lip and palate patient: a case report.

Cleft lip and palate is the most common congenital anomaly. Its association with hematologic disorders is rarely reported. Cyclic neutropenia is a rare blood disorder that may occur spontaneously or has a genetic predisposition. Periodicity/recurrence of cyclic neutropenia has a cyclical pattern reoccurring in multiples of 7 days, usually at 21- or 28-day intervals between attacks, with the patient being fairly asymptomatic. There is no case in the literature that has reported the presence of cyclic neutropenia in cleft patients. We report a case of cleft patient associated with cyclic neutropenia. The clinical features, diagnosis, and course of management are described.

Analysis for speech and esthetics in sixty consecutive patients with cleft lip and palate.

BACKGROUND: A double-blind retrospective study was carried out at our oral and maxillofacial surgery department to assess speech and esthetics of primary cheiloplasty in patients operated for unilateral complete cleft lip, alveolus and palate. MATERIALS AND METHODS: Total sample size was 60. All were operated for unilateral complete cleft lip, alveolus and palate. Age range was between 1 and 21 years. Results of surgeries performed by two surgeons were assessed. The speech of all these patients was judged by a single speech therapist who was unaware of the operating surgeon. All patients were assessed for articulatory errors, namely, omission, distortion, substitution, addition and intelligibility. Sixty-eight words in local language (Kannada) were selected by the speech pathologist. All patients were subdivided into three age groups: ≤5 years, 6-10 years and ≥11 years. The cheiloplasty was assessed using VLS (V: vermilion, L: lip, S: scar) scale for vermilion, lip and scar patterns. RESULTS AND CONCLUSION: Patients undergoing palatoplasty in ≤1 year showed good articulation between the age of 5 and 10 years. Articulation and intelligibility was maximum in patients ≥11 years. Patients at this age try various compensatory mechanisms to overcome communication disabilities. Based on the VLS scale, scarring was the least in all patients. Vermilion and lip patterns showed satisfactory results in most of the patients.

Comparison of maxillofacial space infection in diabetic and nondiabetic patients.

INTRODUCTION: Orofacial space infections are common presentations in maxillofacial clinics even in the post-antibiotic era. One of the main factors determining the spread of infection is the host defense mechanism. Diabetes is one of the most common systemic illness suppressing the immunity of an individual and increasing their susceptibility to infections. This study was carried out to compare the spaces involved, the severity of infection, the virulent organism, the efficacy of empirical antibiotics, the length of hospital stay, and the complications encountered in the management of maxillofacial space infection of odontogenic origin in diabetic patients as compared with nondiabetic patients. METHODOLOGY: A 4-year prospective study was carried out on patients with maxillofacial space infection of odontogenic origin. The patients were divided into 2 groups on the basis of presence or absence of diabetes. RESULTS: A total of 111 patients were identified out of which 31 were diabetic. The organisms commonly isolated were Streptococcus species with submandibular space being the most common space involved in both the groups. The empirical antibiotic used was amoxicillin plus clavulanic acid combined with metrogyl in 70.27% cases. CONCLUSION: Streptococcus species is still the most common causative pathogen irrespective of the diabetic status of the patient. The same empirical antibiotic therapy of amoxicillin plus clavulanic acid combined with metrogyl along with hyperglycemia control and surgical drainage of infection yielded satisfactory resolution of infection in the diabetic patients as well.

Plasmablastic lymphoma of the oral cavity in immunocompetent patients: report of two cases.

Plasmablastic lymphoma (PBL) is a diffuse large B-cell lymphoma, a new entity, the incidence of which is increasing, predominantly in the oral cavity of immunocompromised patients, most of whom are infected with human immunodeficiency virus (HIV); only four cases have been reported in non-HIV-infected patients. This report details two cases of PBL of the oral cavity in immunocompetent patients. In both cases, the tumour manifested as a solitary, firm mandibular swelling with dense infiltration of plasma and blastoid cells in the stroma with strong positivity for CD 138 and negativity for CD 20. The patients received radiotherapy and chemotherapy, which resulted in complete remission of the lesion. This is the only case report of two cases of PBL in the oral cavity in immunocompetent patients in which both patients received treatment and showed complete remission of the lesion.

Evaluation of Parental Nasomaxillary Asymmetry as a Risk Factor for Development of Palatal Clefts in their Offsprings.

Background and Objectives : It has been suggested previously that increased width of midfacial structure is associated with the development of palatal clefting. One of the most important heritable characteristics predisposing towards the development of orofacial clefting in an embryo is craniofacial morphology. The aim of the study was to compare nasomaxillary width of parents of children with unilateral complete cleft lip alveolus and palate with parents of noncleft children. Methods : 25 biologic parent sets of children with unilateral complete cleft lip alveolus and palate and 25 biologic parents of noncleft children were included in this study for PA cephalometric analysis. Results : There was no statistically significant difference between study and control groups. An association was found between the side of the cleft in the affected children and the parents in the same side with narrower nasomaxillary width. Interpretation and conclusion : The result of this study was in contrast with other previous studies. We observed a narrower nasomaxillary width, which suggested that this feature may be of morphogenetic importance in the etiopathogenesis of orofacial clefting in this geographic and ethnic group.

Synthesis, structure, and magnetic properties of amine-templated open-framework nickel(II) sulfates.

Two organically templated nickel sulfates of the compositions [C(4)N(2)H(12)][Ni(3)F(2)(SO(4))(3)(H(2)O)(2)] (I) and [C(4)N(2)H(12)][Ni(2)F(4)(SO(4))H(2)O] (II) with open architectures have been synthesized under hydro/solvothermal conditions in the presence of piperazine. I has a layered structure formed by sinusoidal chains comprising hexameric units, whereas II has a three-dimensional structure with 10-membered channels. The layered Ni(II) sulfate, I, is ferrimagnetic, exhibiting hysteresis at low temperatures. The three-dimensional Ni(II) sulfate, II, is essentially paramagnetic. We have also obtained layered compounds isostructural with I containing other amines.

Does seminal fluid viscosity influence sperm chromatin integrity?

A retrospective study was undertaken to investigate whether viscosity alters sperm chromatin integrity. Semen samples were obtained from 269 men attending the infertility clinic. The viscosity was measured quantitatively by needle and syringe method and the viscosity ratio was calculated against distilled water. The chromatin integrity was evaluated by in vitro decondensation test using 1% SDS and 6 mM EDTA. According to the viscosity ratios the samples were divided into 2 groups: I, normal (ratio < 9, n = 239): and II, abnormal (ratio > 9, n = 30) viscosity. Chromatin integrity was significantly lower in the group with higher viscosity. Significant decrease in sperm count and motility were seen in group II as compared to group I. Thus, hyperviscosity of seminal fluid alters the sperm chromatin integrity.