Assessment of Mandibular Canal Using Cone-Beam Computed Tomography (CBCT) and Its Relevance in Post-Operative Neurosensory Disturbances Following Bilateral Sagittal Split Osteotomy Setback.

AIM: Damage to the inferior alveolar nerve (IAN) during bilateral sagittal split osteotomy (BSSO) causes neurosensory disturbances (NSD) of the lower lip and chin. The study aims to investigate the pre-operative position and course of the mandibular canal using cone-beam computed tomography (CBCT) and orthopantomogram (OPG) and compare if there is any difference in NSD following the BSSO setback procedure. MATERIALS AND METHODS: This is an observational study. This study was conducted in the Department of Oral and Maxillofacial Surgery, Mar Baselios Dental College, Kothamangalam, from November 2017 to October 2019. Thirty patients undergoing BSSO setbacks are selected based on the inclusion and exclusion criteria and randomly grouped into two groups - group A (15) and study group B (15). OPG was done for both groups as it was required during surgical orthodontic evaluation and preoperative assessment of the mandibular canal was done using CBCT in group B. Neurosensory assessment was done in all the patients and compared the results. RESULTS: NSD were reported in all the patients on the first postoperative day. The correlation between subjective and objective evaluation showed absolute coincidence but nearly all the patients returned to their presurgical situation within six months in group B and one year in group A who had NSD problems. CONCLUSION: From the study, it can be concluded that a CBCT scan is a useful and reliable modality in the pre-operative evaluation of the mandibular canal in patients undergoing BSSO setback procedures, which helps to improve the patient's post-operative care and quality of life.

Evaluation of Changes in the Alar Base Width Following Lefort 1 and AMO with Conventional Alar Cinch Suturing: A Photographic Study of 100 Cases.

OBJECTIVE: To assess the changes in alar base width in patients who underwent Lefort 1 osteotomy with anterior maxillary osteotomy (AMO), where conventional alar cinch suturing was done to control the alar base widening. MATERIALS AND METHODS: This study was conducted on pre-operative and post-operative photographs of 100 female patients aged between 18 and 30 years who underwent Lefort 1 osteotomy with AMO. The derived values were then compared and analysed using t test. RESULTS: The mean alar base width pre-operatively was 14.11 mm and post-operatively was 15.28 mm. The mean increase in alar base width was 1.176 mm. The result indicated a definitive change between pre-operative and post-operative alar base widths with mean increase in width of 1.176 mm (P = 0.000), which is clinically not very significant. CONCLUSION: The effect of Lefort 1 osteotomy on the alar base can be well controlled by the conventional alar cinch suturing without any additional anchorage on the ANS with predictable results.

Esthetic Outcome and Airway Evaluation following Bi-Jaw Surgery V/S Mandibular Setback Surgery in Skeletal Class III Malocclusion Using Surgery First Approach.

BACKGROUND: Class III skeletal deformity is the result of mandibular prognathism, maxillary deficiency, or a combination. Treatment frequently requires a combination of orthodontics and orthognathic surgical procedures to improve facial esthetics and harmonize facial profile. OBJECTIVES: The objective of the study is to assess and quantify, by means of cephalometric analysis, the pre- and postoperative soft-tissue and airway changes following bi-jaw surgery and mandibular setback surgery after the correction of skeletal Class III deformities using surgery-first approach. MATERIALS AND METHODS: Patients with skeletal Class III malocclusion were classified based on the A point-nasion-B point, beta angle, and Witt's appraisal. The cases were divided based on the type of surgery-first orthognathic approach they received. Group A (20 patients) comprised patients who underwent bi-jaw surgery (Le Fort I + bilateral sagittal split osteotomy [BSSO]) and Group B (20 patients) who underwent BSSO alone. After the lateral cephalograms were digitized, the cephalograms were evaluated for soft-tissue changes and airway changes. RESULTS: The soft-tissue response to simultaneous two-jaw surgery was superior to those seen in mandibular setback procedures with the exception of the changes seen in the facial contour angle and soft-tissue facial angle. There was a significant decrease in lower airway in cases treated with mandibular setback alone. CONCLUSION: Cases treated with bi-jaw surgeries had a significant soft-tissue improvement in the long term compared to mandibular setback surgeries. Since there was a significant reduction in the lower airway in cases treated with isolated mandibular surgeries, bi-jaw surgeries maybe preferred over mandibular setback surgeries.

Eosinophilic granuloma of mandibular condyle: resection and complete regeneration.

Eosinophilic granuloma is a rare disease of abnormal proliferation of Langerhan cells affecting the jaws of young individuals. We report a case of complete regeneration of condyle in a 13 year old boy with eosinophilic granuloma condyle, who had undergone condylectomy.

Hybrid Implant: A Novel Implant System.

INTRODUCTION: Replacement of missing tooth has evolved from removable dentures to fixed dentures and recently to dental implants. The need of sufficient bone around the endosseous implant is critical for the success of the implant. The present study was aimed to evaluate the efficacy of a novel implant (HYBRID IMPLANT-submitted for patency) for replacement of the missing teeth. MATERIALS AND METHODS: 1. Research design A prospective research design with a follow up after 1st week ,2nd week ,3rd week,1st month ,3rd month,6th month and 1st year postoperatively. 2. Sampling method Population: All patients who reported for replacement of missing teeth. Inclusion criteria 1. All patients above the age group of 16years 2. Patients who need replacement of single or multiple teeth in the anterior or posterior region of the maxilla and mandible. Exclusion criteria 1. Medically compromised patients. 2. Patients having craniofacial syndromes. 3. Sample size 5 patients were selected taking into consideration the inclusion and exclusion Criteria. Results PAIN All the patients were non symptomatic during the 1st month to 1st year postoperative periods. MOBILITY: We experienced mobility during the 1st and 2nd postoperative periods where the implants were inserted in the mandibular molar region. BONE LOSS: Radiographic assessment showed no bone loss during the postoperative periods. CONCLUSION: The novel implant (hybrid implant) showed good stability and minimum patient discomfort during one year postoperative period evaluation. The implant system leads to new prospect in the field of prosthetic rehabilitation.

Update on the classification of hemangioma.

Despite the fact that a biological classification of congenital vascular tumors and malformations was first published in 1982 by Mulliken and Glowacki, significant confusion still prevails due to the indiscriminate and interchangeable use of the terms hemangioma and vascular malformation. Hemangiomas are true neoplasms of endothelial cells and should be differentiated from vascular malformations which are localized defects of vascular morphogenesis. On an analysis of various scientific articles and latest edition of medical text books an inappropriate use of various terms for vascular lesions was found, contributing further towards the confusion. The widely accepted International Society for the Study of Vascular Anomalies (ISSVA) classification differentiates lesions with proliferative endothelium from lesions with structural anomalies and has been very helpful in standardizing the terminologies. In addition to overcoming obstacles in communication when describing a vascular lesion, it is important that we adhere to the correct terminology, as the therapeutic guidelines, management and follow-up of these lesions differ.

Management of Cleft Maxillary Hypoplasia with Anterior Maxillary Distraction: Our Experience.

Maxillary hypoplasia is a common developmental problem in cleft lip and palate deformities. Since 1970s these deformities have traditionally been corrected by means of orthognathic surgery. Management of skeletal deformities in the maxillofacial region has been an important challenge for maxillofacial surgeons and orthodontists. Distraction osteogenesis is a surgical technique that uses body's own repairing mechanisms for optimal reconstruction of the tissues. We present four cases of anterior maxillary distraction osteogenesis with tooth borne distraction device-Hyrax, which were analyzed retrospectively for the efficacy of the tooth borne device-Hyrax and skeletal stability of distracted anterior maxillary segment.

Polymorphous low-grade adenocarcinoma--management and reconstruction with temporalis myofacial flap.

Polymorphous low-grade adenocarcinoma is a rare, malignant salivary gland tumor, which is found almost exclusively in minor salivary glands. It is more frequent in the third-seventh decade of life, with a clear female predilection in a 2:1 ratio. It is usually located in the hard or soft palate, although it may be found in the rest of the oral cavity too. It is rare in major salivary glands. In general it has good prognosis, with recurrence rates in the range of 17-24%. Although rare, metastasis to regional lymph nodes has been reported. We report a case of 38 year old female patient who reported with recurrent low grade polymorphous adenocarcinoma in the hard palate, who has been treated with wide excision of the lesion, with reconstruction of the defect using temporalis myofacial flap.

Cherubism: Report of a case.

Cherubism is an uncommon fibro-osseous disorder of the jaw that presents with varying degrees of involvement and tendency towards spontaneous remission. Children are normal at birth and the expanding jaw is noticed within the first year of life becoming progressively larger until the beginning of adolescence. Lesions are characterized by replacement of bone with fibrovascular tissue containing abundant multinucleated giant cells. Here, we describe a case of cherubism in a 4-year-old child with swelling on both sides of mandible with clinic radiographic features and suggestions for therapy.

Gnathic osteosarcomas: Review of literature and report of two cases in maxilla.

Primary neoplasms of the skeleton are rare, accounting for 0.2% of overall human tumor burden. Osteosarcoma (OS) accounts for 15-35% of all primary bone tumors, while gnathic osteosarcomas (GOS) represent 4-8% of all osteosarcomas. GOS shows a predilection for men, a peak incidence of 33 years, and affects the mandible more than the maxilla. We review the scientific literature for a better understanding of the clinical, radiographic, and histopathological features of GOS, along with its etiology, staging, treatment protocol, prognosis, and survival. Evidence from molecular research suggests that it is a differentiation disease that disrupts osteoblasts differentiation from mesenchymal stem cells. The classical radiographic finding of a "sunburst" appearance is appreciated only in 50% of GOS. The universally accepted staging system is not commonly used due to the rarity with which they metastasize to the regional lymph nodes. A number of distinct histopathological subtypes have been described, of which osteoblastic GOS are most common. The treatment protocol is multimodal consisting of preoperative chemotherapy followed by surgery and postoperative chemotherapy, and has a 60-70% five-year survival rate. We present two case reports of osteosarcoma involving the maxillary that were initially misdiagnosed as peripheral giant cell granuloma and osteoma of the maxilla, respectively. These case reports demonstrate the diverse clinical, radiographic, and histopathological features that can be encountered in GOS.

A case report of nasopharyngeal teratoma with a cleft palate and an inguinal hernia.

Nasopharyngeal teratoma is a rare teratoma arising anywhere from the oronasal cavity, regarded as an expanding, cavity-filling lesion, with a high mortality rate due to severe airway obstruction, especially in the neonatal period. We report a patient with a single, firm, hairy swelling arising from vomer, protruding into the oral cavity associated with cleft palate and an inguinal hernia. Excision of the lesion and reconstruction of the cleft palate was successfully performed in a single stage. To the best of our knowledge, this is the first report of a child with a nasopharyngeal teratoma, cleft palate and an inguinal hernia.

On two fungal rots of cacao.

Two new fungal rots, Phomopsis folliculicola and Fusarium decemcellulare, of cacao fruits collected from Kerala (Southern India) are described together with their etiology.