Horizontally Impacted Permanent Maxillary First Molars: A Rare Riddle.

Complete failure of eruption leads to impaction. Impacted teeth are more common in maxilla as compare to mandible. The impaction of permanent dentition is not uncommon but out of them, few permanent teeth are rarely impacted such as maxillary first molars. Etiology behind this can be multifactorial. Here, we report two rare cases of impacted maxillary first molars which require very technique sensitive surgical removal so as to minimize risks of injury to adjacent teeth and other adjacent structures. Follow-up was made first day, third day, seventh day, and 1 month with no complication.

Electromyographic Study of Facial Nerve Function Using Two Different Surgical Approaches in Low Condylar Fractures of the Mandible: A Randomized Controlled Clinical Trial.

BACKGROUND: Facial nerve (FN) dysfunction is a potential complication during open reduction of mandibular condylar fractures. PURPOSE: The purpose of this study was to measure and compare the postoperative FN function following transparotid (TP) and transmasseteric anterior parotid (TMAP) operative approaches in open reduction and internal fixation of condylar fractures using electromyogram. STUDY DESIGN, SETTING, SAMPLE: A randomized controlled clinical trial was designed. The study was conducted in a single tertiary-care hospital in the inpatient setting. Patients aged above 18 years with unilateral condylar fracture of the jaw or bilateral condylar fractures undergoing surgery on only 1 side were included. Patients were excluded if they had fractures of the head, bilateral condylar fractures with surgery planned on both sides, a previous history of surgery in the retromandibular area, existing lacerations to approach condyle, preoperative signs of FN weakness, or a history of parotid surgery. PREDICTOR VARIABLE: The predictor variable was the operative approach and the subjects were allocated randomly to TMAP and TP. MAIN OUTCOME VARIABLE(S): The primary outcome variable was postoperative FN function in the surgical approach employed using the House-Brackmann scale and electromyography (EMG) to record any subtle weakness in nerve function. The FN function is recorded at 3 time intervals postoperatively 1 week (T1), 1 month (T2), and 3 months (T3). The secondary outcomes studied were operating time and any other complications recorded. COVARIATES: Age, sex, fracture pattern with classification of condylar fractures into condylar neck or base fractures according to Loukata et al.4 Any associated fracture of mandible describing the anatomical location viz symphysis and parasymphysis (anterior mandible), body, contralateral condyle or greater than 1 associated fracture were recorded. Similarly, the presence or absence of any associated midface fracture was also recorded to suggest that the study participants were homogenous in all aspects. ANALYSES: Analytical statistics included χ2 test, t-test, and repeated measures ANOVA followed by post hoc test to compare EMG data (mean power and mean amplitude) between 2 operative approaches (TP vs TMAP) for facial muscles including frontalis, oculi, and buccinator at different time intervals (T0, T1, T2, T3). Patients within each group were also analyzed to check for nerve recovery occurring during the follow-up period. The level of significance was set at P < .05. RESULTS: The study sample was composed of 22 patients with a mean age of 32.82 ± 11.21 years in TMAP and 27.82 ± 8.54 years in the TP group respectively (P = .26); male predominance of 81.8 and 90.9% in TMAP and TP group respectively (P = .53) was noted. The FN deficit as assessed by the House-Brackmann scale clinically, was at 54% (T1), 36.4% (T2), and 9.1% (T3) for the TP group and 27% (T1),9% (T2), and 0% (T3) for TMAP group; however, the results were statistically insignificant (P = .31). In surface EMG evaluation, the mean power for the frontalis muscle was significantly higher in the TMAP approach at the T3 time (105.03 ± 9.7 vs 89.56 ± 10; 95% confidence interval -24.28 to -6.65 with P value = .002). TP approach was faster with a mean exposure time of 9.9 minutes. CONCLUSION AND RELEVANCE: The results show that both approaches give comparable long-term results with the TMAP group showing better frontalis muscle activity.

Infantile fibromatosis of the mandible- Is radical treatment justified?

Infantile fibromatosis is characterized by proliferation of fibrous soft tissue with a potential of invading the adjacent structures but lacks the ability to metastasize, thus making it a fairly benign lesion with borderline characteristics. The pathology resembles sarcomatous growth, therefore making it difficult for the clinician to correctly diagnose. There are two variants of extra-abdominal desmoid juvenile and adult variant depending upon the age group it predominately involves. Fibromatosis is comparatively a rare tumour with unpredictable growth and varying local recurrence rates. The mass usually grows slowly, rapid growth and recurrences being mostly associated with the juvenile forms. The disease may present as single or multifocal lesion with widespread distribution, thus requiring whole body scans to identify any insidious growth elsewhere. Here, we report a case of recurrent juvenile/infantile fibromatosis in a 2-year-old child, conservatively managed without any growth disturbance and signs of recurrence.

Rare Presentation of Tuberculous Osteomyelitis of Mandibular Condyle Mimicking as Parotid Tumor: A Case Report.

Tuberculosis (TB) is a significant health problem and mortality in most developing countries. It is a chronic granulomatous disease caused by Mycobacterium tuberculosis and M. tuberculosis complex. It can be pulmonary form or Extra pulmonary form. Extrapulmonary tuberculosis involving temporomandibular joint is infrequent presentation of Skeletal TB. Here we present a rare case of extrapulmonary tuberculosis that was initially misdiagnosed as a parotid lesion due to atypical signs and symptoms and multiple in-conclusive FNAC reports. The final diagnosis was established by histopathological report.

A Rare Case of Ewing's Sarcoma of Maxilla Managed with a Newly Proposed Multimodality Approach to Achieve Optimal Outcome.

Rare case of Ewing's Sarcoma of maxilla managed with newly proposed multimodalityapproach in which First neo-adjuvant chemotherapy was done to shrink the size oftumor mass and control possible occult distant metastasis and in the second phase surgical management that is followed by adjuvant chemotherapy was done. During Surgical phase, instead of doing a complete surgical resection, we have decided intraoperatively and performed only curettage of the tumor mass left after shrinkage of the tumor mass post chemotherapy phase. This concludes that there is the scope of trying newer ideas for management and, thus, more contemporary approaches for this rare entity. Like in our case, curettage of the tumor rather than radical resection as a part of multimodality approach also gave optimal outcome.

Management of a Late Presentation of Bear Mauling with a Complex Maxillofacial Defect in a Tertiary Care Hospital - A Case Report.

Rationale: Bear mauling is the most common wild animal-inflicted injury in India. Ideally, these injuries should be managed early with fracture fixation, wound debridement, and appropriate coverage. Delay may lead to devascularization and a more severe deformity, which needs complex and multi-staged procedures for optimal outcome. Patient Concerns: Facial deformity in bear mauling is upsetting to the patient. Apart from facial aesthetics, the victim has difficulties in speech, eating, and respiration when the midface is involved. Diagnosis and Treatment: Patients require proper assessment of the soft tissue and bony defects by clinical assessment and imaging before planning any reconstruction. Outcome: The complex defect was managed in stages by both microsurgical and nonmicrosurgical methods including debridement, fracture fixation, local flaps, free flap, and prosthesis. Take-away Lessons: Systematic approach in categorizing each component of the problem, finding the best possible solution for each of them, and inter-departmental collaboration are important.

Use of Two Lag Screws for ORIF of Mandibular Condylar Sagittal Split fracture: An Anti-rotational Concept-A Prospective Clinical Trial.

BACKGROUND: Condylar process fracture is one of the most common mandibular fractures. Approximately 11-16% of all facial fractures and 30-40% of all mandibular fractures are fractures of the mandibular condyle. Treatment can broadly be divided into open or closed, but there are no clear criteria to determine the choice between them. Sagittal split fracture of the mandibular condyle is rare and can be easily missed on conventional radiographs, like OPG and multiple standard films, but because of the high incidence of subsequent ankylosis is an important entity. So a CT scan with axial and coronal cuts is advisable in high condylar or intracapsular fractures of mandibular condyle. PURPOSE: The hypothesis in this study is that open reduction and internal fixation (ORIF) of sagittal split mandibular condylar fractures with two lag screws is more stable and there is no rotation of the medial fractured segment of condyle. METHODS: In this prospective clinical trial, ORIF of four patients with sagittal split fracture of mandibular condyle was done using two lag screws. In all the patients, pre-op and post-op clinical and radiological findings were evaluated, with a follow-up of two years. RESULTS: All the patients were evaluated postoperatively at periodical interval with various clinical parameters, viz. mouth opening, occlusion, pain, deviation of mandible while opening, other complaints (like clicking, tenderness), and radiologically with CT scans. All patients showed good occlusion and adequate mouth opening postoperatively. In this series, there was no pain, deviation of mandible while opening and other complaints like tenderness and clicking. In CT scan, the medial fragment was reduced anatomically in position and the lag screws were not protruding in the TM joint space. CONCLUSION: Use of two lag screws for ORIF of sagittal split mandibular condylar fractures is recommended to prevent the rotation of fractured medial condylar segment and for more stable fixation.

Hemangiopericytoma/Solitary Fibrous Tumor of the Buccal Mucosa.

Hemangiopericytomas (HPCs)/Solitary fibrous tumor are rare neoplasms of vascular origin that occur in head-and-neck region. These tumors arise from capillary pericytes and are difficult to distinguish from other tumors of vascular origin. HPC, initially described by Stout and Murray in 1942, usually occur in the fifth decade of life and account for 3%-5% of all soft-tissue sarcomas and 1% of all vascular tumors. The tumors usually occur in limbs, pelvis, or head-and-neck region; 15%-30% of all HPCs occur in head and neck. We report a case of HPC located in the right buccal area of a 60-year-old man.