Challenges during implant-assisted prosthetic rehabilitation in fibula reconstructed jaws and its management: a scoping review protocol.

Introduction: Oral cancer is the sixth most prevalent cancer type worldwide. Patients are placed in a crippling predicament due to the functional and psychosocial difficulties brought on by the illness and its treatments. Both surgeons and maxillofacial prosthodontists may encounter challenges with reconstruction and therapy following cancer treatment. Over 20 years, the fibula has remained the mainstay of reconstructions for head and neck cancer. Maxillary and mandibular jaws with fibula reconstructions can use fixed or removable prosthetic rehabilitation solutions. The proposed scoping review aims to ascertain the volume and nature of evidence concerning the difficulties and corrective measures in the prosthetic rehabilitation of fibula-reconstructed head and neck cancer cases. The findings will aid in improving the prosthetic treatment care for the affected population. Materials and Methods: The Joanna Briggs Institute (JBI) scoping review protocol will be followed in developing and reporting the scoping review methodology. Methods to identify the relevant literature will involve the systematic search of databases like PubMed, Scopus, Google Scholar, Cochrane Library, and gray literature sources for pertinent articles on the subject. Only papers published in English literature will be considered for the review, and the data collection period is limited to the past 20 years. The screening process will utilize defined inclusion/exclusion criteria for Title/Abstract and Full-text screening by two independent reviewers in covidence, and a third reviewer will resolve any conflicts. The data extracted will include specific details about the participants, concept, population, study methods, challenges encountered during prosthetic rehabilitation, and their management. Inductive thematic analysis and descriptive statistics will be applied where appropriate. The narrative synthesis of the evidence will be accomplished through data extraction in a tabular format, and the results will be presented as a narrative summary.

Speech following Le Fort I Maxillary Advancement in Cleft Maxillary hypoplasia - an objective and subjective outcome analysis.

PURPOSE: To objectively evaluate the effect of maxillary advancement on speech and VPI using video-fluoroscopy (VFS), direct nasoendoscopy, and speech evaluation and subjectively assess patients and their peer's perception regarding their speech outcome. MATERIALS AND METHODS: 27 cleft patients who underwent Lefort 1 maxillary advancement were divided into 2 groups- Group A with 4-7 mm of advancement and Group B with 8-13 mm advancement. VFS in lateral view, nasoendoscopy, and speech recordings were performed pre and 6 months postoperatively. VFS assessed the relative position of velum in relation to the pharyngeal wall, speech was evaluated for changes in nasal emission, resonance, and articulation along with nasal endoscopy to assess the overall function of the velopharyngeal valve. Subjective speech evaluation was done with a Patient-Reported Outcome Measure [PROM] questionnaire. RESULTS: As per VFS, for every 1 mm maxillary advancement, the velopharyngeal gap at rest increased by 1.75 mm in group A and 1.58 mm in group B. The compensatory changes in group B were more pronounced. Post-operative VFS showed velar closure remained the same as preoperative closure in 86.7%, and worsened in 13.3% in group A whereas it remained unchanged in 66.7%, improved in 25%, and worsened in 8.3% in group B. In nasoendoscopy, the closure pattern showed no change in 86.6%, improved in 6.7%, and deteriorated in 8.3% in group A while there was no change in 83.4%, improved in 8.3%, and deteriorated in 8.3% in group B. Dental and labiodental articulation statistically improved [p < 0.05] after surgery. PROM reported 85.7% of patients with improved speech, 82.1% improved sound quality along with 89.3% improvement in articulation. CONCLUSION: The primary cause for functional impairment and poor aesthetics in cleft deformity is the maxillary hypoplasia and therefore, should be the focus during correction. The pre-operative VP status or the amount of maxillary advancement could not predict the postoperative VP status. Maxillary advancement over 10 mm did not seem to significantly affect the final VP status. Articulation improves due to increased tongue space and favorable dental segment positioning. Mild to moderate immediate post op changes in nasality improves or even reverts to their preoperative status in the majority of the cases in about six months.

Computed Tomographic Analysis of Position of Mandibular Canal and Mandibular Foramen in Patients with Mandibular Asymmetry.

Introduction: Mandibular osteotomies in facial asymmetry are complicated by the abnormal position and course of inferior alveolar nerve. This manuscript aims to evaluate the possible variations in the preoperative positions of mandibular canal and mandibular foramen in patients with mandibular asymmetry due to condylar hyperplasia or condylar hypoplasia. Materials & Methods: This study included 15 patients with mandibular asymmetry due to condylar hyperplasia or condylar hypoplasia for which bilateral sagittal split osteotomy (BSSO) was performed as a corrective procedure. The presence/absence and extent of postoperative neurosensory deficiency was recorded subjectively and objectively. The measurements were done using multiplanar reconstruction (MPR) of three-dimensional radiographic imaging and were compared to normal subjects. Discussion: The results revealed that the mandibular canal was closer to the buccal cortex on the affected side and the inferior border on both sides in the region of second molar in condylar hyperplasia. In condylar hypoplasia, the canal was nearer to the inferior border and the alveolar crest in relation to second and third molars respectively on the affected and contralateral sides.The mandibular foramen was also more superior to the occlusal plane on both sides in both condylar hyperplasia and hypoplasia. Conclusion: Based on the study outcomes, the authors propose that assessment of the positions of mandibular canal and mandibular foramen is crucial to avoid postoperative neurosensory deficiencies.

A Survey on Alveolar Bone Grafting in Indian Cleft Centers.

OBJECTIVE: To assess the factors influencing the type and timing of Alveolar Bone Grafting (ABG) among cleft centers throughout India. To examine the decision-making criteria for orthodontic treatment and the timing of ABG. DESIGN: Cross sectional survey. METHOD: This survey was based on a convenience-based sample selected from cleft teams across India. The survey was formulated using the SurveyMonkey platform and emailed to 40 cleft teams. The survey included questions on demographics, timing, surgical protocol, orthodontic protocol, radiograph prescription rate, assessment methods for the success of ABG and three scenarios for evaluating the timing of the bone graft. The Chi-squared test was performed to evaluate the difference in opinion between specialists. The inter-examiner reliability was assessed using Kappa statistics. RESULTS: Thirty-five units completed the questionnaire. Most units operate with 1-2 surgeons, with 42.9% of them treating cleft patients for under 5 years. Only 11.4% of centres routinely advised oblique occlusal radiographs for post-surgery evaluation, and 31.4% prescribed CBCT. However, 40% of cleft teams did not perform audits to evaluate the success of ABG, and less than 50% advised radiographs six months post-surgery. Around 26% of centres do not routinely provide orthodontic treatment pre-ABG. The inter-examiner reliability for case scenarios showed poor agreement between the clinicians. CONCLUSION: The survey showed a serious lack of consensus in the ABG treatment among cleft teams in India and emphasises the need for standardised protocols for the treatment of children with cleft palate. There is an urgent need to develop core outcome set in cleft.

Simplified Virtual Surgical Planning Method for Reconstruction of Secondary Maxilla and Mandibular Defects Using Free Bone Flap.

Objective: Free fibula flap is the commonly used microvascular free tissue transfer for maxillary and mandibular reconstruction to restore form and function after ablative procedures. Bony reconstruction is an important aspect of reconstruction. This paper describes our technique in using virtual surgical planning for secondary reconstruction of the maxilla and mandible using only stereolithographic models. Discussion: In the recent past, virtual surgical planning has become a game changer in planning complex reconstruction of maxilla and mandible. This becomes even more important in the cases of secondary reconstruction. Virtual surgical planning requires close interaction between the surgeon and the design and manufacturing team. The latter is often done remotely making the process cumbersome and less user friendly. We have been using a simplified version of the virtual surgical planning at a low cost set up with effective outcomes. This report consists of 22 cases in which secondary reconstruction using osteo-cutaneous free fibula flap was carried out using virtual surgical planning. Mock surgery was performed on stereolithographic (STL) models (face and fibula), pre-bending of plates and fabrication of occlusal splints helped in precise translation of the treatment plan to the operating room which in turn helped in reducing the surgical time and attaining more predictable results. Conclusion: Secondary reconstruction of maxilla and mandible is complex and requires meticulous planning to achieve optimal and predictable results which directly improves the quality of life of the patients.

Concomitant Microvascular Aided Extended Temporo-Mandibular Joint Replacement (ME-TJR) and Stock Temporo-Mandibular Joint Replacement (MS-TJR) During Mandibular Reconstruction.

Background: Disarticulation is indicated when pathologic process involves the condyle or when a body/ramus lesion extends into condylar process. The goal of reconstruction is to reinstate joint mechanism for function and also to restore facial symmetry. Aim: Retrospective evaluation of functional and aesthetic outcomes in patients with disarticulation defects of mandible treated with concomitant alloplastic temporomandibular joint replacement and microvascular free flap reconstruction. Materials and Methods: Nine patients (8 benign pathologies and 1 secondary reconstruction for malignant neoplasm), who underwent mandibular resection with condylar disarticulation and reconstruction with Free microvascular flap and Alloplastic total joint replacement between 2015 and 2022 were included in the study. A modified functional intra-oral Glasgow scale (FIGS)2 was used for quality of life (QOL) scoring. Speech, mastication, swallowing, VAS pain score, mouth-opening, occlusion, facial symmetry and overall patient satisfaction were assessed. Results: 8 patients with benign pathology reported excellent outcome with a QOL score of 13-15 in terms of speech, chewing and swallowing. Pre-operative occlusion of native mandible was maintained in all dentulous patients. VAS score of 0-1 was reported. Mouth opening was adequate in all patients. 2 patients reported mild ipsilateral deviation of mandible. Mild facial asymmetry was reported by 2 patients with an overall satisfaction of 8-9. There were no significant intra/post-operative complications in patients with benign pathology. Failure of stock joint was observed in secondary reconstruction for malignant neoplasm. Conclusion: Microvascular free flap aided stock or custom alloplastic replacement of temporomandibular joint (MS-TJR, ME-TJR) restores function and aesthetics following mandibular resection with disarticulation of condyle.

Bite Force Evaluation in Implant-Assisted Prosthetic Rehabilitation of Reconstructed Jaws Utilizing Vascularized Free Fibula Flap: A Retro-Prospective Cohort Study.

Introduction: Maxillary and mandibular defects due to tumor ablation pose considerable challenges to the reconstructive surgeon and in prosthetic management. Dental implants placed in vascularized fibula free flaps are considered to be a dependable technique for prosthetic rehabilitation in head and neck cancer patients. Although, there is evidence of survival of dental implants in the reconstructed jaw bones, there is lack of information regarding the masticatory performance and prosthetic success. The maximum bite force achieved through the prosthetic appliance is a measure of the therapeutic outcome. The purpose of this study was to determine the maximum bite force achieved through implant-assisted prosthetic rehabilitation in reconstructed jaw bones utilizing vascularized free fibula flap. Methods: The study included a total of 65 implants, from 16 patients who underwent surgical resection of jaw bones due to benign tumors followed by rehabilitation with implant-assisted fixed or removable prosthesis. The maximum bite force was determined with a transducer. Occlusal interferences were analyzed with mounted casts. The parameters were reviewed every 3 months have T 0 marked the baseline assessment, and T 3, T 6, T 9, T 12, and T 15 were subsequent review periods. Results: The mean occlusal force was increased in most of the patients through 15 months (P < 0.01). The maximum bite force measured in the reconstructed mandible and maxilla were 225.63 N and 176.51 N, respectively. Occlusal interferences were absent in 68.8% of the study population. Conclusion: The bite force measured in reconstructed maxilla and mandible is comparable to the masticatory force measured with conventional implant supported prosthesis in native mandible and maxilla.

Prosthetic Rehabilitation Options in Post-Ablative Maxillomandibular Microvascular Reconstructions.

Objective: Surgery remains the mainstay for managing most neoplasms arising in the head and neck area. Removable or fixed prostheses are commonly used for prosthetic rehabilitation of head and neck defects following surgical resection. Some major challenges in prosthetic rehabilitation after maxillomandibular microvascular reconstruction include excessive prosthetic space, soft tissue bulk, and occlusal disharmony in the remaining dentition. This review focuses on the challenges we have experienced in the real clinical scenario while rehabilitating reconstructed maxillomandibular defects and the effective prosthetic treatment options that could be considered in each situation. Discussion: Digital revolution has changed all arenas of life, and it has created a significant impact on cancer treatment planning and the delivery of quality treatment to the needy. Creating adequate retention while ensuring stability and support for the prosthesis can be challenging with temporary acrylic and cast partial removable dentures. Endosseous dental implants are considered a stable, reliable, and esthetic option for reconstruction with advantages such as increased chewing efficiency, preservation of the remaining bone height and width, and improved quality of life. The FP3 to RP5 (Misch's classification) are some commonly followed prosthetic rehabilitation options after microvascular reconstruction. The prosthetic design should permit the usage of interdental aids that ensure the longevity of prostheses. Conclusion: Occlusion-driven/prosthetic-driven implant-assisted prostheses are considered a reliable option that ensures stable and functional oral rehabilitation among patients with free fibula flap reconstruction. Multidisciplinary teamwork is mandatory for an optimal outcome that improves patients' quality of life.

Patient Specific Alloplastic Implant Reconstruction of Mandibular Defects-Safe Practice Recommendations and Guidelines.

Mandibular continuity defects are commonly seen after tumor resection, osteomyelitis or maxillofacial trauma. Three-dimensional reconstruction of these mandibular segmental defects is critical for proper mandibular functioning and esthetics. Various methods used to reconstruct such defects include bridging reconstruction plates, modular endoprosthesis, non-vascularized and vascularized bone grafting with stock reconstruction plate or patient specific implants (PSI) and tissue engineering bone transfer. But in the recent years, literature documents use of PSI only alloplastic reconstruction as an alternate to microvascular bone flap reconstruction. Representative cases enumerate current practice of 'patient specific implant only' mandibular reconstruction and its pitfalls. This article discusses current status of literature on PSI's, choice of indications for 'PSI only' mandibular reconstruction and also proposes guidelines for safe practice of patient specific implant reconstruction of mandible.

Controlling and Stabilising Mandible During Reconstruction: Significance and Techniques.

Objective: Stable and accurate positioning of condyle in the glenoid fossa is necessary for maintaining occlusion, facial symmetry and normal function of the temporomandibular joint following segmental resection of mandible. In non-reconstructed mandibular segments or those with fractured reconstruction plates the bony defect gets altered due to contraction or inadvertent muscular pull. This paper describes various techniques used to control dentate and edentate segments of the mandible during reconstruction following an ablative procedure. Discussion: Secondary mandibular reconstruction has always been a tedious task for the surgeons. Several techniques have been described in literature ranging the use of external fixators, gunning splints and dentures for stabilising mandibular segments. Use of a pre-bent and adapted reconstruction plate is a common practice but may not be feasible in malignancies, benign tumours causing expansion and secondary reconstruction. The current advances in virtual surgical planning allows mandibular reconstruction to be performed in a simpler yet predictable manner. Conclusion: The paper describes techniques ranging from twin K-wire placement to occlusal wafers, 3D printed splints and patient specific implants to enable accurate positioning of the segments and achieve pre-operative form. Advances in virtual surgical planning will continue to allow this field to evolve and to improve the quality of life of the patients.

Frameshift mutation in exon 17 of PTCH1 gene in Nevoid basal cell carcinoma syndrome: A case report.

Nevoid basal cell carcinoma syndrome (NBCCS) is a rare autosomal dominant disorder characterized by a wide range of developmental abnormalities and a predisposition to neoplasms. In majority of the cases, the presence of multiple and recurrent jaw cysts especially during the first two decades of life is one of the first symptoms of this syndrome. We present here a case of 14-year-old female patient who reported with a chief complaint of facial swelling for 3 weeks. The radiographs revealed multiple cysts in maxilla and mandible. Incisional biopsy of the lesions was done and the histopathologic features were suggestive of odontogenic keratocyst. Further investigations revealed the presence of falx cerebri calcifications and multiple nevi on palms and feet. Genetic study was done to confirm the diagnosis of NBCCS, which showed mutations in PTCH gene. This case stresses the importance of genetic study in suspected cases of NBCCS especially in young patients of nonsyndromic parents.

NANOTEX BONE Graft along with Fibula Flap in the Reconstruction of Segmental Mandibular Defect: Protocol for Pilot Clinical Trial.

Introduction and objectives: Mandible reconstruction with vascularized fibula flap is the standard treatment for segmental mandibulectomy in patients with tumor or trauma. But the height of the fibula graft is insufficient for dental implant placement and prosthetic rehabilitation to replace the missing teeth, which in turn will compromise the functional efficiency and aesthetics of the patient. Although the bone height can be augmented through onlay grafting with iliac crest, it is associated with limitations like donor site morbidity and fast resorbability. This suggests the need for a synthetic biomaterial for vertical bone augmentation in implant dentistry.We have developed a biomimetic, porous, mechanically stable, and biodegradable nanocomposite named "NANOTEX BONE Graft" and its bone regeneration potential was evaluated in pre-clinical animal models. In this clinical trial, the safety as well as the efficacy of NANOTEX to augment new bone over fibula and further its ability to integrate with dental implants will be studied. The study has received the approval of the Ethics Committee of Amrita Institute of Medical Sciences and Central Drugs Standard Control Organization (CDSCO), India. Methods: We have designed a prospective, single-center, non-randomized pilot clinical study. Patients with benign tumor or trauma indicated for mandibular reconstruction followed by implant rehabilitation will be included in the study. Eligible patients will be enrolled after obtaining informed consent. The study will be initiated and followed up as per defined timelines. Highlights: Resection of benign mandibular tumours necessitates surgical removal of jaw bone and adjacent affected areas.The segmental mandibulectomy leaves the patient with functional impairments and aesthetic defects which in turn affect the quality of life.The standard treatment of reconstruction with vascularized fibula flap has challenge in achieving sufficient vertical bone height for implant placement and prosthetic rehabilitation.Alternate surgical techniques cause donor site morbidity and surgical complications.There is need for a synthetic biomaterial to be grafted over fibula for vertical bone augmentation.NANOTEX BONE Graft, a nanofibrous composite scaffold that mimics native bone, promote cell infiltration, neo-angiogenesis and new bone formation.Preclinical studies of NANOTEX in animal models showed bone tissue regeneration, better biodegradation in critical sized defects and efficient integration with dental implants.This clinical study propose to evaluate the safety and efficacy of NANOTEX bone graft augmented over fibula in bone regeneration and Titanium dental implant integration.

Efficacy of Gas Combination Cryotherapy in the Management of Odontogenic Keratocyst of the Maxilla and Mandible: A Pilot Study.

Aim: The aim of this study was to evaluate outcome of management of odontogenic keratocyst (OKC) using gas combination cryotherapy (GCC). GCC is a treatment modality where cyst enucleation is followed by applying an adjuvant agent, a spray containing propane, butane and isobutene gas onto the bony bed. Materials and Methods: This was a prospective interventional study which included patients with radiographic and histopathologic evidence of OKC. All patients underwent enucleation of the cysts followed by spraying of the bony cavity with "ENDOFROST ™"(commercially available agent for GCC). Patients were periodically reviewed and the presence of wound dehiscence, infection and neurosensory deficit was noted. After 15 months, a CBCT was taken to assess the amount of bone formation, the presence of any pathologic fracture or recurrence. Comparison of the preoperative and the postoperative size of the defect was also assessed. Results: A total of 10 patients were included in the study of which only 2 presented with neurosensory deficit in the post-op period. One patient of the two patients recovered completely within 12 months, while the other recovered within 15 months. There was no evidence of any patient developing infection, wound dehiscence, recurrence or pathologic fracture. Conclusion: The results of the study show that enucleation followed by GCC is a safe, effective and low-cost therapy for the management of OKC.

Nonspecific Cystic Degeneration in Craniofacial Fibrous Dysplasia: A Rare Finding.

Fibrous dysplasia (FD) is a developmental pathology of the bones in which normal bone is replaced by fibrous tissue and immature bone. It can affect single bone (monostotic) or multiple bones (polyostotic), sporadically or in association with McCune-Albright syndrome, Jaffe-Lichtenstein syndrome, or Mazabraud syndrome. When multiple bones in the craniofacial region are affected, the term "craniofacial FD" is used. Nonspecific cystic degeneration occurring in FD of the jaws has rarely been reported in the literature. Here, we present a 52-year-old male patient who reported with a longstanding gradual expansion of the mandible unilaterally. Investigations revealed the presence of mixed radiolucent radioopaque appearance in the mandible and dense sclerotic multiple craniofacial bones. In addition, a lytic lesion in the mandible was appreciated. Histopathological examination of the mandible confirmed the diagnosis of FD with nonspecific cystic degeneration.

Robot-assisted frontofacial correction in very young children with craniofacial dysostosis syndromes: a technical note and early functional outcome.

OBJECTIVE: In this study, the authors aimed to 1) retrospectively analyze the early functional outcomes in a cohort of very young children with craniofacial dysostoses who underwent robot-assisted frontofacial advancement (RAFFA) or robot-assisted midface distraction (RAMD), and 2) analyze the utility of robotic assistance in improving the accuracy and safety of performing transfacial pin insertion for RAFFA or RAMD. METHODS: A retrospective analysis of a cohort of 18 children (age range 1-42 months at presentation), who underwent RAFFA or RAMD from February 2015 to February 2021 in the craniofacial unit at Amrita Institute of Medical Sciences and Research Centre in Kochi, India, was performed. Inclusion criteria were patients who had undergone RAFFA in a single stage or RAMD where the cranial vault had been addressed earlier, had been addressed on follow-up, or had not been addressed and had follow-up of at least 6 months. RESULTS: Overall, 18 children with syndromic craniosynostosis underwent LeFort level III midface distraction, with or without RAFFA, from February 2015 to February 2021 at a single center in India. The patients' ages ranged from 6 to 47 months at the time of the procedure. All patients had significant obstructive sleep apnea (OSA), significant ocular issues, and disturbed sleep as determined by the authors' preoperative protocol. Clinically significant intracranial pressure issues were present in 17 patients. None of the patients had injury due to the transfacial pin trajectory such as globe injury, damage to the tooth buds, or the loss of purchase during the active distraction phase. The mean distraction achieved was 23 mm (range 18-30 mm) (n = 16/18). Of the 18 patients, 10 (56%) had an excellent outcome and 6 (33%) had a satisfactory outcome. In all cases, the degree of OSA had significantly reduced after surgery. Eye closure improved in all patients, and complete closure was seen in 11 patients. On follow-up, the functional gain remained in 14 of 16 patients at the final follow-up visit. The distraction results were stable during the follow-up period (mean 36 months [range 6-72 months]). CONCLUSIONS: The early RAFFA and RAMD protocols investigated in this study gave a significant functional advantage in very young patients with craniofacial dysostoses. The results have demonstrated the accuracy and safety of robotic assistance in performing transfacial pin insertion for RAFFA or RAMD.

Recommendations for Safely Performing Major Head and Neck Surgery During the COVID-19 Pandemic: Experience with Implementation of a Workflow.

COVID 19 pandemic has affected the delivery of surgical services as a part of management of head and neck cancers all over the world. Since it may affect the overall cure as well as quality of life of these patients, it is necessary to continue providing surgical treatment but with minimal additional health hazards to the patient or the health care worker. For this, a workflow was formulated in a university teaching hospital in India with large head and neck cancer workload and implemented during the period of national lockdown. 125 major head and neck cancer cases were operated during this period out of which 25 patients were of high-risk status. Emergency (10%) and semi-emergency (83%) cases predominated with few electives. The number of noncancer reconstructive and craniomaxillofacial cases operated was 81, out of which 25% was of emergency in nature. When compared to the data of similar period in the previous year, 60% of the workload in the cancer-related cases could be offered surgical treatment, whereas the noncancer cases operated were only 25%. The workflow may be useful for all surgical departments in safely performing procedures during this pandemic or similar situations in future with suitable refinements.

Four novel mutations in EFNB1 in Indian patients with craniofrontonasal syndrome.

Craniofrontonasal syndrome (CFNS) (OMIM #304110) is a very rare, X-linked developmental disorder characterized by facial stigmata, including hypertelorism, frontonasal dysplasia, craniosynostosis, bifid nasal tip, and digital abnormalities. CFNS is caused by mutations in the Ephrin 1 gene (EFNB1) located at Xq13.1, which encodes the transmembrane protein Ephrin B1. Interestingly, heterozygous females are more severely affected than hemizygous males. We report on four individuals from four unrelated Indian families with mild-to-severe CFNS. All patients had variable degrees of hypertelorism and nasal bridge depression, which did not correlate with changes in other tissues. Although patients 3 and 4 showed the most severe facial dysmorphism and syndactyly, there were no structural CNS changes or developmental delay. In contrast, patient 1 displayed agenesis of corpus callosum and developmental delay, although facial and finger abnormalities were milder. Patients 1, 2, and 4 showed different degrees of clefting. DNA sequencing revealed four previously undescribed heterozygous mutations in exons 1 and 2 of EFNB1. Patient 1 carried the second single amino acid deletion reported up to date. The other three affected individuals harbored frameshift mutations, leading to premature termination codons. Our findings broaden the spectrum of EFNB1 mutations and illustrate the absence of an obvious correlation between mutation type, severity, and expression of symptoms.

Comparison of the efficacy of amoxicillin-clavulanic acid with metronidazole to azithromycin with metronidazole after surgical removal of impacted lower third molar to prevent infection.

OBJECTIVES: The goal of the study was to investigate the clinical effects of amoxicillin-clavulanic acid (500+125 mg) with metronidazole 400 mg administered three times daily (Group I) versus azithromycin 500 mg administered once daily and with metronidazole 400 mg three times daily (Group II) for the prevention of postoperative infection following mandibular third molar surgical removal. MATERIALS AND METHODS: The study design was a single-center prospective study. Patients who reported to the Department of Oral and Maxillofacial Surgery between February 2015 and January 2017 for removal of mandibular third molar were screened, and 108 patients were chosen. One surgeon carried out all procedures. Patients were prescribed antibiotics until the two groups contained a similar number of cases. RESULTS: Our data showed that Group II had fewer incidences of surgical site infection, but with no statistical significance. CONCLUSION: Although both treatments are used routinely after removal of the mandibular third molar, neither is significantly better than the other.

Fever after maxillofacial surgery: a critical review.

PURPOSE: The aim of this paper is to review the pathophysiology of thermoregulation mechanism, various causes of fever after maxillofacial surgery and the different treatment protocols advised in the literature. DISCUSSION: Fever is one of the most common complaints after major surgery and is also considered to be an important clinical sign which indicates developing pathology that may go unnoticed by the clinician during post operative period. Several factors are responsible for fever after the maxillofacial surgery, inflammation and infection being the commonest. However, other rare causes such as drug allergy, dehydration, malignancy and endocrinological disorders, etc. should be ruled out prior to any definite diagnosis and initiate the treatment. Proper history and clinical examination is an essential tool to predict the causative factors for fever. Common cooling methods like tepid sponging are usually effective alone or in conjunction with analgesics to reduce the temperature. CONCLUSION: Fever is a common postoperative complaint and should not be underestimated as it may indicate a more serious underlying pathology. A specific guideline towards the management of such patients is necessary in every hospital setting to ensure optimal care towards the patients during post operative period.

Flap hitching technique to the teeth after oral cancer resection.

OBJECTIVES: After resection of the tumors of oral cavity adjacent to the mandible, it is a common situation that the whole of one side of the gingival mucosal segment has to be stripped off the mandible to get an adequate margin. When a cutaneous flap is used for reconstruction, it has to be hitched to the teeth to get a watertight seal. We describe a technique to hitch the flap to the adjacent teeth in such an instance. MATERIALS AND METHODS: The technique was applied in 10 patients with oral cancer, resected, and reconstructed with cutaneous flaps. RESULTS: The technique was found to be effective in all 10 patients. Adequate seal was obtained in all patients. Oral diet was started within 7 days. CONCLUSION: An effective and simple technique to approximate a cutaneous flap to the teeth-bearing mandible, when all the mucosa is removed as part of oncological resection, is reported.