Does the Retromandibular Transparotid Approach Provide Quicker Access to Fracture of Mandibular Subcondyle Compared With the Retromandibular Transmasseteric Anterior Parotid Approach?

PURPOSE: Limited studies are available in the literature comparing various surgical approaches for the management of condylar fractures, and those comparing different types of retromandibular approaches are even fewer in number. This study aimed to compare the efficacy of 2 variants of the retromandibular approach-retromandibular transmasseteric anterior parotid (RMTMAP) and retromandibular transparotid (RMTP) in terms of exposure time, blood loss, facial nerve palsy, sialoceles or parotid fistula formation, infection, and esthetics of scar tissue. PATIENTS AND METHODS: A randomized controlled trial was designed in patients with mandibular subcondylar fractures requiring operative intervention. Patients were randomized into 2 groups based on a computer-generated randomization table. Group A included 37 cases, treated with the RMTMAP approach, and group B included 38 cases treated with the RMTP approach. The primary outcome variable was exposure time. Secondary outcome variables were blood loss during exposure, complications like facial nerve palsy, sialocele formation, surgical site infection, and scar esthetics. All patients were followed for 3 months. Collected data were analyzed using the χ2 and analysis of variance tests. RESULTS: The mean exposure time for fractures treated with the RMTMAP approach and RMTP approach was 21.08 ± 9.18 and 13.57 ± 6.09, respectively (P < .05). The mean blood loss for RMTMAP and RMTP approach was 11.75 ± 5.11 and 9.9 ± 3.77 mL, respectively (P = .078). No facial nerve injury was seen in patients treated with the RMTMAP approach, whereas 3 (7.8%) patients in the RMTP group had transient facial nerve injury (P = .08). CONCLUSIONS: This study concludes that the RMTP approach provides quicker access to the condyle as compared with the RMTMAP approach. However, the incidence of transient facial nerve injury was more in the RMTP approach. Except for reduced blood loss in the RMTP approach, all other parameters were comparable in both the approaches.

Orthodontic management of amelogenesis imperfecta: A case report.

Key Clinical Message: Amelogenesis imperfecta (AI) is a rare developmental anomaly characterized by poorly developed or absent tooth enamel, which complicates orthodontic treatment due to weak enamel-bracket bond strength. This case report presents a successful management of AI using fixed orthodontic appliances and prosthodontic rehabilitation. Abstract: Amelogenesis imperfecta (AI) causes enamel defects, complicating oral hygiene, reducing masticatory function and lowering self-esteem. This case report details an 18-year-old female with AI who underwent fixed orthodontic treatment followed by prosthodontic rehabilitation. The multidisciplinary approach restored function and aesthetics, significantly improving her quality of life.

Surgical orthodontic intervention for impacted maxillary permanent central incisors: A case series.

Key Clinical Message: Impacted maxillary central incisors represent a relatively infrequent occurrence. This condition significantly impacts the patient's self-esteem and aesthetic concerns. Effective resolution is achievable through a combined strategy involving surgical exposure, bracket attachment, and subsequent orthodontic extrusion. The Surgical orthodontic approach is the optimal strategy for addressing impacted maxillary central incisors. Abstract: Central incisor is rarely impacted teeth often associated with supernumerary teeth. This case series includes three cases of central incisor impaction presented with complaints of missing teeth, unesthetic appearance, and unclear speech. All the cases were managed with surgical exposure followed by traction by orthodontic force, restoring smile aesthetics.

Comprehensive surgical reconstruction of Tessier number 7 congenital craniofacial cleft. A rare case report.

Introduction and importance Tessier 7 craniofacial congenital cleft is a rare anomaly, occurring in about 1 in 80,000 to 1 in 300,000 live births, comprising 0.3% to 1.0% of total cleft cases. A total of 24 cases have been reported since 2000. This case is the 25th instance and possibly the first reported in Nepal. PRESENTATION OF THE CASE: A 3-year-old child, accompanied by parents, presented at the Department of Oral and Maxillofacial Surgery with complaints of feeding difficulties, speech impediment, and aesthetic concerns. Diagnosis revealed Tessier number 7 congenital cleft. Surgical intervention successfully repaired the cleft, involving straight-line closure of mucosa and skin, suturing of perioral muscles to establish a new modiolus and formation of a new commissure. Postoperative follow-up over 6 months demonstrated excellent functional and aesthetic results without any complications. CLINICAL DISCUSSION: Tessier 7 congenital cleft arises from anomalous fetal development, stemming from incomplete fusion of the maxillary and mandibular processes of the first pharyngeal arch. Surgical correction poses challenges due to atypical anatomical positioning and cleft appearance. The repair involves layered closure, linear mucosal closure, perioral muscle reorganization to establish a new modiolus, skin closure via straight-line or z-plasty techniques, culminating in the creation of a new commissure. CONCLUSION: Given its rarity, surgeons must be well-versed in the intricate surgical protocol for Tessier 7 cleft treatment. Early intervention is crucial for optimal functional and cosmetic results. Key steps encompass establishing a new modiolus, forming a new commissure, and achieving effective skin closure.

Management of bilateral temporomandibular joint ankylosis using bilateral custom alloplastic temporomandibular joint prosthesis and genioplasty: A case report.

INTRODUCTION AND IMPORTANCE: Temporomandibular joint (TMJ) ankylosis can be effectively managed through the utilization of autogenous grafts or alloplastic TMJ prostheses. Alloplastic TMJ prostheses are available in two forms: stock or custom. Custom alloplastic TMJ prostheses represent an emerging treatment modality for TMJ ankylosis. PRESENTATION OF THE CASE: A 47-year-old female patient presented with a 30-year history of complete inability to open her mouth, chew, speak, and be on a liquid diet. Bilateral TMJ ankylosis and a nine mm right-sided chin deviation were noted. A bilateral osteoarthectomy was performed, followed by reconstruction of the TMJ using a custom alloplastic TMJ prosthesis via an extended preauricular and submandibular approach. The abdominal fat pad was utilized for interposition to prevent recurrence. Genioplasty was carried out through a vestibular approach, shifting the chin nine mm to the left. Postoperatively, the patient achieved a 30 mm mouth opening, and correction of facial asymmetry resulting from chin deviation was observed. CLINICAL DISCUSSION: Treatment options for TMJ ankylosis include autogenous grafts and alloplastic materials. Autografts have limitations such as prolonged surgery, resorption, undergrowth/overgrowth, donor site morbidity, and graft fracture. Stock alloplastic TMJ prostheses may not suit all patients due to anatomical variations. Thus, custom alloplastic TMJ prostheses have emerged as the preferred treatment modality for adult TMJ ankylosis. CONCLUSION: Custom alloplastic TMJ prostheses are considered an optimal treatment modality for reconstructing the TMJ in adult patients with TMJ ankylosis.

Surgically assisted rapid palatal expansion for transverse maxillary discrepancy in adults - Case report.

INTRODUCTION AND IMPORTANCE: Transverse maxillary deficiency is one of the most detrimental problems to midfacial growth and the integrated dentoalveolar structures. Early diagnosis and proper treatment of such cases is most important to maintain the balance between the basal bones and stable occlusion. CASE PRESENTATION: In our case, a 17-year-old male had irregular upper front teeth with an unpleasant smile. Detail examination revealed a symmetrical face with an orthognathic profile, mild malar deficiency, competent lips, asymmetrical arches, Class I molar and canine relationships bilaterally. Crowding was present in the upper anterior arch with 2 mm of anterior open bite and posterior cross bite present in the premolar region and molar region bilaterally. Lefort-1 osteotomy, midpalatal split, pterygomandibular disjunction without down fracture was done. The HYRAX appliance was cemented. Distraction started after four days of surgery. One mm distraction per day was done for 10 days. The patient was transferred to fixed orthodontic treatment to relive the anterior crowding. Records were taken after 1 year of follow up and analyzed. Skeletal relationships were in harmony. Dental crowding, anterior open bite and posterior crossbite were corrected. CLINICAL DISCUSSION: The zygomatic buttress and the pterygomaxillary junction are considered as the critical areas of resistance for maxillary expansion. Literature claims lefort-1 osteotomy in combination with palatal distraction results in more displacement and less stress in the maxilla. CONCLUSION: SARPE has proved to be clinically effective and stable for the correction of transversely deficient maxilla after cessation of growth in adult patients.

Effects of modified twin block appliance in growing Class II high angle cases: A cephalometric study.

Background: Class II malocclusions represent anteroposterior dysplasia usually resulting from mandibular retrusion. Along with a retropositioned mandible, it can be associated with either upward or backward jaw rotation. High angle cases are often associated with a short ramal height, steeper mandibular plane, and large gonial angle. Twin block is a commonly used myofunctional appliance that incorporates bite planes that direct the occlusal forces in a more favorable direction for correction of the retrognathic mandible. We aimed to evaluate skeletal, dental, and soft tissue changes following modified twin block appliance therapy in high-angle cases. Methods: A cephalometric study was performed on 15 growing (10-14 years) high angle (Frankfort mandibular angle 28-35°) Class II Division I malocclusion patients undergoing twin block therapy. Skeletal, dental, and soft tissue changes were evaluated by cephalometric analysis using Dolphin software. Results: Pre- and post-treatment changes in cephalograms were assessed by analysis of variance and paired t-test. Significant changes in the position of the mandible (angle between Sella-Nasion-Point B [SNB] increased by 3.9 degrees, P=0.02), Wits appraisal (decreased by 1.54 mm, P=0.04), maxillo-mandibular relationship (angle between Point A-Nasion-Point B [ANB] decreased by 3.74 degrees, P=0.02) were observed. Soft tissue changes like the nasolabial angle were also significant, increasing by 3.8 degrees (P=0.04) and lower lip relation to E-line (reduction in lower lip protrusion) by 2 mm (P=0.04). Vertical parameters showed non-significant changes, like the Frankfort mandibular angle (FMA) increased by 0.07 degrees, (P=0.67), the angle between Sella-Nasion and Gonion-Gnathion (SN-Go-Gn) increased by 0.33 degrees, (P=0.67), Y-axis increased by 0.2 degrees, (P=0.32). The upper incisor inclination decreased non-significantly from 115.27±1.33 to 113.42±1.65 degrees, (P=0.12) and lower incisor increased non-significantly from 100.13±2.23 to 101.80 ±1.37 degrees, (P=0.08). Conclusions: Modified twin block appliance can be used to successfully treat Class II Division I high angle cases with good vertical control.