Comparative evaluation of temporal fascia and dermal fat graft in the management of temporomandibular joint ankylosis.

Introduction: Temporomandibular joint (TMJ) ankylosis is a debilitating condition usually afflicting children and young adults, causing long-term functional, aesthetic, and severe psychological impacts on the lives of these patients. Objective: To compare the postoperative outcomes after using one of the most commonly employed inter-positional graft, i.e., temporalis fascia, and a recently introduced 'more suitable' graft, i.e., dermal fat. Methods: A prospective study in which 20 patients of TMJ ankylosis were randomly assigned into two groups of 10 patients each. Temporalis fascia was used as an inter-positional graft in one group, while dermal fat graft was used in the other group. Post-surgical clinical parameters were evaluated, including interincisal mouth-opening and pain. Results: Interincisal mouth opening at six months was greater in group A (32.1 ± 12.93) as compared to group B (33.8 ± 4.89), but statistically, it was not significant (P = 0.478). The mean pain score in group A was 4.60 ± 1.17, 1.50 ± 0.70, 0.20 ± 0.42 on day 1, 7, and 15, respectively. The mean pain score in group B was 4.10 ± 0.99, 1.30 ± 0.48, 0.20 ± 0.42 on day 1, 7, and 15, respectively. Conclusion: Both the graft materials work well in terms of maximum interincisal opening. For more clarification, a larger sample size with a longer duration of follow-up is needed to validate the study.

Ramal Growth Assessment in Temporo-Mandibular Joint Ankylosis in Growing Patient Without Growth Centre Transplantation: Radiograph Based Study.

Introduction: The treatment of temporomandibular joint is mainly surgical and aims at restoring the function of joint and correcting the aesthetics deformity caused by ankylosis. Studies are available in the literature which showed that there is osteogenic potential in condylar stump remaining after gap arthroplasty, especially in children. Our objective was to assess the growth of ramus operated after surgery using orthopantomogram as the tool of assessment. Materials and method: Fifteen patients of prospective study design were selected for study. This study was undertaken to evaluate the mandibular ramal growth in TMJ ankylosis patients treated without growth center transplantation using orthopantomogram as a tool of assessment. Results: Mean ramal length of the operated right side was found to be 42.02 mm in immediate postoperative, 43.18 mm in sixth month postoperative and 44.57 mm in 1 year postoperative follow-up. Mean ramal length of the operated left side was found to be 40.15 mm in immediate postoperative, 42.10 mm in sixth month postoperative and 44.80 mm in 1 year postoperative follow-up. Conclusion: Our investigations showed that mandibular growth rate increases after successful treatment of ankylosis in children. One drawback of this treatment protocol that we observed was that the total growth deficit manifested in all our patients could not be made up.

Quantitative analysis of tumor-associated tissue eosinophils and tumor-associated blood eosinophils in oral squamous cell carcinoma.

BACKGROUND: Stromal response to cancer is usually characterized by intense lymphoplasmacytic infiltrate. However, recently, the attention has shifted to tumor-associated tissue eosinophils (TATE). Tumor-associated blood eosinophils (TABE) are rare in solid cancers; however, carcinoma of the head and neck shows its prevalence. AIM: The aim of the study was to investigate the prevalence and relationship of tissue and blood eosinophils in various grades of oral cancer. The purpose of the article is to emphasize the possible clinical and biological significance of eosinophils in patients of oral squamous cell carcinoma (OSCC) so that appropriate therapeutic strategies can be devised accordingly. STUDY DESIGN: Thirty histologically confirmed cases of oral squamous cell carcinoma were divided into well, moderate and poorly differentiated carcinoma. Eosinophilic infiltration in the tissue was graded as low, moderate and massive TATE. The number of eosinophils per 100 WBCs was taken as the differential eosinophil count. Blood eosinophilia (BE) >6% was considered to be TABE. MATERIALS AND METHODS: Hematoxylin and eosin-stained tissue sections at 5 µ were evaluated. Prolonged staining in dilute 0.05% aqueous eosin demonstrated eosinophils selectively. Blood smears were stained by Leishman stain. STATISTICAL ANALYSIS: Student's t-test, Chi-square test, ANOVA, Newman-Keuls Multiple Comparison Test and Karl Pearson correlation coefficient® method were used. RESULTS: The mean TATE value was highest in poorly differentiated carcinoma. TABE was seen only in a few cases and was associated mostly with poorly differentiated OSCC. CONCLUSION: There was a statistically significant correlation between TATE and histological grades of OSCC. Eosinophilia of the peripheral blood is an adverse sign in patients with carcinoma.

Finite Element Analysis (FEA) of Perpendicular Plating Versus Conventional Plating in Mandibular Symphysis Fracture.

AIM AND OBJECTIVE: To perform the comparative finite element analysis of conventional and perpendicular plating in mandibular symphyseal fracture. MATERIAL AND METHOD: Two FE model of mandible were developed and symphyseal fracture was created in both of them. Each fractured model was fixed by conventional method 2.0 mm system and perpendicular method 2.00 mm system. Stresses which developed in plates and mandible after application of load were observed in the model. RESULTS: Results of the study indicated that perpendicular method was more resistant to displacing forces and rest of the parameters was within the permitted limits. CONCLUSION: Perpendicular method was reasonably effective as conventional method of fixation for mandibular symphyseal fracture.

A Clinical and Radiological Investigation of the Use of Dermal Fat Graft as an Interpositional Material in Temporomandibular Joint Ankylosis Surgery.

Management of temporomandibular joint (TMJ) ankylosis is mainly through surgical intervention. Interpositional materials are a necessity when it comes to prevention of TMJ re-ankylosis after arthroplasty. Early aggressive postoperative physiotherapy is essential for the prevention or treatment of TMJ hypomobility or ankyloses. Recently, it has been shown that abdominal dermis fat helps promote smooth, pain-free joint function and it is stable after interposition and less prone to fragmentation. The purpose of this study was to assess that whether dermal fat is a good choice of interpositional material when it comes to decreased pain perception during aggressive physiotherapy after release of ankyloses thus ensuring good compliance by the patient. We also assessed the fate of the graft material on computed tomography to evaluate any volume changes if occurred after interposition.

Posttraumatic Lateral Dislocation of Mandibular Condyle: A Proposed New Classification with Report of 14 Dislocated Condyles.

Lateral dislocation of the intact mandibular condyle is a relatively uncommon clinical condition. Since the first description and classification of these dislocations given by Allen and Young, few classification systems have been proposed in literature with incorporation of different patterns of dislocations identified over the years. We share our clinical experience of nine cases of such dislocations with 14 dislocated condyles, and on the basis of clinical and radiological findings coupled with the review of existing classification systems, we propose a new classification system which includes all the possible patterns of such dislocations overcoming the major shortcomings of preexisting classification systems identified by the authors.

Management of Odontogenic Fascial Space Infection in Hemophilia Patients: A Proposed Protocol.

PURPOSE: The purpose of this study was to suggest a protocol for the management of odontogenic space infections in patients with hemophilia which is often incompletely addressed by clinicians because of the fear of excessive bleeding leading to prolonged morbidity. METHODS AND RESULTS: Six diagnosed cases of hemophilia (four cases of hemophilia A and two cases of hemophilia B) with odontogenic fascial space infection were included in the study. Apart from routine investigations, assessments were also done to identify inhibitors to factor VIII/IX. Factor VIII/IX was replaced along with infusion of factor eight inhibitor bypass activity (FEIBA) one hour before incision and drainage. All the cases were treated by incision and drainage along with removal of foci under local anesthesia. The postoperative outcome was uneventful in all cases except one in which postoperative bleeding was noted from the extraction site on the third day which was again managed following the designed protocol. CONCLUSION: Maintaining good oral hygiene and seeking early dental care are of prime importance in patients with hemophilia to avoid invasive procedures. However, if odontogenic infection develops in these patients, performing timely incision and drainage using our protocol will minimize the complications and give successful outcome.

Traumatic superolateral dislocation of the mandibular condyle: case report and review.

We describe what is to our knowledge the first report of a patient who presented with a superolateral dislocation of the mandible, in which the medial portion of the left condyle was fractured and the lateral fragment was hooked on the zygomatic arch without any other associated fracture.

Trabecular Variant of Juvenile Aggressive Ossifying Fibroma.

Juvenile aggressive ossifying fibroma (JAOF) is an uncommon benign lesion which is distinctly aggressive in behavior with high tendency for recurrence. It appears in early age and in 79% of patients is diagnosed before 15. It has two histological variants: psammomatoid and trabecular, with the latter being less common with a stronger tendency to recur. In this article, we present a case of trabecular JAOF, in which treatment could not be given despite the availability of all requisites for surgery and good financial status, due to parental indifference and negligence.