Missed injuries associated with maxillofacial trauma.

Background: Maxillofacial trauma in polytrauma settings is often associated with multiple injuries both trivial and life threatening, and their timely detection is the mainstay of definitive trauma management for preventing mortality and morbidity. Emergency management of all the patients reporting to our maxillofacial unit is either done by our center or they have been managed at the peripheral health care facility and relatively stable patient is referred to us. Anecdotally, we found inadequacies in transport methods, diagnosis, and detection of associated injuries in the patients referred to us from the peripheral health care facility. To substantiate our finding, this observational study has been planned. Objective: To identify, diagnose, and document missed injuries associated with the maxillofacial trauma. Materials and Methods: All the trauma patients referred to the maxillofacial unit directly from the peripheral health care facility during the period of October 2017 to March 2019 were included in this study. Results: We observed a total of 270 patients having both pure maxillofacial trauma and patients having documented other injuries associated with maxillofacial injuries. In our maxillofacial unit, functioning as a secondary screen, head to toe clinical examination was performed to document any previously missed out injuries. Missed injuries diagnosed by us included spinal injuries, temporal bone fractures, fractures of the styloid process, and even head injury. Conclusion: Frequent reassessment of trauma patients at all levels of trauma care and training health care personnel particularly those at peripheral health care facility and those involved in prehospital care are pivotal in managing the trauma patients in most efficient manner.

3D assessment of ear morphology.

Introduction: Auricular reconstruction is a technically challenging and aesthetically demanding procedure as the ear has a complex anatomy. Anthropometry aids in achieving aesthetic ear reconstruction. We considered that implication of stereophotogrammetric technology will lead to a better understanding of human ear morphology. Material and methods: A cross-sectional study was conducted in our institutional OPD in a tertiary health care centre in the Northern part of India.400 people were chosen based on selection criteria. facial scans were done for 3D pictures using Canfield VECTRA® H2 3D imaging device. Study variables were assessed after marking landmarks on the 3D-generated auricular image of an individual. Discussion: This study consisted of 55.5% males and 44.5% females belonging to the age group of 5-25 years (30.3%), 26-40 years (38.8%) and>40 yr (31.0%). Out of 400 cases, the majority had; oval shaped auricle, normally rolled helix, square earlobe; knob shaped tragus. The attached type of earlobe attachment was more in the right auricle (37%) and the partial attachment ear lobe was more in the left side auricle (35.5%). Darwin's tubercle showed more proportion in the case of males. The mean length and width of the auricle & attachment length are higher in males compared to females. Ear Angulation is highest among females. Conclusion: Assessment of ear morphology using technologically sound methods like stereophotogrammetry paves the way for a more quick, reliable and easy-to-use method for understanding ear morphology. Precise assessment of ear morphology using stereophotogrammetry helps in providing more cosmetic and acceptable ear restoration.

Combination of double-sliding advancement genioplasty and prearthroplastic distraction osteogenesis in cases of TMJ ankylosis with severe mandibular atrophy.

The aim of this study is to present a case of facial asymmetry secondary to unilateral long-standing temporomandibular joint (TMJ) ankylosis managed by a staged treatment protocol. Treatment for facial asymmetry secondary to unilateral TMJ ankylosis can have varied approaches followed by different workers according to their experiences. This predistraction arthroplasty versus prearthroplastic distraction debate has been at the center stage in literature for quite some time. Hereby, we present a case followed by the latter approach along with double-sliding genioplasty to correct chin asymmetry. A 25-year-old male patient with a history of facial trauma 15 years ago reported a complaint of inability to open mouth and gradually developing facial asymmetry. The patient was thoroughly evaluated using radiographs and cephalometric analysis to establish the diagnosis of TMJ ankylosis with facial asymmetry and suspected sleep apnea. The patient was treated according to our institutional protocol of prearthroplastic asymmetry correction followed by ankylosis release along with double-sliding genioplasty to correct residual deformity at a later date. Correction of facial asymmetry before ankylosis release provides a more evidence-based approach as supported by the current literature. Plus, any residual deformity can be rectified using orthomorphic procedures such as genioplasty. Since there is an ongoing debate in the current literature about sequencing in the treatment of facial asymmetry cases, the presented case adds to the argument that the approach followed herein provides for more favorable outcome.

Huge complex composite odontoma of mandible.

A young female patient reported to the department of oral and maxillofacial surgery with complaint of asymptomatic swelling in left posterior region of lower jaw since 6 months. Complete intraoral and extraoral clinical examination was done. Routine radiographical investigations were advised. Based on clinical and radiographical findings she was provisionally diagnosed with odontoma of left mandible. It was a considerably giant mass with thinned out both cortical plates and the inferior border of the mandible. Although we assumed high risk of fracture of the mandible, successful surgical excision of the tumour was done using a minimally invasive intraoral approach and by sectioning the odontoma, sparing cortical bones. We managed to remove the whole of tumour without fracturing the mandible. Final histopathological report confirmed the initial diagnosis of complex composite odontoma. Patient is under regular follow-up.

Comparative evaluation of extrasinus versus intrasinus approach for zygomatic implant placement.

Edentulism, a common problem can occur either as a congenital defect or acquired later due to dental caries, periodontitis, as a consequence of aging, maxillofacial trauma or post-ablation in tumor resections. The rehabilitation of the missing teeth can be done using dental implants. To overcome the deficiency of available bone, processes like sinus augmentation with substituted bone graft and Le Fort I osteotomy with interpositional bone graft have been described in the literature. In order to overcome the associated limitations with these procedures, implants were designed that can be placed in specific anatomical areas like zygoma. This study aims to compare two different types of surgical approaches (Intrasinus vs Extrasinus) for the placement of zygomatic implants to treat atrophic maxilla. The placement of zygomatic implant through both extrasinus and intrasinus approaches were evaluated on the basis of different parameters and it was observed that postoperative pain and swelling was significantly found in intra sinus approach as compared to extra sinus approach. However, in the intranasal approach, poor patient compliance or low satisfaction rate was observed as compared to extra sinus approach. On the basis of the results of the study and post operative evaluation based on various criteria, it was concluded that extra sinus approach has got an edge over intra sinus approach.

The outcome of conventional open reduction approach vs endoscopic approach for orbital floor repair.

Introduction: Blunt trauma to the orbital rim is a frequent cause of both orbital fractures and damage to the surrounding facial bones and soft tissues. The inception of endoscopy and minimal invasive intervention has revolutionized the surgical treatment of blow out fracture of orbital walls. Thus, the present study was conducted to compare the outcome of conventional open reduction approach with endoscopic approach for orbital floor repair. Materials and method: The study included 10 patients with clinical and radiographic evidence of orbital floor fracture, divided randomly into two groups: Group I-operated using endoscopic approach; and Group II- operated using conventional external approach. All the patients were evaluated clinically preoperatively, immediate post-operative and after 1 month for Diplopia, Extrinsic ocular motility, Enophthalmos and Hypoglobus. Results: The study consisted of 40% females and 60% males, with mean age of Endoscopic and Conventional group being 27.20 ± 6.14 years and 27.60 ± 7.23 years respectively. In relation to diplopia, an insignificant difference was observed statistically. The mean change in enophthalmos and hypoglobus in endoscopic and conventional group showed a significant difference statistically (p < 0.001). Unrestricted ocular motility was present only in one case of each group and significantly increased to 5 cases in both the groups (p = 0.048). The mean duration of surgery in endoscopic and conventional group showed a significant difference statistically. Conclusion: Diplopia, hypoglobus and Enophthalmos correction was better achieved in endoscopic group as compared to conventional group. But duration of surgery was more in endoscopic group as compared to conventional group.

Quality of life after reconstruction of traumatic orbital floor defects using titanium mesh and medpore: A randomised controlled trial.

AIM AND OBJECTIVES: The aim of this study was to analyse the outcomes of orbital floor reconstruction with two types of orbital implants and assess patients' quality of life. MATERIAL AND METHODS: 39 sequential patients with clinical and radiological evidence of orbital floor fracture, presenting diplopia, enophthalmos, paraesthesia or a post traumatic residual orbital deformity were included in this study and randomised for orbital floor reconstruction using porous polyethylene sheet (Biopore™) or preshaped titanium mesh on a 3D model. Their pre and postoperative quality of life were compared. Success rate was assessed and scored with a minimum of zero (none) and a maximum of ten (excellent) for improvement in the signs of diplopia, enophthalmos, hypoglobus, paraesthesia and aesthetics. RESULTS: Both QOL scores and Success score was greater in cases which reconstruction of orbital floor was performed with preshaped titanium mesh as compared to those with Biopore™. CONCLUSION: Preshaped titanium mesh shows better results than reconstruction with Biopore™. However a large sample size and a long term follow up is needed for generating the best evidence. Quality of life extensively improves after orbital floor reconstruction motivating the patients desire to live.