Open vs Closed Management of Condylar Fracture Our Experience of 100 Cases in a Suburban Tertiary Care Hospital.

Study Design: Retrospective Observational Study. Objective: Mandibular condyle fractures are distinctive among maxillofacial injuries in which they disrupt mandibular function in a way that other traumatic injuries do not. Condylar fractures can be treated using either the conservative (closed reduction and immobilisation) or surgical (open reduction and internal fixation) approaches. Both of these modalities of treatment have advantages and disadvantages, as well as indications and contraindications. The purpose of this study is to compile and compare our experience in the management of condylar fractures through open and closed reduction. Methods: The present retrospective analysis included a total 100 patients of condylar fractures in patients > 18 years of age who were randomly divided into nonsurgical and surgical group based on Edward Ellies criteria. In the present study, the outcomes of conservative vs surgical management of condylar fractures were discussed in terms of seven parameters, including the maximal inter-incisal mouth opening, protrusive and lateral excursive movements of the mandible, status of occlusion, deviation of mandible during mouth opening, temporo-mandibular disorders and facial nerve paralysis which were measured and evaluated pre- and post-operatively at different intervals of time. Follow-up period was for 6 months. Results: It was noted that the main cause of condylar fracture was trauma with a male predilection with an average age of 32.6 ± 1.2 years. Subcondylar fracture was the commonest type of condylar fracture that we encountered. 33.3% of the patients had restricted mouth opening and 57% of the patients had deranged occlusion. 37% of the patients were treated surgically and 48.6% of these fractures were approached using peri-angular approach. More patients had an increased mouth opening and a stable occlusion at the 6 months follow-up when compared to that of the 2 month follow up. Conclusions: From the above study we can conclude that the treatment plan should be patient specific and follow the algorithm for a particular type of fracture. We endorse the same based on our experience in treating condylar fractures over the last 5 years. The art of decision making solely depends on the surgeon's expertise in managing condylar fractures.

Silent Sinus Syndrome Post Trauma: A Case Report and Literature Review.

Silent sinus syndrome (SSS) is a relatively rare clinical condition occurring in the maxillary sinus exhibiting progressive enophthalmos and hypoglobus. The communication between the orbit and maxillary antrum due to trauma further leads to changes in the maxillary sinus. This could lead to the development of negative pressure within the maxillary sinus, collapse of antrum walls, and sucking in of orbital contents. Here, we present a case of a delayed orbital trauma, which was not treated initially. The patient's complaint was a constant feeling of a sunken right eye along with restriction in eye movements. On examination, the clinical and radiographic features were consistent with SSS. Orbital floor reconstruction was performed with the help of a titanium mesh for the correction of hypoglobus and enophthalmos. During follow-up, the patient showed no recurrence of the presenting functional and esthetic complaints. This clinical entity needs prompt diagnosis and early intervention so as to prevent further complications.

Oral verrucous Carcinoma on mandibular right alveolar region.

Verrucous carcinoma, a low-grade variant of squamous cell carcinoma, defined as a diagnostically squamous cell neoplasia involving lip, oropharyngeal, and laryngeal mucosa and named as 'Ackerman's tumour' by Ackerman in 1948. It usually occurs in the lower lip region and this is one such case in which a painful proliferative growth was evident over the right alveolar region for the period of 8 months. Radiological investigations, biopsies were performed followed by surgical excision of the lesion.

Maxillofacial trauma and ocular injuries: reports from a prospective study from Pondicherry, India.

PURPOSE: To report the spectrum and the factors affecting the visual outcome of ocular injuries associated with maxillofacial trauma. METHODOLOGY: A prospective observational study was carried out from January 2019 to June  2020 on patients of maxillofacial trauma at a rural tertiary care centre, in Pondicherry, India. Detailed history was obtained. Investigations including imaging was done as indicated. Predictors of eye injuries and prognostic factors for vision were assessed. RESULTS: A total of 135 eyes of 126 patients were evaluated. Males constituted 92.06%. Road traffic accident (RTA), domestic injuries, assault, and work-place-related injuries accounted for 86.5%, 4.7%, 2.3%, and 2.3%. Alcohol consumption (42.06%) and lack of eye protective device (94.4%) and injury to posterior segment were the major risk factors. On presentation 80.6% had visual acuity ≥ 6/12. Orbital and maxillofacial fractures were noted in 70.6% of cases. Closed-globe injury was seen in 83 (61.4%) and open-globe injury in 2 (1.4%). Majority (86.7%) suffered soft tissue injuries. Common sight-threatening injuries were traumatic optic neuropathy (4.4%), vitreous haemorrhage (0.7%), retrobulbar haemorrhage (0.7%), and commotio retinae (0.7%). CONCLUSION: Most of the injuries in this population occurred from RTA, with associated fractures, adnexal and globe injuries. Alcohol consumption and lack of eye protective device were the major risk factors. Patients with open-globe injuries and injuries with posterior segment involvement had poor visual outcome.

Platysma myocutaneous flap for reconstruction of intraoral defects following excision of oral sub mucous fibrosis: A report of 10 cases.

Various surgical procedures are available for treating oral submucous fibrosis, but all of them have their inherent drawbacks. The superiorly based platysma myocutaneous flap is a common reconstruction option for intraoral defects followed after excision of fibrous bands in oral submucous fibrosis. The superiorly based flap has an excellent blood supply, but less efficient venous drainage when compared with posteriorly based flap. We present our results of using a superiorly based flap in the treatment of oral submucous fibrosis. Of 10 patients eight had no postoperative complications, one patient developed partial skin loss and other developed venous congestion which was managed conservatively.