Effect of Single dose of Methylprednisolone Injection at Stylomandibular Ligament Insertion on Pain and Various Mandibular Movements Among Patients with Ernest Syndrome: A Pilot Study.

Insertion tendinosis of stylomandibular ligament or Ernest syndrome is a rarely encountered cause of orofacial pain. The pain in this disorder originates from the stylomandibular ligament insertion site and radiates to the temporomandibular joint (TMJ), neck, shoulder, and periauricular region. Ten subjects who had undergone surgery for mandible fractures diagnosed with Ernest syndrome were considered for the present study. The origins and insertions of the stylomandibular ligament were marked and palpated using fingertip and blunt probe. The Ernest syndrome was confirmed by injecting diagnostic local anesthesia injection. A single dose of 2 ml methylprednisolone (40 mg/ml) was injected at the insertion site of a stylomandibular ligament in each subject. The effect of methylprednisolone injection on pain and various jaw movements were assessed at 1-month and 6-months after the injection. The mean pain value ranks during rest & while mouth opening in the visual analogue scale (VAS) reduced significantly after single injection (P < 0.001). The mean mouth opening increased significantly from 23.3 ± 3.94 mm before the treatment to 36.1 ± 3.07 mm at 1-week and 35.4 ± 2.17 mm at 6-months after the treatment (P < 0.001). The mandible protrusive movement increased from 4.07 ± 0.74 mm before treatment to 5.06 ± 0.62 mm at 1-week and 4.94 ± 0.62 mm at 6-months after the injection, respectively. Single dose of methylprednisolone injection at the insertion site of the stylomandibular ligament was proved effective on pain and various mandibular movements among patients with Ernest syndrome.

Orthomorphic surgery for correction of mandibular dysmorphology post TMJ ankylosis. A report of 4 cases and review of literature / Cirugía ortomórfica para la corrección de la dismorfología mandibular posterior a la anquilosis de la ATM. Un informe de 4 casos y revisión de la literatura

La dismorfología mandibular es predominantemente el resultado de una deficiencia o exceso de crecimiento no coordinado. La anquilosis unilateral de la articulación temporomandibular durante la fase de crecimiento activo, si no se opera, produce cambios en el tamaño y la forma de la mandíbula y las estructuras circundantes. El uso de la cirugía ortognática para corregir las deformidades faciales que surgen de las discrepancias en las relaciones espaciales, aunque bien aceptado, no puede corregir las anomalías que surgen de una morfología alterada. La corrección quirúrgica utilizando principios ortomórficos restaura la morfología sin cambiar el estado oclusal, lo que demuestra ser una adición invaluable al repertorio de un cirujano maxilofacial.Cuatro pacientes previamente operados por anquilosis unilateral de la articulación temporomandibular que presentaban asimetría mandibular fueron tratados mediante corrección ortomórfica. El factor etiológico en todos los pacientes reclutados fue un traumatismo en la articulación temporomandibular durante la infancia. Los pacientes fueron evaluados para cambios neurosensoriales, evaluación de la apertura bucal antes y después de la cirugía, evaluación postoperatoria de la simetría mandibular y complicaciones postoperatorias al 3.er día, 3 semanas y 3 meses después de la cirugía. Se observó una buena a moderada corrección de la asimetría en todos los casos. Se observó parestesia del nervio mentoniano en un paciente. No se observaron complicaciones postoperatorias.La técnica descrita se puede utilizar como complemento de la cirugía ortognática convencional o como una alternativa de tratamiento de una sola etapa confiable para entidades dismórficas complejas. (AU)

Mandibular dysmorphology is predominantly a result of uncoordinated growth deficiency or surfeit. Unilateral temporomandibular joint ankylosis during the active growth phase, if left unoperated, brings about changes in the size and shape of the mandible and the surrounding structures. The use of orthognathic surgery in correcting the facial deformities arising from discrepancies in spatial relationships although well accepted is unable to correct anomalies arising from an altered morphology. The surgical correction using orthomorphic principles restore the morphology without changing the occlusal status, thus proving to be an invaluable addition to a maxillofacial surgeon’s repertoire.Four patients previously operated on for unilateral temporomandibular ankylosis having mandibular asymmetry were managed by orthomorphic correction. The etiological factor in all the recruited patients was trauma to the temporomandibular joint during childhood. The patients were evaluated for neurosensory changes, assessment of mouth opening before and after surgery, postoperative assessment of mandibular symmetry, and postoperative complications on 3rd day, 3 weeks, and 3 months postoperatively. Good to moderate asymmetry correction was seen in all the cases. Mental nerve paraesthesia was noted in one patient. No postoperative complications were noted.The described technique can be used as a complement to conventional orthognathic surgery or as a reliable single-stage treatment alternative for complex dysmorphic entities. (AU)

Comparative Evaluation of Drill-Free and Self-Tapping Titanium Miniscrews for Semi-Rigid Internal Fixation in Maxillofacial Trauma.

Introduction: Conventional semi-rigid fixation systems in maxillofacial trauma use self-tapping titanium miniscrews (STS) that require preliminary drilling of a pilot hole. Although drill-free miniscrews (DFS) accompany these systems, they have not dominated practice despite their allure of improved screw-bone contact and holding power. The COVID-19 pandemic has brought these DFS to light as they avoid aerosol production. The present study has compared DFS to STS in patients being treated with miniplate fixation for maxillofacial trauma to understand their feasibility for maxillofacial fracture fixation. Methodology: This prospective case-control study sampled 16 patients each with zygomaticomaxillary buttress fracture and parasymphysis fracture of the mandible and grouped alternating patients as case (DFS) and control (STS). Intraoperatively duration of fixation, incidence of screw failures and fragment stability; postoperatively occlusion, neurosensory deficits, teeth vitality and infection and removal rates were evaluated at postoperative week 1, 3, 6, 12 and 24 using Cramer's V test. A P value < 0.05 was considered significant. Results: In the 32 patients evaluated, DFS reduced internal fixation time at zygomaticomaxillary buttress (P = 0.001) but not at parasymphysis (P = 0.206). No significant difference in screw failures or fragment stability was observed. Stable occlusion was maintained in all groups with vital teeth and intact neurosensory function, but the summative incidence of infection was significant at week 24 when STS was used at parasymphysis (P = 0.019). Discussion: While DFS may facilitate ease of insertion with a single instrument pick-and-screw-in approach, avoiding thermal osteonecrosis and aerosol production, they fail to confer any other clinical advantage.

Efficacy of Prolotherapy in Temporomandibular Joint Disorders: An Exploratory Study.

INTRODUCTION: Temporomandibular joint (TMJ) disorders can be treated by both conservative and surgical approaches. Conservative interventions with predictable benefits can be considered as first-line treatment for such disorders. Dextrose prolotherapy is one of the most promising approaches in the management of TMDs, especially in refractory cases where other conservative management has failed. AIM: To study the efficacy of prolotherapy and to establish it as an effective procedure in patients with TMJ disorders, to provide long-term solution to chronic TMJ pain and dysfunctions. PATIENTS AND METHODS: We conducted a study on 25 patients suffering from various TMJ disorders who were treated with prolotherapy, the solution consisting of 1 part of 50% dextrose (0.75 ml); 2 parts of lidocaine (1.5 ml); and 1 part of warm saline (0.75 ml). The standard programme is to repeat the injections three times, at 2-week interval, which totals four injection appointments over 6 weeks with 3-month follow-up. RESULTS: There was appreciable reduction in tenderness in TMJ and masticatory muscles with significant improvement in mouth opening. The effect of the treatment in improving clicking and deviation of TMJ was found to be statistically significant (P < 0.05). There were no permanent complications. CONCLUSION: Our study concluded that prolotherapy is an effective therapeutic modality that reduces TMJ pain, improves joint stability and range of motion in a majority of patients. It can be a first-line treatment option as it is safe, economical and an easy procedure associated with minimal morbidity.

Zygomaticomaxillary fracture fixation: a prospective comparative evaluation of two-point versus three-point fixation.

PURPOSE: Zygomatic bone has a higher risk of sustaining injuries in the maxillofacial skeleton. On fracturing, zygomatic bone separates from the four neighbouring bones at its articulations. Treatment for zygomaticomaxillary fractures has evolved a long way since 3000 BC. With the advent of miniplates for midface fracture, controversies still exist regarding the stability of zygoma following 1, 2, and 3 points for fixation. The study aims to compare and determine the most effective technique for the reduction of zygomaticomaxillary fractures and the ability to retain the fractured zygoma in a stable position. Hence, a study was conducted in our institute to compare 2 and 3-point fixation of zygomaticomaxillary fractures taking into account the clinical and radiographic parameters. METHODS: Twenty-four patients were divided into 2 equal groups A and B, receiving 2- and 3-point fixation respectively. Fracture displacement and stability were assessed using coronal and axial CT scan tracings at preoperatively, immediate, and 5-week postoperatively. RESULTS: Group B showed a significant reduction in postoperative mean displacement at sphenozygomatic and infraorbital region when compared with group A. Patients in group A had an increase incidence in vertical dystopia and enophthalmos. There was no postoperative displacement at any site in both the groups. CONCLUSION: The fractured segment was held in place by both the fixation methods but 3-point fixation gave better stability in maintaining the fractured segment in desired reduced position.

Objective and subjective comparison of submucosal and intravenous routes of single-dose preoperative dexamethasone for mandibular third molar surgery-a prospective randomized observer-blind study.

PURPOSE: Adjuvant corticosteroid administration through local routes has gained popularity due to ease of technique, lesser morbidity and presumed advantage of achieving therapeutic dosage at the site. To evaluate this, present study has compared submucosal route with an intravenous route control using single-dose preoperative dexamethasone. The study investigated objective facial measurements, mouth opening and compared them with subjective scores on a visual analogue scale and quality of life (QOL) recovery questionnaire. MATERIALS AND METHODS: This was a prospective, randomized, open-label study with blinded end-point assessment of submucosal and intravenous routes of single preoperative dexamethasone administration, in patients undergoing mandibular third molar surgery. Patients were randomly divided into two groups and received 8 mg DX as either submucosal or intravenous injection 5 min after administration of local anaesthesia. Data was collected at 2nd and 7th post-op intervals. Statistical analysis was done keeping a P value < 0.05 as significant. RESULTS: Thirty patients were evaluated in the study. SM route behaved similarly to IV route in producing changes in facial measurements [P = 0.533], mouth opening [P = 0.533] and pain [VAS] scores [P = 0.533] at early and late intervals. Questionnaire subscale scores were not significantly different between groups, but total mean score was significant [P = 0.050] with a measure of variance 17.54 in group IV compared with 39.54 of group SM showing that subjectively, IV route brought better recovery. CONCLUSION AND CLINICAL RELEVANCE: Submucosal route can be an effective less invasive, painless, straightforward alternative to systemic administration of corticosteroid for improving QOL recovery in mandibular third molar surgery.

Tongue flap: a "workhorse flap" in repair of recurrent palatal fistulae.

AIM AND OBJECTIVE: A prospective study done to evaluate the efficacy of tongue flaps in secondary palatal defects, in terms of functionality, esthetics, and donor site morbidity, and to clarify the technique of elevating and insetting of tongue flap. MATERIALS AND METHOD: Twenty patients having recurrent secondary palatal fistula, post cleft treatment were treated with anteriorly and posteriorly based dorsal tongue flaps. Patients were evaluated for outcome in terms of flap uptake and effectiveness, correction of oronasal regurgitation, speech and articulation, donor site morbidity, and esthetics. RESULTS: Twenty patients in age range of 11-24 years, with secondary palatal fistulae, were treated with anteriorly/posteriorly based tongue flap. There were two recurrences as the flap got detached in one patient and necrosis of flap in another. In other patients, healing was uneventful. The flap showed good success rate in terms of uptake and correction of oronasal regurgitation, with imperceptible donor site morbidity. With speech therapy assistance and periodic evaluation by a therapist, significant improvement in speech and articulation was noted over time in all successfully healed patients. CONCLUSION: Use of tongue flap for repair of palatal fistulae is a successful technique as it provides appreciable quality and quantity of well-vascularized tissue for fistula closure with negligible functional and esthetic morbidity associated with donor site. As per our study, it is a reliable technique for palatal fistula closure. It even provides good speech improvement over time.

To Evaluate the Efficacy and Effectiveness of N-butyl-2-cyanoacrylate glue (TRU SEAL) in Closure of Oral and Maxillofacial Laceration and Surgical Incisions.

INTRODUCTION: Effective wound closure is critical for minimizing wound complications and preventing wound dehiscence. The various wound closure techniques include staples, traditional nylon and skin sutures, subcuticular sutures, and skin adhesives. Currently topical skin adhesives are frequently being used. It offers countless advantages: short application time, easy execution as well as possessing hemostatic character. N-butyl-2-cyanoacrylate is bacteriostatic and biodegradable and exhibits suitable tensile strength. MATERIALS AND METHODS: Under nasoendotracheal intubation, the reduction in fracture and plating was done. In 80% of the patients, subcutaneous sutures were placed. Skin closure was done with N-butyl-2-cyanoacrylate glue. RESULTS: In this study, REEDA scale was used to assess healing. Redness, edema, and ecchymosis were seen in all 10 patients, which subsided by the second week postoperatively. None of the patients had discharge from surgical site on the first postoperative day but was noted in two patients the first week postoperatively. There was evidence of wound gaping in one patient on the first postoperative day and two patients at end of the first week postoperatively. Stony Brook Scar Evaluation was used to evaluate postoperative cosmesis. No significant cosmetic impairment was found in all patients at the end of the study. CONCLUSION: The study reflects qualitative assessment of cyanoacrylates which is simple to use and proper application which resulted in uniform and everted closure of wound. It is cost-efficient as compared to other wound closure materials.

Evaluation of the Efficacy of Simvastatin in Bone Regeneration after Surgical Removal of Bilaterally Impacted Third Molars-A Split-Mouth Randomized Clinical Trial.

PURPOSE: Simvastatin has been reported to promote osteoblastic activity, inhibit osteoclastic activity, and support osteoblast differentiation induced by bone morphogenetic protein. This split-mouth randomized clinical trial evaluated the effect of local application of simvastatin (10 mg) on bone regeneration after surgical removal of bilaterally impacted mandibular third molars. MATERIALS AND METHODS: A randomized, split-mouth, single-blinded, single-center trial was performed in 30 patients 18 to 40 years old requiring surgical extraction of bilaterally impacted mandibular third molars. These patients underwent 2 surgical sessions, with extraction of 1 third molar during each session. Each participant was randomly assigned to receive Gelfoam soaked with normal saline or with the drug simvastatin (10 mg) at the first session and were blinded to the use of drug for that particular socket. The alternate regimen was used during the second session. The study was conducted over a period of 3 months. Patients were evaluated for pain, postoperative swelling, and bone density measurement and analysis using intraoral periapical radiographs at the end of 1, 4, 8 and 12 weeks, respectively. In addition, cone-beam computed tomographic (CBCT) images were obtained for every fifth patient at the end of 12 weeks. RESULTS: Mean gray-level histographic values were significantly higher for the study sockets at the end of 1, 4, 8, and 12 weeks (P = .001) compared with the control sockets (30 sockets each). CBCT analysis further substantiated accelerated bone regeneration in the study sockets. CONCLUSION: The study was statistically and radiographically in favor of the drug, indicating that local application of simvastatin could be a cost-effective and simple way to stimulate and hasten osseous regeneration.

Comparison of intravenous tramadol versus ketorolac in the management of postoperative pain after oral and maxillofacial surgery.

BACKGROUND: The aim of this study was to assess the better postoperative analgesic, tramadol, and ketorolac, in patients with maxillofacial trauma and who had undergone maxillofacial surgery, i.e., open reduction internal fixation, under general anesthesia. MATERIALS AND METHODS: After taking ethical approval from the institution and informed consent, 46 ASA grade I-II patients were block randomized (ABAB) based on inclusion and exclusion criteria and equally divided into two groups in which one group of patients was given intravenous tramadol 100 mg and another group of patients was given intravenous ketorolac 30 mg at the time of closure of skin and was repeated after 8 and 16 h following surgery. Pain using VAS at the 2nd, 4th, 6th, 12th, and 24th postoperative was assessed, and association of results was compared using Cramer's V test SPSS (Version 22). Vital signs and side effects were recorded. RESULTS: Although both drugs resulted in significant decrease in pain intensity from the 2nd to 24th postoperative hour, intravenous tramadol always resulted in better pain control than intravenous ketorolac at every postoperative hour (p value < 0.05) except at 2nd hour where changes are non-significant (p value > 0.05). CONCLUSION: Apart from first 2 h where the changes are non-significant, this study clearly demonstrates the advantage of the intravenous tramadol in the management of postoperative pain and ease of administration in postoperative patient through IV cannula. The side effects of both the drugs were insignificant and did not have any effect on the result.

A Comparative Prospective Study of Two Different Treatment Sequences i.e. Bottom Up-Inside Out and Topdown-Outside in, in the Treatment of Panfacial Fractures.

PURPOSE: To compare the sequence bottom-up inside-out with top-down outside-in, in the treatment of pan facial fractures and to evaluate the outcome of these approaches. PATIENTS AND METHODS: The data from 11 patients with panfacial fracture are prospectively analysed. Five cases are treated with bottom-up approach and six patients with top-down approach. RESULTS: There were 11 male patients (six in top-down approach and five in bottom-up approach), ranging in age from 24 to 50 years. All injuries were result of RTA (n = 11, 100 %). Final treatment outcome was excellent in 3 (50 %), 1 (16 %) good and 2 (32 %) cases were fair in topdown approach, 3 (60 %) excellent and 2 (40 %) fair in bottom up approach with contingency coefficient value (P < .632) which was insignificant. There was no significant deviation from the two groups in the final treatment outcome. CONCLUSION: Within the limitation of low sample size we found that both bottom-up inside-out and top-down outside-in approaches have similar clinical outcomes. Hence it could be suggestive to start fixation of least disrupted (more stable) facial half as a guide for reconstruction of the remaining. Choice of the bottom-up inside-out or top-down outside-in sequence should be according to the pattern of fractures and preference of the surgeon. However, further controlled clinical trials, comparative studies with a larger sample size would be better to evaluate the final clinical outcome of individual techniques.

Cherubism: a case report.

Cherubism is a benign, self-limiting fibro-osseous lesion characterized by bilateral symmetric painless expansion of jaw which is more prominent in mandible than in maxilla. Males are commonly affected (2:1) and with greater severity. It becomes noticeable in early childhood and gradually regresses after puberty. Although cherubism is considered as a familial/inherited disease but many sporadic cases have been reported in literature with no familial history. Osteoblastic and osteoclastic remodeling replaces normal bone by excessive amount of fibrovascular tissue containing multinucleated giant cells. Here, we present a case report of cherubism in a 10 year old boy describing the clinical, histological, biochemical and radiographic features.

The karapandzic flap in lower lip reconstruction.

Human bite injuries are both deceptive and challenging in their presentation and management. They are particularly notorious due to the polymicrobial nature of human saliva inoculated in the wound and the risk they pose for transmission of infectious diseases. Early treatment, appropriate prophylaxis and surgical evaluation are the key to achieving desired treatment outcomes. Here we present a case report of human lip bite with significant tissue loss that required reconstruction. The reconstructive techniques are usually varied but the ultimate objectives of treatment are to achieve healing, function, and aesthetics. Through this article, we have tried to focus on the diagnostic features, reconstructive procedure as well as other recommended treatment options for human lip bites based on the current available evidence.

Evaluation of neurosensory disturbance following orthognathic surgery: a prospective study.

AIM AND OBJECTIVES: The prospective study was to evaluate the incidence, type of neurosensory disturbance (NSD), grade its severity and monitor its recovery occurring in the lower lip and chin due to damage to inferior alveolar nerve following orthognathic surgery involving mandible. MATERIALS AND METHODS: The study included 10 patients who have undergone sagittal split osteotomy, genioplasty, and anterior subapical osteotomy (ASO). All the patients examined preoperatively and post operatively 1 week, 1 and 6 months according to standardized test to clarify the subjective and objective neurosensory status of the injured nerve. Pin prick test, blunt test, two-point discrimator test, brush stoke direction, light touch test, warm and cold test were used bilaterally to lower lip and chin area. RESULTS: Seven patients underwent bilateral sagittal split osteotomy (BSSO) (70 %), one patient had BSSO with genioplasty (10 %), two patients had BSSO with ASO (20 %). During the operation none of the nerves were transectioned, in 60 % of patients nerve was not visible and in 40 % of patients nerve was seen in distal segment. 70 % of patients underwent setback, 30 % of patients underwent advancement. The subjective evaluation of the patients revealed the incidence of 90 % at 1 week, 30 % at 1 month, 20 % at 6 months and 10 % at 1 year post operatively. The altered sensation reported subjectively was hypoesthesia in 50 % of the patients, anaesthesia in 40 % of the patients. There was 100 % recovery in advancement cases and 93.5 % recovery in setback cases. CONCLUSION: There is a high incidence of NSD of the lower lip and chin after BSSO related to advancement, setback, intraoperative nerve encounter and surgical skill. However, recovery of sensation occurs with increasing frequency during the follow-up period. The clinical neurosensory tests are effective guides to study the neurosensory deficit.

Orthopaedic protraction of the maxilla with miniplates: treatment of midface deficiency.

Class III malocclusion is a consequence of maxillary deficiency and/or mandibular prognathism, resulting in an anterior crossbite and a concave profile. Early class III malocclusion treatment with reverse pull headgear generally results in maxillary skeletal protraction but is frequently also accompanied by unfavourable dentoalveolar effects. Titanium miniplates used as temporary anchorage device might permit equivalent favourable skeletal changes without unwanted dentoalveolar effects. We report two cases having class III malocclusion with maxillary deficiency treated by using titanium miniplates. Cephalometric tracings were done pre and post treatment to determine the anatomic changes during the course of treatment.

A Prospective Study on Management of Mandibular Angle Fracture.

PURPOSE: To evaluate the results of management of mandibular angle fracture by open reduction and internal fixation using single non compression miniplate via transbuccal, intraoral or extraoral approaches. PATIENTS AND METHODS: In this prospective study, 30 patients were randomly selected regardless of age, sex requiring open reduction and internal fixation of non comminuted angle fracture with/or without other associated fractures of the mandible. All the patients were operated under general anaesthesia following routine haematological, biochemical, general physical examination and routine radiographic examination. Patients were randomly distributed into 3 groups namely: (1) intraoral, (2) transbuccal, and (3) extraoral groups depending on the surgical approach used for open reduction and internal fixation of fracture of the angle of mandible. In the intraoral group (12 patients), angle fracture was approached through the intraoral vestibular incision similar to sagittal split incision. In the transbuccal group (8 patients), angle fracture was approached through the intraoral vestibular incision and transbuccal stab incision for screw fixation via trochar. In the extraoral group (10 patients), angle fracture was approached through the Risdon's submandibular incision. In all the patients, fractures were reduced with upper and lower Erich's arch bar fixation as means for IMF intraoperatively. In all the patients, fracture of the angle of the mandible was fixed with single non compression 2.5 mm, 4 holed with gap stainless steel miniplate and 6/8 mm monocortical screws. All patients were followed up for minimum of 6 months to maximum of 24 months. RESULTS: Complications were relatively minor such as paresthesia (on average 26.7 % first post-operative day which was gradually improved and on average after 1 month was 3.3 %), mild to moderate occlusal discrepancies (on average 36.7 %) which needed the post-operative intermaxillary fixation with elastics for 1-2 weeks, infection (20 % on average) was mild to moderate which was managed with antibiotic therapy and/or incision and drainage except in one case, plate removal was done under general anaesthesia (extraoral group) because of recurrent infection. Post-operative pain was mild to moderate (mean VAS score pre operative-6.17, post-operative 1 week-1.63) which was managed with analgesics. Mouth opening was recorded in all patients which was on average 20.98 mm preoperatively which improved to 40.57 mm after 1 month. CONCLUSION: The use of a single non compression miniplate for fractures of the angle of the mandible is a simple, reliable technique with relatively rare major complications and few minor complications irrespective of the surgical approach used for the open reduction.

Fixation of zygomatic and mandibular fractures with biodegradable plates.

CONTEXT: In this prospective study, 13 randomly selected patients underwent treatment for zygomatic-complex fractures (2 site fractures) and mandibular fractures using 1.5 / 2 / 2.5-mm INION CPS biodegradable plates and screws. AIMS: To assess the fixation of zygomatic-complex and mandibular fractures with biodegradable copolymer osteosynthesis system. MATERIALS AND METHODS: In randomly selected 13 patients, zygomatic-complex and mandibular fractures were plated using resorbable plates and screws using Champy's principle. All the cases were evaluated clinically and radiologically for the type of fracture, need for the intermaxillary fixation (IMF) and its duration, duration of surgery, fixation at operation, state of reduction at operation, state of bone union after operation, anatomic reduction, paresthesia, occlusal discrepancies, soft tissue infection, immediate and late inflammatory reactions related to biodegradation process, and any need for the removal of the plates. STATISTICAL ANALYSIS USED: Descriptives, Frequencies, and Chi-square test were used. RESULTS: In our study, the age group range was 5 to 55 years. Road traffic accidents accounted for the majority of patients six, (46.2%). Postoperative occlusal discrepancies were found in seven patients as mild to moderate, which resolved with IMF for 1-8 weeks. There were minimal complications seen and only as soft tissue infection. CONCLUSIONS: Use of biodegradable osteosynthesis system is a reliable alternative method for the fixation of zygomatic-complex and mandibular fractures. The biodegradable system still needs to be refined in material quality and handling to match the stability achieved with metal system. Biodegradable plates and screws is an ideal system for pediatric fractures with favorable outcome.

Reconstruction of Post-traumatic Internal Orbital Wall Defects with Titanium Mesh.

INTRODUCTION: The management of orbital injuries is one of the most interesting and difficult areas in facial trauma. The improper reconstruction of the orbit frequently results in ophthalmic complications. Though a number of materials are available for use in orbital wall reconstruction, at present titanium mesh could be considered to be the ideal orbital floor repair material. MATERIALS AND METHODS: The study involved patients with symptomatic zygomatico-orbital fractures requiring orbital wall reconstruction. Under general anaesthesia the floor of orbit was explored and reconstructed with contoured titanium mesh after repositioning of the entrapped orbital contents. The patients were on periodic follow-up for 6 weeks where clinical and radiographic data were recorded. RESULT: Ten male patients age ranging from 22 to 53 years (mean 29.88 years) received titanium implants for impure orbital fractures (eight patients) and pure orbital floor fractures (two patients). The main cause of fractures was road traffic accidents. They also complained of enophthalmos (n = 7), diplopia (n = 4), infraorbital nerve paresthesia (n = 6), dystopia (n = 1) and epiphora (n = 2). No implant extrusion or infection was seen. The symptoms were corrected in six patients with enophthalmos, three with diplopia, four with infraorbital nerve paresthesia and all patients with epiphora. Dystopia persisted post-surgically in one patient. CONCLUSION: Titanium orbital implants were used to confirm titanium as a useful repair material for orbital floor fractures. Their use leads to less morbidity as no donor site operation is needed. Also it provides favourable healing as it is biocompatible.

A study on orthomorphic correction of mandibular dysmorphology.

PURPOSE: To evaluate the usefulness of orthomorphic surgery in correcting mandibular dysmorphology. MATERIALS AND METHODS: This is a prospective study in which five patients having mandibular dysmorphology were treated using orthomorphic surgery. The patients were evaluated for outcome in terms of duration of surgery, assessment of mandibular split, mental nerve paresthesia/ neurosensory changes after surgery, assessment of mouth opening before and after surgery, postoperative assessment of mandibular symmetry, and postoperative complications. STATISTICAL ANALYSIS USED: Descriptive statistics, frequencies, contingency coefficient test (cross tabs). RESULTS: Our study has revealed results in support of the technique mentioned, showing good success rate in terms of mandibular dysmorphology correction when used in mild to moderate dysmorphology cases. CONCLUSION: Orthomorphic surgery will play an increasingly important role in the repertoire of the maxillofacial surgeon in correcting mandibular dysmorphology.

"Tension band wiring" a simplified approach for fracture reduction and intermittent stabilization.

INTRODUCTION: Development in plating systems and technical knowledge regarding the osteosynthesis has made open reductions and rigid internal fixation as the most frequently used mode of treatment in facial skeleton fractures. Various modalities for fracture reduction/stabilization during fixation have been mentioned in literature, describing the use of custom made instruments or reduction forceps etc. MATERIAL AND METHOD: We have used a method of "TENSION BAND WIRING" as a means of reducing and temporarily stabilizing the fracture segments in the mandible during rigid fixation. TENSION BAND WIRING method has been used in eighty patients having fractures in relation to mandibular symphysis, parasymphysis and body region. CONCLUSION: In our opinion, this method is quick, simple and effective way of achieving initial reduction and stabilization of bone prior to final rigid fixation. The added advantages are reduced operating time, reduced instrumentation and assistance which in turn provide clear and more accessible surgical field.