Two-Point versus Three-Point Fixation in the Management of Zygomaticomaxillary Complex Fractures: A Comparative Study.

Introduction: The zygoma plays an important role in the facial contour for both cosmetic and functional reasons; therefore, zygomatic bone injuries should be properly diagnosed and adequately treated. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements that require a protocol for management and long-term follow-up. The objectives of this study were to compare the efficacy of zygomatic bone after treatment with open reduction internal fixation (ORIF) using two-point fixation and ORIF using three-point fixation and compare the outcome of two procedures. Materials and Methods: Twenty patients were randomly divided equally into two groups. In Group A, ten patients were treated by ORIF using two-point fixation by miniplates and in Group B, ten patients were treated by ORIF using three-point fixation by miniplates. They were evaluated with their advantages and disadvantages and the difference between the two groups was observed. Results: We found that postoperative facial and neurological complications are minimum in two-point fixation group. Based on this study, open reduction and internal fixation using two-point fixation by miniplates is sufficient and the best available treatment of choice for the management of zygomaticomaxillary complex fractures. Discussion: Alignment of the fracture at three points and fixation at two stable points provide the most accurate and satisfactory postoperative results. Two-point interosseous fixation at the "buttress" fracture and the frontozygomatic (FZ) fracture is suitable for routine surgery. The results of these studies confirm with the present study that two-point fixation provided better stability in patients with clinical and radiological evidence of fracture in FZ and zygomaticomaxillary buttress area.

Bilateral canine space infection secondary to odontogenic origin: a rare case report

Odontogenic infections (OI) are a major reason for consultation in dental practice. They affect people of all ages, and most of them respond well to current medical and surgical treatments. The aim of this paper is to emphasize different and rare etiological factors that can play a role in odontogenic abscesses, which can lead to complications. A 54-year-old man complaints of pain and swelling on the upper front-side of his face. Physical examination of the face showed enlargement and swelling in the upper front region. Panoramic radiograph images showed a ra-diolucent appearance of the canine region. Based on the results of the clinical and radiographic examinations, the patient was diagnosed with a bilateral canine space infection. The treatment performed was FNAC (Fine neddle aspiration cytology) from canine region followed by intraoral drainage incision at the most prominent part of swelling (Modified Hiltons method), 5 ml of pus was removed, postoperative dressing was applied and regular follow-up was done with continued antibiotic therapy. Bilateral canine space abscess is a rare odontogenic infection that can cause life-threatening complications. The success of treatment requires early recognition, determination of etiological factors, and appropriate medical and surgical management. To per-form treatment of odontogenic infections, the Oral & Maxillofacial Surgeon should understand the terminology regarding infectious diseases and pathophysiology. The success of treatment requires early recognition, determination of etiological factors, and appropriate medical and surgical management.

Is amalgamated ligno-bupivacaine an answer to complicated minor oral surgical anesthesia? A randomized split-mouth double-blind clinical trial.

PURPOSE: The purpose of this study was to find a suitable anesthetic combination for complicated and protracted minor oral surgical procedures. METHODS: Fifty patients with bilaterally impacted deep-seated mandibular third molars were included in this study and randomly divided on the basis of anesthetic used into two groups. Group A received 2% lignocaine with 1:200,000 adrenaline while in group B, amalgamated mixture of 2% lignocaine and 0.5% bupivacaine was used. The onset time, duration of anesthetic effect, supplementary injections, pain (during local anesthetic deposition, intra and postoperatively), and postoperative analgesia were the study parameters. Chi-square and unpaired t tests were used to compare means. RESULTS: The onset time in both the groups was comparable and showed statistically significant difference between the duration of anesthetic effect with notable requirement of supplemental anesthetic injections in group A (54%) (p < 0.05). Pain scores also revealed a statistically significant intergroup difference (p < 0.05). Requirement of postoperative analgesics was delayed in group B. CONCLUSIONS: The amalgamated mixture of lignocaine and bupivacaine had equivocally rational onset and provided a more profound and in-depth anesthesia especially in complicated and protracted minor oral surgical procedures. Though this mixture is widely used in other surgical fields, its efficacy still remains unexploited and undocumented in oral and maxillofacial surgical procedures.

Utility of superiorly based platysma myocutaneous flap for reconstruction of intraoral surgical defects: our experience.

PURPOSE: Various surgical modalities have been advocated for the soft tissue reconstruction of oral cavity with variable results. This prospective study evaluates the utility of platysma myocutaneous flap (PMF) in the reconstruction of surgical defects followed by treatment of oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) in terms of healing and functional outcomes. METHODS: In this prospective study, 47 patients with OSMF and 15 of OSCC were evaluated and selected for PMF reconstruction. OSCC was selected under T1N0M0 category only. Patients were operated under general anaesthesia followed by PMF grafting. In OSCC, ipsilateral and for OSMF, bilateral PMF was used. RESULTS: In 47 patients treated for OSMF, 46 were male and 1 female while 15 cases of OSCC, 10 were male and 5 females aged between 18 and 44 years. Intraoperative mouth opening was achieved up to 48 mm in OSMF followed by 42.5 mm postoperatively after 2 years. However, uneventful healing and acceptable scar on cervical region was noted in all the cases including OSCC. In OSMF, three cases of dehiscence, four partial necrosis at end of flap and in OSCC one case shows skin loss at flap and two partial necrosis at tip of flap and extraoral localised abscess at ipsilateral donor site in one case was noted. An uneventful healing, anatomical form and functional results were restored with acceptable scarring at donor site without any evidence of difficulty in neck movements were observed. CONCLUSION: The PMF is simple, versatile and could be valued as a reconstructive alternative, with interesting visual qualities. It is a good therapeutic alternative tool for reconstruction of the buccal mucosa, especially for small- and medium-sized defects between 2 and 4 cm2 of the oral cavity.

Utility of Superiorly Based Masseter Muscle Flap for Postablative Retromaxillary Reconstruction.

PURPOSE: Resections in the posterior component of the oral cavity usually lead to severe functional compromise and lower quality of life for patients. Notable advances in reconstruction of the posterior part of the mouth and of the oropharynx have occurred in recent decades. The anatomic and physiologic rehabilitation of the defect to a reasonable outcome with low morbidity and mortality remains the founding basis of any surgical reconstruction, which also holds true for oral oropharyngeal and retromaxillary reconstructions. PATIENTS AND METHODS: A retrospective chart review study of all patients who underwent surgery for retromaxillary malignancy at the Department of Oral and Maxillofacial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital (Nagpur, India) from 2006 to 2015 was performed. Patients underwent selective neck dissection of levels I to IV using wide local excision. The decision for the type of maxillary resection (marginal ostectomy, partial posterior maxillectomy, or hemimaxillectomy) depended on the degree of osseous infiltration of the tumor. Reconstruction was performed in all cases using the regional masseter muscle flap and advancement of the palatal flap into the defect. The necessary findings and observations were tabulated. RESULTS: Of 76 patients who presented at the hospital, 69 had biopsy specimens positive for squamous cell carcinoma and 7 had biopsy specimens positive for verrucous carcinoma. Twenty-three patients with lesions extending and encroaching into the infratemporal fossa or skull base, distant metastasis, or guarded prognosis were not included in the study. Also excluded from the study were those patients in whom flaps other than the masseteric flap were used primarily for reconstruction. In the remaining 53 patients who underwent resection of retromaxillary malignancy with masseter muscle reconstruction, 48 showed a satisfactory outcome. Postoperative infection was noted in 5 patients and 2 of these patients needed debridement. Postoperative wound contracture with muscular spasm and decreased mouth opening in the early postoperative period were a general observation. In all patients, the vitality of the flap was excellent, with epithelization and adequate mouth opening within 3 weeks. Postoperative speech, swallowing, and facial esthetics were satisfactory and acceptable. CONCLUSION: The masseter muscle flap is a promising reconstruction alternative for retromaxillary reconstruction because of advantages such as regional access, ease of harvesting, optimum bulk, flexibility, pliability for larger defects, and minimum postoperative morbidity.

Immediate versus delayed aggressive physical therapy following buccal fat pad interposition in oral submucous fibrosis-a prospective study in Central India.

PURPOSE: Oral submucous fibrosis is a disease of an Indian subcontinent with obscure aetiology and poorly treated with varying signs and symptoms. OSMF occurs at any age but is most commonly seen in teenagers and adults in the age ranging between 16 and 35 years. A number of surgical treatments have been used for the treatment of oral submucous fibrosis with unpredictable results. PATIENTS AND METHOD: In this study, 220 patients were randomly divided into two groups with mouth opening less than 16 mm and evaluated with immediate and delayed aggressive physiotherapy with buccal fat pad interposition after fibrotomy. Group A (n = 110) patients underwent aggressive mouth opening exercise from the next postoperative day while in group B (n = 110), patients underwent physiotherapy 7th day postoperatively. Pain and discomfort, mucosalization, infection, flap dehiscence and necrosis were noted. Patients were followed for 1 year on a regular interval basis. RESULTS: At the end of 1-year follow up, the post-operative mean mouth opening in group A was 38.63 mm and 34.19 mm in group B. In group A, the immediate physiotherapy results in mild to moderate pain and discomfort to the patients as compared to no apparent pain in the group B. The mean mucosalization time in group A and group B was 4.2 and 5.1 weeks, respectively. Postoperatively, all patients achieve satisfactory mouth opening. CONCLUSION: Immediate aggressive physiotherapy yields a comparatively superior result than delayed physiotherapy with respect to mouth opening in 1 year of follow-up.