Craniofacial fibrous dysplasia.

Fibrous dysplasia can present clinically in varied forms which may appear as collision of different pathologic processes. We report a rare case of craniofacial fibrous dysplasia with coexisting epithelial lined cyst and superimposed osteomyelitis with sequestrum formation. Its clinical features and management with possible hypotheses are described along with the post operative course. Pertinent literature has been reviewed with emphasis on pathogenesis of this unique occurrence.

Type B idiopathic bone defect of mandible: an etiopathogenic dilemma.

Etiopathogenesis of the pathologic lesions forms the basis for formulation of appropriate intervention and further prevention. There is still a vast unknown field that has to be explored to know the causative reason behind certain benign & malignant lesions. Idiopathic bone defects are nonodontogenic pseudocystic cavities that are seen in the long bones & jaw bones. Radiographic interpretation is at times inadequate in diagnosis of odontogenic & nonodontogenic radiolucent lesions involving jaw bones. Histopathology has different criteria to segregate this lesion. In this paper, we discuss a case of type B histopathological variant of idiopathic bone defect that may suggest an alternative pathogenesis from type A variant.

A Comparative Evaluation of Fixation Techniques in Anterior Mandibular Fractures Using 2.0 mm Monocortical Titanium Miniplates Versus 2.4 mm Cortical Titanium Lag Screws.

OBJECTIVE: To compare the efficacy and surgical outcome of treatment of anterior mandibular fracture using either 2.0 mm titanium miniplate or 2.4 mm titanium lag screw technique. MATERIALS AND METHODS: A total of 30 patients were managed by open reduction and internal fixation utilizing the miniplate and lag screw technique for fractures of anterior mandible. The patients were randomly divided into two groups. Group I: (15 patients) were treated with Leibinger, 2.0 mm titanium mini plates system with self-tapping screws and Group II: (15 patients) were treated with 2.4 mm cortical lag screw (Synthes). Intraoperatively duration of surgery was measured from the time incision was placed till the closure of wound. Subsequent follow up was done at 3, 6, 12, 24 weeks, postoperatively. During every follow up, patients were assessed clinically for malocclusion, neurosensory deficit, biting efficiency, implant failure, mal-union/non-union. Pre and postoperative radiographs were taken to assess the gap between fracture segments. Results were evaluated using Chi square and the unpaired t test. RESULTS: In our study, the mean duration of surgery (hours) was 1.97 ± 0.52 for group I and 1.26 ± 0.55 for group II. The difference was found to be statistically significant (p value 0.001). i.e. more time was taken in case of surgery with mini-plates when compared to the lag screw. Short surgical procedure reduces the incidence of infectious complications, which significantly lowers the financial burden. The mean post-operative radiographic distance between all measuring points were considerably more in case of mini-plate group as compared to lag screw group. Lag screw group showed faster improvement in terms of biting efficiency as compared to mini-plate group which showed a tendency to masticate only medium hard food items by 24 weeks. In both groups, no postoperative malocclusion was noted. In initial weeks, neurosensory deficit was seen more in mini-plate group as compared to lag screw group but after six weeks all patients showed improvement in neurosensory function without any permanent nerve damage. CONCLUSION: According to this prospective study, rigid internal fixation provided by lag screw technique for anterior mandibular fracture offers several advantages over conventional bone plating. It is an excellent means of achieving rapid and safe fixation which is followed by primary bone healing in anterior mandibular fractures, without any major complications.

Comparative evaluation of surgical outcome after removal of impacted mandibular third molars using a Piezotome or a conventional handpiece: a prospective study.

Our aim was to compare the use of a conventional rotary handpiece and a Piezosurgical unit for extraction of lower third molars. We studied 40 patients, who were allocated alternately to have the third molar removed with either the handpiece or the Piezosurgical unit. Pain, trismus, and oedema were evaluated at baseline and then postoperatively, together with paraesthesiae, on postoperative days 1, 3, 5, 7, and 15. Damage to surrounding tissue was checked on the same day whereas dry socket was evaluated from postoperative day 3 onwards. More patients complained of pain in the conventional group, they also required more analgesics, and they developed trismus more often than in the Piezosurgery group. There was also significantly more postoperative swelling in the conventional group. Patients were also evaluated using the subjective Postoperative Symptom Severity (PoSSe) scale. Our results suggest that apart from some inherent limitations with the Piezotome, it is a valuable alternative for extraction of third molars.

Impacted Canines: Our Clinical Experience.

BACKGROUND: To discuss the management of impacted canines and the various approaches used for the same. MATERIALS AND METHODS: The data of 33 cases, with 43 impacted canine teeth, seen and operated over a period of 3-year in Santosh Dental College and Hospital has been compiled. The diagnostic methods and treatment modalities undertaken are described and discussed. RESULTS: Canine impactions were more common in the maxilla as compared with mandible in our study, which was statistically significant. Impacted canine position was mostly palatal in maxilla and labial in mandible. Chi-square test yielded a p-value of 0.002 which shows that there is an association between arch and position. The treatment options used were surgical exposure and orthodontic repositioning, cyst enucleation with extraction of impacted canine and surgical removal of impacted canine. CONCLUSION: Surgical exposure and orthodontic repositioning was successfully applied as first-line treatment for correcting ectopic positioned canine. In cases where exposure and subsequent orthodontic treatment was not indicated, the impacted canine was surgically removed to prevent future problems and surgical procedure was designed according to position of impacted canine.

Central giant cell lesion of mandible managed by intralesional triamcinoloneinjections. A report of two cases and literature review

Central giant cell lesion (CGCL) is a benign lesion which has unpredictable biologic behaviour and is amenable toa plethora of treatment alternatives. We describe our experience in managing this lesion by intralesional triamcinolone.The mainstay of treatment of CGCL in our centre until now has been surgical curettage or resection. We chosetwo patients for this pilot endeavour at our hands. Case I is a 10 year old girl having CGCL of left side mandible.Case II is a 20 yr old man with CGCL affecting the left side posterior mandible. Both patients responded wellto intralesional administration of triamcinolone acetonide (Kenacort-10®) with no obvious recurrences to date.Successful application of this conservative drug therapy for managing CGCL can not only save the patient from amutilating procedure but also has significant financial implications. The amount of triamcinolone injected rangedfrom 85mg to 180mg by 5-6 injections at weekly intervals (AU)

Central giant cell lesion of mandible managed by intralesional triamcinolone injections. A report of two cases and literature review.

Central giant cell lesion (CGCL) is a benign lesion which has unpredictable biologic behaviour and is amenable to a plethora of treatment alternatives. We describe our experience in managing this lesion by intralesional triamcinolone. The mainstay of treatment of CGCL in our centre until now has been surgical curettage or resection. We chose two patients for this pilot endeavour at our hands. Case I is a 10 year old girl having CGCL of left side mandible. Case II is a 20 yr old man with CGCL affecting the left side posterior mandible. Both patients responded well to intralesional administration of triamcinolone acetonide (Kenacort-10) with no obvious recurrences to date. Successful application of this conservative drug therapy for managing CGCL can not only save the patient from a mutilating procedure but also has significant financial implications. The amount of triamcinolone injected ranged from 85 mg to 180 mg by 5-6 injections at weekly intervals.

Comparative efficacy of spiral computed tomography and orthopantomography in preoperative detection of relation of inferior alveolar neurovascular bundle to the impacted mandibular third molar.

PURPOSE: To assess the relationship of the inferior alveolar neurovascular canal (IANC) and the impacted mandibular third molar on spiral computed tomography (SCT), determine the validity of this assessment, and compare it with that for an orthopantomogram (OPG). MATERIALS AND METHODS: Patients visiting the Oral and Maxillofacial outpatient department at the Government Dental College and Hospital, Nagpur, India, were chosen as the subjects for our study. Patients were operated on and the actual clinical findings were compared with the SCT findings. Sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve were determined as a part of ROC analysis. The values for both the diagnostic modalities were then compared using a chi(2) test. RESULTS: Objective evaluation of the SCT showed that the number of positive clinical findings (marking on tooth surface, visualization of the neurovascular bundle, intraoperative excessive hemorrhage, and IAN paresthesia) were significantly more in patients with no measurable distance between the tooth and the canal. Also, the positive clinical findings were observed significantly more in patients who had the following features observed on spiral CT: lack of cortication of the canal and lingual or intraradicular course of the inferior alveolar neurovascular bundle (IANB). ROC analyses of both these diagnostic modalities have shown that the SCT performed better than OPG, although the difference is not statistically significant (P = .9871; chi(2) test). CONCLUSIONS: The spiral CT images definitely enhanced the visualization of the relation of the tooth to the IANB, which might provide a higher level of intrasurgical safety and safeguard the interests of both the surgeon and the patient.

A chronicle of Tessier no. 0 and 1 facial cleft and its surgical management.

Description and successful management of a patient with Tessier no. 0 and 1 facial cleft is being presented. This bizarre coexistence of two of the rare facial clefts in a single patient deserves a place in the cleft database. Appropriate evaluation was done to rule out the presence of median cleft face syndrome. Lip cleft was repaired by straight line technique with staggering at the vermilion border. Nasal cleft was reconstructed by replacing the missing lower lateral cartilage with conchal cartilage via endonasal approach. Satisfactory outcome was achieved for this singular deformity by conforming to the basic tenets of plastic surgery.