Feasibility and Reliability of Microvascular Reconstruction in the Vessel-depleted Previously Operated Neck.

BACKGROUND: Microvascular reconstruction of defects in the head and neck has always been a challenge in patients who have undergone previous neck dissection, owing to the prior resection of potential recipient blood vessels used for free flap perfusion. OBJECTIVE: The objective of the study is to evaluate the reliability and safety of free flap reconstruction in patients who have had previous neck dissection. MATERIALS AND METHODS: Twenty-four free flaps were performed in 22 patients with a previous history of neck dissection for head-and-neck squamous cell carcinoma. These included patients who underwent salvage surgery for recurrent cancer as well as patients undergoing secondary reconstruction following previous oncological resections. Flap includes 12 radial forearm free flaps, 5 fibula flaps, 1 rectus abdominis flap, and 6 anterolateral thigh flaps. RESULTS: In cases with the previous history of selective neck dissection, recipient vessels on the ipsilateral/same side of the previously operated neck were used, while contralateral vessels were used in patients with a history of modified radical or radical neck dissection. Vein grafts were not necessary, except for one case. In our series, we did not have any flap loss or considerable increase in operative time. CONCLUSIONS: Free flap reconstruction of head-and-neck defects is highly successful in patients with a history of previous neck dissection, despite a relative scarcity of recipient blood vessels. Careful planning and relying on flaps with a long vascular pedicle obviates the need to perform a suitable vein graft. In our present series, careful planning and the right choice of a free flap with a long vascular pedicle contributes to the absence of free flap failure. In our experience, previous neck dissection should not be considered as a contraindication to microvascular reconstruction of previously operated oncologic defects.

Anterior Tonsillar Fossa Approach to Elongated Styloid Process.

AIM: To demonstrate the efficacy of a new novel anterior tonsillar fossa approach in management of elongated styloid process syndrome. MATERIAL AND METHOD: We operated upon 20 patients with confirmed, symptomatic elongated styloid process. None of these patients gave a previous positive history of trauma or any other procedure relating to tonsillar area. All these patients had undergone treatment or were under treatment for neuralgia/TMJ dysfunction syndrome. Diagnosis was confirmed by clinical examination followed by radiological findings. RESULTS: 12 patients underwent bilateral styloidectomy (60%) and 8 patients, underwent unilateral styloidectomy (40%). The length of stolid process ranged from 34mm to 62mm (mean 44 mm). Post operative follow up period ranges from 6 months to 12 months.17 patients (85%) were asymptomatic & had complete remission of symptoms over a follow up period of 12 months. 2 patients had partial remission of symptoms & 1 patient was lost to follow-up. CONCLUSION: Our anterior tonsillar fossa approach to elongated styloid is safe & adequate in effective surgical management & more so with an additional advantage of not requiring tonsillectomy which is often performed in trans-pharyngeal technique.

Palatal perforation secondary to tuberculosis: a case report.

Palatal perforation though rarely seen in adults but may have infectious, inflammatory, neoplastic, or traumatic cause. We present here a case of palatal perforation due to tuberculosis which was managed successfully using greater palatine artery pedicled flap closure at our centre.

Use of buccal fat pad for treatment of oral submucous fibrosis.

PURPOSE: The aim of this study was to clinically evaluate the application of pedicled buccal fat pad (BFP) in the surgical management of stage III and IV oral submucous fibrosis (OSMF). MATERIALS AND METHODS: Twenty-eight cases of clinically and histologically diagnosed cases of OSMF were divided into 2 groups: group I (n = 15) and group II (n = 13), corresponding to clinical stage III and stage IV, respectively. All the patients underwent incision of fibrotic bands and coverage of the buccal defect with a pedicled BFP flap. Both groups were analyzed separately for mouth opening (interincisal distance in millimeters) preoperatively and 1 year postoperatively, time taken for epithelialization of BFP, time taken for establishment of normal contour, and changes in symptoms (painful ulcerations, burning sensation, and intolerance to spices) 1 year after grafting. RESULTS: The mean preoperative mouth opening was 19.6 mm (SD, 2.43) in group I and 12.92 mm (SD, 1.21) in group II. The mean postoperative mouth opening after 1 year was 35 mm in group I (SD, 1.96) and 31.76 mm in group II (SD, 1.97). The time taken for epithelialization of BFP was 4 weeks in group I and 5 weeks in group II. The mean time taken for establishment of normal contour after grafting was 12.25 weeks (SD, 1.42) in group I and 15.07 weeks (SD, 1.26) in group II. In 2 cases in group II, there was remission of painful ulcerations, burning sensation, and intolerance to spices. CONCLUSION: BFP is reliable for the treatment of OSMF.

A clinical evaluation of midface advancement using intraoral distractors in management of bone stock deficiencies.

BACKGROUND: Cleft lip and palate patients present large osseous defects of the alveolus and midface hypoplasia. Traditional orthognathic surgery has limitations of relapse and limited age group. Distraction osteogenesis (DO) as a modality for midface advancement is relatively new. Modular internal distractor (MID) offers the advantage of patient compliance and minimal discomfort. The purpose of this study was to evaluate the versatility of intraoral distractors in midface advancement. METHOD: Nineteen patients with midface bone stock deficiency were selected for maxillary advancement. At the first surgery under general anaesthesia, after the osteotomy (Le Fort I/II), MID system was used. After distraction, evaluation was done for ease of the procedure, stability, and complications. Lateral cephalograms were evaluated at three stages: T1, pre-distraction; T2, post-distraction; and T3, one year post-distraction. RESULTS: Significant changes showed 13.3 mm mean midface advancement bone formation at the pterygomaxillary region. The results were stable even at one year follow-up. CONCLUSION: Maxillary position improved in relation to the cranial base. This study showed that the MID was versatile in midface advancement in stability and patient compliance with minimal complications.

Reconstruction of a large posterior scalp defect using occipital artery based pedicled island v-y advancement flap: a case report.

Repair of scalp defects using local hair bearing scalp is technically challenging. Transposition or rotation of local flaps to close the defect has its own disadvantages. Reconstruction of a large posterior scalp defect using occipital artery based pedicled V-Y advancement flap following the excision of a recurrent fibrolipoma of epicranial aponeurosis is reported here. It is possible to reconstruct the defect with hair bearing scalp in a single stage along with primary closure of the donor site using this technique.

Meniscopexy for internal derangement of temporomandibular joint.

The term internal derangement was first adopted to describe any pathologic entity that interfered with the smooth function of the temporomandibular joint (TMJ). The term is currently used exclusively to describe alterations in disc-fossa relations. Internal derangement of the TMJ does not always cause pain, although when the disc becomes displaced, noises and locking can occur and ligamentous, capsular or retrodiscal pain may dominate the clinical picture. Meniscopexy of TMJ was done in ten patients where clinical features suggest true internal derangement of the TMJ refractory to conservative treatment with restricted movement and pain identified as arising primarily from the joint. Magnetic resonance imaging was done to identify the cause of problem.

Etiology and Management of Zygomaticomaxillary Complex Fractures in the Armed Forces.

BACKGROUND: The nature of duties in the Armed Forces predisposes its personnel to various kinds of injuries. The rise in violence coupled with an exponential increase in motorized population has contributed towards maxillofacial injuries. The aim of this study was to determine the incidence, cause and pattern of various injuries resulting in fracture of the zygomaticomaxillary complex in Armed Forces personnel and their families. METHODS: A study was conducted between January 2001 - December 2002 in maxillofacial surgical wing of an Army Dental Centre with specific regard to age, sex, location and etiology of zygomaticomaxillary complex fracture. Out of 201 maxillofacial injuries received, 87 individuals were treated for zygomaticomaxillary fractures. Majority of the individuals were in their third decade of life and road traffic accident was the leading cause of the fractures. RESULTS: Uneventful recovery was there in 81 individuals (93.10%). Six patients (6.89%) had post operative complications in the form of enophthalmos, hypophthalmos, paraesthesia, diplopia and facial asymmetry. These complications were subsequently treated successfully as a secondary procedure for all the patients. CONCLUSION: Facial bones, especially of the middle third of the face, are composed of a network of fragile bones which give way in case of force to a lesser extent than other parts of the body. It is imperative to educate people regarding the importance of restraints and use of protective headgears/use of seat belts while travelling in motorized transport.