Outcomes of Non-surgical Management of Zygomaticomaxillary Complex Fractures.

Introduction: With little evidence available in the literature, this study tries to clinically determine the efficiency and outcomes of non-surgical management of post-traumatic Zygomaticomaxillary complex (ZMC) fractures. Materials and Methods: One hundred and three patients with post-traumatic isolated ZMC fractures managed conservatively for various reasons were identified. The patients were classified based on the Zingg et al. criteria into Types A, B, and C. We evaluated the resolution of signs and symptoms of six standard parameters over 6 months-persistent pain, restriction in mouth opening, infraorbital nerve (ION) paresthesia, aesthetic deformity, infraorbital step deformity with associated tenderness on palpation, and ophthalmic status. The study variables were then statistically analyzed using Cochran's Q test with an associated confidence interval of 95%. Results: A six-month follow-up revealed persisting residual deformities for all three groups. However, Type A and Type B showed significant improvement in pain reduction, mouth opening, and infraorbital nerve (ION) paresthesia. No significant improvement was noted in any of the groups for aesthetic deformity, infraorbital step deformity, and ophthalmic status. Type C, which had comminuted fracture patterns, exhibited significant defects in all the parameters. Significant inter-variable relationship between certain paired parameters was also observed. Conclusion: The Type A group is most suited for non-surgical management. Type B with a mono-bloc fracture is a crucial group that demands broader, long-term studies to extract a proper treatment protocol. Type C with severe fracture displacement validates surgical correction.

Assessment of quality of life in patients with surgically treated maxillofacial fractures.

Background: The complex nature of maxillofacial injuries can affect the surgical treatment outcomes and general well-being of the patient. To evaluate the efficiency of the surgical treatment, assessment of the quality of life (QOL) of the patients is of vital importance. Due to the absence of an exclusive QOL assessment tool for maxillofacial fractures, we introduce the 'Twenty-point quality of life assessment in facial trauma patients in Indian population'. The aim of this study was to assess and evaluate the QOL following surgical management of maxillofacial trauma patients based on the severity of the injury. Methods: The study consisted of 182 subjects divided into two groups of 91 each (Group A: severe facial injury and Group B: mild to moderate facial injury). The Facial Injury Severity Scale (FISS) was used to determine the severity of facial fractures and injuries. The twenty-point quality of life assessment tool includes Zone 1 (Psychosocial impact) and Zone 2 (Functional and aesthetic impact), with ten domains each to assess QOL. Results: In Zone 1, the mean scores for Group A and Group B were 38.6 and 39.26, respectively. In Zone 2, Group B (44.56) had higher mean scores compared to Group A (32.92) (p< 0.001). Group B (83.8) had higher mean scores compared to Group A (71.58) when the total of both Zone 1 and Zone 2 were taken into consideration (p<0,001). In Group A, 9 out of 91 patients had a total score of 81- 100 compared to 68 in the same range in Group B. Conclusions: Proper surgical management with adequate care to the hard and soft tissues can improve the QOL by reducing postoperative psychosocial and functional complications. Aesthetic outcomes play an important role in determining the QOL. Mild/ Moderate injuries show better QOL compared to severe maxillofacial injuries.

Retrieval of Fractured Implant Abutment Screws: A Narrative Review.

Objective: Implant abutment screws can fracture due to various biomechanical factors. Improper fit of the prosthesis, inadequate seating of the abutment, occlusal interference, and manufacturing errors are some of the causes that can result in an abutment screw fracture. Retrieval of the retained fractured abutment screw is quite challenging to the clinician. The objective of this review is to provide information on various fractured abutment screw retrieval techniques reported in literature and to formulate a structured treatment protocol for the management of fractured abutment screws. Materials and Methods: An electronic search of Scopus and PubMed databases was performed for articles between January 1989 and December 2021 using the keywords "Implant screw fracture" and "screw retrieval." Results: Most of the articles were of the opinion that abutment screw fractures occurred due to screw loosening. Both conservative approaches and the use of commercial retrieval kits have been advocated to retrieve the fractured abutment screws. Based on various review articles, an innovative novel technique to retrieve an abutment screw fractured due to excessive torque was devised in our unit. Conclusion: Although clinicians can use various techniques to remove fractured abutment screws, every effort should be made to eliminate the cause of screw fracture. Retrieval of the broken screw fragment should be done judiciously to prevent any internal damage to the implant structure.

The Influence of the Mandibular Chin Angle on the Occurrence of Mandibular Condylar Fracture: A Retrospective Study.

BACKGROUND: Condylar fractures are commonly associated with symphysis/parasymphysis fractures. Condylar fractures have been attributed to direct and indirect traumatic forces, the direction and magnitude of the forces, and the condylar anatomy. The chief aim of this study was to determine the association between the newly defined mandibular chin angle and the occurrence of condylar fractures. MATERIALS AND METHODS: A retrospective study was conducted to analyze two-dimensional computed tomography (2D CT) scans of patients with a history of chin trauma. The outcome was a symphysis/parasymphysis fracture with or without fracture of the mandibular condyle. The Mediff InstaRISPACS web-based platform was used to measure the chin angle. The cerebral aqueduct of Sylvius in the corresponding 2D CT midsagittal image was the standard reference plane to measure the chin angle. The SPSS Version 20 (IBM Corp, Armonk, NY) was used for data analysis. RESULTS: The sample size included 120 2D CT scans of patients with symphysis/parasymphysis fractures (60 associated with condylar fractures and 60 without condylar fractures). The mean chin angle in the group without condylar fracture was 133.35 ± 3.87°, which was approximately 15° lesser than in the condylar fracture group (mean, 148.56 ± 5.49°), and these findings were statistically significant (P < 0.05). CONCLUSION: Individuals with a high chin angle are potentially at a higher risk of sustaining associated condylar fractures.

Effect of Oral and Maxillofacial Injuries on the Development of Post-Traumatic Stress Disorder: A Cross-Sectional Study

ABSTRACT Objective: To assess the influence of oral and maxillofacial trauma on the development of Post-Traumatic Stress Disorder (PTSD) and to determine the efficiency of the Impact of Event Scale-Revised (IES-R) as a diagnostic tool for detecting PTSD in patients with Oral and Maxillofacial injuries. Material and Methods: PTSD was assessed one month postoperatively by the diagnostic instrument, IES-R, to arrive at a provisional diagnosis. A structured clinician-administered PTSD Scale then assessed the patients for the Diagnostic and Statistical Manual of Mental Disorders-5th edition (CAPS-5) to establish a final diagnosis. The assessment of the severity of PTSD was done based on various types of oral and maxillofacial injuries. Results: The IES-R scale provisionally diagnosed 54 subjects with PTSD, out of which 42 were diagnosed to have PTSD by the CAPS-5 scale. Subjects with injuries involving the 'orbital complex,' those presenting with a perceptible scar in the maxillofacial region and with multiple avulsed/ luxated anterior teeth, showed a higher affinity to develop PTSD, and this was statistically significant. Conclusion: Higher levels of PTSD in patients with injuries to the maxillofacial region warrants correct diagnosis and detection, and hence the maxillofacial surgeon plays a vital role in this regard. The IES-R is a useful diagnostic tool to detect PTSD early.

The Influence of the Suture-less Anterior Releasing Incision in a Triangular Flap Design on Postoperative Healing Following Surgical Removal of Impacted Mandibular Third Molars.

OBJECTIVES: The objective of this study was to determine the effect of suture-less anterior releasing incisions on postoperative wound healing following surgical removal of impacted mandibular third molars. MATERIALS AND METHODS: A total of 112 patients were included in the study. Group 1 had 56 patients in which the anterior releasing incision was not sutured postoperatively, and group 2 had 56 patients, in whom the anterior releasing incision was sutured. The two groups were compared in terms of pain, swelling, and trismus at 1 day, 3 days, and 7 days postoperatively. The Univariate Type III Repeated-Measures ANOVA Assuming Sphericity was used to compare the two modes of treatments at different time points. The periodontal healing distal to the second molar was assessed on the first day and at 2 months following the surgical intervention. The independent t test was used to compare the periodontal healing between the two groups at two time points. RESULTS: No significant difference was observed between the two groups for pain and trismus (P > 0.05). However, the swelling was significantly greater in group 2 as compared to group 1 (P < 0.001). Periodontal healing was better in group 2, which showed lower periodontal probing depth distal to the mandibular second molar, compared to group 1 (P < 0.05). CONCLUSION: Suture-less anterior releasing incision decreases the postoperative swelling and edema, but the periodontal healing was poor when compared to the sutured anterior releasing incision cases. The type of closure technique did not have any significant influence on pain and trismus.

Posttraumatic stress disorder among patients with oral and maxillofacial trauma in a South Indian population.

AIM: To determine the incidence and severity of Post-Traumatic Stress Disorder (PTSD) in maxillofacial trauma patients and to assess the predisposing factors. METHODS AND RESULTS: Post-Traumatic Stress Disorder (PTSD) was assessed as per the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. The PTSD checklist for DSM-5 (PCL-5), was used initially to screen patients for PTSD for a provisional diagnosis. These provisionally diagnosed patients were then subjected to a structured interview by a Clinician Administered PTSD Scale for DSM-5 (CAPS-5). The PTSD status outcome of PCL-5 and CAPS-5 were correlated. PTSD was compared among patients with different types of facial fractures/injuries and also compared based on their anatomic location. The reliability of PCL-5 scale in relation to the structured CAPS-5 was assessed and the specificity was found to be 71.4%. Patients with both aesthetic and functional deformity exhibited greater severity of injury and showed higher incidence of PTSD with higher conversion rate from the 1st month to 3rd month. The frequency of PTSD in deformities with higher severity like zygomaticomaxillary complex injuries was found to be statistically significant. CONCLUSION: A high incidence of PTSD is associated with maxillofacial trauma and early detection is essential.

Anatomical variations in the cutaneous innervation on the dorsum of the foot.

Generally among the branches of common peroneal nerve, the superficial peroneal nerve provides cutaneous innervation to major part of the dorsum of the foot whereas the deep peroneal nerve innervates the skin over the first interdigital cleft region. The sural and saphenous nerves supplies the smaller lateral and medial margins of the dorsum respectively. The present study has been taken to classify the patterns of innervations of the nerves on the dorsum of the foot in South Indian population. A total of 40 formalin fixed lower limbs from 20 adult cadavers (15 males, 5 females) aged between 35 to 60 years were dissected and the branching patterns of nerves on the dorsum of the foot were noted and specimens were photographed. Gross anatomical variations were noted in the branching pattern of superficial peroneal, deep peroneal and sural nerve on the dorsum of foot. Results obtained in our study were classified into four groups. The cutaneous nerves are at risk of iatrogenic injuries during surgeries involving ankle, open reduction and internal fixation of fracture, arthroscopy etc. Knowledge of such anatomical variations of the nerves provides information to clinicians to avoid injury to them in real clinical situations.

Surgical Management of Double/Triple Mandibular Fractures Involving the Condylar Segment: Our Perspective.

A series of surgical cases operated in our unit are considered to analyze and evaluate the different techniques and sequencing employed in the surgical management of double/triple mandibular fractures involving a condylar fracture. Deviating from the normal sequence of reducing and fixing the dentate segment first, we addressed the condylar segment first. A combination of different approaches for different cases such as a periangular with a vestibular, a preauricular and a retromandibular with a vestibular were used according to the type of fractures. The accessibility to one difficult case with a medially displaced condyle was facilitated by using Hegar's uterine dilators. In all cases, good anatomical reduction was achieved with stable occlusion and without any signs of facial nerve impairment. The 'Condyle first' approach in the surgical management of double/triple mandibular fractures, is a reliable and efficient technique.

The effects of Mucuna pruriens extract on histopathological and biochemical features in the rat model of ischemia.

Stroke is considered to be one of the most important causes of death worldwide. Global ischemia causes widespread brain injury and infarctions in various regions of the brain. Oxidative stress can be considered an important factor in the development of tissue damage, which is caused because of arterial occlusion with subsequent reperfusion. Kapikacchu or Mucuna pruriens, commonly known as velvet bean, is well known for its aphrodisiac activities. It is also used in the treatment of snakebites, depressive neurosis, and Parkinson's disease. Although this plant has different pharmacological actions, its neuroprotective activity has received minimal attention. Thus, this study was carried out with the aim of evaluating the neuroprotective action of M. pruriens in bilateral carotid artery occlusion-induced global cerebral ischemia in Wistar rats. The carotid arteries of both sides were occluded for 30 min and reperfused to induce global cerebral ischemia. The methanolic plant extract was administered to the study animals for 10 days. The brains of the Wistar rats were isolated by decapitation and observed for histopathological and biochemical changes. Cerebral ischemia resulted in significant neurological damage in the brains of the rats that were not treated by M. pruriens. The group subjected to treatment by the M. pruriens extract showed significant protection against brain damage compared with the negative control group, which indicates the therapeutic potential of this plant in ischemia.

Cadaveric Study on Morphology of Dorsal Interossei of Hand and its Anatomical Variation.

INTRODUCTION: The dorsal interossei are the abductors of the fingers and the knowledge of its variation help the surgeon in treatment of fractures, claw hand and compartment syndromes. AIM: To note the origin, insertion, pattern of muscle fibres and tendon length of all the dorsal interossei of hand. MATERIALS AND METHODS: Routinely dissected 30 formalin fixed hand in the Department of Anatomy, KMC, Manipal, were observed for origin, insertion and tendon length and muscle pattern of dorsal interossei. RESULTS: Out of 30 hands, presence of supernumerary muscle was observed in three hands. Presence of three heads of dorsal interossei was noted in one hand. CONCLUSION: The finding of present study is of importance to surgeons and orthopaedicians during conservative and surgical management of hand deformity. Adequate knowledge of these muscular variations is also important in treatment of fractures, stiff hand, claw hand or tendon transfer.

A Rare Case of Mandibular Exostoses and its Review.

Mandibular exostosis is a type of bony prominence caused due to hyperostosis in the mandibular bone. They are benign, broad-based surface masses on the outer or facial aspect of the jaw bones; slowly enlarge over the years to form the bulky masses. During the period between the 10th to 13th week of intrauterine life, changes in the structure of the Meckel's cartilage and the protrusion of the medial lamina of the mandible onto the cartilage can result in the formation of such exostosis. We discuss here a very rare case of a 49-year-old male, in which the buccal exostoses formed underwent changes in size and shape due to certain factors, resulting in a bony bar formation in the mandibular anterior region.

Efficacy of locking plates/screw system in mandibular fracture surgery.

PURPOSE: The purpose of this study was to determine the efficiency of locking plates and screw system in the treatment of mandibular fracture surgery, by comparing them with the conventional system. PATIENTS AND METHODS: A protocol for selection of patients with mandibular fractures was developed. One hundred patients were treated by locking plates and screw system and another 100 patients were treated with the conventional system. The patients were prospectively evaluated for the duration of surgery, difficulties encountered during surgery, neurologic changes, postsurgical occlusal relationship, adequacy of reduction and postsurgical complications. Data were compared for statistical significance with Chi-square test and Z-test. RESULTS: There was statistically significant difference in postoperative infection, postoperative occlusal discrepancy, postoperative plate fracture and postoperative screw loosening and mobility of the fractured fragments and also the working time between the two systems. CONCLUSION: The results of the present study are comparable with other published data and support the notion that the locking miniplate system is a valid alternative to conventional miniplates with several advantages, the only drawback being the additional working time required during adaptation of this hardware.

A cephalometric evaluation of pretreatment and post-treatment outcome using Tetragon analysis: a retrospective study.

STATEMENT OF PROBLEM: Few cephalometric analyses have been put forward to assess the treatment outcome after orthodontic treatment. However, these analyses are somewhat complicated and time consuming. The Tetragon analysis is introduced with measurement of treatment outcome as one of its objectives. PURPOSE OF STUDY: The study was undertaken to evaluate the treatment outcome by checking the skeletal and dental changes using pretreatment and post-treatment radiographs and to evaluate the efficiency of treatment in the Department of Orthodontics, College of Dental Sciences, Davangere, using the Tetragon analysis. MATERIALS AND METHODS: Records of 35 finished patients with fixed orthodontic therapy using preadjusted edgewise appliance were selected. The samples were analyzed separately for the skeletal parameters consisting of skeletal class I, II and III using Tetragon analysis. RESULTS: The post-treatment reduction of upper incisor palatal plane angle was found to be statistically significant in skeletal class I (p < 0.01) and skeletal class II patients (p < 0.05). The post-treatment increase in interincisal angle was found to be statistically significant in skeletal class I (p < 0.01) class II patients (p < 0.05). CONCLUSION: Fixed appliance therapy reduced the proclination of upper incisors and increased the interincisal angle in skeletal class I and II cases but not in skeletal class III cases. The lower incisal angulation and the maxilla-mandibular plane angle did change significantly and so were the angles of the Trigon. The Tetragon analysis proved easy to measure the treatment outcome.