Comparative evaluation of temporal fascia and dermal fat graft in the management of temporomandibular joint ankylosis.

Introduction: Temporomandibular joint (TMJ) ankylosis is a debilitating condition usually afflicting children and young adults, causing long-term functional, aesthetic, and severe psychological impacts on the lives of these patients. Objective: To compare the postoperative outcomes after using one of the most commonly employed inter-positional graft, i.e., temporalis fascia, and a recently introduced 'more suitable' graft, i.e., dermal fat. Methods: A prospective study in which 20 patients of TMJ ankylosis were randomly assigned into two groups of 10 patients each. Temporalis fascia was used as an inter-positional graft in one group, while dermal fat graft was used in the other group. Post-surgical clinical parameters were evaluated, including interincisal mouth-opening and pain. Results: Interincisal mouth opening at six months was greater in group A (32.1 ± 12.93) as compared to group B (33.8 ± 4.89), but statistically, it was not significant (P = 0.478). The mean pain score in group A was 4.60 ± 1.17, 1.50 ± 0.70, 0.20 ± 0.42 on day 1, 7, and 15, respectively. The mean pain score in group B was 4.10 ± 0.99, 1.30 ± 0.48, 0.20 ± 0.42 on day 1, 7, and 15, respectively. Conclusion: Both the graft materials work well in terms of maximum interincisal opening. For more clarification, a larger sample size with a longer duration of follow-up is needed to validate the study.

A Multicentric Prospective Study on Maxillofacial Trauma Due to Road Traffic Accidents: The World Oral and Maxillofacial Trauma Project.

ABSTRACT: The purpose of this prospective multicenter study was to analyze the epidemiology, patterns, and management of maxillofacial fractures due to road traffic accidents (RTAs) worldwide.Between Monday September 30, 2019 and Sunday October 4, 2020,1066 patients with RTAs related fractures were admitted to 14 maxillofacial surgery departments. The following data were analyzed: age, gender, mechanism of injury, alcohol or drug abuse at the time of trauma, maxillofacial fracture site, facial injury severity scale (FISS) score, associated injuries, day and month of trauma, time of treatment, type of treatment and length of hospital stay. Data were analyzed using bivaried and multivaried statistical analysis.Eight hundred seventy patients were male, and 196 were female. The most common mechanism of injury was motorcycle accidents (48%). More than half of the patients had fractures of the middle third of the maxillofacial skeleton. In total, 59% of the study sample underwent open reduction internal fixation. The median facial injury severity scale (3 points) and the medial hospital stay (3 days) were significantly lower in patients with seatbelts and helmet (P  < 0.001).This first prospective, multicenter epidemiological study shows that motorcycle accidents are the leading cause of RTAs related fractures, mostly in young males. Particularly in Australia and Europe, the incidence of RTAs was significantly lower. Moreover, this study found that the severity of maxillofacial lesions was significantly higher in patients without safety devices, with consequent longer hospital stay demonstrating the efficacy of road safety policies in preventing maxillofacial injury.

Ramal Growth Assessment in Temporo-Mandibular Joint Ankylosis in Growing Patient Without Growth Centre Transplantation: Radiograph Based Study.

Introduction: The treatment of temporomandibular joint is mainly surgical and aims at restoring the function of joint and correcting the aesthetics deformity caused by ankylosis. Studies are available in the literature which showed that there is osteogenic potential in condylar stump remaining after gap arthroplasty, especially in children. Our objective was to assess the growth of ramus operated after surgery using orthopantomogram as the tool of assessment. Materials and method: Fifteen patients of prospective study design were selected for study. This study was undertaken to evaluate the mandibular ramal growth in TMJ ankylosis patients treated without growth center transplantation using orthopantomogram as a tool of assessment. Results: Mean ramal length of the operated right side was found to be 42.02 mm in immediate postoperative, 43.18 mm in sixth month postoperative and 44.57 mm in 1 year postoperative follow-up. Mean ramal length of the operated left side was found to be 40.15 mm in immediate postoperative, 42.10 mm in sixth month postoperative and 44.80 mm in 1 year postoperative follow-up. Conclusion: Our investigations showed that mandibular growth rate increases after successful treatment of ankylosis in children. One drawback of this treatment protocol that we observed was that the total growth deficit manifested in all our patients could not be made up.

World Oral and Maxillofacial Trauma (WORMAT) project: A multicenter prospective analysis of epidemiology and patterns of maxillofacial trauma around the world.

BACKGROUND/AIM: The World Oral Maxillofacial Trauma (WORMAT) project was performed to analyze the causes and characteristics of maxillofacial fractures managed in 14 maxillofacial surgery divisions over a 1-year period. METHODS: The following data were collected: age, sex, cause and mechanism of maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score (FISS), associated injury, day of trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software. RESULTS: Between 30 September 2019 and 4 October 2020, 2,387 patients (1,825 males and 562 females [ratio 3.2:1], 47.6% aged 20-39 years [mean age 37.2 years, median 33.0 years]) were hospitalised. The main cause of maxillofacial fracture was road traffic accidents (RTA), which were statistically associated with male adults as like as assault, sport, and work (p<0,05). Half of the fractures involved the middle third of the face, statistically associated with fall and assault (p<0.05). Trauma in multiple locations was significantly associated with longer hospital stay (p<0.05). The mean length of hospitalization was 3.9 days (95% Confidence Interval 3.7-4.2). CONCLUSIONS: This prospective, multicenter epidemiological study confirmed that young adult males were the ones most commonly affected by maxillofacial fracture. RTAs and assaults are statistically associated with the adult population, while falls are associated with females and older population.

A multicentric, prospective study on oral and maxillofacial trauma in the female population around the world.

BACKGROUND/AIMS: Approximately 20% of patients with maxillofacial trauma are women, but few articles have analysed this. The aim of this multicentric, prospective, epidemiological study was to analyse the characteristics of maxillofacial fractures in the female population managed in 14 maxillofacial surgery departments on five continents over a 1-year period. METHODS: The following data were collected: age (0-18, 19-64, or ≥65 years), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment, and length of hospitalization. RESULTS: Between 30 September 2019 and 4 October 2020, 562 of 2387 patients hospitalized with maxillofacial trauma were females (24%; M: F ratio, 3.2:1) aged between 1 and 96 years (median age, 37 years). Most fractures occurred in patients aged 20-39 years. The main causes were falls (43% [median age, 60.5 years]), which were more common in Australian, European and American units (p < .001). They were followed by road traffic accidents (35% [median age, 29.5 years]). Assaults (15% [median age, 31.5 years]) were statistically associated with alcohol and/or drug abuse (p < .001). Of all patients, 39% underwent open reduction and internal fixation, 36% did not receive surgical treatment, and 25% underwent closed reduction. CONCLUSION: Falls were the main cause of maxillofacial injury in the female population in countries with ageing populations, while road traffic accidents were the main cause in African and some Asian centres, especially in patients ≤65 years. Assaults remain a significant cause of trauma, primarily in patients aged 19-64 years, and they are related to alcohol use.

Characteristics and age-related injury patterns of maxillofacial fractures in children and adolescents: A multicentric and prospective study.

BACKGROUND/AIMS: Paediatric maxillofacial trauma accounts for 15% of all maxillofacial trauma but remains a leading cause of mortality. The aim of this prospective, multicentric epidemiological study was to analyse the characteristics of maxillofacial fractures in paediatric patients managed in 14 maxillofacial surgery departments on five continents over a 1-year period. METHODS: The following data were collected: age (preschool [0-6 years], school age [7-12 years], and adolescent [13-18 years]), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injuries, day of the maxillofacial trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software. RESULTS: Between 30 September 2019 and 4 October 2020, 322 patients (male:female ratio, 2.3:1) aged 0-18 years (median age, 15 years) were hospitalized with maxillofacial trauma. The most frequent causes of the trauma were road traffic accidents (36%; median age, 15 years), followed by falls (24%; median age, 8 years) and sports (21%; median age, 14 years). Alcohol and/or drug abuse was significantly associated with males (p < .001) and older age (p < .001). Overall, 474 fractures were observed (1.47 per capita). The most affected site was the mandibular condyle in children <13 years old and the nose in adolescents. The proportion of patients who underwent open reduction and internal fixation increased with age (p < .001). CONCLUSION: The main cause of paediatric maxillofacial fractures was road traffic accidents, with the highest rates seen in African and Asian centres, and the frequency of such fractures increased with age. Falls showed an inverse association with age and were the leading cause of trauma in children 0-6 years of age. The choice of treatment varies with age, reflecting anatomical and etiological changes towards patterns more similar to those seen in adulthood.

A multicentric prospective analysis of maxillofacial trauma in the elderly population.

BACKGROUND/AIMS: The growth of the global elderly population will lead to an increase in traumatic injuries in this group, including those affecting the maxillofacial area, with a heavier load on health systems. The aim of this multicentric prospective study was to understand and evaluate the incidences, causes and patterns of oral and maxillofacial injuries in patients aged over 60 years admitted to 14 maxillofacial surgical departments around the world. METHODS: The following data were collected: gender, cause and mechanism of maxillofacial fracture, alcohol and drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment and length of hospitalization. Statistical analyses were performed using non-parametric and association tests, as well as linear regression. RESULTS: Between 30 September 2019 and 4 October 2020, 348 out of 2387 patients (14.6%), 197 men and 151 women (ratio 1.3:1; mean age 72.7 years), were hospitalized. The main causes of the maxillofacial fractures were falls (66.4%), followed by road traffic accidents (21.5%) and assaults (5.2%). Of the 472 maxillofacial fractures, 69.7% were in the middle third of the face, 28% in the lower third and 2.3% in the upper third. Patients with middle third fractures were on average 4.2 years older than patients with lower third fractures (95% CI 1.2-7.2). Statistical analysis showed that women were more involved in fall-related trauma compared with males (p < .001). It was also shown that road traffic accidents cause more fractures in the lower third (p < .001) and in the middle third-lower third complex compared with upper third (p < .001). CONCLUSIONS: Maxillofacial fractures in the elderly were more frequent in European and Australian centres and affected men slightly more than women. Falls were the leading cause of fractures, especially among women. The middle third of the face was most often affected, and conservative treatment was the most common choice for the management of such patients.

A Clinical and Radiological Investigation of the Use of Dermal Fat Graft as an Interpositional Material in Temporomandibular Joint Ankylosis Surgery.

Management of temporomandibular joint (TMJ) ankylosis is mainly through surgical intervention. Interpositional materials are a necessity when it comes to prevention of TMJ re-ankylosis after arthroplasty. Early aggressive postoperative physiotherapy is essential for the prevention or treatment of TMJ hypomobility or ankyloses. Recently, it has been shown that abdominal dermis fat helps promote smooth, pain-free joint function and it is stable after interposition and less prone to fragmentation. The purpose of this study was to assess that whether dermal fat is a good choice of interpositional material when it comes to decreased pain perception during aggressive physiotherapy after release of ankyloses thus ensuring good compliance by the patient. We also assessed the fate of the graft material on computed tomography to evaluate any volume changes if occurred after interposition.

Finite Element Analysis (FEA) of Perpendicular Plating Versus Conventional Plating in Mandibular Symphysis Fracture.

AIM AND OBJECTIVE: To perform the comparative finite element analysis of conventional and perpendicular plating in mandibular symphyseal fracture. MATERIAL AND METHOD: Two FE model of mandible were developed and symphyseal fracture was created in both of them. Each fractured model was fixed by conventional method 2.0 mm system and perpendicular method 2.00 mm system. Stresses which developed in plates and mandible after application of load were observed in the model. RESULTS: Results of the study indicated that perpendicular method was more resistant to displacing forces and rest of the parameters was within the permitted limits. CONCLUSION: Perpendicular method was reasonably effective as conventional method of fixation for mandibular symphyseal fracture.

Pattern of buccal and palatal bone density in the maxillary premolar region: an anatomical basis of anterior-middle superior alveolar (AMSA) anesthetic technique.

BACKGROUND: The anterior-middle superior alveolar (AMSA) anesthetic technique has been reported to be a less traumatic alternative to several conventional nerve blocks and local infiltration for anesthesia of the maxillary teeth, their periodontium, and the palate. However, its anatomic basis remains controversial. The present study aimed to determine if the pattern of cortical and cancellous bone density in the maxillary premolar region can provide a rationale for the success of the AMSA anesthetic technique. METHODS: Cone-beam computed tomography scans of 66 maxillary quadrants from 34 patients (16 men and 18 women) were evaluated using a volumetric imaging software for cortical and cancellous bone densities in three interdental regions between the canine and first molar. Bone density was measured in Hounsfield units (HU) separately for the buccal cortical, palatal cortical, buccal cancellous, and palatal cancellous bones. Mean HU values were compared using the Mann-Whitney U test and one-way ANOVA with post-hoc analysis. RESULTS: Cancellous bone density was significantly lower (P ≤ 0.001) in the palatal half than in the buccal half across all three interdental regions. However, there was no significant difference (P = 0.106) between the buccal and palatal cortical bone densities at the site of AMSA injection. No significant difference was observed between the two genders for any of the evaluated parameters. CONCLUSIONS: The palatal half of the cancellous bone had a significantly lower density than the buccal half, which could be a reason for the effective diffusion of the anesthetic solution following a palatal injection during the AMSA anesthetic technique.

Posttraumatic Lateral Dislocation of Mandibular Condyle: A Proposed New Classification with Report of 14 Dislocated Condyles.

Lateral dislocation of the intact mandibular condyle is a relatively uncommon clinical condition. Since the first description and classification of these dislocations given by Allen and Young, few classification systems have been proposed in literature with incorporation of different patterns of dislocations identified over the years. We share our clinical experience of nine cases of such dislocations with 14 dislocated condyles, and on the basis of clinical and radiological findings coupled with the review of existing classification systems, we propose a new classification system which includes all the possible patterns of such dislocations overcoming the major shortcomings of preexisting classification systems identified by the authors.

Management of Odontogenic Fascial Space Infection in Hemophilia Patients: A Proposed Protocol.

PURPOSE: The purpose of this study was to suggest a protocol for the management of odontogenic space infections in patients with hemophilia which is often incompletely addressed by clinicians because of the fear of excessive bleeding leading to prolonged morbidity. METHODS AND RESULTS: Six diagnosed cases of hemophilia (four cases of hemophilia A and two cases of hemophilia B) with odontogenic fascial space infection were included in the study. Apart from routine investigations, assessments were also done to identify inhibitors to factor VIII/IX. Factor VIII/IX was replaced along with infusion of factor eight inhibitor bypass activity (FEIBA) one hour before incision and drainage. All the cases were treated by incision and drainage along with removal of foci under local anesthesia. The postoperative outcome was uneventful in all cases except one in which postoperative bleeding was noted from the extraction site on the third day which was again managed following the designed protocol. CONCLUSION: Maintaining good oral hygiene and seeking early dental care are of prime importance in patients with hemophilia to avoid invasive procedures. However, if odontogenic infection develops in these patients, performing timely incision and drainage using our protocol will minimize the complications and give successful outcome.

Meta Analysis of Etiology and its Clinical and Radiological Correlation in Cases of Craniomaxillofacial Trauma.

AIM: The present study was planned to investigate the etiology of injuries and to analyze correlation between clinical and radiological findings in cases of craniomaxillofacial trauma. STUDY DESIGN: An 18 months cross-sectional study was done and 325 patients with maxillofacial fractures were analyzed from January 2013 to June 2014 who reported to the department of oral and maxillofacial surgery, Aligarh, Uttar Pradesh. Data was recorded in a preformed case sheet which included: patient's demographic data, cause of injury, type of injury, treatment plan. RESULTS: Out of the 325 patients, 74.4 % were males with a male: female ratio of 2.91:1. The 21-30 year age group was found to be maximum. Road traffic accidents accounted for 71.3 %, followed by fall from height (19 %) and assault (9.5 %). Most commonly involved vehicles were two wheelers followed by public transport. Mandibular fractures (65 %) were most prevalent, followed by zygomaticomaxillary complex (44.27 %), parietal bone (48 %) and orbital fractures (21.3 %). Thirty-seven fractures (7.14 %) were missed clinically which were confirmed later by radiographic technique. Maximum were in cranium region (57 %) followed by mandible (27 %), mid face region (16.21 %). Thirty-three fractures (6.37 %) were overestimated or suspected clinically which could not be confirmed by radiographic technique. Maximum were in mandible (48.5 %) followed by mid face (36.33 %) and cranium (15.15 %). CONCLUSION: The idea behind this article is to analyze the various trends and affecting factors and correlation between clinical and radiological findings. A better understanding of the above said would help in future treatment planning and management of facial injuries.

Dental esthetics and its impact on psycho-social well-being and dental self confidence: a campus based survey of north Indian university students.

To evaluate the subjects perceived satisfaction of their dental appearance and to compare it with a various attitudes and practices which may affect social and psychological behavior and dental self confidence. This was a questionnaire based cross-sectional study done in the campus of Aligarh Muslim University, Aligarh (India). 426 students participated in the study. Questions were pooled in from various components of psychosocial impact of dental esthetics questionnaire (PIDAQ) for various attitudes and practices. Quantitative analysis was done using descriptive analysis and Chi square test using SPSS software. Majority of subjects (57.7 %) was highly satisfied with their smile, more than one-third (37.3 %) were satisfied and there were only 4.9 % subjects who were not satisfied with their smile. Tooth color was the most common (27.9 %) smile component causing dissatisfaction amongst the subjects. More than two-fifth (42.5 %) liked to show their teeth, one-half (49.5 %) liked to see their teeth in mirror, photographs and videos, almost one quarter (23.9 %) subjects used to hide their teeth while smiling. As compared to females, significantly higher proportion of males was conscious of opposite sex while smiling. The proportion of subjects which was highly satisfied with their smile was significantly higher for the item 'like to show their teeth and who liked to see their teeth in mirror, photographs and video' whereas for all the other items the proportion of respondents which was not satisfied with their smile was significantly higher. Self perceived satisfaction of dental esthetics has positive impact on person's social and psychological behavior and dental self confidence.

Neutral zone and oral submucous fibrosis.

Oral submucous fibrosis is a premalignant condition in which rigidity of the lip, tongue, and palate results in reduced mouth opening and tongue movement. Limited mouth opening, mucosal rigidity, and reduced salivary flow makes prosthodontic procedures difficult in these patients and affects the stability, retention, and the support of removable prostheses. The burning sensation in the mouth that these patients experience reduces the tolerance to prostheses. We report a case of oral submucous fibrosis where the conventional neutral zone technique with certain modifications was utilized to rehabilitate a completely edentulous patient with this condition.