Cavitary myiasis and its management.

OBJECTIVE: Myiasis is a parasitic disease of humans and vertebrates, caused by fly larvae feeding on the host's necrotic or living tissue. Myiasis is classified into cutaneous and cavitary myiasis. Cavitary myiasis is rare and occurs more frequently in tropical and subtropical regions of Africa and America associated with low economic status and poor hygiene. This article reviews current literature, provides general descriptions, and discusses life cycles of each species. It also gives diagnosis, treatment techniques and descriptions of each type of illness that result from interaction / infestation.

A comparative analysis of periimplant bone levels of immediate and conventionally loaded implants.

BACKGROUND: With the trend of shortening the treatment time and reducing patient discomfort/inconveniences immediate loading of implants has emerged as an alternative approach for replacing missing natural teeth. The aim of this study is to evaluate and compare the effectiveness of immediate implant loading protocol over conventional implant loading protocol in partially edentulous mandible. METHODS: Twenty patients were selected from out patients department who needed the replacement of one of the missing mandibular first molar. They were divided into two groups. In Group A patients implants were loaded with immediate implant loading protocol, whereas in Group B they were loaded with conventional loading protocol. Periimplant bone loss and soft tissue health were measured and compared using OPG and IOPA radiographs 06 and 12 months after implant placement. RESULTS: One implant failed in immediate loading group (Group A), whereas all implants survived in conventional loading group (Group B). The average periimplant bone loss after 6 months and 1 year for Group A were 0.69 mm and 1.09 mm respectively, whereas it was 0.74 mm and 1.13 mm respectively for Group B. The difference in the bone loss between Group A and B was not statistically significant. CONCLUSION: Immediate implant loading protocol has a highly acceptable clinical success rate in partially edentulous lower jaw although implant survival rate is slightly inferior to conventional loading protocol.

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.

Free dermal fat graft for restoration of soft tissue defects in maxillofacial surgery.

Various local flaps have been used for reconstruction of developmental and post surgical soft tissue defects of maxillofacial region. They include nasolabial flap, palatal pedicled flap, buccal fat pad, temporalis muscle and fascia flap. An ideal flap for all indications is yet to be found. Our experience with free dermal fat graft in the correction of deformities associated with Parry Romberg syndrome and oral submucous fibrosis is presented.

Surgical management of recurrent odontogenic keratocyst.

The odontogenic keratocyst is a distinct entity arising from odontogenic epithelium. The unique histopathological appearance and the propensity for recurrence has made it management controversial in terms of the conservatism to be followed. This article describes the management of a case of recurrent odontogenic keratocyst with an aggressive therapy being adopted due to the nature of the pathology.

Efficacy of two point rigid internal fixation in the management of zygomatic complex fracture.

PURPOSE: To evaluate the efficacy of two point rigid internal fixation in the immobilization of zygomatic complex fractures. PATIENTS AND METHODS: 30 patients with zygomatic complex fractures were managed by open reduction and internal fixation using titanium mini bone plate screws at the frontozygomatic and zygomatic buttress region. This prospective study was carried out at the Department of Oral & Maxillofacial Surgery, Armed Forces Medical College (AFMC), Pune, India between 1st August 2005 to 1st August 2007. Isolated unilateral zygomatic complex fractures of less than six weeks duration were included in the study. RESULT: Clinically and radiologically satisfactory results were achieved in all 30 patients using two point rigid internal fixation at the frontozygomatic and zygomatic buttress region of zygomatic complex fracture. CONCLUSIONS: Stable fixation and immobilization of isolated zygomatic complex can be achieved with two point fixation using titanium mini bone plate and screws at the frontozygomatic and zygomatic buttress region of zygomatic complex fracture. Postoperative complications like scarring, ectropion and neurological deficit can be avoided by not using infraorbital rim as the third point of fixation.

Endosseous alveolar distractor (LEAD™) in the management of residual alveolar ridge resorption.

BACKGROUND: Lack of sufficient alveolar bone height or width is one of the most frequent problems in the dental rehabilitation of the edentulous patient. METHODS: A prospective study to evaluate the efficacy of an endosseous alveolar distractor (LEADTM) in managing residual alveolar ridge resorption was carried out. The complications related to the surgical procedure and the quantitative changes in the regenerate over a 6 month period following distraction were studied in 13 cases with alveolar ridge atrophy. RESULT: Desired ridge augmentation was achieved in 11 cases. In 2 cases the distraction failed. Some unusual complications were encountered. CONCLUSION: The LEAD™ alveolar distractor produces consistent augmentation of the alveolar bone but is confronted with stability issues.

Management of Mandibular Fractures.

BACKGROUND: To evaluate the cases of mandibular fractures treated by open reduction and rigid fixation at the Armed Forces Medical College, Pune. METHODS: Two hundred and thirteen mandibular fractures cases were treated by open reduction and rigid fixation from Jun 1998 to Jun 2006. These were retrospectively analyzed based on the following patient related factors i.e. mode of injury, age and sex distribution, site of injury, associated injuries and surgical treatment. RESULT: The significant finding was that the most common etiology for fracture mandible was road traffic accidents (RTA), [196 (92%)]. Of the patients who reported, 147 (95.4%) were males in the third decade of life. 96 (45%) patients had parasymphysis fractures, 65 (30.5%) had angle fractures, 33 (15%) subcondylar fractures, 17 (7.9%) body fractures and 2(0.9%) had ramus fracture. Early intervention using open reduction and internal fixation was the protocol followed which resulted in minimum morbidity and complications. CONCLUSION: As RTA especially two wheelers accidents appeared to be the most common cause of mandibular fractures, use of suitably designed protective head gear (crash helmets) is advisable. Moreover open reduction and rigid internal fixation appears to be the suitable treatment modality in successful treatment of mandibular fractures in reducing morbidity and complications and ensuring early return to normalcy.

Reconstruction of Cranial Defects in Armed Forces Personnel - Our Experience.

BACKGROUND: The aim of this study was to evaluate the efficacy of heat cured 'poly methyl methacrylate resin prosthesis and to assess the acceptability of the indigenously manufactured titanium mini bone plate and screws in patients treated for repair of cranial defects. METHODS: 17 patients with cranial defect were treated for reconstruction of the skull defect with two types of implants i.e. Acrylic resin plate prosthesis and titanium minibone plates, either in combination or singularly. In these cases, the skull defects resulted from trauma (88.23%) or due to ablative tumour surgery (11.96%). Acrylic implant was used in 12 cases (70.85%), titanium plates and screws in 2 cases (11.76%) and a combination of both of the above in 3 cases (17.64). RESULTS: The primary reconstruction was carried out in 2 cases (11.96%) and secondary reconstruction was done in 15 cases (88.23%). Majority of the cases underwent secondary reconstruction because of the initial surgical emergency requiring quick debulking and closure. In 2 cases where primary reconstruction was done, the second surgery could be avoided with gratifying results. CONCLUSION: 70.85% underwent reconstruction with polymethyl methacrylate resin prosthesis and in the rest either titanium plates were used singly or in combination. Only in one patient, there was rejection of the implant due to infection. In 94% cases the graft was well taken up with excellent results.