Subcutaneous Emphysema of Periorbital and Canine Space Following Endodontic Treatment.

Emphysema of the subcutaneous tissue is an uncommon complication of dental procedures. Certain dental surgical procedures, such as extraction of teeth using air-driven handpieces and endodontic procedures are more prone to cause subcutaneous emphysema. Subcutaneous emphysema is typically self-limiting and only in a few instances has an impact on the long-term health of the patient. Patients with subcutaneous emphysema experience pain, distress and inconvenience. This paper presents a case of subcutaneous emphysema of the right canine and periorbital space following endodontic treatment of the upper right front tooth.

Clinical Evaluation of Modified Technique of Alar Base Cinch Suture to Prevent Widening of Alar Base.

Introduction: Following Lefort I osteotomy, widening of the alar base is the most common secondary postoperative change resulting in deepening of the alar facial groove, which may be unaesthetic. Therefore, various surgical techniques to control lateralization of the alar base have been widely described in the literature. The purpose of this study was to analyze the cause and to prevent the changes in the nasolabial region, especially excessive widening of the alar base following Lefort I osteotomy by using modified alar base cinch suture. Materials and Method: Twenty patients with the diagnosis of maxillary retrognathism or vertical maxillary excess requiring Lefort I osteotomy with superior repositioning or advancement were included in this prospective, non-randomized clinical study. Following Lefort I osteotomy, the widening of alar base was managed using modified alar base cinch suture. Result: The mean alar width preoperatively was 41.09 ± .38 mm, intra-operatively it was 43.69 ± .28 mm, and after 6 months, it was 41.93 ± .47 mm. Statistical analysis using paired t test revealed that there was a significant change in alar width after placing alar base cinch suture. Discussion: The results of the current study show that the modified alar cinch suture technique is effective in preventing flaring of the alar base in case of Lefort I osteotomies with superior repositioning or advancement.

Application of N-Butyl-2-Cyanoacrylate for the Treatment of Comminuted Fractures in the Anterior Wall of the Maxillary Sinus: A Prospective Clinical Study.

Objective The purpose of the study was to assess the clinical outcome of patients by using n-butyl-2-cyanoacrylate in the management of comminuted fracture segments of the anterior wall of the maxillary sinus in the zygomatico-maxillo-facial complex region. Material and methods A prospective study was done at a tertiary care teaching institute in India with a study population of ten patients in a single group. The method of recruitment was a convenient sampling method. Out of all the study subjects, three patients had isolated maxillary sinus wall fractures, whereas the remaining seven had other associated facial fractures that required stable fixation with mini plates. The comminuted fractures of the anterior wall of the maxillary sinus were carefully reduced through an intra-oral approach, and n-butyl-2-cyanoacrylate was applied over the edges of fractured segments. The segments were left undisturbed for one minute and closed with a 3-0 vicryl. The outcome variables, namely bone alignment visualised through computed tomography (CT) scan postoperatively, paresthesia or hypoesthesia of the infraorbital nerve, postoperative infection, and wound dehiscence, were noted at one-week, one-month, three-month, and six-month intervals. Data were analysed using the Chi-square test. Results Among all patients, seven had satisfactory bone alignment. A total of seven patients recovered from hypoesthesia of the infraorbital nerve. The association of bone alignment with hypoesthesia or paresthesia revealed a highly significant p-value (0.002) using the Chi-square test. Also, an association between postoperative infection and wound dehiscence showed substantial results with a p-value less than 0.05. Conclusion Good bone alignment was seen postoperatively in 70% of patients. The cyanoacrylate used had no adverse reactions, and its application was restricted to non-load-bearing areas in this study. Further studies with a higher level of evidence and a larger sample size are needed to validate the use of adhesives for bone fixation in other regions of the face.

Single Versus Two Plate Osteosynthesis for Parasymphysis Fractures of the Mandible: A Prospective Comparative Study.

Background The treatment of mandibular fractures has undergone a revolutionary change after the invention of miniplate osteosynthesis. There aren't many studies in the literature comparing the outcomes of treating mandibular parasymphysis fractures with two miniplates versus one miniplate.  Aim To evaluate the outcomes of single vs. two plate osteosynthesis in the management of parasymphysis fractures of the mandible. Materials and methods Sixteen patients with parasymphysis fracture of the mandible treated with a single high-profile miniplate or with two miniplates were included in the study. Multiple outcome variables such as fracture union, wound infection, dehiscence, iatrogenic dental injury, intraoperative time, plate exposure, and need for plate removal were recorded and analyzed statistically using the Student's t-test. Results The occurrence of iatrogenic dental injury (P= 0.021) and the mean operating time showed a statistically significant difference between the groups, whereas variables such as osseous healing, plate exposure, wound dehiscence, and postoperative paresthesia had no significant difference (P > 0.05). Conclusion Despite both systems providing enough stability for osseous healing, the use of a single high-profile miniplate demonstrated fewer post-operative problems, such as iatrogenic injury to the dental roots and occurrence of infection/dehiscence and plate exposure, than the use of two miniplates.

Evaluation of Mini-Preauricular Incision in the Surgical Management of Condylar Fracture.

Introduction Mandibular fractures have the highest incidence next to nasal bone fractures of which condylar fractures account for one-third of it. Various approaches for condylar fracture include intraoral and extraoral approaches such as coronal, preauricular, postauricular, endaural, endoscopic, rhytidectomy, transparotid, submandibular, and retromandibular approaches. The purpose of this study was to evaluate the mini-preauricular incision in open reduction and internal fixation of condylar and subcondylar fractures of the mandible. Materials and methods Twenty patients with condylar fracture underwent open reduction and internal fixation under general anesthesia using a modified mini-preauricular incision and subdermal dissection approach. Parameters assessed were pain, mouth opening, occlusal derangement, accessibility of fracture site, duration of surgery, neurosensory deficit (facial nerve), postoperative edema, wound infection, wound dehiscence, and scar. Patients were followed up at an interval of one week, one month, three months, and six months. Results On comparing the parameters preoperatively and postoperatively, occlusal derangement, mouth opening, and pain showed statistical significance with a p-value of 0.01, while nerve weakness and scar assessment showed a high level of statistical significance with a p-value of 0.001. The anatomical reduction of the condyle and internal fixation with miniplates was easy when this approach was used. Patients showed transient facial nerve paralysis only. No permanent damage was noted. The resultant scar was aesthetically acceptable. Discussion The mini-preauricular approach is an effective and safe technique for open reduction and internal fixation of condylar and subcondylar fractures. This approach provided good access, good cosmetic results, and patient satisfaction. This approach resulted in very less morbidity to the facial nerve.

Langerhans Cell Histiocytosis of the Mandible.

The unusual disorder known as Langerhans cell histiocytosis, which is most frequently seen in children and young adults, is caused by the clonal proliferation of Langerhans cells. Even if clinical signs and radiographic evidence of destructive bone lesions may raise suspicion of the disease, a reliable diagnosis without a thorough pathological examination is challenging. This report describes a case of eosinophilic granuloma of the mandible in a nine-year-old child with characteristic radiological, histopathological, and immunohistochemical features.

Evaluation of 3D Trapezoidal Plates in Open Reduction and Internal Fixation of Subcondylar Fractures of Mandible: A Clinical Trial.

Background  Fractures of the mandibular condyle are common and account for 25% to 50% of all fractures of the mandible. Various methods exist for open reduction and internal fixation (ORIF) of condylar fractures. This study was done to explore three-dimensional (3D) plates as a viable option. Aim  This study aims to evaluate the effectiveness of 3D trapezoidal plates in open reduction and internal fixation of subcondylar fractures. Materials and methodology This was a non-randomized clinical trial conducted on 20 patients who reported at the Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, India. The ORIF was done under general anesthesia. A retromandibular transmasseteric approach was used to expose the fracture site, and the fracture was stabilized using 3D titanium trapezoidal plates. Parameters, such as mouth opening, mandibular deviation, occlusion, surgical accessibility, fracture reduction, adaptability, the difference in ramal height, angulation of the fractured condyle, operative time, facial nerve weakness, implant failure, complications, and scar formation were assessed. Statistical analysis was done using Statistical Package for Social Sciences (SPSS), version 21 (IBM SPSS Statistics for Windows, Armonk, NY). Results  There was an improvement in mouth opening and occlusion in the immediate postoperative period. The surgical accessibility ranged from good to excellent. The fracture reduction was excellent in 60% of patients and good in 40%. In one patient, there was a transient weakness of the marginal mandibular nerve which recovered by three months. Another patient had a wound infection that subsided within the first postoperative week. None of the patients had a device failure during the six-month follow-up period. Conclusion  The trapezoidal 3D plates could be considered as a viable option for treating subcondylar fractures of the mandible in terms of surgical accessibility, stability, ease of device placement, stability of reduced fracture, reduced osteosynthesis material requirement, and minimal damage to the surrounding tissues.

Vanishing Mandible: A Rare Case Report with Accent to Recent Concepts on Aetio-pathogenesis.

Massive osteolysis is a rare idiopathic bone disease resulting in progressive destruction of bone. Considering the rarity of encountering this fascinating bone disease, it is often misinterpreted as some other osteolytic disease. Hence, we present a well-documented case of massive osteolysis in a 29-year-old female patient with complete clinical, radiographic, macroscopic and microscopic features along with surgical photographs, which has been effectively managed at our hospital.