Soft Tissue Changes Following Combined Anterior Segmental Bimaxillary Orthognathic Procedures.

AIMS & OBJECTIVES: To analyze the soft tissue response in patients treated by combined anterior segmental bimaxillary procedures. METHODS: A  Prospective, observational and analytical study was carried out for a period of 2 years involving 37 patients with predefined inclusion and exclusion criteria; lateral cephalograms were taken by the same operator on the standardized unit immediately before and 6 months after surgery; hard and soft tissue landmarks were measured in millimeters to both horizontal and vertical reference lines; any differences in distances were recorded as a surgical change; appropriate statistical test was carried; level of significance was p < 0.05. RESULTS: All patients underwent anterior maxillary osteotomy with 34 anterior mandibular osteotomies, 2 advancement genioplasties and 1 reduction genioplasty. Analysis showed significant angular, horizontal and vertical change. The significant differences in skeletal variables were observed in N-Pg distance, overjet, overbite, U1-NF angle, L1-Mp angle and soft tissue variables like labiomental angle, upper-lower lip protrusion, upper-lower lip length and lower incisor to labrale inferius distance. Nasolabial angle, interlabial gap and upper incisor exposure were extremely significant. CONCLUSION: Soft tissue response to surgery is perhaps more predictable after 6 months, so this may be a treatment modality of choice in adult bimaxillary/dentoalveolar protrusion patients who need instant esthetic facial results.

Immediate implants in anterior maxillary arch.

AIM: The aim of the study was to evaluate the osseo-integration and soft tissue status of the endosseous implants placed in immediate extraction socket. METHODOLOGY: Seven patients (4 males and 3 females) aged 20-30 years were selected for the study. Nine implants were placed in seven patients in the maxillary arch. All the patients were clinically αnd thoroughly examined. Under local anesthesia, the indicated tooth was extracted. The extracted socket was prepared using standard drills with palatal wall as guide. The longest and widest implants were placed (Hi-Tec Implants). All implants showed good primary stability. The implants used in the study were tapered design endosseous implants with Threaded implants (TI) unit plasma-sprayed surface. Surgical re-entry (secondary surgery) was performed to remove the healing cap after 6 months for supra crestal fabrication. All patients were reviewed periodically at 3(rd) and 6(th) month interval and the following clinical parameters including modified plaque index (mPlI), modified bleeding index (mBI), probing depth (PD), attachment level (AL), and distance between the implant shoulder and mucosal margin (DIM), distance between the implant shoulder and first bone-implant contact, and Clinical Mobility Index were recorded. The results were computed and subjected to statistical evaluation. RESULTS: The mPlI, mBI, PD, AL, and DIM were evaluated around the implants at baseline, 3(rd) and 6(th) month intervals and analyzed statistically by Friedman T-test. The results of the above were shown to be statistically non-significant. The distance between the implant shoulder and first bone implant contact was evaluated around the implants at base line, 3(rd) and 6(th) month intervals. The results proved to be statistically significant (0.01) implying that there was a bone apposition around the implants. CONCLUSION: During the course of the study, soft tissue status around implants was found to be healthy. Osseointegration as assessed by clinical and radiographic findings was found to be sound.

Deep vein thrombosis: A rare complication in oral and maxillofacial surgery: A review of two cases.

Deep vein thrombosis (DVT) is caused by obstruction of blood flow of deep veins in upper and lower limb. One of the precipitating factors for DVT is surgery under general anesthesia exceeding 30 min. However, there are very few reports of DVT associated with surgery of oral and maxillofacial region. In this paper we report two cases of DVT involving left ilio-femoropopliteal deep vein in one patient treated for fractured left angle of mandible and left peroneal vein in the other patient treated for oral sub mucous fibrosis. Clinical and color Doppler examination were performed to diagnose the condition and were referred to vascular surgical unit of higher institute for further management. These cases illustrates any surgery of maxillofacial region is not free from risk of DVT, which can cause fatal pulmonary thromboembolism.

Low flow vascular malformation of the buccal mucosa treated conservatively by sclerotherapy (3% sodium tetradecyl sulfate).

Vascular anomalies constitute some of the most difficult diagnostic and therapeutic enigmas in the head and neck region. It is of paramount importance that a modern classification system is established to differentiate vascular lesions from vascular malformations. Vascular malformations are usually congenital and venous anomalies usually expand because of hormonal changes such as puberty, pregnancy, or secondary to trauma. Here, we report a case which was diagnosed as low flow vascular malformation of buccal mucosa involving the lower lip and subsequently treated with 3% sodium tetra decyl sulfate. This paper provides overall understanding regarding the presentation and management of small vascular lesions in the orofacial region. Percutaneous sodium tetradecyl sulfate when used either alone or as adjunct to surgery is a safe, effective, and inexpensive agent in the treatment of venous malformations. However, proper case selection, evaluation, and careful planning are necessary to reduce the unwarranted risks and complications.

Double-layered closure of oroantral fistula using buccal fat pad and buccal advancement flap.

Some of the traditional methods that are being employed in the repair of oroantral communication can be broadly divided into local and distant flaps. Recently, because of various advantages, buccal fat pad is increasingly being employed in the repair of oroantral fistula and other oral defects worldwide. However, there are some problems that can be encountered while harvesting BFP which has to be taken care of. In this paper, we present a case with one of such problems, its management, and review of literature on the same.

Ludwig's Angina - An emergency: A case report with literature review.

Ludwig's angina is a form of severe diffuse cellulitis that presents an acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a state of emergency. Early diagnosis and immediate treatment planning could be a life-saving procedure. Here we report a case of wide spread odontogenic infection extending to the neck with elevation of the floor of the mouth obstructing the airway which resulted in breathlessness and stridor for which the patient was directed to maintain his airway by elective tracheostomy and subsequent drainage of the potentially involved spaces. Late stages of the disease should be addressed immediately and given special importance towards the maintenance of airway followed by surgical decompression under antibiotic coverage. The appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection remains the standard protocol of treatment in advanced cases of Ludwig's angina.

Trichorhinophalangeal syndrome type 1: A case report with literature review.

Trichorhinophalangeal syndrome is a very rare genetic disorder, where damage and mutation to the number 8 chromosome affects sufferers in numerous ways. The syndrome has three types, all characterized by abnormally short stature, sparse hair, short deformed fingers with cone-shaped epiphyses visible in radiographs. Type I is the most common. Type II is characterized by the development of multiple bony exostoses and frequently, mental disability. Type III is a more severe form of type I and is associated with short stature. This report presents a 28-year-old man who had the characteristic features of type I with the presence of multiple erupted supernumerary teeth with normal mentation and karyotyping with high resolution G banding displayed normal chromosomal complements.