Two-Point versus Three-Point Fixation in the Management of Zygomaticomaxillary Complex Fractures: A Comparative Study.

Introduction: The zygoma plays an important role in the facial contour for both cosmetic and functional reasons; therefore, zygomatic bone injuries should be properly diagnosed and adequately treated. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements that require a protocol for management and long-term follow-up. The objectives of this study were to compare the efficacy of zygomatic bone after treatment with open reduction internal fixation (ORIF) using two-point fixation and ORIF using three-point fixation and compare the outcome of two procedures. Materials and Methods: Twenty patients were randomly divided equally into two groups. In Group A, ten patients were treated by ORIF using two-point fixation by miniplates and in Group B, ten patients were treated by ORIF using three-point fixation by miniplates. They were evaluated with their advantages and disadvantages and the difference between the two groups was observed. Results: We found that postoperative facial and neurological complications are minimum in two-point fixation group. Based on this study, open reduction and internal fixation using two-point fixation by miniplates is sufficient and the best available treatment of choice for the management of zygomaticomaxillary complex fractures. Discussion: Alignment of the fracture at three points and fixation at two stable points provide the most accurate and satisfactory postoperative results. Two-point interosseous fixation at the "buttress" fracture and the frontozygomatic (FZ) fracture is suitable for routine surgery. The results of these studies confirm with the present study that two-point fixation provided better stability in patients with clinical and radiological evidence of fracture in FZ and zygomaticomaxillary buttress area.

Utility of esthetic eyebrow incision in the management of anterior table fracture of frontal bone: our experience.

PURPOSE: The purpose of this study was to provide detailed information about the eyebrow approach for the reduction of the frontal bone and its esthetic results with the help of clinical data available. Thus, suggesting this technique is minimally invasive and highly esthetic for frontal bone management. METHOD: In this series, 96 cases were studied, and results were based on variable clinical criteria and satisfaction of patients. All the surgeries were performed through eyebrow incision for the management of fractures. Intraoperatively, minimal tissue dissection, less invasion with reduced operating time was observed. RESULTS: Postoperatively, the eyebrow approach leads to its normal contour and esthetics. No complications related to the procedure were seen with partially recoverable neuropraxia and speedy recovery. This makes it an important technique to consider in carefully selected patients. CONCLUSION: In craniofacial trauma, frequently involved site is the frontal bone, and its treatment should be completed more esthetically. Eyebrow approach is a good alternative to other surgical approaches, and it is a minimally invasive technique and thus should be practiced for esthetic management of frontal bone fractures.

Evaluation of demographic, radiological and intraoperative factors for assessment of postoperative pain and complications in surgical removal of impacted mandibular third molar: a prospective study / Evaluación de factores demográficos, radiológicos e intraoperatorios para la evaluación del dolor postoperatorio y las complicaciones en la extracción quirúrgica del tercer molar mandibular impactado: un estudio prospectivo

Third molars usually erupt within the age of 17 ­ 21years. Usually, due to the evolution of human jaws, the size is decreasing leading to the impacted tooth. An impacted tooth may lead to external resorption of the adjacent tooth, trismus, infection, etc. Many studies have been reported in the literature for evaluating the surgical difficulty and postoperative complications secondary to impacted third molars. This study includes a sample of 100 subjects evaluated for the surgical difficulty and postoperative complications. Various demographic, radiological, and intraoperative factors were evaluated which may lead to postoperative complications. Factors responsible for postoperative sequelae were also evaluated with complications. Postoperative pain after 4 hours and 7 days was assessed to mark the factors commonly responsible. Pain at 7th postoperative day was significant involving factors like fully impacted, horizontal impaction, level C, no/very little retromolar space, and root contact. Postoperative complications were not reported in this study.

Los terceros molares suelen erupcionar entre los 17 y los 21 años de edad. Por lo general, debido a la evolución de las mandíbulas humanas, el tamaño disminuye, lo que conduce al diente impactado. Un diente impactado puede conducir a la reabsorción externa del diente adyacente, trismo, infección, etc. Se han reportado muchos estudios en la literatura para evaluar la dificultad quirúrgica y las complicaciones postoperatorias secundarias a terceros molares impactados. Este estudio incluye una muestra de 100 sujetos evaluados por la dificultad quirúrgica y las complicaciones postoperatorias. Se evaluaron diversos factores demográficos, radiológicos e intraoperatorios que pueden conducir a complicaciones postoperatorias. También se evaluaron los factores responsables de las secuelas postoperatorias con las complicaciones. Se evaluó el dolor postoperatorio después de 4 horas y 7 días para marcar los factores comúnmente responsables. El dolor al séptimo día postoperatorio fue significativo e involucró factores como impacto total, impactación horizontal, nivel C, espacio retromolar nulo o muy pequeño y contacto con la raíz. En este estudio no se informaron complicaciones posoperatorias.

CRB modification to retromandibular approach for management of subcondylar fractures

The aim of this study was to evaluate the efficacy of CRB modification of retromandibular approach to gain surgical access for open reduction and internal fixation of mandibular sub-condylar fractures. A total number of 264 sustained extra-capsular subcondylar fractures from 230 patients were selected for the study over the period of 5 years. Evaluation of intraoperative accessibility, postoperative facial nerve function, postoperative complications and scar was ca-rried out. All the patients were treated using CRB Curvilinear approach. Patient follow up was re-corded for 1 year on a regular interval basis. Symptoms of postoperative facial nerve injury were seen in 2 patients which recovered with time, postoperative complications were not encountered in any case and minimum scar mark hidden in the cervical skin crease. Hence open reduction and internal fixation for Subcondylar fracture of mandible by using the CRB modification of re-tromandibular approach is a good alternative for other conventional approaches in having ease of access, ease of fixation, reduced incidences of injury to facial nerve and its branches with good aesthetic outcome

Assessment of intraoperative risk factors for surgical difficulty in surgical extraction of impacted mandibular third molar: a prospective study

The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. For proper planning of surgical extraction, espe-cially for impacted mandibular third molars the estimated level of surgical difficulty of the case is important. This study was conducted to evaluate the intraoperative risk factors contributing to surgical difficulty in extraction of impacted mandibular third molars and consequently the post-operative outcome. Here, we have undertaken a study in which the intraoperative variables were considered, to evaluate their contribution for surgical difficulty and postoperative complica-tions in surgical removal of 100 impacted mandibular third molars. Three variables were found significant associated with total surgical time intervention, i.e., surgeon's experience (p=0.006), Inter-incisal opening (p=0.032), and cheek flexibility (p=0.004). Total surgical time intervention for 'right side' was higher with 49.20 ± 17.94 minutes (p=0.691). Total surgical time intervention for 'gagging reflex present' was 50.21 ± 17.812 (p=0.674). Multiple linear regression shows that surgeon's experience was the only predictor (p<0.001). The surgical difficulty of impacted mandibular third molar are likely to depend on the intraoperative factors like Surgeon's time, surgeon's experience, check flexibility, and inter incisal mouth opening.

Comparative Evaluation of Healing Pattern After Surgical Excision of Oral Mucosal Lesions by Using Platelet-Rich Fibrin (PRF) Membrane and Collagen Membrane as Grafting Materials-A Randomized Clinical Trial.

PURPOSE: To compare the healing potential of platelet-rich fibrin (PRF) and collagen membranes in oral mucosal healing. MATERIALS AND METHODS: Thirty patients with oral premalignant lesions were randomly included in the study and divided in groups A and B. After excising the lesions under local anesthesia, patients in groups A and B underwent grafting with the PRF membrane and the collagen membrane, respectively. Patients were evaluated at postoperative days 7, 15, 30, and 60 for pain, healing, and complications, such as recurrence, fibrosis, scar hypertrophy, and loss of vestibular depth. RESULTS: In group A, 66.66% of patients reported substantially less pain postoperatively at 15-day follow-up than those in group B. At 30-day follow-up, 86.66% of patients in group A reported no pain versus 60% in group B. Pain scores were similar at 7- and 60-day follow-ups. Healing was accelerated in group A at 15- and 30-day follow-ups, but was the same on day 60. Complications, such as fibrosis, loss of vestibular depth, and scar hypertrophy, were seen in group B. Recurrence was seen in 1 patient in group A at 60-day follow-up. CONCLUSION: PRF proved superior to collagen membrane for grafting of oral mucosal surgical defects. However, further study with larger samples is required to prove its efficacy.

Is amalgamated ligno-bupivacaine an answer to complicated minor oral surgical anesthesia? A randomized split-mouth double-blind clinical trial.

PURPOSE: The purpose of this study was to find a suitable anesthetic combination for complicated and protracted minor oral surgical procedures. METHODS: Fifty patients with bilaterally impacted deep-seated mandibular third molars were included in this study and randomly divided on the basis of anesthetic used into two groups. Group A received 2% lignocaine with 1:200,000 adrenaline while in group B, amalgamated mixture of 2% lignocaine and 0.5% bupivacaine was used. The onset time, duration of anesthetic effect, supplementary injections, pain (during local anesthetic deposition, intra and postoperatively), and postoperative analgesia were the study parameters. Chi-square and unpaired t tests were used to compare means. RESULTS: The onset time in both the groups was comparable and showed statistically significant difference between the duration of anesthetic effect with notable requirement of supplemental anesthetic injections in group A (54%) (p < 0.05). Pain scores also revealed a statistically significant intergroup difference (p < 0.05). Requirement of postoperative analgesics was delayed in group B. CONCLUSIONS: The amalgamated mixture of lignocaine and bupivacaine had equivocally rational onset and provided a more profound and in-depth anesthesia especially in complicated and protracted minor oral surgical procedures. Though this mixture is widely used in other surgical fields, its efficacy still remains unexploited and undocumented in oral and maxillofacial surgical procedures.

Utility of superiorly based platysma myocutaneous flap for reconstruction of intraoral surgical defects: our experience.

PURPOSE: Various surgical modalities have been advocated for the soft tissue reconstruction of oral cavity with variable results. This prospective study evaluates the utility of platysma myocutaneous flap (PMF) in the reconstruction of surgical defects followed by treatment of oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) in terms of healing and functional outcomes. METHODS: In this prospective study, 47 patients with OSMF and 15 of OSCC were evaluated and selected for PMF reconstruction. OSCC was selected under T1N0M0 category only. Patients were operated under general anaesthesia followed by PMF grafting. In OSCC, ipsilateral and for OSMF, bilateral PMF was used. RESULTS: In 47 patients treated for OSMF, 46 were male and 1 female while 15 cases of OSCC, 10 were male and 5 females aged between 18 and 44 years. Intraoperative mouth opening was achieved up to 48 mm in OSMF followed by 42.5 mm postoperatively after 2 years. However, uneventful healing and acceptable scar on cervical region was noted in all the cases including OSCC. In OSMF, three cases of dehiscence, four partial necrosis at end of flap and in OSCC one case shows skin loss at flap and two partial necrosis at tip of flap and extraoral localised abscess at ipsilateral donor site in one case was noted. An uneventful healing, anatomical form and functional results were restored with acceptable scarring at donor site without any evidence of difficulty in neck movements were observed. CONCLUSION: The PMF is simple, versatile and could be valued as a reconstructive alternative, with interesting visual qualities. It is a good therapeutic alternative tool for reconstruction of the buccal mucosa, especially for small- and medium-sized defects between 2 and 4 cm2 of the oral cavity.

Utility of Superiorly Based Masseter Muscle Flap for Postablative Retromaxillary Reconstruction.

PURPOSE: Resections in the posterior component of the oral cavity usually lead to severe functional compromise and lower quality of life for patients. Notable advances in reconstruction of the posterior part of the mouth and of the oropharynx have occurred in recent decades. The anatomic and physiologic rehabilitation of the defect to a reasonable outcome with low morbidity and mortality remains the founding basis of any surgical reconstruction, which also holds true for oral oropharyngeal and retromaxillary reconstructions. PATIENTS AND METHODS: A retrospective chart review study of all patients who underwent surgery for retromaxillary malignancy at the Department of Oral and Maxillofacial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital (Nagpur, India) from 2006 to 2015 was performed. Patients underwent selective neck dissection of levels I to IV using wide local excision. The decision for the type of maxillary resection (marginal ostectomy, partial posterior maxillectomy, or hemimaxillectomy) depended on the degree of osseous infiltration of the tumor. Reconstruction was performed in all cases using the regional masseter muscle flap and advancement of the palatal flap into the defect. The necessary findings and observations were tabulated. RESULTS: Of 76 patients who presented at the hospital, 69 had biopsy specimens positive for squamous cell carcinoma and 7 had biopsy specimens positive for verrucous carcinoma. Twenty-three patients with lesions extending and encroaching into the infratemporal fossa or skull base, distant metastasis, or guarded prognosis were not included in the study. Also excluded from the study were those patients in whom flaps other than the masseteric flap were used primarily for reconstruction. In the remaining 53 patients who underwent resection of retromaxillary malignancy with masseter muscle reconstruction, 48 showed a satisfactory outcome. Postoperative infection was noted in 5 patients and 2 of these patients needed debridement. Postoperative wound contracture with muscular spasm and decreased mouth opening in the early postoperative period were a general observation. In all patients, the vitality of the flap was excellent, with epithelization and adequate mouth opening within 3 weeks. Postoperative speech, swallowing, and facial esthetics were satisfactory and acceptable. CONCLUSION: The masseter muscle flap is a promising reconstruction alternative for retromaxillary reconstruction because of advantages such as regional access, ease of harvesting, optimum bulk, flexibility, pliability for larger defects, and minimum postoperative morbidity.

Immediate versus delayed aggressive physical therapy following buccal fat pad interposition in oral submucous fibrosis-a prospective study in Central India.

PURPOSE: Oral submucous fibrosis is a disease of an Indian subcontinent with obscure aetiology and poorly treated with varying signs and symptoms. OSMF occurs at any age but is most commonly seen in teenagers and adults in the age ranging between 16 and 35 years. A number of surgical treatments have been used for the treatment of oral submucous fibrosis with unpredictable results. PATIENTS AND METHOD: In this study, 220 patients were randomly divided into two groups with mouth opening less than 16 mm and evaluated with immediate and delayed aggressive physiotherapy with buccal fat pad interposition after fibrotomy. Group A (n = 110) patients underwent aggressive mouth opening exercise from the next postoperative day while in group B (n = 110), patients underwent physiotherapy 7th day postoperatively. Pain and discomfort, mucosalization, infection, flap dehiscence and necrosis were noted. Patients were followed for 1 year on a regular interval basis. RESULTS: At the end of 1-year follow up, the post-operative mean mouth opening in group A was 38.63 mm and 34.19 mm in group B. In group A, the immediate physiotherapy results in mild to moderate pain and discomfort to the patients as compared to no apparent pain in the group B. The mean mucosalization time in group A and group B was 4.2 and 5.1 weeks, respectively. Postoperatively, all patients achieve satisfactory mouth opening. CONCLUSION: Immediate aggressive physiotherapy yields a comparatively superior result than delayed physiotherapy with respect to mouth opening in 1 year of follow-up.

Reconstruction of Orbital Floor Fractures with Autogenous Bone Graft Application from Anterior Wall of Maxillary Sinus: A Retrospective Study.

INTRODUCTION: Orbital wall fracture implies a situation where disruptions of the walls or floor have occurred. It is a blowout type fracture where bone fragments with torn periosteum are pushed outside of the original bony orbit. There is no intact bone even near the defect area except the thin bone rim surrounding the blowout fracture. The purpose of this defect repair is to support orbital contents, free entrapped tissue, and, especially, restore the original orbital volume. MATERIAL AND METHODS: Ten patients (seven males and three females) who underwent repair of orbital floor factures with maxillary sinus bone grafts were included in this study. Surgical procedure for harvesting graft and its fixation was almost same in all operated cases. CONCLUSION: The collection in the maxillary sinus due to fracture of floor of orbit, blood and bony fragments collected in the maxillary sinus can be easily drained and removed after removal of anterior wall of maxillary sinus and through the same approach you can reduce the floor of orbit manually to the proper position which helps to decease the orbital floor defect.

Extended nasolabial flap compared with the platysma myocutaneous muscle flap for reconstruction of intraoral defects after release of oral submucous fibrosis: a comparative study.

We compared extended nasolabial flaps and coronoidectomy with platysma myocutaneous muscle flaps in the management of 20 randomly selected patients with histologically confirmed oral submucous fibrosis. Ten patients were treated by release of fibrous bands, bilateral coronoidectomy, and reconstruction with an extended nasolabial flap (nasolabial group), and the other 10 by bilateral release of fibrous bands, coronoidectomy, and reconstruction with a platysma myocutaneous muscle flap (platysma group). In the nasolabial group the mean preoperative interincisal mouth opening was 12(range 3-14)mm, and in the platysma group it was 11 (3-13). All 20 patients were given vigorous postoperative physiotherapy, and were followed up for 3 years. The interincisal mouth opening improved to 47(35-45)mm in the nasolabial group and 48(41-52)mm in the platysma group. The procedures were equally effective in the management of the oral submucous fibrosis, except that the extraoral scar was not aesthetically acceptable in the nasolabial group.

Prevalence, treatment and recurrence of odontogenic keratocyst in central India.

OBJECTIVE: The present study aimed to evaluate the prevalence, sex predilection and treatment modalities of OKC in Central India. MATERIALS AND METHODS: Total 2900 patients were screened from various hospitals and centers. Age of patients and site of lesion was recorded. OKC was classified into initial, moderate and advanced depending on the radiological involvement and treatment modalities given with respect to the extent of the OKC. RESULT: Total 49 patients were diagnosed with the presence of OKC. It was found that mostly it is common in 3rd and 4th decades, with the mean age 28 years in males and 31 years in females. The most common site of occurrence was angle of mandible and the ramus region. The treatment of OKC, on the basis of the radiographic classification, gives excellent results with minimum recurrences. CONCLUSION: The most common age and site occurrence was relevant with that of previous studies (Browne, Br Dent J 128(5):225-231, 1970, Chen and Lin, Gaoxiong Yi Xue Ke Xue Za Zhi 2(9):601-607, 1986). This study concluded by considering multicentric incidence, prevalence of OKC in Central India, that the population should be screened for OKC. The screening should be done by clinical, radiological and histopathological. While screening all the parameters should be considered to diagnose and treat the patients for the prevention of morbidity.

Two atypical case reports of foreign bodies in the maxillary sinus and nasal septum.

We present cases with foreign bodies in maxillary sinus and nasal septum which was due to peculiar habit of the patient of inserting sticks in between teeth. There was oroantrualfistula and nasal abcess observed. The ectopic foreign bodies were removed surgically.