Subcuticular Suture Technique: Alternative to Frost Suture to Prevent Ectropion After Transcutaneous Incision of Lower Eyelid.

INTRODUCTION: An ectropion is a complication that can arise from reconstruction in the infraorbital region. Often, this complication occurs despite proper positioning of the lower lid at the time of closure. Various transcutaneous approaches to orbit skeleton have investigated in view of complication arising from them. A subtarsal approach with a postoperative Frost suture gives an advantage to reduce the occurrence of ectropion especially after treatment of orbital floor fractures. MATERIAL AND METHODS: This case describes a method of subcuticular suturing technique for subtarsal incision of lower lid which can be used to support the lid during healing period, thus decreasing the rate of ectropion. CONCLUSION: The technique described here is an alterative method for frost suturing with certain advantages.

Platelet-rich fibrin combined with synthetic nanocrystalline hydroxy apatite granules in the management of radicular cyst.

Radicular cysts are inflammatory jaw cysts confined to the apices of teeth with infected and necrotic pulp. They arise from the epithelial residues in the periodontal ligament as a result of inflammation, following the death of pulp. The treatment of such lesions vary with regard to their sizes; the small cystic lesions heal after an endodontic therapy, but larger lesions, may require additional treatment. Apical surgery for radicular cysts generally involves apical root resection and sealing with endodontic material. This case report, describes the treatment of a cyst related to the maxillary central and lateral incisors using platelet rich fibrin along with synthetic nanocrystalline hydroxyapatite granules for the regeneration of lost tissues. A follow-up evaluation at 6 months and 1-year revealed a significant radiographic bone fill with satisfactory healing at the surgical site.

An Erupted Silent Tumour.

Odontomas are the most common odontogenic tumors of the oral cavity which are nonaggressive, hamartomatous in nature consisting of enamel, dentin and cementum. They are called as composite because they contain more than one type of tissue. They are generally asymptomatic, hence recognised on routine radiologic examination. The compound odontoma is composed of multiple small tooth like structures, whereas the complex odontoma consists of a conglomerate mass of enamel and dentine, which bears no anatomical similarity to the tooth. The eruption and infection of odontoma are uncommon, only few cases of erupted complex odontoma are reported in the literature. We report a case of silent erupting complex odontoma.

Hybrid ameloblastoma: An amalgam of rare and conventional ameloblastoma.

Ameloblastoma is a common benign odontogenic tumor with multiple histologic types. This case report describes an unusual type of ameloblastoma called "Hybrid Ameloblastoma" with features of both follicular and desmoplastic ameloblastoma in a 50-year-old female. This is a very rare form of ameloblastoma as <30 cases have been reported so far in literature. Though this rare form of ameloblastoma is only a histologic variant, it poses a great challenge to diagnosticians and thus to surgeons as there will be mismatch of biopsy reports at different sites in the same tumor thereby changing the treatment plan. This case report is one such example of diverse presentation of this ameloblastoma with conflicting histopathological diagnosis at initial biopsy and on surgical excision.

Role of Rapid Tetanus Antibody Test in Accident and Emergency Department.

INTRODUCTION: Tetanus remains a problem of immense concern worldwide. Management of tetanus with its attendant complications are challenges to the physician and its prevention is the chief priority. The choice of tetanus prophylaxis for patients with wounds depends on obtaining their vaccination history, which has been demonstrated to be unreliable. The tetanus antibody test may avoid inadequate prophylactic measures and reduce costs. PURPOSE: This study is conducted to determine the feasibility of rapid tetanus antibody test (SD Bioline) in the accident and emergency department. METHODS: A randomized prospective study was conducted on 50 patients, divided into two groups-A and B with 25 patients each respectively. Group A had patients with a history of tetanus immunization <5 years elapsed from the last booster dose. Group B had patients who did not know the immunization status or more than 5 years elapsed from the last booster dose of tetanus immunization. Groups A and B were further classified into Group 1 and Group 2 based on whether the wound is tetanus prone or a clean wound respectively. Tetanus antibody test was done using whole-blood from the patients by finger prick. RESULTS: Among the 50 patients, 25 (50 %) were classified as 'unprotected' according to the history. Thirteen of the 25 patients showed tetanus antibody positive. In Group A, only 9 of the 25 patients showed tetanus antibody positive. CONCLUSION: The rapid tetanus antibody test in the emergency room could make tetanus prevention more accurate with improved technical feasibility. The test may eliminate unnecessary injecting of vaccine, reduce the cost and can be performed at the hospital setting.

Effect of platelet-rich plasma on bone regeneration after removal of cysts and benign tumours of the jaws.

INTRODUCTION: Platelets are involved in regeneration at sites of pathology, apart from their role in clotting. A preparation composed mainly of platelets (platelet-rich plasma gel) applied to sites of bony pathology, after surgical treatment of lesions, may hasten bone regeneration. MATERIALS AND METHODS: An autologous platelet-rich plasma (PRP) gel was prepared using a standardized technique, without using thrombin clot accelerator, and applied to surgical site in six patients of study group. Five patients were enrolled as controls, in whom PRP gel was not used. The differences in the occurrence of radiographic changes between the study and control group at 6, 12, 18 and 24 weeks after surgery were analysed with chi-square test. Intragroup radiographic changes, i.e. within the study and control groups occurring over the 24 weeks of follow-up, were analysed with Friedman test. RESULTS: A trend towards more rapid healing was observed in the study group at 6, 12, 18 and 24 weeks. However, these differences between the study and control group were not statistically significant. Both the study and control group demonstrated significant healing changes over the 24 weeks of follow-up. CONCLUSIONS: It is possible to prepare platelet-rich plasma gel without using thrombin clot accelerator. PRP, as prepared and applied to surgical sites in this study, was not observed to significantly enhance bone regeneration. All surgical sites, both in the PRP and control group, showed significant healing changes over 6 months.

Botulinum toxin type a for the treatment of hyperkinetic lines of the face.

BACKGROUND: This study sought to determine the efficacy of Botulinum toxin A (BTA) for the treatment of hyperkinetic lines of the face. Twenty three patients who were concerned for facial wrinkles and desiring correction are presented. METHODS: This clinical study evaluated the postoperative results of 23 patients who underwent treatment for facial wrinkles with BTA. Among the patients included in the study, 20 were males and remaining 3 were females. The age of the patients ranged from 27 to 46 years (mean 34.69 years) and the treatment was done in three different sessions and divided into 3 treatment subgroups of forehead, crow's feet, and glabellar wrinkles. RESULTS: All the patients were followed up for a period of at least 6 months and graded for the response to treatment with BTA by the operator, observer and the patient independently using the facial wrinkle scale. The patient's satisfaction to the treatment was also noted on all the follow-up visits on the satisfaction scale and the results were subjected to statistical analysis using Kappa analysis, Chi-square test and T test. The results showed that the treatment of facial hyperkinetic lines with BTA is associated with few adverse events like pain on injection, transient headache, and mild change in facial appearance in subjects with high hair line which are not serious and thus safe. CONCLUSION: The findings of this study support the use of BTA for the treatment of hyperkinetic lines of the face although further studies with more sample size are required.

Current perspectives in intra operative airway management in maxillofacial trauma.

OBJECTIVE: Maxillofacial trauma presents a complex problem due to the disruption of normal anatomy. In such cases, we anticipate a difficult oral intubation that may hinder intraoperative IMF. Nasal and skull base fractures do not advocate use of nasotracheal intubation. Hence, other anesthetic techniques should be considered in management of maxillofacial trauma patients with occlusal derangement and nasal deformity. This study evaluates the indications and outcomes of anesthetic management by retromolar, nasal, submental intubation and tracheostomy. METHODOLOGY: Of the 49 maxillofacial trauma cases reviewed, that required intraoperative IMF, 32 underwent nasal intubation, 9 patients had tracheostomy, 5 patients utilized submental approach and 3 underwent retromolar intubation. RESULTS: Among patients who underwent nasal intubation, eight cases needed fiberoptic assistance. In retromolar approach, though no complication was encountered, constant monitoring was mandatory to avoid risk of tube displacement. Consequently, submental intubation required a surgical procedure which could result in a cosmetically acceptable scar. Though invasive, tracheostomy has its benefits for long term ventilation. CONCLUSION: Intubation of any form performed in a maxillofacial trauma patient is complex and requires both sound judgement and considerable experience.

Three dimensional titanium mini plates in oral & maxillofacial surgery: a prospective clinical trial.

AIM: The purpose of the study was to evaluate the efficacy of three dimensional titanium miniplates as treatment modality for the stabilization of the fractured or osteotomized bone fragments in maxillofacial region. PATIENTS AND METHODS: 24 patients with maxillofacial trauma and one patient who underwent orthognathic surgery constituted the sample of the study. All the patients with maxillofacial injuries required open reduction internal fixation of the fractures and the orthognathic surgery patient required stabilization of the osteotomized segments. CONCLUSIONS: Three dimensional plates provide good stability of bone fragments due to closed quadrangular geometric shape, and the ease of contouring and adapting. Because of better inter fragmentary stability; supplemental fixation is not necessary, thereby enhancing the overall comfort, convenience and well being of the patient.

Inferior alveolar nerve deficits and recovery following surgical removal of impacted mandibular third molars.

AIMS AND OBJECTIVES: (1) To determine the incidence of inferior alveolar nerve (IAN) deficits following surgical extraction of mandibular third molar. (2) To document recovery of IAN injuries. MATERIALS AND METHODS: A total of 400 lower third molars were extracted, 205 male patients and 195 females. All underwent extraction by the prescribed buccal approach. All cases were examined by one examiner preoperatively and postoperatively, at 7 days, one month, two months and six months. Two-point discrimination test (2-pd), brush stroke direction (BSD), contact detection, pin prick and thermal testing was carried out. RESULTS AND CONCLUSION: One patient presented with IAN injury (0.25%). This single case of nerve injury was mesioangular, Level B, Class 2, impaction with a difficulty rating of 5. Levels A and B tests (2PD, BSD, Contact detection) were altered. In these tests, the IAN did not show any signs of recovery by six months. Level C tests (pin prick test, sharp blunt detection) showed that the nerve had recovered completely by two months.

A Retrospective Study of Temporalis Muscle and Fascia Flap in Treatment of TMJ Ankylosis.

BACKGROUND: This study sought to determine the efficacy of interpositional arthroplasty with temporalis muscle and fascia flap in the treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults. METHODS: This retrospective study of nine cases evaluated the postoperative results of interpositional arthroplasty on temporalis muscle and fascia flap in adults. The operative protocol for unilateral TMJ ankylosis entailed (1) resection of ankylotic mass, (2) intraoral ipsilateral coronoidectomy, (3) contralateral coronoidectomy when necessary, (4) interpositional tissue transfer to the TMJ with temporalis muscle, fascia flap, and (5) early mobilization, aggressive physiotherapy. RESULTS: The study evaluated nine patients with follow-up checks from 13 to 31 months (mean 18.3 months). Patients had a preoperative maximal interincisal opening of 9-19 mm (mean 11.7 mm). During the last follow-up observation after surgery, the patients had a maximal interincisal opening of 35-40 mm (mean 38.3 mm).The results of this protocol were encouraging, the functional results of interpositional arthroplasty on temporalis muscle and fascia flap were also satisfactory. CONCLUSION: The findings of this study support the use of temporalis muscle and fascia flap in adult patients with unilateral TMJ ankylosis. Early postoperative initial exercise, physiotherapy and strict follow-up play an important role in preventing postoperative recurrences.

Ramsay-Hunt syndrome complicating osteonecrosis of edentulous maxilla and mandible: report of a rare case.

Review of literature revealed atleast 30 cases of post herpes zoster osteonecrosis of maxilla or mandible. To our knowledge this is a first reported case of Ramsay-Hunt syndrome with post herpetic neuralgia and post herpes zoster osteonecrosis of edentulous maxilla and mandible. We have briefly reviewed the pathophysiology and management of post herpes zoster osteonecrosis and post herpetic neuralgia.

Concrescence: report of rare complication.

Concrescence is an uncommon developmental anomaly that may influence exodontia as well as periodontal, endodontic, orthodontic and even prosthodontic diagnosis and treatment planning. Unexpected complications arising from this condition may lead to legal complications. To minimize risk and adverse outcome of treatment, consideration should be given to recognizing this condition and, possibly, modifying treatment planning. This article presents an unsuspected case of concrescence with a review of the literature.

Scapholunate dislocation: a rare occupational hazard.

Dentists and their assistants are at risk of physical injuries during dental operations. The most common injuries are musculoskeletal. The need to work in a fixed working position using continuous repetitive movements can predispose dentists to wrist ache, lower backache, and neckache. We encountered a rare case of scapholunate dislocation with ligamentous injury, an unusual complication of extraction of teeth.

Cervical necrotizing soft tissue infection - A case report.

A small but nevertheless important part of a surgeons experience comprises necrotizing soft tissue infections of the head and neck. These infections are characterized by their fulminating, devastating, and rapid-progressing course resulting in extensive necrosis of fascia, subcutaneous tissues, skin and muscle. Although necrotizing facilities is a more frequently used terminology, the authors prefer to use the term necrotizing soft tissue infection to describe this potentially fatal condition. A case of cervical necrotizing soft tissue infection of dental origin is reported here. The purpose of this report is to heighten awareness of necrotizing soft tissue infections in any patient with an infection of the neck. The article also outlines an appropriate management strategy for use in such patients with emphasis on prompt diagnosis and early radical surgical debridement.

C-Arm for accurate reduction of zygomatic arch fracture--a case report.

Fracture of the zygomatic arch is usually treated using blind methods. As the fracture lines cannot be visualised directly in closed reduction, digital exploration and crepitus noise or conventional radiographic imaging are used clinically as a guide to reposition the fragments. Successful closed reductions are often difficult to evaluate clinically because of the great amount of swelling that often accompanies these fractures. Postoperative radiographs are often the only way to assess the adequacy of the reduction. This article describes a technique that uses the C-Arm to quickly and accurately evaluate the reduction intraoperatively so that appropriate corrections can be made. A case report of a patient who suffered a w-shaped depressed fracture of the left zygomatic arch and zygomatico-maxillary complex fracture is presented.