Comparative Evaluation of Open Reduction with Internal Fixation Against Closed Reduction Methods for Condylar Fracture Management: A Systematic Review and Meta- analysis.

Background: Mandibular fractures are frequent in facial trauma. Management of mandibular condylar fractures (MCF) remains an ongoing matter of controversy in maxillofacial injury. A number of techniques, from closed reduction (CR) to open reduction and internal fixation (ORIF), can be effectively used to manage these fractures. The best treatment strategy, that is, closed reduction or open reduction with internal fixation, remains controversial. Aim: The aim of this study is to systematically review the existing scientific literature to determine whether open reduction with internal fixation or closed reduction is a better treatment alternative for the patients with condylar fractures through a meta-analysis. Methods: A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, google scholar and Ebsco Host were searched from 2000 to December 2021 for studies reporting management of condylar fractures through open reduction with internal fixation against closed reduction and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included case control and cohort studies was performed using Newcastle-Ottawa Scale, and randomized studies were evaluated using Cochrane risk-of-bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value <0.05 as statistically significant. Results: Seventeen studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only nine studies were suitable for meta-analysis. The pooled estimate through the Standardized Mean Difference (SMD) of 0.80, 0.36 and 0.42 for maximum inter incisal opening, laterotrusion and protrusion favours CR compared to ORIF for condylar fracture management. Also, most results of heterogeneity tests were poor and most of the funnel plots showed asymmetry, indicating the presence of possible publication bias. Conclusion: The results of our meta-analysis suggest that CR provides superior outcomes in terms of maximum inter incisal opening, laterotrusion and protrusion compared to ORIF in condylar fractures management. It is necessary to conduct more prospective randomized studies and properly control confounding factors to achieve effective results and gradually unify clinical guidelines.

Efficacy of Nasal Floor Augmentation on the Survival Rate of Dental Implants: A Systematic Review.

Aim: To systematically review the existing scientific literature, to summarize and assess the efficacy of the nasal floor augmentation on the survival rate of dental implants by systematically reviewing the available literature. Methodology: Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO-CRD42027289143. Electronic databases like PubMed, google scholar and Ebsco Host were searched from 2000 to December 2021 for studies reporting efficacy of nasal floor augmentation and reporting outcomes in terms of survival rates of dental implants. Quality assessment of included comparative follow-up studies was done using the critical checklist put forward by the Joanna Briggs Institute (JBI) was used. Results: Only nine studies fulfilled the eligibility criteria and were included in the qualitative synthesis. Of those nine studies, five were case reports and four comparative follow-up studies. A total of 14 implants were placed in five patients with a survival rate of 100% in included case reports, while a total of 408 implants were placed in 130 patients with survival rates ranging from 89% to 100% in included comparative follow-up studies. No complications were observed during follow-ups, and the patients were satisfied with the functional and aesthetic results of the treatment. Quality assessment of included studies showed moderate to low risk of bias with overall high quality of studies. Conclusion: The results of this systematic review indicate that implant placement by nasal floor augmentation techniques can be considered as a predictable treatment modality. However, due to the scarcity of literature, more studies should be carried out on proving the efficacy of nasal floor augmentation on survival rate or success of dental Implants.

Reconstruction of the external ear using implant-supported alloplasts-Our experience.

Surgical reconstruction of the missing external ear is difficult, and the results are often far from satisfactory. An implant-retained auricular prosthesis is a suitable alternative. Microtia, malformation, deformity, and partial or complete loss of the external ear may be due to various congenital or acquired factors. A case series of three patients treated with implant-retained auricular prostheses is presented in this article. For each missing pinna, two titanium implants were placed in the temporal bone. After 6 months of osseointegration, the implants were loaded. All three cases were rehabilitated with a bar and clip retained prosthesis. There were two male and one female patient with an average age of 16.6 years. One patient had unilateral absence of external ear and two had bilateral absence. A total of 10 implants were placed, 4 on the right side and 6 on the left. The average post rehabilitation follow-up was 18 months. Peri-implant tissue reactions were observed at two sites. The implant-retained auricular prosthesis is an alternative treatment approach with good retention and patient satisfaction. Long-term follow-up is required to assess delayed sequelae.

Surgical Stent Guided Versus Conventional Method of Implant Placement.

Aim: The aim of this study is to compare the surgical accuracy and efficiency of endo-osseous implant placement using a conventional method and when placed using a custom surgical guide. Materials and methods: The study was carried out in a case control design on 20 patients aged between 15 years and 60 years. In the study group (n = 10) the implants were placed with the help of a surgical stent, while in the control group (n = 10) implants were placed in a conventional manner (without surgical stent) planned only with CBCT scan. The same surgeon placed the implants in both the groups. Results: Each patient was considered in terms of the number of implants received. Each planned and actual implant was compared in terms of the 8 quantitative variables, which were used to observe and compare the accuracy of the surgical guides and conventionally placed implants. Data were analysed by a single blinded statistician using statistical software (Graphpad Prism (Version 5)). The Microsoft excel and Student T test for parametric data and Chi-square test for categorical data were used to observe significant differences between the 2 study groups. The nonparametric Chi-Square test revealed a statistically significant difference between surgical stent guided and conventional surgery in terms of buccal and lingual/palatal cortical plate to implant deviation, adjacent tooth to implant deviation, and mesiodistal angular deviation, whereas the differences between the marginal bone loss deviation, stability deviation, pain and swelling deviation, treatment time and number of sessions deviation, satisfaction deviation were not statistically significant. Conclusion: From our study, we can conclude that guided surgery is essential for insertion of the implants regardless of the surgical technique. The success of the guided surgery depends on accuracy of the clinical and/or laboratorial steps of the virtual planning. Despite all the limitations and probability of errors encountered in our study, the guided surgery is superior in better positioning of implants.

Ophthalmic Complications Associated with Zygomatic Complex Fractures: A Randomised Descriptive Clinical Study.

Background and Objectives: Trauma to the maxillofacial region is usually associated with varying degrees of disruption of the soft and hard tissues in the region and injuries to the neighbouring structures such as eyes, brain, nasal apparatus and paranasal sinuses. Injuries to the middle third of the face commonly destroys the integrity of the orbital skeleton, and are frequently complicated by injury to the eye, ranging between 2.7 and 67% as reported in the literature. These injuries may result in loss of vision or compromised ocular function. When these injuries are severe, they may be detected with ease by any medical or maxillofacial surgeon but many injuries appear minimal and may be missed by the non-ophthalmologist. Methods: A total of thirty patients were selected who were diagnosed with a zygomatic complex fracture, irrespective of sex predilection and in the age group of 18-70 years. All patients underwent a thorough ophthalmic examination by an Oral and Maxillofacial Surgeon and an Ophthalmologist preoperatively and on postoperative day 2, and 7 and all findings were documented separately by the surgeon and the ophthalmologist and the findings were later compared. Results: The statistical analysis was performed using SPSS VERSION 21.0, Shapiro-Wilk test which was used to assess the normality. Descriptive analysis was done for age and gender distribution of study subjects, which are expressed as number and frequency. Cochran's q test was used to determine if there are differences in various study factors among OMFS and ophthalmologists at three time intervals which are expressed as number and frequency. Kappa agreement was used to assess the measurement of agreement between OMFS and ophthalmologists for each factor at each time interval and these are expressed as number and frequency, and p ≤ 0.05 is considered as statistically significant. Upon examination by an OMFS periorbital oedema (p = 0.000), periorbital ecchymosis (p = 0.002), chemosis (p = 0.02) and exophthalmos (p = 0.03) were considered clinically significant. Upon examination by an ophthalmologist subconjunctival haemorrhage (p = 0.05), periorbital oedema (p = 0.05), periorbital ecchymosis (p = 0.00), ptosis (p = 0.006), enopthalmos (p = 0.05) and diplopia (p = 0.05) were considered to be clinically significant. Upon correlation of the findings of the surgeon and the ophthalmologist it was seen that certain parameters like corneal injury, Phthisis bulbing, examination of posterior segment can be better done by the ophthalmologist. Interpretation and Conclusion: In conclusion, it was determined that there is a significant correlation between ophthalmic injuries caused by zygomatic complex fractures. There are a wide array of injuries affecting the eye due to trauma to the middle third of the face, and the superficial injury can be well evaluated and documented by a surgeon; however due to the extensive nature of the injuries in trauma and the importance of the eye, an ophthalmic examination cannot be ruled out. The need for evaluation of such injures deem it pertinent for observation by an ophthalmologist.

Correlation of Panoramic Radiological and Intra-Operative Findings of Impacted Mandibular 3rd Molar in Relation to Inferior Alveolar Canal: A Prospective Study.

AIM: The objective of this study was to correlate the preoperative radiological findings and intraoperative surgical findings during removal of impacted mandibular 3rd molar with respect to the inferior alveolar canal. MATERIALS AND METHOD: The prospective study design included 100 patients between the age group of 20 years and 50 years who visited the Department of Oral and Maxillofacial Surgery at Vydehi Institute of Dental Sciences and Research Centre, Whitefield, Bengaluru. A preoperative panoramic radiograph was taken and the parameters were assessed and a normal surgical protocol was followed to extract the impacted mandibular 3rd molar with intra-operative assessment as well. RESULTS: Out of the 100 patients with definitive radiological signs showing close relation of the third molar to the mandibular canal who underwent surgical removal, only 12 patients presented with definitive clinical findings of the association. CONCLUSION: A true close relationship between the third molars and mandibular canal increases the risk of inferior alveolar nerve injury, and accurate evaluation of the relationship is essential to avoid the risk of surgery. The accuracy of the plain radiographs to diagnose an intimate relationship between the neurovascular bundle and the third molar root has its limitations, since only 12 of the 100 patients with positive radiological signs showed clinical evidence of involvement. Surgeons should be aware of the limitations of the radiographic markers of panoramic radiography and should consider more detailed imaging in more specific cases in which one or more radiographic marker is present.

Feasibility and Reliability of Microvascular Reconstruction in the Vessel-depleted Previously Operated Neck.

BACKGROUND: Microvascular reconstruction of defects in the head and neck has always been a challenge in patients who have undergone previous neck dissection, owing to the prior resection of potential recipient blood vessels used for free flap perfusion. OBJECTIVE: The objective of the study is to evaluate the reliability and safety of free flap reconstruction in patients who have had previous neck dissection. MATERIALS AND METHODS: Twenty-four free flaps were performed in 22 patients with a previous history of neck dissection for head-and-neck squamous cell carcinoma. These included patients who underwent salvage surgery for recurrent cancer as well as patients undergoing secondary reconstruction following previous oncological resections. Flap includes 12 radial forearm free flaps, 5 fibula flaps, 1 rectus abdominis flap, and 6 anterolateral thigh flaps. RESULTS: In cases with the previous history of selective neck dissection, recipient vessels on the ipsilateral/same side of the previously operated neck were used, while contralateral vessels were used in patients with a history of modified radical or radical neck dissection. Vein grafts were not necessary, except for one case. In our series, we did not have any flap loss or considerable increase in operative time. CONCLUSIONS: Free flap reconstruction of head-and-neck defects is highly successful in patients with a history of previous neck dissection, despite a relative scarcity of recipient blood vessels. Careful planning and relying on flaps with a long vascular pedicle obviates the need to perform a suitable vein graft. In our present series, careful planning and the right choice of a free flap with a long vascular pedicle contributes to the absence of free flap failure. In our experience, previous neck dissection should not be considered as a contraindication to microvascular reconstruction of previously operated oncologic defects.