The frequency of occult cervical metastasis in oral squamous cell carcinoma patients - A cross sectional study.

OBJECTIVE: To determine the frequency of occult cervical metastasis in oral squamous cell carcinoma patients. METHODS: This cross sectional study was conducted in the department of maxillofacial surgery, Mayo Hospital, Lahore from July 31st, 2015 to January 31st, 2016 on 100 patients of oral Squamous Cell Carcinoma (SCC) having clinically and radiologically negative nodes. Prophylactic functional neck dissection was done in each patient and was sent to the pathology lab for evaluation of any occult metastasis. RESULTS: Overall frequency of occult cervical metastasis was found to be 27%. In 41(41 %) specimens of SCC of tongue, 13(31.7%) had occult metastasis. In Alveolar mucosa occult metastasis was found in 4(20 %) out of 20(20 %) patients. In SCC of buccal mucosa occult metastasis was found in 10(29.4%) out of 34(34 %) patients. In SCC of lip no occult metastasis was detected. CONCLUSIONS: Within the boundaries of the present study, it is concluded that occult cervical metastasis was most frequent in cases of SCC tongue, whereas no occult cervical metastasis detected in SCC of lip.

Comparison of mean decrease in mouth opening by autologous blood injection in superior joint space with and without pericapsular tissue in treatment of chronic recurrent temporomandibular joint dislocation in Mayo Hospital Lahore.

OBJECTIVE: To compare the mean decrease in mouth opening by autologous blood injection in superior joint space with and without pericapsular tissue in the treatment of chronic recurrent temporomandibular joint dislocation. METHODS: The prospective study was conducted at the department of Oral and Maxillofacial Surgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan, from July, 2015, to January, 2016, and comprised patients, divided into two equal groups, having chronic temporomandibular joint dislocation. Group A patients were injected with autologous blood 2ml by 18-gauge single needle technique in superior joint space, while in group B patients, the needle was moved outward for 1cm and an additional 1ml of blood was injected in the pericapsular tissue under local anaesthesia in single setting after scrubbing local area with antiseptic solution. Data was analysed using SPSS 17. RESULTS: Of the 80 patients, there were 40(50%) in each of the two groups. In group A, there were 18(45%) males and 22(55%) females with an overall mean age of 30.93±11.04 years, and in group B there were 16(40%) males and 24(60%) females with an overall mean age of 30.38±11.80 years. In group A, the decrease in mouth opening in 34(85%) patients was 2-4 mm, and 6 (15%) had 5-7 mm. In group B, 14(35%) patients had 2-3 mm and 26(65%) patients had 5-7mm (p=0.001). CONCLUSIONS: The procedure was found to be safe, simple and cost effective for the treatment of temporomandibular joint dislocation, and it caused no foreign body reaction.

Correction of hypoplastic mandible in non-syndromic temporomandibular joint ankylosis patients with distraction osteogenesis in Mayo Hospital Lahore: A descriptive study.

OBJECTIVE: To evaluate the efficacy of simultaneous gap arthroplasty and distraction osteogenesis in the treatment of non-syndromic temporomandibular joint ankylosis patients with hypoplastic mandible. METHODS: The descriptive prospective study was conducted at the Department of Oral and Maxillofacial Surgery, King Edward Medical University / Mayo Hospital, Lahore, Pakistan, from January to December, 2016, and comprised patients having temporomandibular joint ankylosis with hypoplastic mandible. Interpositional gap arthoplasty, osteotomy and application of distractor were done in all the patients. Preoperative and post operative data was collected and analysed us in gSPSS12 . RESULTS: Of the 63 patients, 29(46%) were males with a mean age of 18.48±2.32 years and 34(54%) were females with a mean age of 16.41±3.21 years. Overall mean age was 17.37±3 years (range: 9- 24 years). Of the total, 20(32%) patients were given a single distractor on ramus per side, while 43(68%) were given double distractors (ramus + body) per side. Lengthening was achieved in all (100%) patients both in ramus and body. Only 1(1.6%) patient presented with a complication during the distraction period, and the case was successfully managed surgically. CONCLUSIONS: Distraction osteogenesis is a promising treatment option for the correction of mandibular deformities as a result of temporomandibular joint ankylosis.

Outcomes of extra oral versus intraoral approach for Mandibular angle fracture reduction.

OBJECTIVE: To compare the outcomes of intraoral versus extraoral approach in the treatment of mandibular angle fracture. METHODS: The randomised controlled trail was conducted at the Department of Maxillofacial Surgery, Mayo Hospital, Lahore Pakistan, from September 2016 to March 2017, and comprised patients of mandibular angle fracture who were divided into two equal extraoral group A and intraoral group B. . Baseline and post-operative data on 1st and 7th days as well as 3 months following the surgery was collected. Data was analysed using SPSS 20. RESULTS: Of the 100 patients, there were 50(50%) in each of the two groups. Mean age of group A was 32.28±7.79 years compared to 33.72±8.13 years in group B. There were 39 (78%) males in group A and 36(72%) in group B. The mean pain score at baseline in the groups was not significantly different (p=0.795). On the 7th day and 3 months post-operation, mean pain score was significantly lower in group A (p=0.002). Nerve complication in group A was significantly high compared to group A (p=0.005). CONCLUSIONS: Extra oral approach for the management of mandibular angle fracture is better with regards to pain while intra-oral approach is less associated with nerve complications.

Outcome of treatment of Zygomatic bone fracture by two point fixation versus three point fixation in Mayo Hospital Lahore.

OBJECTIVE: To compare the outcome of two-point internal fixation versus three-point internal fixation for the treatment of zygoma fractures. METHODS: The quassi-experimental study was conducted at the King Edward Medical University, Mayo Hospital, Lahore, Pakistan, from April to September 2016, and comprised patients with zygomatic bone fracture who were randomly divided into two groups. In Group A, patients were treated with two-point fixation and in Group B, patients were treated with three-point fixation. All patients were treated by the same consultant. Patients were followed up on first, third and sixth week postoperatively and malar height and mouth opening were recorded at the sixth week follow-up. Data was analysed using SPSS 17. RESULTS: Of the 60 patients, there were 30(50%) in each of the two groups. There were 39(65%) males and 21(35%) females. The mean age in Group A was 29.56±9.89 years (range: 17-50 years), while in Group-B it was 29.45±8.68 years (range: 17-49 years). Mean malar height at 6th week post-operative follow up showed a significant reduction in Group B compared to Group A (p= 0.001). Significant improvement in mouth opening was seen in Group B compared to Group A (p= 0.034). CONCLUSIONS: Three-point fixation was found to give more stable reduction compared to 2-point fixation for treating zygomatic bone fractures in terms of malar height and mouth opening.