Reconstruction of buccal mucosa: A minimalist symbiotic approach with local flaps.

BACKGROUND: Buccal mucosa defects following resection of premalignant or malignant lesions require adequate reconstruction. Both locoregional and microvascular flaps have been extensively used based on operator and patient factors. This paper focuses on the outcomes of a simplified approach for reconstruction of large buccal mucosa defects with posterior extent using a combination of two loco regional flaps. METHOD: A combination of buccal fat pad graft and nasolabial flap was used to reconstruct large defects spanning the buccal mucosa extending to the soft palate or retromolar trigone areas. Post operative outcomes were noted in patients who underwent reconstruction using this combination technique. RESULT: This paper highlights the favourable results and ease of technique with this combination of flaps, i.e complete coverage of large buccal mucosa defects extending to critical areas such as soft palate, retromolar trigone or tonsillar pillars; avoiding sophisticated free flaps. Satisfactory healing with adequate functional and esthetic outcomes were seen. CONCLUSION: Defects post ablation of buccal mucosa lesions, larger than 5 cm × 5 cm, can be reconstructed using double local flaps. Buccal fat pad and nasolabial flaps heal excellently with nil morbidities and their combination provides a simple and an economical alternative option for reconstructive surgeons.

Comparison of Extraction Socket Healing in Non-Diabetic, Prediabetic, and Type 2 Diabetic Patients.

OBJECTIVE: To compare the healing of extraction socket among non-diabetic, prediabetic, and diabetic patients. MATERIALS AND METHODS: A single-center prospective observational study was conducted. Glycated hemoglobin and random blood glucose were recorded for all the participants before the procedure. A trained and calibrated examiner evaluated the socket size on postoperative days 0 and 7. Postoperative pain (PoP), discharge, swelling, infection, erythema, dry socket, and the number of analgesics were also recorded. RESULTS: A total of 100 participants completed this study with a mean age of 54.7±12.11. There was no significant difference in the mean socket size among the three study groups on day 0 (P=0.101). However, there was a significant difference in the mean socket size on day 7 among the three groups. A post hoc test showed that the diabetic group had a larger socket size than the non-diabetic group (P=0.011). Complications like swelling and infection were more in the diabetic group. There was no significant difference in the mean number of analgesics among the three groups (P=0.169). The adjusted means for the socket size on postoperative day 7 was significantly higher for diabetic than the non-diabetic group. CONCLUSION: The socket dimension was larger on postoperative day 7 in people with diabetes which suggested delayed healing without persistent complications. Dental extractions can be performed safely in optimally controlled diabetic patients with minimal complications.

Modified Bilateral Perialar Crescent Flap for Reconstruction of Combined Upper Lip and Premaxillary Defect.

Many reconstruction methods are performed for combined defects of upper lip and premaxilla in oral cancer patients, which are complicated and multiple staged procedures, compromising the functional or structural unit. In this case report, we present a modification of the bilateral perialar crescent flap for reconstructing the combined defect of upper lip and premaxilla in a single stage. A patient diagnosed with well-differentiated squamous cell carcinoma of premaxilla and upper lip, involving a surgical defect of more than one-third but less than two-thirds of the lip underwent two cycles of neoadjuvant chemotherapy. Later wide local excision of the lesion and simultaneous reconstruction with a modified perialar crescent flap was performed in a single stage. Patient recovered uneventfully and tolerated the procedure well, without any complications. The patient was found to be satisfied with the functional and esthetic result. The reduced upper lip support which was a result of the bony defect of the premaxilla, was corrected with a dental prosthesis. This modification is a useful reconstruction tool for oral cancer patients with combined defects of upper lip and premaxilla.

Metastatic Tumour to the Mandible - A Diagnostic and Management Dilemma.

Metastatic tumours of the jaw are overlooked due to their relatively rare incidence. However, they are often the first indicators of an unknown primary malignant lesion. In this case report, we present a 68-year-old male patient with a suspected intraosseous malignancy of the mandible who was treated by a right segmental mandibulectomy. The final histopathology report was indicative of a secondary metastatic tumour. Positron emission tomography scan revealed a suspicious lesion in the right lung, which was identified as the primary tumour by biopsy using the Tru-Cut® biopsy device (MeritMedical, Jordan UT). The metastatic lesion to the oral soft tissues was easily recognized, in contrast to the jawbone metastasis. Differentiating between primary intraosseous and metastatic mandibular tumours relies on the histopathologist and the surgeon working in tandem to arrive at an early conclusive diagnosis. Knowledge of metastatic tumours to the facial bones is indispensable to a surgeon as it can often be the first indication of an unknown primary malignancy. Identification of early signs, appropriate and timely investigative procedures, coordination between pathologist and surgeon, and choosing the correct treatment modality can help prolong and improve the quality of life of the patient.

Application of Piezosurgery in Surgical Extraction of Impacted Mandibular Third Molars Versus Conventional Rotatory Technique: A Randomized Controlled Trial

Objective: To compare the effectiveness of conventional rotatory and piezosurgery technique for surgical removal of lower third molars. Material and Methods: Twenty patients with impacted lower third molars (with no acute symptoms) were divided into two groups (G1 and G2) and evaluated clinically and radiographically. They were allotted alternately into rotatory (G1) and piezotome (G2). Parameters assessed were the pain, swelling, trismus, comfort, analgesics consumed, the time taken for the procedure, intraoperative soft tissue damage and any other complications. Findings were then tabulated and analyzed. Results: Findings of pain, swelling, trismus, analgesics consumed and tissue damage were favorable in the piezosurgery group. However, the time taken for the procedure was significantly more as compared to the rotatory group. Post-operative trismus, values from the piezosurgery group were found to approach normality by day seven while in the rotatory group, a significant difference was found to exist up to day 14, suggesting that patients tend to return to normal function faster in the piezo group. Conclusion: Piezosurgery was found to be a good alternative to the conventional rotatory handpiece in select cases where extraction of the tooth could be carried out with minimal bone removal.

A Modified Peri-Angular Approach for Exposure of Condylar Fractures.

PURPOSE: To describe a modified peri-angular approach to address subcondylar and condylar neck fractures. MATERIALS AND METHODS: A modified peri-angular incision is used to approach a fractured condyle through the anteroparotid transmasseteric approach. RESULTS: In the authors' experience, this method provides quick and clean exposure to the fractured condylar base and neck fractures for open reduction and internal fixation. CONCLUSION: Although the peri-angular approach has been discussed in the literature, the authors' modification lessens the chance of complications, such as marginal nerve injury and parotid fistula formation, because the nerve is visualized and kept isolated throughout.

Rare case of giant unicystic ameloblastoma: Luminal variant.

OBJECTIVE AND IMPORTANCE: Ameloblastoma is a locally aggressive benign tumor, commonly occurring in the mandible. While giant ameloblastoma of multicystic or plexiform variant have been reported, the authors report a rare case of giant unicystic ameloblastoma of luminal variant, which was treated by compartmental resection and planned for delayed reconstruction. CLINICAL PRESENTATION: A 46 year old male patient reported to the oral surgery out-patient department with a swelling of the left side mandible region of 2 years duration. He had undergone ayurvedic treatment for the same with no improvement. The size of the lesion on presenting was approximately 9 × 12 cm. INTERVENTION: Compartmental resection with plan for secondary reconstruction, after adequate follow up period. CONCLUSION: While conservative management is being explored as a treatment option for unicystic ameloblastoma, resection is still the standard of care regardless of the histopathological subtype for giant lesions.