A Comparative Clinical Evaluation of the Buccal Fat Pad and Extended Nasolabial Flap in the Reconstruction of the Surgical Defect in Oral Submucous Fibrosis Patients.

PURPOSE: The aim of this study was to compare the efficacy of locally available nasolabial and buccal fat pad flaps for increasing postoperative mouth opening in the reconstruction of the defect created after fiberotomy in surgically treated cases of oral submucous fibrosis (OSMF). MATERIALS AND METHODS: Of 32 patients selected for the study, 21 patients underwent closure of the surgical defect using the buccal fat pad (group 1) and 11 patients underwent closure of the surgical defect using a nasolabial flap (group 2). Histologically proven cases of OSMF with a mouth opening no larger than 25 mm were included in the study. Patients in groups 1 and 2 were evaluated at regular intervals and mouth opening was documented preoperatively, intraoperatively, and at 3 and 6 months of follow-up. The results were analyzed by paired and unpaired t tests. RESULTS: In groups 1 and 2, mouth opening differed substantially at all periods of follow-up from preoperative values. At 3-month follow-up, mean mouth opening increased to 32.41 mm in group 2 compared with 30.47 in group 1. No relevant difference was observed in mouth opening between groups 1 and 2 at the end of 6 months. The effective increase in mouth opening at the end of 6 months compared with the preoperative value was statistically different in group 2 (mean increase, 24.2 mm) compared with group 1 (mean increase, 19.2 mm). CONCLUSION: Nasolabial flaps are a good option for the coverage of surgically treated defects in OSMF compared with the buccal fat pad.

Craniofacial fibrous dysplasia with facial asymmetry, canted occlusion and open bite: a case report with 2 years follow-up.

AIM: Fibrous dysplasia is a benign fibro-osseous disorder of unknown etiology that may affect the craniofacial region causing significant impairment of facial esthetics and function. This paper reports a case of a 21-year-old male, which was investigated and diagnosed with craniofacial fibrous dysplasia involving an overgrowth over right maxillary and mandibular region associated with facial asymmetry, severe occlusal cant and anterior open bite. Management of the case included surgical excision, cosmetic contouring and orthodontic intervention. The case was reviewed over a period of two years, which demonstrate stable treatment outcome.

Narrow ridge management with ridge splitting with piezotome for implant placement: report of 2 cases.

Narrow dentoalveolar ridges remain a serious challenge for the successful placement of endosseous implants. Several techniques for this procedure may be considered, such as guided bone regeneration, bone block grafting, and ridge splitting for bone expansion. The ridge split procedure provides a quicker method wherein an atrophic ridge can be predictably expanded and grafted with bone allograft or allograft, eliminating the need for second surgical site. Traditionally, osseous surgery has been performed by either manual or motor-driven instruments. Piezosurgery is a relatively new technique for osteotomy and osteoplasty that utilizes ultrasonic vibration which allows clean cutting with precise incisions. This case series describes reports of 2 such cases in which narrow mandibular ridge splitting was carried by mean of piezotome with immediate placement of implants in the osteotomy site. Five months later, the implants were uncovered followed by impression and restored with impant- supported porcelain-fused-to-metal crowns.

Post-COVID mucormycosis in presentation of periodontal abscess.

COVID-19 pandemic has traumatized deep inside in minds and lives of human beings. Those who have survived are at risk of many post-COVID complications; mucormycosis being one of the most common as well as morbid infections. Mucormycosis is also known as black fungus, it is a life-threatening opportunistic fungal infection. Inoculation occurs by inhalation of spores in nose, paranasal air sinuses and in lungs. Mucormycosis is often associated in patients with compromised immunity and it presents with characteristic black necrotic eschar and necrosis. Disease affecting the facial region possess a challenge because it often disseminates with sino-orbital and cranial involvement at the time of diagnosis. Dental practice occasionally encounters unusual and subtle symptoms with non-pathognomonic clinical signs of several fatal diseases which may pretend like a common oral disease. Hence, the key knowledge to oral and primary care physicians and its precise application is necessary for the early diagnosis of such fatal infections to prevent untoward consequences in this COVID era. This article presents a case of mucormycosis with chief complaint of pain and swelling in right front tooth region, which mimicked as periodontal abscess in a patient, leading to delay in the diagnosis possess greater challenges during the treatment.

Epidemiology, Microbiology and Antibiotic Sensitivity of Odontogenic Space Infections in Central India.

INTRODUCTION: Odontogenic infections are the most commonly encountered orofacial infections, which may spread into the adjacent anatomical spaces along the contiguous fascial planes, leading to involvement of multiple spaces which can progress to life-threatening situations. MATERIALS AND METHODS: A prospective study was carried out on 100 consecutive cases of odontogenic infections treated at our institute over a period of 18 months by surgical intervention and intravenous antibiotics. Morphologic study of the isolates and antibiotic sensitivity testing was performed. RESULTS: Caries was the most frequent dental disease (53.27%), and the mandibular first molar was the most frequently involved tooth (41.9%) associated with the etiology of odontogenic infections. A total of 158 spaces were involved in 100 patients. In subjects with single space odontogenic infections (n = 61), submandibular space was most commonly affected (44.26%) followed by buccal space (27%). In subjects with multiple space infections (n = 39), submandibular space (30.19%) was most frequently involved followed by buccal space (17.92%). In the aerobic group/microaerophilic group, 17 different species were isolated in a total of 102 aerobic isolates. A total of 18 species were identified in 65 anaerobic isolates sampled. CONCLUSION: Amoxicillin possess antimicrobial activity against major pathogens in orofacial odontogenic infections, but ß-lactamase production has restricted the effectiveness of amoxicillin against the resistant strains of Staphylococcus aureus, Bacteroides, Prevotella and Porphyromonas. For the management of orofacial infections, the use of amoxicillin/clavulanate and clindamycin is recommended because of stability against ß-lactamases.

Congenital bilateral syngnathia and tracheoesophageal fistula: A rare presentation.

Congenital syngnathia (CS), first reported by Burket in 1936, is a rare condition, with <50 reported cases and is associated with other conditions and syndromes. CS restricts mouth opening, causing difficulty in feeding, swallowing, and respiration. This report puts forth the clinical findings and management of this challenging condition in association with tracheoesophageal fistula in a neonate.

Surgical defect coverage in oral submucous fibrosis patients with single-stage extended nasolabial flap.

PURPOSE: Long standing oral submucous fibrosis (OSMF) is associated with involvement of the oral submucosa and the muscles of mastication leading to difficulty in mouth opening. Various surgical modalities are mentioned for release but each has its own limitations. The aim of the study was to evaluate the postoperative mouth opening in patients of OSMF after excision of fibrous bands followed by coronoidotomy and surgical defect coverage by extended nasolabial flap. METHODS: We evaluated the use of extended nasolabial flaps and coronoidectomy in the management of 11 randomly selected patients with histologically confirmed oral submucous fibrosis. They all had interincisal opening of less than 25 mm and were treated by bilateral release of fibrous bands, coronoidectomy or coronoidotomy, and extended grafting with a nasolabial flap. RESULT: Their interincisal opening improved significantly from a mean of 8.68±7 mm to a mean of 36.75±4.05 mm at 6-month follow-up. CONCLUSION: The procedure was effective in the management of patients with oral submucous fibrosis, the main disadvantage being the extraoral scars.

Bioterrorism: Law Enforcement, Public Health & Role of Oral and Maxillofacial Surgeon in Emergency Preparedness.

INTRODUCTION: The contrived and deliberate use of pathogenic strains of micro-organisms such as bacteria, viruses or their toxins to spread life-threatening diseases on a mass scale with the aim to devastate the population of an area is referred to as 'bioterrorism'. RISK ASSESSMENT: The threat of bioterrorism is higher than ever. It is now a well established fact that the capability to create immense panic and unimaginable fear has allured the terrorists for the despicable use of biological agents for causing terror attacks. Moreover to add to the grievance, this era of biotechnology and nanotechnology has created an easy accessibility to more sophisticated biologic agents apart from the conventional bacteria, viruses and toxins. These biologic weapons can cause large-scale mortality and morbidity in large population and create civil disruption in the shortest possible time. PREPAREDNESS AND MITIGATION: Fight against bioterrorism is a global concern and necessitates that the issue should be criminalized internationally with the assistance of international co-operation and laws in favor of global public health. National public health agencies must also fortify their ability to be able to detect and respond to such biological attacks with better research and training facilities to health professionals, enhanced surveillance and improved diagnostic facilities by evolving an empowered public health system. Public health education and awareness are imperative; people should be made aware of reporting early to health institutions on arousal of signs and symptoms related to suspicious bioterrorist attack. CONCLUSION: Effective bioterrorism planning, prevention and response requires cooperation and collaboration between law enforcement and public health; Oral and maxillofacial surgeons can be successfully integrated into the emergency medical response system. With their education, training, skills and amenities in form of equipments they can augment medical and surgical personnel in early identification and subsequent control of a bioterrorist attack.

Sodium hyaluronate: an effective adjunct in temporomandibular joint arthrocentesis.

BACKGROUND: Internal derangement of the temporomandibular joint (TMJ) is one of the most common forms of temporomandibular disorders. The minimally invasive treatments such as arthrocentesis as well as arthroscopic lysis and lavage are often used as a first-line surgical treatment or in conjunction with nonsurgical modalities with low morbidity and high efficacy. Sodium hyaluronate (SH) has been proposed as an alternative therapeutic agent with similar therapeutic effects. OBJECTIVE: A prospective study was carried out for evaluation of efficacy of TMJ arthrocentesis with and without injection of SH in management of internal derangements. MATERIAL AND METHODS: A total of 30 patients suffering from internal derangement of TMJ were selected for this study. Patients were randomly divided into the following two groups: group 1-arthrocentesis-only group and group 2-arthrocentesis + SH group. Each group constituted 15 patients. RESULTS: Six-month postoperative mean mouth opening (MMO) increase was 13.61 ± 1.64 and 15.53 ± 3.01 mm in group 1 and group 2, respectively. At 6 months, there was marked improvement in masticatory efficiency with mean increase of 5.07 ± 0.13 in group 1 and 6.40 ± 0.04 in group 2. Mean pain reduction was 5.27 ± 0.67 and 6.48 ± 0.44 in group 1 and group 2, respectively. CONCLUSION: Although our series comprised a limited number of cases and a short follow-up period, initial results suggested that arthrocentesis with SH injection seemed to be superior to art.

KCOT Occurring in Bilateral Maxillary Sinus in Non-Syndromic Patient.

Odontogenic Keratocyst (OKC) also termed as Keratocystic Odontogenic Tumour (KCOT) (WHO 2005) is a pathology with unique behavior because of which it is under much scrutiny and continued study. The pathology usually presents itself commonly in mandible and less commonly in maxilla. The occurrence of KCOT in maxillary sinus is reported as rare and multiple occurrences are mostly associated along with the presence of Nevoid Basal Cell Carcinoma (NBCC) syndrome. Here, we present a rare case of bilateral Maxillary OKC involving maxillary sinuses, without the presence of NBCC syndrome. An interesting feature of this case is the presence of left upper third molar in ectopic position in maxillary sinus and a vertically impacted right third molar suggesting an origin from the dental lamina.

A Simple Technique for Removal of Broken Root Tip of Maxillary Premolars: A Technical Note.

INTRODUCTION: Therapeutic extraction of maxillary premolars is often indicated for orthodontic treatment. Extraction as well as retrieval of broken root tips in cases should be minimally invasive aiming to preserve the alveolus as well as the buccal and palatal cortical plates. MATERIALS AND METHODS: Here a technique is described that we have been employing for retrieving broken maxillary premolar root tips which have the bevel towards the buccal cortex. CONCLUSION: The method is simple, atraumatic and effective.

External manifestations of Gardner's syndrome as the presenting clinical entity.

Gardner's syndrome is an autosomal dominant disease characterised by the presence of colonic polyposis, osteomas and a multitude of soft tissue tumours. Pathological features such as osteomas of the mandible, skull and facial skeleton are unaesthetic as well as incapacitating. We present the case of a 22-year-old man with pain and discharge from the left eye and a firm swelling in the left infraorbital region leading to proptosis of the left eye. A detailed examination of the patient led to the presence of a large osteoma in the left orbital region, multiple cystic lesion, corneal opacity and parapapillary atrophy in the left eye. Radiography revealed the presence of multiple unerupted supernumerary teeth and osteomas. Colonoscopic findings showed the presence of multiple polyps. Thus, external manifestations of the patient's facial region led to the establishment of the diagnosis of Gardner's syndrome. The importance of our case highlights the necessity of maintaining a high vigilance with regard to the occurrence of such an entity.

Etiology, incidence and patterns of mid-face fractures and associated ocular injuries.

A prospective study on mid-face fractures was carried out in the Department of Oral and Maxillofacial Surgery at College of Dentistry, Indore, from August 2007 to September 2009 to analyze etiology, incidence and patterns of midface fractures and associated ocular injuries. Two hundred patients were included in this study, amongst those who reported to the Department of OMFS, College of Dentistry, Indore. After confirmed diagnosis of mid face fracture all the patients were stratified according to age, sex, cause of the accident, influence of alcohol, location, type of fractures and associated ocular injuries. The study included 200 patients with a mean age of 29.6 years. The most frequently injured patients belonged to the 21-30 year-old age group. The male predilection was 76 %. Road traffic accident was the most common causative factor (64 %), followed by assault (21 %), cases of fall (9.5 %) and other causes (5.5 %). The most common fracture in this study was found to be zygomatic complex fractures (62.5 %) (more in the age group of 21-30 years). This was followed by Lefort II fractures (23 %), multiple fractures (10 %) and Lefort I fractures (6 %), Lefort III fractures (4.5 %) and Naso-ethmoidal fractures (4 %) in descending order. 84.5 % subjects were having ocular involvement. Subconjunctival hemorrhage was present mostly in 83.5 % followed by remaining as corneal injury 15 %, reduced acuity 11.5 %, diplopia 10.5 %, enophthalmos 8.5 %, telecanthus 5 %, hyphema 3.5 %, blindness 3 % and proptosis 0.5 %. Zygomatic complex fractures were the most frequent type of injury that was complicated by blindness or a serious eye injury (61 %). Collection of data regarding the epidemiology of maxillofacial fractures is important because it may assist healthcare providers to provide necessary information for the development and evaluation of preventive measures. Ocular injuries should have an early ophthalmological examination at the time of trauma to detect any kind of ocular dysfunction.

Biocompatibility of root-end filling materials: recent update.

The purpose of a root-end filling is to establish a seal between the root canal space and the periradicular tissues. As root-end filling materials come into contact with periradicular tissues, knowledge of the tissue response is crucial. Almost every available dental restorative material has been suggested as the root-end material of choice at a certain point in the past. This literature review on root-end filling materials will evaluate and comparatively analyse the biocompatibility and tissue response to these products, with primary focus on newly introduced materials.

Advances in dental local anesthesia techniques and devices: An update.

Although local anesthesia remains the backbone of pain control in dentistry, researches are going to seek new and better means of managing the pain. Most of the researches are focused on improvement in the area of anesthetic agents, delivery devices and technique involved. Newer technologies have been developed that can assist the dentist in providing enhanced pain relief with reduced injection pain and fewer adverse effects. This overview will enlighten the practicing dentists regarding newer devices and methods of rendering pain control comparing these with the earlier used ones on the basis of research and clinical studies available.

Management of polyostotic eosinophilic granuloma.

Eosinophilic granuloma is a rare disease which is difficult to diagnose clinically and radiographically. Localized Langerhans' cell histiocytosis, previously known as eosinophilic granuloma, mainly affects the skull, mandible, vertebrae, pelvis and ribs in children and the long bones of adults. We present a case report of a female who developed pain and swelling over the left mandibular region, and was later diagnosed as eosinophilic granuloma, which after administration of intralesional corticosteroid with surgical enucleation showed positive response. This disease is of importance to dental professionals because early clinical signs can occur in the jaw and can cause extensive destruction of the periodontal tissues and bone. The purpose of this case report is to describe a case of eosinophilic granuloma with emphasis on conservative approach for the treatment and the radiographic changes observed during and after the treatment.

Unilateral coronoid hyperplasia treated by coronoidectomy using a transzygomatic approach.

Coronoid hyperplasia is a rare disorder, which effectively is a mechanical problem associated with limited mouth opening. In some cases, enlarged coronoid pushes the zygoma forward causing facial asymmetry. This article looks at the case of a 15-year-old boy reporting in OPD of Government College of Dentistry, Indore, with chief complaint of facial asymmetry. Transzygomatic approach was taken to get proper access to the enlarged coronoid. Coronoidectomy was performed which significantly reduced facial asymmetry. Postoperative healing was uneventful and recurrence was not reported.