Cleidocranial dysplasia- a case report and literature review

Cleidocranial dyspalsia is a rare congenital skeletal disorder, associated with hypoplasia or aplasia of clavicles, delayed closure of cranial sutures and fontanels, frontoparietal bossing, delayed exfoliation of primary dentition, delayed or failure of eruption of permanent teeth, and presence of multiple supernumerary teeth. The disorder is caused by mutation in the CBFA1 gene, on the short arm of chromosome 6p21. Estimated prevalence ofcleidocranial dysplasia is one per million, without gender or ethnic predilection. A multidisciplinary approach is often required for dental management of multiple supernumerary teeth. We report clinical and radiographic presentation and surgical management of multiple supernumerary teeth in an 11-year-old child with cleidocranial dysplasia.

Management of obstructive sleep apnea and facial asymmetry by distraction osteogenesis of mandible

Micrognathia and obstructive sleep apnea syndrome [OSAS] are problems subsequent to temporomandibular joint ankylosis [TMJa] in growing patients. For patients with micrognathia and OSAS secondary to TMJa, it is important to restore proper mandibular form and posterior facial height, achieve occlusal stability and satisfactory mouth opening. We report a 2-year follow-up of a patient with Micronesia and OSAS secondary to unilateral TMJ ankylosis of the right side. The patient had an operation of TMJa before she reported to us but mouth opening was limited. The treatment involved vertical ramus osteotomy, coronoidectomy and external distraction osteogenesis of her mandible. After the treatment of micrognathia oropharyngeal airway space was increased, patient was followed up for 2 years and the results remain uneventful

Use of continuous low pressure suction on chest drain in thoracic surgical unit

To assess the merits and demerits of continuous Low Pressure Suction applied to the chest drain in both preoperative and postoperative thoracic patients. Department of Cardiothoracic Surgery, Postgraduate Medical Institute, ady Reading Hospital Peshawar from Jan 2005 to March 2005. It was a prospective study carried out over the period of three months to assess the benefits of Low Pressure Suction. Patients with Chest trauma, inflammatory disease of the lung and pleura, carcinomas and postoperative patients were included in the study. Patients with multiple trauma and moribund patients were excluded from the study. Postoperative patients were given priority for suction beds. The suction applied to the chest drain ranged from -05 to -20 KPa. It was continuously applied to the chest drain 24hrs a day and 7 days a week and only interrupted at the time of bottle change or patients going to toilets. A total of 180 patients were included in the study, which were divided into two groups depending upon the availability of suction beds. Group I: Included those patients who were put on Continuous Low Pressure Suction. Group II: Included those patients who were not put on Continuous Low Pressure Suction because lack of suction beds. Ninety patients were included in group I and similar number of patients into group II. In group I out of 90 patients 40 were non-operative and 50 were operative. In group II out of 90 patients 55 were non-operative while 35 were operative. Out of operated patients [total 85] full lung expansion was achieved in 42 [84%] in group I and 25 [71.4%] in group II while partial lung expansion was achieved in 08 [16%] in group I and 10 [28.6%] patients in group II. Out of non-operated patients [total 95] full expansion was achieved in 35 [87.5%] in group I and 42 [76.4%] in group II while partial expansion was achieved in 05 [12.5%] patients in group I and 13 [23.6%] in group II. Out of 5 partial expansions in group I suction had to be discontinued in 2 patients because of increasing air leak. Continuous low pressure suction helps to decrease the need for surgery in patients following chest trauma, inflammatory lung disease and decreases morbidity in postoperative patients