Pattern of presentation of mandibular condylar fractures in relation with known risk factors

Mandibular fractures are one of the most common fractures of facial bones. Parasymphysis is the most common site followed by condylar and subcondylar areas of the mandible. A descriptive study was carried out at Department of Oral and Maxillofacidl Surgery, King Edward Medical University I Mayo Hospital, Lahore from 27th September 2011 to 26th September 2012. The study was carried out on forty patients with mandibular condylar fractures. The fractures were classified according to the Spiessl and Schroll classification system. Objective of this study was to describe pattern of presentation of mandibular condylar fractures and to evaluate factors leading to mandibular condylar fractures in a tertiary care hospital. 32 [80%] were males and 8 [20%] females. The age ranged from 1% to 65 years with mean of 26 years [SD +/- 16.90]. Road traffic accidents including motor bike, auto-rickshaw and car accidents were found to be predominant risk factors [15 patients - 37.5%]. Type II fractures [low neck displacement] comprised the highest proportion - 16 out of 48 fractures [33.3%]

Road traffic accidents and falls were the leading risk factors for mandibular condylar fractures identified in this study. Type II fractures were seen to be the most frequent variant of condylar fracture. It was noted that no specific pattern of condylar fracture was associated with any specific risk factors

Utilization of nasolabial flap for reconstruction of oral cavity defects

Objective of this study was to highlight the utilization of nasolabial flap for reconstruction of oral cavity defects. The study revealed the results of 21 nasolabial flaps in 14 patients over the period of two and a half year. The patients presented at the Department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital, Lahore from November 2009 to November 2011 and at the Department of Oral and Maxillofacial Surgery, Fatima Memorial Hospital Lahore from May 2012 to October 2012. In 08[57.14%] patients the defects were secondary to Oral Submucous Fibrosis of buccal mucosae; 03[21.43%] patients were with biopsy proven Squamous Cell Carcinoma of the oral cavity and in 02[14.28%] patients flap was used to cover the post traumatic oro-antral defects secondary to firearm and machine injuries to the maxilla. One patient [7.14%] had the defect after resection of the cystic lesion of the maxilla. Uneventful flap healing was observed in 20[95.24%] and partial flap loss occurred in only 01[4.76%]. It was concluded that the nasolabial flap is a reliable and minimally traumatic local flap for reconstruction of small-to-medium sized oral cavity defects with predictable functional and good aesthetic results

Postoperative complications in primary definitive management of hard and soft tissues in mandibular gunshot injuries; a review of 47 cases

Background: Firearm injuries cause significant morbidity and mortality among its victims. The type and extent of tissue damage vary from simple small size wound to a large soft tissue or skeletal defect. The selection of the appropriate surgical technique is as important as the timing because incorrect selection or improper application of surgical techniques may also lead to infection, sequestration, wound dehiscence, graft rejection, facial deformity and subsequent re-visional operations

Objective: The present study, carried out at Oral and Maxillofacial Surgery department, King Edward Medical University/ Mayo Hospital, Lahore, was aimed at highlighting the frequency of Postoperative complications in primary definitive management of hard and soft tissues in mandibular gunshot injuries

Study design: Descriptive case series

Setting: Department of Oral and Maxillofacial Surgery, King Edward Medical University/ Mayo Hospital, Lahore, from November 2010 to November 2012; including 6 months follow up

Patients and methods: The study was conducted on 47 patients. All patients suffered gunshot injuries to the mandible and had soft and hard tissue defects at a single site. Patients ranged in age from 17 to 54 years with a mean age of 32.31 years. Males dominated in the study and were n=37 and females n=10. All patients were treated definitively in the first operation by addressing the hard and soft tissue defects

Results: All had single site fracture with angle of the mandible being most common 27 [57.44%]. For reconstruction of soft tissue defect local advancement by undermining and primary closure was carried out in 35 [74.47%] patients, buccal pad of fat in 4 [8.51%] patient, deltopectoral flap in 5 [10.64%] patients and skin graft in 3 [6.38%] patient. For hard tissue reconstruction, nonvascularized bone graft was given in all cases i.e. n=47 [100%]. Iliac crest bone graft was given in 34 [72.34%] patients, rib graft in 6 [12.77%] patients and symphyseal outer cortex bone graft in 7 [14.89%] patients. Post-operative complications were noted in terms of infection, plate exposure, plate fracture and malocclusion which appeared to be 9 [19.1%], 5 [10.6%], 2 [4.3%], 5 [10.6%] respectively

Conclusion: All patients in this series required surgical intervention for treatment of their facial gunshot wounds. Primary definitive hard and soft tissue management can be considered in patients suffering from gunshot injuries to the mandible. Although post-operative complications can result at higher rates in such injuries yet properly selected surgical techniques and post-operative infection control can produce excellent desired esthetic and functional results

Anterior lamellar marginal z-plasty with transverse tarsotomy for management of trichiasis with cicatricial entropion -a new surgical approach

Trichiasis is the main risk factor for corneal opacification. The primary treatment of trichiasis is surgical. Successful surgery is likely to halt the progression of corneal opacity. The aim of the study is to report the efficacy of the anterior lamellar marginal z-plasty combined with transverse tarsotomy in the management of severe trichiasis andcicatricial entropion of upper eyelid. A prospective study was carried out from January 2009 to June 2012, on 54 eyelids [44 patients] who underwent anterior lamellar marginal z-plasty with transverse tarsotomy for correction of trichiasis and cicatricial entropion involving upper eyelid with a minimum of 6 months' follow-up. Results were classified according to the presence and location of residual trichiasis and symptoms were assessed according to a three-level subjective scale [better, worse or no change]. Failure was defined as recurrent trichiasis with one or more lashes touching any part of cornea in primary position. Secondary outcomes were visual acuity and corneal opacification. At the end of six month period, none of patients had any trichiatic eye lash touching the cornea in primary position [100% success]. Forty-eight [88.9%] of the operated eyelids were free of trichiasis, while residual trichiasis was noticed only in 6 [11.1%] operated lids. At the end of six months, there was a significant reduction of lash burden from median of 12 trichiatic lashes from the base line to the median of 2. All the patients reported significant reduction in symptoms of irritation. Significant improvement in visual acuity [p<0.000] and reduction in the density of corneal opacity [p<0.000] was notified from the base line. Anterior lamellar marginal z-plasty combined with transverse tarsotomy seems to have promising surgical outcome for the correction of trichiasis and cicatricial entropion secondary to cicatricial trachoma.

Cervical lymph node metastases in squamous cell carcinoma of tongue and floor of mouth

Oral squamous cell carcinoma has high chances of cervical lymph node metastasis. This case series describes the distribution of cervical lymph nodes in 50 cases of squamous cell carcinoma of tongue and floor of mouth. The mean age was 47.28 +/- 10.5 years. Thirty positive metastatic lymph nodes were found; 90% occurring at level l-ll mostly in T4 size but also in T1 and T2 cases. The distribution of involved lymph nodes in oral cancer affects the neck dissection extent and is, therefore, an important pre-operative feature

Recurrent episcleritis in children-less than 5 years of age

Episcleritis, though common in adults, is a rare disease in children. Episcleritis is associated with systemic diseases in a third of cases in adults. Here we describe systemic diseases associated with recurrent episcleritis in children less than five years of age. This Retrospective Observational case series study was conducted at the Department of Ophthalmology of Ayub Teaching Hospital, Abbottabad, from March 1995 till February, 2006. Six children diagnosed clinically with recurrent episcleritis were included in this study. Complete ophthalmologic as well as systemic evaluation was done in each case. This study was conducted on 6 children with a diagnosis of recurrent episcleritis. There were four boys and two girls, with an age range of 35-52 months. Right eye was involved in three cases, left eye in two cases while one case had a bilateral disease. Recurrence occurred in the same eye in all cases, with one bilateral involvement. Four children [66%] had a history of upper respiratory tract infection in the recent past. No other systemic abnormality was detected in any case. Two cases had a history of contact with a pet animal. Recurrent episcleritis in young children is a benign condition. Upper respiratory tract infection is the most common systemic association. Pet animals may be a contributory factor