Comparison between extra oral and intraoral surgical procedures for the management of mandibular angle fractures

Objective: To evaluate and compare the treatment outcomes of isolated mandibular angle fractures managed by open reduction and internal fixation using intra oral and extra oral approaches. Study Design: Randomized control trial. Place and duration of Study: Department of oral and maxillofacial surgery, Liaquat University Hospital Hyderabad, from May 2011 to Nov 2011

Patients and Methods: The patients who presented with isolated mandibular fracture were selected according to inclusion criteria. The diagnosis was made by standard history, clinical examination and radiographic investigations. The patients were randomly divided into two groups, A and B. Group A patients were managed by extra oral approach and group B patients were managed using intra oral approach. The patients were prescribed antibiotics for one week and follow up was carried for four weeks. Nerve damage, limited mouth opening, infection, mal-occlusion, hypertrophic scar and aesthetic dissatisfaction were immediate and late post operative complications observed and documented

Results: Road traffic accident [RTA] was the main etiologic factor [66.66%]. Marginal mandibular nerve damage was noted in 20% cases treated with extra oral approach [group A]. Post operative esthetic dissatisfaction was present in 60% patients [group A] as compared to 6.66% of the patients [group B]. The rate of mouth opening compromise and mal-occlusion were also higher in the patients treated with extra oral approach compared with intra oral approach, although statistically not significant

Conclusion: The intra oral approach for mandibular angle fracture management is an effective and comparatively better technique as compare to the extra oral approach

Correction of facial asymmetry associated with unilateral hypoplastic mandible with monobloc distraction osteogenesis in adult

Facial asymmetrey can be corrected by bimaxillay orthognathic surgery and distraction osteogenesis. We report a case of facial asymmetry which was corrected using monobloc distraction osteogenesis. A monobloc was created using an osteosynthesis fixation device from the zygomatic buttress to the mandible, LeFort I osteotomy was combined with mandiular angle osteotomy and the bloc was distracted using uni-directional distractor

Efficacy of greater auricular nerve infiltration anesthesia in patients having less than optimal analgesia after conventional inferior alveolar nerve block for surgical removal of mandibular third molar

The aim of this study was to determine efficacy of greater auricular nerve infiltration anesthesia in patients having less than optimal analgesia after conventional inferior alveolar nerve block for surgical removal of mandibular third molars particularly those fallig in category calss 2, position B and C. It was a Quasi-Experimental study done in Minor Oral Surgery Department at Armed Forces Institute of Dentistry, Rawalpindi from 19th August 2010 to 10th June 2011. Conventional inferior alveolar nerve block was given to 40 patients. Out of these 14[35%] patients had no pain while 26[65%] experienced pain in the angle of mandible area. These 26 patients were given greater auricular nerve infiltration which relieved pain in 21 patients [80.8%] while 5[19.2%] patients remained symptomatic [p=0.007]. Based on this study it was concluded that intraoperative analgesia is enhanced by greater auricular nerve infiltration in patients complaining of less than optimal analgesia after conventional inferior alveolar nerve block during mandibular third molar surgery

Distraction osteogenesis of a unilateral hypoplastic mandible

Distraction osteogenesis [DO] is a surgical process in which two bony segments are gradually separated so new soft tissue and bone will form between them by applying tension through a fixation device. There are three phases to this process: latency phase, distraction phase, and consolidation phase. The technique was originally applied to long bones but in recent years the method has been adapted for use in maxillofacial surgery. Distraction osteogenesis is a new variation of more traditional; orthognathic surgical procedures which can be applied for the correction of dento-facial deformities and syndromes of the jaws, treating upper airway obstruction in paediatric patients with mandibualr retrognathia, due to tongue collapse and physical obstruction in the hypopharangeal region. It is an effective and powerful reconstructive surgical technique, which can be performed safely without the need of bone graft or blood transfusion. We present treatment of a child with severe facial asymmetry after unilateral TMJ ankylosis corrected by distraction osteogenesis