Maxillofacial trauma and associated brain injuries

The aim of this study is to find out the distribution of brain injuries in patients with craniofacial trauma. Retrospective study. This study was conducted at the Departments of Oral and Maxillofacial Surgery and Neurosurgery of Liaquat National Hospital from Jan. 2010 to Dec. 2010 History form and radiographs of 112 patients who visited the Departments of Oral and Maxillofacial Surgery and Neurosurgery of Liaquat National Hospital were reviewed. Mean age of the sample was 31.7 years [+/- 8.8], minimum 18 years and maximum 65 years. The most common cause of cranio-facial trauma was road traffic accidents accounting for 94.6% followed by gunshot 2.7% fall 1.8% and assault 0.9%. Young adult males were most frequently affected. The most common site of trauma was midface 49.5% followed by mandible 26.8%, orbit 16.1% and panfacial 8%.Brain injury was recorded in 37.8 % of patients. Contusion, concussion and direct trauma to the brain was most common in mid face fractures hemorrhage was most common in Panfacial fracture. Mean GCS score was 14.77 in Mandibular trauma, 13.17 in isolated orbital fractures 12.98 in Midface trauma and 9.18 in Panfacial trauma. There is a strong correlation noticed between the craniofacial trauma and brain injury in this study. Young adult males sustained most craniofacial fractures as a result of road traffic accidents. A clearer understanding of risk factors associated with road traffic accidents and strict implantation of road traffic safety measures should be emphasized to avoid serious complications. Education of oral and maxillofacial surgeons regarding brain injury and its significance in terms of neurological outcomes should be emphasized

Immediate reconstruction with fibula free flap in patients with mandibular ameloblastoma

Management of ameloblastoma has been controversial because of the unique biologic behavior of this neoplasm as a slow-growing, locally invasive tumor with a high rate of recurrence. Recurrence rates of ameloblastoma are reportedly as high as 15% to 25% after radical treatment and 75% to 90% after conservative treatment. With the advancement of craniofacial surgical techniques, use of free flaps for mandibular reconstruction, and dental rehabilitation [such as osseointegration] the surgical management of mandibular Ameloblastoma has become more convincing. The aim of this article is to evaluate the clinical results of the patients with mandibular ameloblastoma who were treated with segmental mandibulectomy and immediate reconstruction with free flaps. Ten patients with primary ameloblastoma treated at Oral and Maxillofacial Surgery Department of Liaquat National Hospital from 2006 to 2010 were included. The average age of the patients was 36.3 years [range, 24-54 years]. Clinical information radiographs OPG [Orthopantomogram] and CT Scans were obtained. All the tumors were located in the posterior region of the mandible and confirmative diagnosis was made on histopathological examination of the biopsy specimen. We present 10 patients of mandibular ameloblastoma who had segmental mandibulectomy and immediate reconstruction with fibula free flap preformed. The average age of the patients was 36.3 years [range, 24-54 years]. There were 8 male and 2 female patients. All presented with the multilocular radiolucency in the posterior mandible. The patients were followed for a mean period of 22.4 months [range, 12-36 months]. All flaps survived. Recurrence was not detected during the mean follow-up period of 22.4 months. It was noted that all patients had remarkable changes in their function and esthetics after immediate reconstruction. We experienced that segmental mandibulec-tomy with safe borders and immediate reconstruction with fibula free-flap is an ideal reconstruction method for mandibular ameloblastoma

Association of mandibular third molar impaction with mandibular second molar root resorption

A two year retrospective study was conducted to find the association of mandibular third molar im-paction with the root resorption of mandibular second molar tooth at Oral Surgery Department of Baqai Dental College and Abbasi Shaheed Hospital, Karachi from July 2003 to July 2005. The impactions were diagnosed on the basis of radiograph Orthopantomogram [OPG]. The status of the third molar impaction was classified according to Pell Gregory as A,B,C and 1,2,3. Root resorption of second molar was assessed on the basis of discontinuity and irregularity of the root surface and loss of tooth substance at the cervical region, lateral side, or apex. Age and gender distribution was evaluated by using chi-square test. The sample size was 125 [n]. Mean Age was 28.2. Male to Female ratio was 2:3.The incidence of radiographic superimposition of the second molar on the third molar was 75/125 [60%]. Root formation of impacted third molar was found to be significantly associated with root resorption of adjacent second molars with p-value < 0.05 at 95% Cl and likelihood ratio of 44.17. Ramus relationship of impacted third molar showed a significant association with root resorption of adjacentsecond molar with p-value < 0.05 at 95% Cl and likelihood ration of 14.9. Early detection of resorption and early removal of third molar can save future complications