Management dilemma of cervicofacial necrotizing fasciitis

Cervicofacial necrotizing fasciitis is a rare polymicroibial infection, which carries high morbidity as well as mortality rate. It is usually the result of rapid spread of infection along the fascial planes, causing necrosis of the fascia and overlying skin, which eventually involve the blood vessels and muscles. Early diagnosis is crucial in limiting the fatal consequences of the disease process and the establishment of the appropriate line of management. We discuss the management dilemma in selected cases treated at the Department of Oral and Maxillofacial Surgery, Salmaniya Medical Complex, Bahrain during the period 1 999-2006 and outline briefly the medical as well as the surgical management

Clinical applications of bioabsorbable materials in zygomatico-orbital fractures: 7 years experience

A retrospective study to review the clinical outcome and stability of biodegradable materials for the fixing zygomatico-orbital fractures using two different methods. One hundred and seven consecutive patients with zygomatico-orbital fractures during the period of January 2001 to December 2007 were treated using PDLLA Martin biodegradable hardware. They were included into two groups. Study group 1 [n=45] in which predrilling and tap was done before screw insertion. Study group 2[n=62] where sonicweld pin were used. It was done in accordance with the development of new hardware.Treatment outcome and complications recorded for both groups. In group 1, forty-two [93.4%] patients had uneventful healing while three [6.6%] patients developed mild soft tissue reaction. Seventy-two plates and 300 tapped screws used. Fifty-five [18.4%] screws were broken and 4[5.6%] plates replaced for margin shear. In group 2, 62 patients had seventy fractures were treated using 570 sonic weld pins and 135 plates. There were 2[1.5%] plates replaced due to excessive bending and 10[1.7%] screws improperly welded. Biodegradable osteosynthesis materials can be safely used for treatment of zygomatico-orbital factures with minimal postoperative complications and can replace titanium hardware

Cranial bone grafting in orbital reconstruction - Review of technique

to assess the versatility of calvarial bone grafting in the reconstruction of the facial and orbital skeleton following traumatic injuries of the face. Materials and ninety-eight patients underwent 135 bone graftings for periorbital deformities. Eighty-five [86.7%] males and 13 [13.3%] females were included and age ranged from 2-54 years [mean 27.6 years]. Craniomaxillofacial trauma was the main reason for calvarial bone grafting; orbital floor [55.6%], lateral orbital wall [18.4%] and orbital roof [9.6%]. Access for calvarial bone graft harvest was via coronal or temporoparietal incision. Design: retrospective analysis of patients undergoing periorbital reconstruction using calvarial bone graft. ninety-eight percent of patients achieved satisfactory cosmetic and functional results following primary surgery. Four [4.1%] patients needed secondary reconstructive surgery to correct persistent diplopia and 5.1% had correction of residual enophthalmos and ocular dystopia. Postoperative wound complications were minimal and responded to local therapy. There was no intracranial complication but one intraoperative dural tear during calvarial bone harvest, which was sutured primarily. No intra- or postoperative bleeding and no neurological injuries were encountered. calvarial bone is a reliable and safe grafting material in the hands of experienced surgeons. Its reliability stems from the fact that it is thick, can be harvested in large amounts, in different shapes and sizes, proximity to the recipient site, minimal morbidity and low resorption velocity

TMJ arthrocentesis for acute closed lock: retrospective analysis of 40 consecutive cases

The aim of the study was to evaluate the long-term results of arthrocentesis in the management of anchored disc phenomenon with its resultant limitation of jaw movement. The study involving 62 patients with suddenly occurring severe and persistent limited mouth opening originating from TMJ were retrospectively analyzed. The study group consisted of 40 consecutive patients with 64 involved TMJs. These were treated by arthrocentesis. All patients rated their pain level on visual analogue scale and filled information on jaw pain, jaw dysfunction and daily living activity scores on a self-questionnaire pre-operatively and at 6, 12, 24, and 36 months postoperatively. The interincisal opening was measured on each setting. Pre-operative and post-operative differences were analyzed statistically and the success rate was calculated according to the success criteria. The success rate was 95% at 36 months follow-up. All post-operative scores showed marked improvements. Athrocentesis is considered to be the treatment modality of choice for acute closed lock cases of temporomandibular joint in carefully selected cases

Impacted wisdom teeth: an aduit

This study aimed at identifying the indications and postoperative complications of third molar surgery. This is a retrospective study of a randomized sample of 255 patients who were treated at the department of oral surgery, salamniya medical complex for surgical removel of wisdom teeth during the period January 1993 to may 1996. most common indicationfor wisdom teeth surgery was pericoronitis [50.6%]. Minor indication included orthodontic reasons [11.4%]. Surgery was commonly contemplated under local anesthesia [55.7%] using surgical drill in 75%. One [0.39%] patient who had the tooth removed using the lingual split technique suffered permanent lingual paresthesia

Traumatic aneurysm of the internal maxillary artery: an unusual complication of loose teeth

False arterial aneurysms are frequent late complication of penetrating injuries. They can also occur following diagnostic or therapeutic arterial puncture and following surgery. A case of traumatic aneurysm of the maxillary artery presumably caused by loose molar teeth is reported. The lesion was successfully treated by ligation of the external carotid artery and excision of the aneurysm

Ranula and the sublingual salivary glands review of 32 cases

Comparative study to evaluate various surgical methods for the treatment of ranula. Thirty two patients were retrospectively studied regarding treatment method namely, excision of the ranula, marsupialization, excision of the ranula combined with sublingual gland removal, recurrence and complications. All available specimens were histologically studied. There were 25 female and 7 male patients. The mean age was 13.5 years. Six patients had ranula excision, 4 had marsupialization and 22 had excision of the ranula combined with sublingual gland removal. These treatment methods showed 18.7%, 80% and 0% recurrence rate respectively. There was no complication with any method employed. The most reliable method for eradicating ranula of the floor of the mouth is by surgical excision of the ranula with the sublingual gland removal

Mandibular fractures in Bahrain A 10 year study

Determine the aetiology and pattern of mandibular fractures in Bahrain over a period of 10 years. Design: Retrospective analysis of medical records of all of 325 patients who sustained mandibular fractures between 1984-1995. The total number of cases of mandibular fracture was 325 with male: female ratio of 6:1. The peak age of fracture incidence is in the 20-30 years age group. Road traffic accidents [RTA] is the most common aetiology of mandibular fractures in Bahrain accounting for 44.6%. Falls is the second common cause accounting for 40%. The treatment method employed remained static for the provision of intermaxillary fixation [IMF]. Road traffic accidents constituted the main cause of mandibular fractures in Bahrain from 1984 - 1995 and intermaxillary fixation was the standard treatment method employed. There is a great need for more open reduction and rigid internal fixation [ORIF] which would decrease the length of patient hospitalisation, increased patient safety, improved communication and easier nutrition

pattern of maxillofacial trauma in Ireland: a prospective study

A survey was undertaken to assess the pattern of maxillofacial trauma in Ireland in the year 1994. A total number of 598 patients were seen with facial trauma at the National Maxillofacial Unit at St. James's Hospital, Dublin. The most common fracture site was the mandible [42.7%], followed by the malar [41.3%].The male to female ratio was 4.1: 1 and the highest proportion of patients were in the 20-29 years age group. Alleged assault is the most common cause of facial fractures accounting for 52.3%, followed by sports injuries 20.2%. Road traffic accidents accounted for 15.3%. The most common complication prior to surgery was sensory nerve deficit accounting for 55.2%. Eleven cases [0.18%] of blindness due to facial injuries were recorded. There were two deaths in patients who sustained severe craniofacial injuries, both being due to the severity of their head injuries