Role of mandibular third molar in mandibular condylar fracture

Mandibular condylar fracture is one of the most common fractures of mandible. Presence or absence of mandibular third molar is an important risk factor in addition to various other factors. Presence of unerupted mandibular third molar concentrates the stress in angle region leading to its fracture while, in absence of unerupted third molar, forces are diverted towards condyle making it more vulnerable to injury. The objective of this study was to evaluate role of unerupted mandibular third molar in reducing incidence of condylar fracture. A cross sectional descriptive study was conducted at the department of Oral and Maxillofacial surgery, Ayub Medical College, Abbottabad, on 150 patients having condylar fractures over a period of eighteen months. Data on patient's demographics, side of condylar fracture and status of mandibular third molar was obtained and observed. Total number of hemimandibles under study was 175. In 120 patients i.e. 68.6% mandibular third molar was erupted while, in 55 patients i.e. 31.4%, mandibular third molar was unerupted. The results concluded that presence of unerupted mandibular third molar reduces incidence of condylar fracture by 2.2 times so prophylactic removal of these teeth in practice should be discouraged

Evaluation of ocular injuries associated with mid-facial trauma

The aim of this study was to evaluate frequency, etiology and association of ocular injuries with fractures in the middle third region of face. 129 patients with mid-face fracture were included in the study. An elaborated history was taken regarding trauma, followed by assessment of patients clinically and characteristics of fracture and associated ocular injuries noted. Out of 129 in total 52 patients [40.3%] sustained ocular injuries. Frequencies for gender involvement were 38[73.1%] male and 14 [26.9%] female patients. The most common etiology associated was Road Traffic Accident [RTA] 25 [48.1%] followed by Assault 11[21.2%], Fall 8 [15.4%], sports injury 5 [9.6%] and Firearm injury [FAI] 3[5.8%]. Subconjuctival Hemorrhage [71.15%] was the most common ocular injury found to be associated with mid facial fracture in this study. Other ocular complication found in these patients were Diploipa [19.23%], decreased visual acuity [17.3%], Enophthalmous [9.61%], Hyphema [5.76%] and blindness as 3.85%

Etiology, clinical and radiographic features of temporomandibular joint ankylosis

Objective of the study was to find out the frequency of different etiological factors, clinical and radiographic features of Temporomandibular joint ankylosis. Ninety six patients suffering from Temporomandibular joint ankylosis visited Oral and Maxillofacial Surgery Department, Khyber College of Dentistry, Peshawar from December 9, 2009 to December 8, 2010 and were included in the study. Patient demographics, etiology and clinical features of the disease were noted. Orthopantomograph was taken of all patients to confirm the diagnosis and to record the radiographic findings of the disease. Males were the predominant group [60.4%] as compared to females [39.6%]. Trauma was the etiological factor in 88.5% cases followed by infection and inflammation. Clinical deformity was present in the form of facial asymmetry [85.4%], < 5mm inter-incisal distance [76%], disturbed occlusion [64.6%] and poor oral hygiene [78.1%]. Bilateral involvement was found in 40.6% cases, left side was involved in 30.2% cases while right side was effected in 29.2% cases. Radio-graphically, the disease presented in the form of mushrooming of condyle, loss of joint space, anti-gonial notch and coronoid hyperplasia. Trauma is the main etiological factor for Temporomandibular joint ankylosis. Clinically the disease presents in the form of facial asymmetry, limitation of mouth opening, disturbed occlusion and sleep apnea while on radiographs, there is partial or complete loss of joint space, mushrooming of condyle, anti-gonial notch and coronoid hyperplasia

Frequency, etiology and characterstics of zygomatic complex fractures

Objective of this study was to find out the frequency, etiology and characteristics of zygomatic complex [ZMC] fractures. Forty patients with ZMC fracture visiting Oral and Maxillofacial Surgery Department, Ayub Teaching Hospital, Abbottabad from 27[th] January 2006 to 16[th] June 2006 were included in the study. A detailed history of patients was taken to find out the etiology, followed by clinical and radiographic examination to find out the characteristics of ZMC fractures. There were 31[77.5%] male and 9 [22.5%] female patients. The most common cause of ZMC fractures was Road Traffic Accident [RTA] 17[42.5%] followed by fall 8[20%], Firearm injury [FM] 5[12.5%], earthquake injury [EQI] 4[10%], interpersonal violence [IPV] 3 [7.5%], sports injury 2 [5%] and explosion [EXP] 1 [2.5%]. The most common characteristic of ZMC fracture in this study was periorbital ecchymosis 13 [32.5%] followed by paresthesia 8 [20%], flattening of cheek 6 [15%], subconjunctival ecchymosis 5 [12.5%], epistaxis 5 [12.5%], pain 5 [12.5%], step deformity of orbital margins 4 [10%], trismnus 3 [7.5%], diplopia 3 [7.5%] and buccal sulcus ecchymosis 2 [5%]

Frequency of unerupted mandibular third molar in mandibular angle fractures

Fractures of the mandibular angle are common and comprise 31% of all mandibular fractures. Multiple recent studies report a 2-3 fold increased risk for mandibular angle fractures when un-erupted mandibular third molars are present. The objective of this study was to assess the frequency of un-erupted mandibular third molar in mandibular angle fractures. This crosssectional study was conducted at the Department of Oral and Maxillofacial Surgery, Ayub Medical College, Abbottabad from April to October 2009. One hundred and two patients were included both from the outdoor and ward on consecutive non-probability sampling base. Data were recorded on a structured Performa and analysed using SPSS-16. A hemi-mandible containing un-erupted mandibular third molar was seen to have a 1.41 times the risk of mandibular angle fracture then a hemi-mandible containing an erupted mandibular third molar. The presence of unerupted mandibular third molar is associated with an increased risk for mandibular angle fracture.

Our experience of pectoralis major myocutaneous pedicled flap

The pectoralis major myocutaneous pedicle flap [PMMPF] has been considered to be the "workhorse" of pedicled flaps in head and neck reconstruction. Despite the use of free flaps, this flap is still considered the mainstay of head and neck reconstruction. The flap is usually associated with a high incidence of complications compared with the free fasciocutaneous flaps yet its size, viability, and versatility make it a valuable tool for extending the limits of resectability and reconstruction. It is type V muscle flap with the dominant vascular supply from the pectoral branch of thoracoacromial artery. To share our experience of pectoralis major myocutaneous pedicle flap in selected cases of head and neck reconstruction. The indications, type of reconstruction and complications of the flap utilization were evaluated. Between March 2005 and August 2010, a 37 head and neck reconstructive procedures using the PMMPF were carried out. The indications for the flap use were defects due to resection of stage II-IV cancer in the head and neck region. The site, stage of the disease and the postoperative complications were all documented. Pectoralis major myocutaneous pedicled flap reconstructions were used to reconstruct defects in the following sites: oral cavity [25 patients]; oropharynx/ hypopharynx, [7 patients]; and neck or face [5 patients]. Of the 37 PMMPF reconstructions, 30 flaps were carried out as primary reconstructive procedures, whereas 7 flaps were "salvage" procedures. Twentyfive patients [67.59%] had complications. A higher complication rates were associated with the utilization of the flap as a salvage procedure, number of co- morbidities, and in oral cavity reconstructions. The pectoralis major myocutaneous pedicled flap is still an acceptable method of head and neck reconstruction. It is fast, reliable, provides safe repair and is indicated especially where bulk is needed

Delayed consultation of patients having temporomandibular joint ankylosis with an oral and maxillofacial surgeon - factors responsible for it

To find out the factors responsible for delay in seeking consultation by patients having Temporomandibu-larjoint A kylo sis. A.H the patients of Temporomandibularjoint ankylosis visiting Oral and Maxillofacial Surgery Department at Khyber college of Dentistry Peshawar from 1[st] January 2009 to 31[st] December 2009 were included in the study. Patient s gender, age, address, socio-economic status, educational level of parents, history of disease, health care professional initially contacted and delay in seeking consultation with an Oral and Maxillofacial Surgeon were documented. Out of 60 patients, 33 were males and 27 were females. Majority of them [86.7%] were from Khyber Pakhtunkhwa with 83.3% having history of previous trauma. 51.7% of the patients initially contacted local practitioners, 10% contacted trained Medical specialists, 15% consulted an Oral and Maxillofacial Surgeon without prior referal while 23.3% did not consult any health professional. Overall, 50 patients were delayed in consultation with an Oral and Maxillofacial Surgeon. The mean delay was 9.1 +/- 9.05 years [1-50 years]. Poverty, illiteracy, mis-diagnosis or non-diagnosis of con ay larfractures due to lack of trained specialists, improper follow up and the trend of non-referral to the specialised health professionals are the main jactors delaying consultation of patients, having TMJ ankylosis, with an Oral and Maxillofacial Surgeon