Distraction osteogenesis for correcting maxillo-mandibular deformities

To determine the effectiveness of distraction osteogenesis [DO] for correcting maxillofacial deformities. Case series. Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from June 2008 to November 2010. Patients with diverse maxillofacial deformities were selected for the study. In all cases, intraoral distractors were used. Mandibular osteotomies were done using submandibular incision and maxillary osteotomy was done using standard vestibular incision. In paediatric patients, DO was started on third postoperative day while in adults, a 7-day latency period was followed. Distraction was carried out at a rate of 0.5 mm twice daily [1 mm/day]. Distractors were removed after a consolidation period of 2 months. A total 7 cases were operated for DO. Out of these, 3 were males and 4 females. The age ranged from 2-24 years [mean 12.57 +/- 9.48 years]. Five patients had their deformity owing to temporo mandibular joint [TMJ] ankylosis, one had congenital micrognathia and one patient had skeletal class-III deformity. Five patients underwent mandibular DO, one underwent maxillary DO and in one case simultaneous maxillo-mandibular DO was carried out. Amount of distraction varied from 9.0 mm to 19.2 mm [mean 15.04 +/- 4.33 mm]. Mean follow-up was 18.14 +/- 5.39 months. Distraction osteogenesis can be employed satisfactorily to correct diverse maxillofacial deformities like retrognathia, facial asymmetry and skeletal class-III

Magnitude and causes of low vision disability [moderate and severe visual impairment] among students of Al-Noor institute for the blind in Al-Hassa, Saudi Arabia: a case series

This study aimed to estimate the magnitude and causes of low vision disability [severe visual impairment [SVI] and moderate visual impairment [MVI]] among students at Al-Noor Institute for the Blind [NIB] in Al-Hassa, Saudi Arabia in 2006. An optometrist conducted refraction of 122 eyes of the 61 students [27 boys and 34 girls] with MVI [vision <6/18 to 6/60] and SVI [vision <6/60 to 3/60]. Ophthalmologists examined the anterior and posterior segments, and analysed the outcomes of additional investigations to finalise the diagnosis. The results were categorised as 'preventable', 'treatable' and 'not amenable to treatment'. The low vision care was also reviewed. In 12 [9.8%] eyes, visual acuity was >/= 6/18 and in 28 [23%] eyes, it was <3/60. MVI and SVI were found in 82 eyes [67.2%]. Hereditary retinal disorders were found in 68 [55.7%] eyes. Although refractive errors were found in 112 [91.8%] eyes, isolated refractive error was found in only 9 students. Congenital glaucoma and cataract were responsible for visual impairment in 16 [13.1%] and 9 [7.4%] eyes. These students were prescribed optical and non-optical low vision aids. Retinal disease was the main cause of SVI and MVI in our series. Some students at Al-Noor Institute for the Blind have curable low vision conditions. Rehabilitation of low vision disability should be different from that offered to the absolutely blind

AFP surveillance; review of Mohmand Agency Fata

To determine the status of the AFP surveillance system at Mohmand agency FATA in a sense to improve the sensitivity of the system in 2012. Retrospective study. Mohmand agency FATA. Jan-Dec 2011. The relevant information were recorded from the Rec files of these cases in accordance to the objectives of the study. A total of 25 cases were reported in 2011 in Mohmand agency as AFP cases. Eleven were females [44%] and 14[56%] were males. The age range of these patients were from 6 months to 14 years of age. Mean age with SD was 37.12+33 months. Four cases were confirmed polio type 1 wild type cases. The frequency of cases reported from various tehsils were: safi [36%], Pindialy and ekka ghund, Halimzai 16%, Prang ghar and ambar4%, and Khweze/baizai 8%. Fourteen [56% cases] reported as urgent cases. Majority of the cases [28%] were injection neuritis, 20% cases diagnosed as traumatic neuritis, 4% as Guillain barre syndrome, and 8% as meningitis. 16 cases were cross reported from other agencies and the remaining from the agency itself. Ghallani AHQ Hospital, RHC Ekka ghund and Mechany BHU are main diagnostic and referral centers for AFP in the agency. The lab results reported 4 cases with P1 wild type virus. We have at time a bit weak surveillance system for AFP and the agency being a part of FATA and its security volatile situation, all makes it more suitable for the polio virus to circulate. There is low level of awareness and stigma associated with Polio vaccines which is alarming for public health workers. The cross reported cases ration is more which shows bit weak catch up at station level

Correction of airway obstruction in congenital micrognathia by mandibular distraction osteogenesis

Varying degrees of upper airway obstruction is almost universally present in patients of congenital micrognathia which needs to be corrected as early as possible. This allows appropriate feeding and growth and prevents long-term complications such as pulmonary hypertension and cor pulmonale. We report the case of a tracheostomy-dependent, 4-year-old child with congenital micrognathia who was treated with mandibular distraction osteogenesis. This is the treatment of choice for surgical correction of mandibular hypoplasia and for the challenging airway management in infants. Once a bone length of 2 cm was achieved through distraction osteogenesis, the child was completely relieved of respiratory obstruction and tracheostomy tube was removed through the process of decannulation