Management of temporomandibular joint dislocation at mayo hospital Lahore

For the management of TMJ dislocation, controversies always surround to the various conservative and surgical modalities. Hence a retrospective study was planned to audit the demographics, etiology and patterns of occurrence and to enumerate the treatment modalities of TMJ dislocation at the De-partment of Oral and Maxillofacial Surgery/Mayo Hospital Lahore, fifty two cases of TMJ dislocation were retrospectively studied from 2013 to 2017. Patient records contained information about age, sex, type of dislocation, immediate event preceding the dislocation, treatment modality used and reported complications regarding dislocation. Thirty two patients [62%] were males and 20 [38%] were females. Their ages ranged from 1-80 years with a mean of 37 years. 23/52 patients were presented with acute dislocation which were managed by manual reduction and analgesics. 19/52 patients were presented with chronic recurrent dislocation in which 7 patients were injected with autologous blood, 9 patients were treated with intermaxillary fixation and three patients were given STD injection. Chronic long standing TMJ dislocation in 10 patients were managed by eminectomy in 7 patients and condylecto-my in 3 patients. This study concluded that male sex, middle age, yawning, and low socio-economic status appeared to be associated with TMJ dislocation; however, this observed relationship was not statistically significant. Different treatment modalities exist. This study highlighted the advantages and effectiveness of conservative methods of treatment

Comparison of post operative complications in mandibular angle fractures treated by single versus two miniplates

The ojective of this study was to compare the complications [infection and non union] when fractures through the angle of the mandible are treated with a single noncompression miniplate versus 2 noncompression miniplates. 300 patients were randomly divided in two groups, 150 patients in each. Group A was treated by single non compression miniplate plate at superior borber of angle of mandible using intraoral approach. Group B was treated by two noncompression plates one at superior border as in group A, and other plate at lower border using extra oral approach. Patients were assessed for infection and non union on 21st, 45th and 60th days after the procedure. Mean age of patients in Group-A was 35.87 +/- 1.90 and in Group-B mean age of patients was 31.30 +/- 3.45 years respectively. Gender distribution showed that there were 241 [80.34%] [Group-A=124, Group-B=117] male and 59 [19.67%] female patients [Group-A=26, Group-B=33]. There were 10[6.67%] patients in Group-A and 22[14.67%] patients in Group-B who got infection at fracture site at 21st day.. At 45th day 6 [4%] patients in Group-A and 17[11.33%] patients in Group-B had infection. At 60th day infection was present in 10 [6.67%] patients and in Group-A only 2 patients had infection. This study shows that there are less chances of Infection when the patients are treated with one miniplate as compared to two miniplates for the treatment of displaced mandibular angle fractures

Oral malignant melanoma: a case report

Oral Malignant melanoma is a rare neoplasm representing less than 1% of all melanomas and -0.5% of all oral malignancies.[1-2] Approximately one half of melanomas occur in oral cavity [48%], and the remaining portions are located in nasal cavity [44%] and sinuses [8%].[3] As this type of tumor is rare so data collection from the case reports will be the best source of information and further research. A case report is presented here

Ophthalmic injuries in orbito-zygomatic fractures

To assess the frequency and severity of ophthalmic injuries in patients with orbito-zygomatic fractures. A case series. Oral and Maxillofacial Department, KEMU/Mayo Hospital Lahore, from January 2009 to December 2011. Patients with orbito-zygomatic fractures were divided into three groups. Group-1 patients had fracture of floor/medial wall of the orbit [orbital-blow out fracture]. Group-2 had comminuted orbito-zygomatic fractures. Group-3 had simple zygomatic bone fractures. Frequency and types of ocular injuries were determined on each group. There were 296 [260 male, 36 female] patients with mean age of 31.7 years. Group-1 [n = 20] had 28 ocular findings in 12 [60%] patients including diplopia [n = 10, 36%], enophthalmos [n = 6, 14%], and hyphema, vitreous hemorrhage, retinal hemorrhage, choroidal rupture, traumatic mydriasis, and commotio retinae in 2 cases, 7% each. In Group-2 [n = 106], 44 ocular findings were identified in 30 [28%] patients including diplopia [n = 10, 23%], enophthalmos [n = 4, 9%], commotio retinae [n = 10, 23%], reduced visual acuity [n = 6, 14%], retinal hemorrhage [n = 4, 9%] and corneal laceration, corneal abrasion, retinal detachment, traumatic mydriasis, and canthal laceration in 2 cases, 4.5%. In Group-3 [n = 170], 22 ocular findings were seen in 16 [9%] patients included diplopia [n = 10, 45%], enophthalmos [n = 4, 18%], and retinal tear, hyphema, angle recession, and traumatic mydriasis in 2 cases, [9%] each. Ophthalmic injuries are a common complication of orbitozygomatic fractures occurring in about 20% of patients in this study, most frequent in the orbital blow fractures subgroup. Ophthalmology consultation is recommended for patients presenting with midface fractures

Prosthetic rehabilitation of traumatic nasal defect: a case report

Trauma, tumor resection, and congenital deformities results in facial defects.1 These defects are highly unpleasing and cause a considerable psychological stress to patients. Site and size of defect, etiology of tissue loss and age of the patients are the factors which are to be considered when planning for reconstruction. Some people may not be medically fit for long reconstructive surgeries or may not wish to undergo surgery. Here is the case report of the patient who preferred prosthetic nasal rehabilitation rather plastic reconstructive surgery

Number of rami of marginal mandibular nerve and its communication with other terminal motor branches of facial nerve in adult unclaimed cadavers - an anatomical study

Marginal mandibular nerve is one of the five terminal motor branches of facial nerve given in the substance of parotid gland. Injury to this nerve during surgical procedures hampers the actions of muscles of the lip and chin causing functional and aesthetic impairment. This study on number of rami and communication of marginal mandibular nerve will benefit maxillofacial, general, cosmetic /plastic surgeons to safely prevent iatrogenic injury to this important branch of facial nerve. Dissection of one hundred [100] hemi-faces of adult unclaimed cadavers of both genders was done [from September 2009 to March 2010] in Forensic and Anatomy departments of King Edward Medical University, Lahore. Cadavers with any scar or mutilated face/ neck were excluded from this study. In 100 hemi faces, number of rami of marginal mandibular nerve varies from 1-3. Single branch is most common [74%] followed by two [20%] and three rami [6%]. In 36% of cases communication was seen with buccal branch, 1% with cervical branch, with both buccal and cervical branches in 1% of cases. No communication with either buccal or cervical branch of facial nerve was seen in 62% of cases. Frequency of communication increases with number of Rami of marginal mandibular nerve. In our population single marginal mandibular nerve is most common [74%] which does not communicate with other branches of facial nerve frequently [74.3%]. Therefore transection of this nerve during surgical procedures can result in permanent paralysis

assessment of maxillofacial gunshot injuries and emergency management

Firearm injuries constitute a major challenging problem in maxillofacial surgery, causing major deformities of human body, and financial Burden to our society. Violent crimes are the major cause. Unemployed youth and socioeconomic deprivations are factors which contribute towards violence. There are few important steps in management of head and neck gunshot injuries, obtaining an airway, control hemorrhage, recognizing additional injuries and finally definitive repair facial deformities. The objective of this study was to report the causes, and patterns of maxillofacial gunshot injuries. A retrospective assessment of patients treated for gunshot injuries at Mayo hospital Lahore from May 2007 to July 2009 and February 2010 to January 2011 at Liaquat University Hospital Hyderabad was conducted, and data was collected with special emphasis on the patient's demographics, mode of injury, initial airway management, and bone injuries The sample consisted of 120 patients. [78.3%] males, in third and fourth decade of age were the most common group, violent crime [62.5%] was the predominant cause, and mandible [58.3%] was the most common site of injury. From this Available information provided in this study, is concluded that violent crime was major cause of facial gunshot injuries. Male gender and young adults were the most commonly victimized patients

Massive leiomyosarcoma of the maxilla

Leiomyosarcoma is a malignant smooth-muscle tumour that is exceedingly rare in the head and neck region. Presenting signs and symptoms of leiomyosarcoma in the orofacial region are generally nonspecific. The tumour is commonly encountered as a slow growing, discreet firm, and non-ulcerated painless mass. We presented a case of massive leiomyosarcoma of the midface which might be the first leiomyosarcoma of midface reported in Pakistan so far to our knowledge. We also discuss the diagnosis and treatment of leiomyosarcoma in this aspect. Keyword: Leiomyosarcoma, tumour, malignant, orofacial

Reconstruction of mandible by free fibular Flap

To determine the results of using the free vascularized fibular flap for comprehensive reconstruction of post-resection or post-traumatic mandibular defects. Department of Oral and Maxillofacial Surgery, King Edward Medical University, Lahore, from March 2007 to June 2009. The study group consisted of patients who underwent reconstruction of continuity defects of the mandible using a fibular vascularized free flap. Indication for mandibular resection were squamous cell carcinoma of the floor of the mouth and alveolar ridge in 5 cases, ameloblastome of the mandible in 6 cases, odontogenic keratocyst in 3 cases, defect due to fire arm injury in 2 cases and central giant cell granuloma of the mandible in one case. The type of reconstruction performed was primary reconstruction in 11 patients and secondary in 6 patients. There were 17 patients including 14 males and 3 females with mean age of 40 years. All flaps except three survived. One patient died due to complications related to blood transfusion. Of those, 2 completely failed, one due to the unfavourable recipient bed of the patient with fire arm injury and other due to venous thrombosis. Donor site morbidity was low; there was some compromise in the ankle function but none of the patient complaint of foot drop. Simple problems with wound healing such as dehiscence and delayed wound healing developed in 5 patients, which usually required only local antiseptic treatment. After the operation patient began oral feeding and walking with some aid in fourth week and became completely ambulant in 8 weeks. In this small series the free fibula flap was a versatile and reliable option for microvascular reconstruction of large mandibular defects. It provided a large quantity of bone, which could be easily shaped and passively adapt to the remaining mandible and for an implant-based prosthetic restoration