‘Frozen Eye’ ? Post Blowout Fracture Surgical Correction ? A Case Report

The Rationale: “Frozen Eye” is a very uncommon sequel after treatment of orbital blowout fractures requiring implant placement. Patient Concerns: The implant may faultily impinge on the ocular and extra?ocular muscle(s), causing the abnormality in the movement of the eye. Diagnosis: We present a 56?year?old male whose ocular implant impinged on muscle, causing “frozen eye” and had an infected implant. Treatment Outcomes: The same was removed and surgically corrected. The manuscript describes the details and discusses the possible mechanism that led to the “Frozen Eye”

Idiopathic Bilateral Mandibular Condylar Resorption Causing AnteriorOpen Bite - A Case Report

Introduction: Mandibular condylar resorption (MCR) is a rare pathological entity, often affecting young females. Patient Concerns: It is accompanied by pain, malocclusion and compromised quality of life including aesthetic perception. Due to this multiplicity of features, the diagnosis, treatment and management of MCR are always a challenge. Diagnosis: This article reports a 25?year?old female suffering from progressive temporomandibular joint pain and compromised aesthetics. This article describes the clinical and radiological findings of this case. Treatment: The possible aetiopathogenesis and treatment are described.

Hemifacial Hypertrophy – Report of 2 Cases

Hemifacial hyperplasia (HH) is a rare congenital condition involving enlargement of one or more tissues of the face. The treatment is surgically challenging and requires expertise. This manuscript aims to report two similar appearing HH but warranting different surgical treatment. A 19?year?old female and a 14?year?old boy presented with right facial asymmetry since birth and sought correction of the same. Surgical treatment was planned. Based on clinical history, diagnosis and imaging, HH was diagnosed. The first case was entirely a soft tissue abnormality that was treated with debulking while the second case had involvement of facial bones, necessitating surgical recontouring. The facial asymmetry was addressed. Healing was uneventful. Though the aesthetical concern and appearance of the two cases of HH were same, the treatment vastly differed. This was based on the source of asymmetry. Proper diagnosis and informed decision are a key for successful surgical outcome.

Diagnostic efficacy of urine dipstick in detecting chronic kidney disease

Background: Proponents of routine urine dipstick screening to identify patients at risk for ESRD in the primary care setting have argued that urine dipsticks are inexpensive, low risk, acceptable to patients, and now, more accurate. Proponents believe that urine dipstick screening has the potential to improve outcomes for people with early disease and increase awareness of CKD. Most primary care physicians agree that populations who are at high risk for CKD should be tested and appropriately treated to decrease complications of ESRD. However, proponents of mass screening may not appreciate the challenges, limitations, and potential harms of screening. Urine dipstick testing does not meet all of the criteria for a good screening test. The aim of the study: To elucidate the diagnostic efficacy of the urine dipstick in detecting chronic kidney disease by assessing its validity as a screening test for detecting CKD. Materials and methods: A community-based cross-sectional study was conducted among 287 subjects aged 20 years and above residing in the P.K. Garden area of Chennai during November 2018 to January 2019. Subjects were interviewed with a questionnaire and blood samples were collected to estimate serum creatinine and a urine sample was collected to estimate the proteinuria using urine S. Thirumavalavan, Noormohamed, Balaji S.M., R Vijaya Kumar. Diagnostic efficacy of urine dipstick in detecting chronic kidney disease. IAIM, 2019; 6(3): 137-142. Page 138 dipstick. eGFR was calculated using CKD – EPI equation and CKD was diagnosed using KDOQI CKD guidelines. Results: The prevalence of Chronic Kidney Disease (<60 ml/min eGFR) in the study group was 10.45%. The Area under Curve (AUC) of the ROC curve for urine dipstick in detecting CKD was 0.948 (0.900 – 0.996) and the 2+ proteinuria was closest to the ideal test point. When proteinuria criteria set at dipstick 2+ or more, the sensitivity was 83.33% and specificity was 98.36%, positive predictive value was 83.33% and κ coefficient of agreement of proteinuria with CKD was 0.81. Conclusion: The urine dipstick test can be used as an effective screening tool in detecting CKD in primary care level. Non Communicable Diseases screening at primary health care level should include the screening of proteinuria using urine dipstick especially for people with risk factors like Diabetes and Hypertension.

Comparison of soft‑tissue changes in simultaneous maxillomandibular distraction with mandibular distraction with second‑stage maxillary osteotomy.

Background: The purpose of this study was to compare the frontal lip cant changes in common facial asymmetry (FA) cases after simultaneous maxillomandibular distraction osteogenesis (DO) and mandibular DO with maxillary orthognathic surgery. Materials and Methods: Retrospective analysis of FA cases at tertiary craniofacial referral was performed. Patients of either gender with all medical imaging records and pre‑ and post‑operative (1 year) facial photographs in natural head position were included in the study. The lip cant change was assessed by the ratio of the linear dimension between affected and unaffected side labial commissures and the bi‑pupillary reference line. Difference between the pre‑ and post‑operative ratio was analyzed. Statistical analysis was performed for the outcome. P ≤0.05 was taken as significant. Results: The mean preoperative measured value of the affected side was 0.845 ± 0.036 while the postoperative value was 0.95 ± 0.032. The effective change was 0.11 ± 0.044. The postoperative ratio compared with simultaneous DO case was 0.98 ± 0.06 while that of mandibular distraction with orthognathic surgery was 0.92 ± 0.08 (P = 0.048). The mean change of the simultaneous DO case was measured as 0.114 ± 0.041 while the same for the mandibular distraction with orthognathic surgery was 0.069 ± 0.035 (P = 0.013). Discussion and Conclusion: The results indicate that the simultaneous DO yields more better frontal lip cant change between both halves than the mono‑DO with orthognathic surgery. The mean change is much higher in the simultaneous DO cases indicating a more effective correction and desired result. The biological reason and lip musculature mechanism behind the response in both conditions are discussed.

Surgical correction of severe enophthalmos caused by bullet injury.

Ballistic injuries of oral and maxillofacial region are usually fatal due to close propinquity with the vital structures. The severity of injury depends on the caliber of the weapon used and distance from which the patient is shot. The preliminary care of facial ballistic wounds strictly adheres to the basics of trauma resuscitation. Early and appropriate surgical management has proved to be influential on the final outcome and esthetic result. Treatment of facial gunshot wounds should be planned and carried out carefully to avoid esthetic complications. It takes even multiple‑staged corrections to achieve the targeted functional and esthetic treatment plan. Prevention and control of infection is one of the most important goals to achieve the success of the treatment. Herewith, we present a case of facial gunshot injury with fractures in the orbital floor, medial wall maxillary sinus, and buttress of the zygomatic bone causing deficit, which was successfully managed by surgical reconstruction.

Modified endaural approach for the treatment of condylar fractures: A review of 75 cases.

Background: There are several treatment approaches for mandibular condyle fractures. Type of fracture, clinical experience, and preference of the operating surgeon dictate the approach. Given this highly varied outcome, this manuscript intends to document the treatment experience of 75 patients with extracapsular condyle fractures using author’s modification of the traditional endaural approach in the region. Materials and Methods: A retrospective chart review was performed on patients with mandibular condylar fractures who visited the author’s center between 2004 and 2014. For the surgical reduction and fixation, an endaural (ear) approach via the author’s modification of Al‑Kayat Bramley’s incision in the superficial temporal region was used. Postoperative clinical parameters were evaluated which include the degree of mouth opening, chin deviation during mouth opening, occlusal relationship, temporomandibular joint function, radiographic stability, and other postoperative complications of condylar fractures such as infection, plate fracture, and permanent paralysis of facial nerve. Adolescence/adult patients with unilateral/bilateral condylar fracture who underwent open reduction with the follow‑up of at least 1 year were included in the study. Edentulous and patients <15 years who underwent closed treatment were excluded from the study. Results: The study group consisted of 75 cases of mandibular condyle fractures, of which 55 cases were of unilateral condyle fractures and 20 cases were of bilateral condylar fractures. Postoperative follow‑up of patients ranged from 1 to 10 years with the mean of 3.04 ± 1.93 years. The occlusal relationships were excellent in all with the mean degree of mouth opening of 40.11 mm (maximum 4.5 cm and minimum 2.9 cm), of which four patients reported restricted mouth opening. Orthopantomogram and computed tomography showed complete anatomical reduction of the condyle fracture in all patients. Nine out of 75 patients developed transient facial weakness, with no other postoperative complications of condylar fractures such as infections, plate fracture, and permanent paralysis of facial nerve were noted. The overall success rate was 92%. Conclusion: Surgery for mandibular condyle fractures with modified approach allows direct vision of the fracture and reduces surgical trauma to the site while avoiding permanent facial nerve injury. Hence, the author’s modified Al‑Kayat Bramley incision via endaural approach could be considered as the best approach for open reduction and internal fixation of condylar neck and subcondylar mandibular fractures.

Total reconstruction of mandible by transport distraction after complete resection for benign and malignant tumors.

Background: Distraction osteogenesis (DO) is a recognized technique for the bone lengthening and correction of various mandibular deformities. It has an aided advantage of both osteogenesis and histiogenesis in achieving a bone supported mandibular ridge covered with attached gingiva, forming an appropriate vestibule. Aim: The aim of this study was to present our clinical experience in using transport DO technique (TDO) for treating mandibular bony defects following tumor ablation in both benign and malignant tumor cases. Materials and Methods: This is a retrospective analysis of patients who underwent mandibular TDO for the correction of mandibular segmental defect at authors’ center from 2000 to 2014 with the inclusion criteria of segmental bony defect in the mandible with moderate soft tissue defect. After the latency period of 10 days, the distraction was initiated at a rate of 0.25–1 mm/day. The distraction period continued until the segment with the transport disc reached the distal base. The total consolidation periods ranged from 6 to 14 weeks. Results: The study group consists of 9 cases of TDO for reconstruction of segmental defect following tumor resection, of which 5 cases of benign and 4 cases of malignant tumor resection. The mean (standard deviation [SD]) bony defect length was 48 mm (9.8). The mean (SD) distracted bone lengthening was 43 mm (9.7), with a mean (SD) consolidation period of 17.9 (3.4) weeks. The bony defect involved the hemimandibular angle in four patients, hemimandibular body in three patients, with greater involvement of the body, symphysis in two patients, and of the bilateral mandibular body in two patients. Except for two patients who required additional bone grafting to complete union with the residual bone, other seven patients in the distraction zone showed the complete ossification by radiological evaluation. The mean (SD) consolidation period of 13.56 (1.5) weeks ranging from 12-15 weeks with the mean (SD) follow‑up years is about 8.7 years (2.95) for the cases. Out of the 9 cases, one case had recurrence in the follow‑up period and underwent resection with reconstruction using reconstruction plate in the created bone. The overall success rate of TDO was 88.9% (8 out of 9) in spite of adequate case selection and TDO protocol. Conclusions: TDO potentially benefits patients with segmental bony defects following tumor ablation in mandible. It is an unswerving tool to achieve sufficient bone in mandible in patients who cannot undergo aggressive surgery or poor general health. Bone resorption remains a critical issue for this reconstruction technique, though blood supply is continuously maintained in TDO.

Bilateral cleft lip and palate, hypertelorism with agenesis of corpus callosum.

Agenesis of corpus callosum (ACC) can have various development abnormalities spectrum. These include delay in milestones to complex neuropsychiatric manifestations. Following case report highlights the case of a young infant presenting with associated features including bilateral cleft lip and palate and hypertelorism. The kid was refused treatment at several centers owing to the central nervous system abnormality. This case reports highlight the ACC as a comorbid diagnosis in cleft lip and palate patient with hypertelorism perhaps owing to ignorance and fear of this apparently innocuous congenital malformation.

Surgical management of necrotizing sialometaplasia of palate.

Necrotizing sialometaplasia (NSM) is a rare benign, inflammatory disease of both major and minor salivary glands, although more commonly reported in the minor glands of the palate. The characteristic clinical presentation can perplex the clinician and may be mistaken for a malignant neoplasm, such as mucoepidermoid carcinoma, as well as invasive squamous cell carcinoma. The clinical and histological similarity between this entity and a malignant lesion may result in unnecessary or mis-treatment. Though clinically mimics malignancy, NSM is considered to be a self-limiting disease, and takes about 3-12 weeks to resolve. Majority of the case resolves itself or by supportive and symptomatic treatment. Surgical intervention is rarely required in NSM except the diagnostic biopsy. Herein we report the clinical, histopathological feature and surgical management of a case of NSM of hard palate in a young adult male.

Immediate implant in single rooted teeth ‑ Study on primary stability and bone formation.

Background: Dental implants (DI) are emerging as an alternative to dentures. Immediate placement of DI for esthetic concern has been always in demand. This is a retrospective analysis of the success rate of immediately placed DI in freshly extracted single‑rooted tooth socket, by clinical, radiographical, soft and hard tissue changes in a follow‑up period of 1 year. Materials and Methods: Retrospective analysis of all cases of immediate DI placed in the single rooted socket was performed. Cases were selected based on previously established inclusion and exclusion criteria. Age, gender, tooth, jaw, cause of impending tooth loss, tooth diameter along the cervical margin, the width of keratinized gingiva (WKG), and radiographic measures were performed for up to a year. Descriptive statistics and comparison of means were presented. P ≤ 0.05 was taken as significant. Results: Of the 324 immediate DI placed in 207 patients during the study period, 61 fulfilled the criteria. There were 49.2% males 31.15% had dental caries, 61% involving maxilla. The mean age of patients was 34.82 ± 7.97 years. Mean extraction socket diameter was 4.6 ± 1.78 mm. From complete stability of DI, the WKG decreased from baseline to 3 months period and regained at 12‑month follow‑up. The difference was statistically significant (P = 0.01). The same trend was noticed in the distance of the mesial and distal papilla as measured in the probe (P = 0.075). Radiographical changes also reflected a similar trend. Discussion: The success of DI, in terms of clinical and radiographical parameters, in an immediate DI placed in a single rooted fresh extracted socket, gives adequate clinical results.

Fate of third molar in line of mandibular angle fracture ‑ Retrospective study.

Aim: The study aimed to answer for the question whether a tooth in line of fracture predispose to complications such as infection and thereby warranting removal of the plates. Materials and Methods: Surgically rehabilitated patients for unilateral angle of mandible fractures at author’s center from 2000 to 2013 were considered in this study. During the study period, about 116 cases fulfilled the inclusion and exclusion criteria, and hence included in this study. All patients were treated by open, rigid fixation. Results: During the fracture reduction and immobilization, 52.6% (n = 61) cases, the third molar was extracted and in 47.4% (n = 55) cases, the tooth was preserved. Only two cases of infection that required the plate removal occurred by 3 months and another one case within the next 6 months. When the tooth in question was removed, infection did not occur. In all, 52.72% (n = 29) of the 55 cases preserved were needs to be extracted for various reasons. The most common being periodontal causes followed by periapical pathology. Statistically the relationship between demographic data and outcome measures were analyzed using Chi‑square test bivariate statistics. A P ≤ 0.05 was taken as significant. Conclusion: The present study fails to identify any concrete factors that would predict the failure of the retained third molar that were involved in the line of mandibular fractures. The proof presented here, especially with low complication rates indicate that all impacted third molar along the line of fracture be removed and unless necessary, the partially erupted teeth would also be extracted. In such a situation, the rate of infection and survival of the third molar would have been entirely different.