Versatile midfacial degloving approach in oral and maxillofacial surgery

OBJECTIVES@#Oral and maxillofacial surgeons must gain mastery of various approaches to the midface due to the increasing incidence, complexity, and severity of presenting midfacial fractures. Unlike in the case of other body parts, the need to preserve facial aesthetics makes it more difficult for the surgeon to select an approach for managing the facial injuries. The midfacial degloving (MFD) approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. The aim of the present study was to evaluate the efficacy of MFD in maxillofacial surgery and to assess its advantages and complications.@*MATERIALS AND METHODS@#The MFD approach was used in five cases, with three cases treated with open reduction and internal fixation and two cases operated on for posttraumatic deformity. Nasal dorsum augmentation was completed in three cases and nasal osteotomy was performed in one case. The bicoronal flap technique was combined with MFD for frontal bone augmentation in one case. The intraoperative time required for flap completion and the ease of performing the planned procedures were noted. Postoperative evaluation was done for reduction, aesthetics, function, and complications.@*RESULTS@#Access was excellent for performing all planned procedures. Average time spent for flap elevation and exposure of the midface was 63 minutes. Complications like postoperative swelling, infraorbital nerve paresthesia, and intranasal crusting were all transient. No long-term complications like stenosis of the nose, sneer deformity, or weakness of the facial muscles were noticed. Additionally, no complications were noted when MFD was combined with bicoronal flap.@*CONCLUSION@#Though the MFD approach is technically demanding and takes more time than other facial approaches, it should be learned and applied by maxillofacial surgeons in selective cases, as it provides complete exposure of the midface without facial scarring.

Versatile midfacial degloving approach in oral and maxillofacial surgery

OBJECTIVES: Oral and maxillofacial surgeons must gain mastery of various approaches to the midface due to the increasing incidence, complexity, and severity of presenting midfacial fractures. Unlike in the case of other body parts, the need to preserve facial aesthetics makes it more difficult for the surgeon to select an approach for managing the facial injuries. The midfacial degloving (MFD) approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. The aim of the present study was to evaluate the efficacy of MFD in maxillofacial surgery and to assess its advantages and complications. MATERIALS AND METHODS: The MFD approach was used in five cases, with three cases treated with open reduction and internal fixation and two cases operated on for posttraumatic deformity. Nasal dorsum augmentation was completed in three cases and nasal osteotomy was performed in one case. The bicoronal flap technique was combined with MFD for frontal bone augmentation in one case. The intraoperative time required for flap completion and the ease of performing the planned procedures were noted. Postoperative evaluation was done for reduction, aesthetics, function, and complications. RESULTS: Access was excellent for performing all planned procedures. Average time spent for flap elevation and exposure of the midface was 63 minutes. Complications like postoperative swelling, infraorbital nerve paresthesia, and intranasal crusting were all transient. No long-term complications like stenosis of the nose, sneer deformity, or weakness of the facial muscles were noticed. Additionally, no complications were noted when MFD was combined with bicoronal flap. CONCLUSION: Though the MFD approach is technically demanding and takes more time than other facial approaches, it should be learned and applied by maxillofacial surgeons in selective cases, as it provides complete exposure of the midface without facial scarring.

Osteoporosis and periodontitis: Is there a possible link.

Background: Periodontitis and osteoporosis are two diseases found worldwide having the main characteristic of increasing intensity with age. Periodontitis is associated with resorption of the alveolar bone. Osteoporosis is characterized by bone loss leading to structural bone transformation. The association between periodontitis and osteoporosis is continually being examined. The aim of this study is to examine the condition of periodontal tissues in patients suffering from osteoporosis and establish a possible link. Materials and Methods: Cross‑sectional study with 200 samples having test (n = 100) and control group (n = 100) were checked for periodontal condition. A total of 100 patients diagnosed as having osteoporosis based on bone mineral density at distal end of radius were regarded as test group and 100 subjects included in control group were healthy. Periodontal parameters measured were plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (CAL). Statistical test performed were Student’s paired t‑test and unpaired t‑test and Pearson’s correlation coefficient. Results: Probing depth and CAL were significantly negatively co‑related with T‑score in test group when compared with control group. This meant an inverse relationship in between the T‑score and the clinical parameters, PD and CAL. Furthermore, some difference was noted in test group in PI, GI and PD, CAL and T‑score when compared with the controls. Conclusion: Thus, we conclude that there is a definite relationship between osteoporosis and periodontitis based on PD and CAL.