Comparative evaluation of post treatment CT scan and clinical parameters in open reduction and closed reduction treatment of condylar fractures.

Background: Mandibular fracture is the second most common fracture of facial bone, next to nasal bone. Twenty-five to forty percent of mandibular fractures involve the condyle. In the literature, there exists no consensus "gold standard" treatment for mandibular condylar fractures, and there is a continuing debate on whether condylar fractures should undergo closed or open reduction. Materials and Method: Twenty patients who had undergone open reduction and closed reduction treatment were included in the study. Clinically maximal interincisal opening, laterotrusive and protrusive movements, pain on mouth opening, malocclusion, chin deviation on mouth opening, facial nerve palsy, hematoma, infected implant, and bite force were evaluated after a minimum of 3 months postoperatively. Also, a postoperative CT is done to evaluate the anatomical position of fragment. Results: On evaluation of clinical parameters, both groups had comparable results. However, none of the patients in open reduction group had deviation of mandible from midline on mouth opening. Also, better anatomical repositioning is obtained in open reduction group. Conclusion: The results of this study suggest that the open reduction method is a better alternative to closed reduction in treatment of mandibular condylar fractures.

Analysis of Variation in Anatomy of Lower Limb Vasculature and Implications for Free Fibula Flap by Color Doppler Imaging.

Background: The free fibula flap (FFF) has proved to be an adequate adjunct tool in the reconstruction of defects following cancer ablation. Although various investigation tools in the past have been proved to be adequate to study the blood supply of the various trunks of arteries, for the survival of graft, the color Doppler flow study (CDF) can be done for the accurate examination of various perforators for the same in the lower limbs prior to its harvest. Materials and Methods: 40 patients were included in the study and were examined for free fibula flap tissue transfer via color Doppler study for the lower limb perforators. Results: In the study, the perforators that are musculocutaneous, septocutaneous and septomusculocutaneous were detected in 80 legs that were examined and all of them had adequate diameter to justify the fact that the graft can be taken for harvesting, except for only two cases where it was found that they were hypoplastic. Conclusion: CDF can be a reliable and informative tool in patients planned for free fibula tissue transfer. Also, the skin perforators can be mapped, so as to determine skin paddle inclusion.

Comparative Evaluation of Reconstructive Methods in Oral Submucous Fibrosis.

BACKGROUND: Oral submucous fibrosis is a chronic, progressive, scarring, precancerous condition of oral mucosa which on progression causes severe trismus. AIM AND OBJECTIVES: To compare and evaluate the efficiency of buccal fat pad, platysmal mucocutaneous flap, nasolabial flap, collagen membrane graft, split thickness skin graft and temporoparietal fascia in reconstruction of surgical defect created by excision of fibrous bands in oral submucous fibrosis. RESULTS: After 6 months of follow-up, the interincisal mouth opening was 40.0 mm in case of buccal pad fat, 24.5 mm in temporoparietal fascia flap group, 33.8 in collagen membrane graft group, 34.5 mm in platysma flap group, 34.7 mm in nasolabial flap group, 29.3 mm in split thickness skin graft. ANOVA statistical analysis for postoperative interincisal distance at various time intervals and between pre-, intra- and postoperative interincisal distances were carried out which showed the results were significant at p value < 0.05 in all groups. No postoperative complications were noted in buccal fat pad group, split thickness skin graft group and collagen membrane group. However, platysmal group had flap necrosis and temporoparietal flap group patients had to undergo a second debulking procedure after one month. CONCLUSION: From our study, we concluded buccal fat pad yields superior results with respect to postoperative mouth opening and related complications.

Versatility of Buccal Pad Fat and Temporoparietal Fascia Flap in Surgical Management of Oral Submucous Fibrosis.

The various surgical procedures for surgical management of oral submucous fibrosis (OSMF) include excision of fibrous bands with or without grafts or flaps. Materials for attempted grafting included skin, placental grafts, and artificial dermis. Materials that can be used as flaps are tongue flaps, buccal fat pad, greater palatine pedicle flaps nasolabial flaps, anterolateral thigh flap, radial forearm flap, and temporalis fascia flap. The temporoparietal flap is ultrathin surgically single layer fibrovascular sheet with high vascularity, flexibility, pliability, and versatility. Ten cases with Grade III and Grade IV OSMF with 5 patients planned for reconstruction with buccal fat pad and 5 patients planned for temporoparietal fascia flap (TPFF) after surgical resection of fibrotic bands were undertaken for the study. After 7 days, both flaps healed nicely with complete epithelization of the two flaps occurred. There were no complications except for hyperplasia of TPFF that covered the defect. Postoperative histopathological examination of hyperplastic temporoparietal fascia revealed well-differentiated squamous-cell carcinoma in one patient and in another case, there was failure of TPFF. Both buccal pad fat and TPFF are reliable for the reconstruction of buccal mucosal defects in surgical management of OSMF.

Mucormycosis in immunocompetent patient resulting in extensive maxillary sequestration.

Mucormycosis or zygomycosis, also called phycomycosis, is an uncommon, invasive, potentially lethal and an aggressive fungal infection of the order Mucorales that usually affects patients with alteration of their immunological system. From its initial description (Paltauf, 1885), this entity still has a high mortality. Imaging techniques are not usually diagnostic, and cultures are not totally reliable. Definitive diagnosis is exclusively obtained by means of histopathological examination. Early recognition and aggressive treatment are of paramount importance and have reduced the mortality and morbidity. We present here a case report of oral mucormycosis in a 32-year-old male, immunocompetent individual resulting in extensive maxillary sequestration.

Comparison of vestibular sulcus depth in vestibuloplasty using standard Clark's technique with and without amnion as graft material.

INTRODUCTION: A number of materials are used as grafts in vestibuloplasty like mucosal and skin grafts with several advantages and disadvantages. To circumvent the disadvantages of these grafts, biological membranes such as amnion membranes are often recommended. MATERIALS AND METHODS: The objective of this study was to clinically assess the vestibular sulcus depth in vestibuloplasty using Clark's technique with and without amnion as graft material. Twenty edentulous patients underwent mandibular labial vestibuloplasty using Clark's technique. Amnion was used as graft material in 10 patients (group I) and no grafts used in remaining 10 patients (group II). The vestibular depth was evaluated at time intervals of 1 week, 2 weeks, 1 month and 3 months, postoperatively. RESULTS: Mean postoperative vestibular depth after 3 months in group I and II were 10.0 ± 3.13 mm and 7.8±0.63 mm, respectively. Mean of 2.2 ± 2.50 mm increase in depth was achieved after 3 months in Group I. CONCLUSION: Amnion graft is a viable and reliable option that promotes early healing and maintains postoperative vestibular depth.