Management of Infraorbital Rim Fracture Through Intraoral Approach.

Purpose: The aim of our study was to evaluate the feasibility of an intraoral approach in the management of infraorbital rim fracture. Patients and Methods: A total of 12 patients of which four were female and five were male with isolated unilateral zygomaticomaxillary complex (ZMC) fractures, essentially involving the infraorbital foramen (right or left), were included in this study. Indications for surgical intervention were cosmetic deformity, disturbance of vision, persistent paresthesia, or impaired mandibular movement. All the patients were subjected to thorough preoperative evaluation. A three-point fixation was performed in all the patients. Various parameters such as time required for exposure and the amount of accessibility were assessed intraoperatively, while the stability of the fixation and paresthesia pertaining to the distribution of the infraorbital nerve were assessed postoperatively. Results: A total of 12 patients with a mean age of 35.75 ± 12.7 years were included in the study. The mean time recorded for exposure and fixation was 21.33 ± 2.8 min. The accessibility was rated as "excellent" in 92% (11 patients) of the operated cases and rated "satisfactory" in 8% (1 patient) of the operated cases. The fixation was found to be stable in 100% of the cases. By the end of 8 months, normal mechanoreceptor response was elicited in 42% (five patients) of the cases and normal nocireceptor response was elicited in 92% (11 patients) of the cases. Conclusion: The intraoral approach for fixation of the infraorbital rim is versatile and can be mastered even by novice surgeons. The virtual lack of complications and short learning curve make this approach an invincible modus operandi in a surgeon's repertoire.

The Use of Tibial Autogenous Cancellous Bone for Late Secondary Alveolar Bone Grafting in Cleft Patients: A Prospective Study.

OBJECTIVES: To evaluate the management of alveolar cleft defects with proximal tibia bone grafts by late secondary alveolar bone grafting. MATERIALS AND METHODS: Fifteen patients were studied, nine males and six females within age range of 21-32 years. All the patients were treated with cancellous portion of the proximal tibial bone graft, harvested through the medial approach. RESULTS: Intraoperatively, sufficient amount of bone was harvested which ranged from 19 to 24 ccs (mean 20.7 ccs). In two patients, moderate bleeding had occurred, whereas in remaining patients, mild bleeding was observed. Operative time ranged between 1.25 and 1.50 h (mean 1.36 h). Infection was reported in one patient (7%), which resolved by the end of one and a half months. Complete elimination of the oronasal fistula was achieved in all cases. Neurosensory disturbance (parasthesia) at the donor site was observed in two patients (13%) from the first postoperative week and subsided within 8 months. Gait disturbance was not reported in any of the cases. However, in two patients (13%), intermittent pain during daily activities remained for more than 2 months, which completely resolved by the end of the third month. CONCLUSION: Tibial graft is a reliable donor site option for grafting in cleft alveolus for which the advantage being minimal donor site morbidity. The resorption rate of the graft is also minimal in the present study.

Secondary Correction of the Midline Defect of Upper Lip: A Report of Five Cases.

INTRODUCTION: Primary surgery of cleft lip and palate has dramatically improved with technical and material advances. Some adults who previously underwent surgery still have upper lip deformities or extensive scar, and they are occasionally seen for secondary treatment. CASES: In our study, a total of five patients with secondary deformity of the upper lip with the scarred tissue with paucity of the muscle in the midline were operated using the modified Abbe flap. CONCLUSION: With this technique, we were able to achieve the bulk in the midline over the upper lip and the functional integrity of the muscle was maintained.

An Intraoral Appliance to Retract the Protrusive Premaxilla in Bilateral Cleft Lip Patients Presenting Late for Primary Lip Repair.

The protruding and deviated premaxilla in bilateral complete cleft lip and palate (BCL/P) patients causes a perplexing problem in achieving a tension-free primary lip closure. An innovative noninvasive active intraoral Fixed Pre-Surgical Cleft Orthopedic (FPSCO) appliance is presented that has enabled to successfully reposition the premaxillary segment to a more favorable position prior to the surgical repair in 4 BCL/P patients, who reported late for treatment with a mean age of 18 ± 3 months. All the patients had at least 1 deciduous tooth erupted in 3 cleft segments, 1 premaxilla (PM), and 2 lateral maxillary (LM) segments. This innovative approach is a noninvasive method of getting the cleft segments closer prior to chelioplasty, where conventional presurgical nasoalveolar molding (PNAM) is not possible, which needs to be done early in life as it requires circulating maternal estrogen levels to achieve results preferably possible in patients younger than 3 to 6 months. Bonding to erupted teeth with glass ionomer cement was implemented to secure the appliance. Nickel-titanium (Ni-Ti) closed-coil springs were used that delivered continuous forces of 150 g/5 oz per side to retract the premaxillary segment. The mean active period of treatment time was 3.5 ± 1.6 months and the retention period was 1.2 ± 0.6 months, following which cheiloplasty was performed.

Maxillofacial Injuries in Women: A Retrospective Study of 10 Years.

INTRODUCTION: Diversities exists in incidence, etiology and epidemiology of facial fractures among male and female individuals due to various reasons. Many of the epidemiological studies published during the millennium have shown male predilection. This study was carried to evaluate the etiology, patterns and distribution of facial fractures among different age groups in women. MATERIALS AND METHODS: This Retrospective epidemiological study dealt with a total of 302 women with 422 fractures in maxillofacial region during a period of June 1st 2005 to May 31st 2015 at Mamata Dental College and Hospital, Khammam, Telangana, India. RESULTS: Mean age of incidence was 31.58 years, mandibular fractures were highest (44.07 %) followed by zygomaticomaxillary complex injuries (ZMC) (20.37 %). Road traffic accidents (RTA) injuries (53.7 %) were highest, followed by assault (23.9 %) and other causes. Highest number (33.8 %) of fractures were sustained in the 3rd decade and least (0.7 %) in the 8th decade of life. Among soft tissue injuries most commonly seen were lacerations (51 %). CONCLUSION: Results of this study suggest that there is an increase in the number of maxillofacial injuries in women, representing changes in the society, exposing women to similar conditions like men and increased number of working women. This study helps to identify trauma burden, assess the awareness of current preventive measures, women protection laws, for instituting new guidelines for prevention and planning health care services for women.

Non Calcifying Type of Calcifying Epithelial Odontogenic Tumor: An Unusual Case Report with Special Emphasis on Histogenesis of Calcifications.

Calcifying epithelial odontogenic tumour also known as Pindborg tumour, is a rare benign odontogenic neoplasm of locally aggressive behavior. It is thought to arise from the epithelial element of the enamel origin which are reminiscent of the cells in the stratum intermedium layer of enamel organ in tooth development. The tumour is characterized histologically by the presence of polygonal epithelial cells, calcifications and eosinophilic deposits resembling amyloid. Non-calcifying epithelial odontogenic tumours are very rare and unusual. Only five cases have been reported in the English literature till date. Here, we present an additional case of non calcifying type along with a review of previously reported cases. It has a much lower recurrence and malignant transformation rate.

Zygomaticomaxillary Complex Fractures: A Review of 101 Cases.

AIM: ZMC fractures are the common facial injuries. The main causes of fractures are trauma due to RTAs, assaults, falls, sports related injuries, and the civilian warfares. This study is to evaluate and review the etiology, incidence, clinical findings and treatment of ZMC fractures. A sincere effort has been put forward in the management of ZMC fractures and their efficacy is evaluated in the larger interest of the patients. MATERIALS AND METHODS: In this study 101 patients having displaced ZMC fractures with insignificant medical history were reviewed to evaluate the versatility of its management, with the main emphasis on post operative stability, restoration of mouth opening, wound healing, esthetic restoration of the prominence of cheek and the complications encountered. RESULTS: A total of 101 patients were reviewed for the management of ZMC fractures. All the cases included were managed during the period from August 2007 to August 2009 in the Department of Oral and Maxillofacial Surgery, Mamata Dental College and Hospital, Khammam. The extremes of ages in this study ranged from 17 to 60 years with the mean of 43. RTA was the most common cause of injury. Seventy-eight patients (77 %) were managed with surgical treatment. CONCLUSION: Attention should be paid to improvement in automobile safety devices and compliance by motor vehicle occupants in addition to the improvement of the rules and regulations in sporting activities.

Analysis of 1,545 Fractures of Facial Region-A Retrospective Study.

Incidence and etiology of facial fractures vary from region to region due to various constituents. This study was carried to evaluate the patterns and distribution of fractures in the facial region among different age groups of patients in both males and females caused due to various etiologies. This is a retrospective epidemiological study, which was performed on patients with fractures in the maxillofacial region during a period of 2005 to 2013 at Mamata Dental College and Hospital, Khammam, India. A total of 1,015 patients with 1,545 fractures were referred for treatment to department of oral and maxillofacial injuries surgery, of Mamata Dental College and Hospital, with a mean age of 31.19. The ratio of males (859):females (156) is 5.5:1. Injuries caused by motorbike injuries (34.9%) are highest. The highest frequency of fractures caused by various reasons is seen more in third decade (39%). Mandible (43.81%) is the most common fracture site in the face. Among soft tissue injuries most commonly seen are lacerations (43%). This study differentiates the etiological factors causing facial trauma in several age groups. Results of this study suggest outcomes indicate that more reliance on individual transport on motor vehicles has increased the frequency of facial bone fractures. Regardless of age, motor vehicle accidents were high in all age groups except the first decade of life and above 60 years of age when traffic accidents dominated. Thus effectiveness of current preventive measures is to be assessed, followed by instituting new guidelines for prevention and inflexible traffic rules shall be levied. More epidemiological surveys can, if encouraged to measure the frequency of fractures, better the world.

Surgical Management of Ossifying Fibroma in Maxilla: Report of Two Cases.

Ossifying fibroma is a rare benign osteogenic neoplasm arising from undifferentiated cells of the periodontal ligament. Ossifying fibroma have a well-defined border that differentiates it from fibrous dysplasia clinically, these tumors manifest as a round or ovoid, expansile, painless, slow-growing mass may displace the roots of adjacent teeth and also cause root resorption. They occur at second to fourth decade of life. Radiologically the lesion appears as a dense radiopaque mass surrounded by a thin, well-defined regular radiolucent rim. Patient underwent thorough history taking and complete face, ear, nose, and throat examination. Computed tomography maxilla, orthopantomogram, paranasal sinus reveals entire maxillary sinus involved in one case. Nasal septum deviated to the opposite side, airway reduced on the side of swelling seen in one case. Root resorption seen in two cases and missing teeth in seen in case 1. In our study in case 1, the tumor involved maxillary sinus, medial wall of the nose. The tumors were excised by Weber-Fergusson and in case 2 the tumor was excised by maxillary vestibular approach. Overall recurrence rates after resection is reported to range from 30 to 56%.

Impacted mandibular third molars and their influence on mandibular angle and condyle fractures--a retrospective study.

BACKGROUND: Previous retrospective analyses prove that impacted mandibular third molars (M3s) increase the risk of angle fractures and decrease the risk of concomitant fractures to the condyle. STUDY DESIGN: A retrospective cohort was designed for patients reported to the Department of Oral and Maxillofacial Surgery from January 2011 till June 2013. The study variables are presence or absence of third molar, if it is present, their position, classified using the Pell and Gregory system; angulation, classified using Shiller's method. The outcome variables were angle and condyle fractures. MATERIALS AND METHODS: Hospital records and panoramic radiographs were used to determine and classify these variables. The study sample comprised of 118 mandibular angle and condyle fractures in 110 patients. Database was constructed and analysed using SPSS version 10.0. CONCLUSION: This present retrospective study concluded that the presence of impacted third molar predisposes the angle to fracture and reduces the risk of a concomitant condylar fracture. However absence of impacted third molar increases the risk of condylar fracture. The highest incidence of angle fracture was observed in position A impacted mandibular third molars. And there is no significant relationship, concerning ramus position and angulation of impacted mandibular third molars with the angle fracture.