ABSTRACT
Purpose: Fractures of lingual cortex are frequently left untreated leading to poor resolution of patient's symptoms and function. Positioning an implant on same side of fracture would provide better reduction. The study aims at improving stability offered by Erich arch bar placed on lingual surface, by Finite element analysis (FEA) along with a pilot clinical trial. Methods: Two FEA models were generated from CT scan of an individual having lingual cortex fracture: control model with labial arch bar and study model with lingual arch bar. Parameters assessed: Stress distribution (Mpa) along lines of osteosynthesis; Separation of fracture fragments (mm) across fracture line. Associated, was a clinical trial of 5 patients, managed by placing lingual arch bar. Feasibility of arch bar, post-operative pain, radiographic inter-fragmentary gap and complications were assessed clinically. Results: Lingual positioning of arch bar demonstrated less displacement (mm) of fracture fragments compared to labial placement (0.123 vs. 0.677) upon application of masticatory load. Insignificant lingual splay and lesser degree of stress distribution (Mpa) was observed (83.1 vs. 99.3) favoring placement of arch bar on lingual side. Clinical trial correlated with outcomes of FEA, resulting in improvement of patient's symptoms. Conclusion: FEA and supporting clinical trial provided an effective method of reduction for lingual cortical fracture.
ABSTRACT
BACKGROUND: The key role played by anastomosis determines the outcome of any free flap surgery. Besides many methods, the application of LASERS for performing microvascular anastomosis gaining popularity in recent times. The ease of application, utilizing lesser time for performing anastomosis than the conventional methods and minimal injury to the vessel layers, are contributing factors to the success of free flap surgery. Laser-assisted vascular anastomosis (LAVA) fulfills the criteria of lesser vessel wall damage and faster anastomosis and thus resulting in reduced flap ischemic time and overall outcome of the surgery. METHODS: A prospective randomized case-control trial comparing conventional suturing methods (group I) with Laser-assisted vascular anastomosis (group II) on free flaps were performed for the reconstruction of orofacial defects. The parameters assessed for evaluation were anastomotic time, ischemic time and vessel patency following anastomosis. Student's t test and Fisher's exact tests were implied for statistical analysis. RESULTS: The mean time taken for anastomosis was 19.75 min in the conventional group and 3.86 min in LAVA anastomosis. This difference was found to be extremely statistically significant (p < 0.00001). The mean ischemic time of the free flap harvested was 384.87 min in group I and 138.7 min in group II. This difference was also found to be extremely statistically significant (p < 0.00001). CONCLUSION: The average anastomosis time for LAVA group was considerably reduced and total ischemic time was considerably less with successful uptake of the flap. In LAVA group, the post-operative complication was less when compared to the conventional anastomosis technique.
ABSTRACT
Basal cell adenoma is a rare benign salivary gland neoplasm. The most common location is in parotid region. Clinically, gradual growth and firm consistency are seen. They account for 1 to 3% among all salivary gland neoplasms. Prominent basaloid cells with cluster of isomorphic cells and interspersed trabeculae are present histopathologically. In this article, we present a rare case of basal cell adenoma of retromolar region from minor salivary gland origin.
