An In vitro study of biomechanical comparison between titanium 4-hole 3D plates and titanium conventional 4-hole miniplates for internal fixation of mandibular angle fractures.

Background: Fracture fixation, in the present times, is classically done using mini plates. The position and number of plates to fixate a mandibular angle fracture have been and are still extensively researched and reported in the literature. A more recent addition is 3D mini plates. Aim: To compare and evaluate the biomechanical behavior of one 2.0 mm titanium 3D miniplate fixation plate (4- hole) and one 2.0 mm titanium 4-hole miniplate in internal fixation of mandibular angle fractures. Objective: To measure load at break, maximum load, and displacement at maximal load for internal fixation done with 3D mini plates and conventional mini plates respectively. Methods: Five dry cadaveric mandibles were sectioned into 10 hemi-mandibles. Each cadaveric mandible was sectioned at the angle of mandible to simulate unfavorable mandibular angle fracture. The obtained hemimandible were divided into experimental groups (GROUP 1 and GROUP 2) with 5 samples in each group, plated with a linear miniplate and 3D miniplate respectively. Maximal load, Load at break, and displacement at maximum load were the only obtained parameters for comparison. Results: Conventional miniplate showed greater mean maximum load values of 174.93 N±54.45 compared to 3D mini plates which recorded a mean maximum load value of 106.96 N ± 23.86. Load at break and displacement at maximum load were found to be both insignificant. Conclusion: The results in this study showed statistically no significant difference with any of the above parameters except maximal load, between the two groups evaluated. Conventional linear miniplate according to Champy's lines of osteosynthesis can be used successfully for providing satisfactory osteosynthesis with the definitive advantage of cost-effectiveness.

Mandibular access osteotomy: Gate way to parapharyngeal space - A case report.

INTRODUCTION: Para pharyngeal tumors often pose a challenge to surgeons for surgical interventions. Maxillofacial access osteotomies offer excellent visualization and permit unhindered surgical manipulation. Access osteotomy allows the surgeon an adequate access of the surgical field to resect the tumor completely and to preserve vital structures. Though numerous techniques exist, selection of the proper technique is the key factor in reestablishing the function and cosmesis. This article describes our experience with mandibular swing approach that has facilitated complete removal of a parapharyngeal space tumor. CASE PRESENTATION: 35years old female complained of deviation of tongue to one side and swallowing difficulty. Clinical and radiographic examinations were suggestive of a skull base lesion involving the hypoglossal nerve. After evaluation the tumor was excised through a mandibulotomy approach. Post operatively the patient was relieved completely of the symptoms and without any postoperative sequalae. CLINICAL DISCUSSION: Accessibility is the main concern while dealing with skull base lesions. But the success of surgery lies on the selection of right approach. Paramedian mandibular swing approach has its own advantages over various other facial osteotomies. The swinging of the mandible gives advantage of accessing neck and skull base together, which is not possible with other facial osteotomies. CONCLUSION: Management of skull base tumors involve a multidisciplinary approach. Choosing the right approach is often a major dilemma. Access osteotomies of facial skeleton is a hatchway to the skull base lesions. Of which mandibular swing approach is a good option for skull base tumors because of the ease of surgical technique even in inexperienced hands.

An extensive swelling in the anterior mandible - A case report.

INTRODUCTION: Glandular odontogenic cyst is a rare developmental odontogenic cyst, which often pose a challenge to diagnose it clinically. PRESENTATION OF A CASE: A 32 year old female patient was referred to the oral and maxillofacial surgery department with a chief complaint of a painless swelling in the anterior mandible, extending from mandibular left premolar to right first molar region, with fluctuancy and egg shell crackling at right premolar region. The associated teeth were firm. Radio graphically a large radiolucent lesion was seen extending from mandibular left premolar to right first molar region. DISCUSSION: We had many differential diagnoses including keratocystic odontogenic tumour, ameloblastoma and radicular cyst. Incisional biopsy was taken from the most fluctuant area, which was histopathologically suggestive of glandular odontogenic cyst. Enucleation of the cyst, peripheral ostectomy, extraction of teeth and Carnoy's solution application were done under general anaesthesia. CONCLUSION: We often neglect to include uncommon lesions in the differential diagnosis, which may lead to inadequacy in the management protocol. Whenever possible, incisional biopsy should be performed to confirm the lesion before surgical enucleation. Here we present a case in which we were fortunate enough to diagnose the lesion by an incisional biopsy and managed according to the standard protocol.

Potential for Osseous Regeneration of Platelet-Rich Fibrin-A Comparative Study in Mandibular Third Molar Impaction Sockets.

PURPOSE: This study investigated the potential of platelet-rich fibrin (PRF) for osseous regeneration and soft tissue healing in mandibular third molar impaction sockets. MATERIALS AND METHODS: A prospective in vivo study was performed. Randomization was performed after extraction. On one side, the socket was sutured primarily (control site); on the other side, autologous PRF gel was placed and then the socket was sutured (test site). Postoperatively, grid periapical radiographs were obtained at periodic intervals (weeks 1, 4, and 16) and digitalized. Gray-level values were measured at 3 different regions of the socket (for regions of newly formed bone) compared with the natural bone area using HL Image++ software, and the percentage bone fill was measured. Clinical evaluation of soft tissue healing was performed using the healing index of Landry et al (J Periodontol 60:212, 1994) at the specific intervals. RESULTS: Thirty healthy men and women (age range, 18 to 35 yr) with bilaterally impacted mandibular third molars were enrolled in this study. In general, there was markedly greater bone formation in sockets treated with PRF (P < .05). In the PRF group, the average gray-level values at the cervical, middle, and apical regions were 61.85 (standard deviation [SD], ±25.186), 64.54 (SD, ±24.831), and 67.80 (SD, ±23.946), respectively, with a mean value of 64.73 (SD, ±24.411). In the control group, these values were 51.58 (SD, ±15.286), 54.30 (SD, ±16.274), and 57.53 (SD, ±16.187), respectively, with a mean of 53.67 (SD, ±16.528). The average percentage of bone fill in the PRF group was 57.90 (SD, ±26.789) and that of the non-PRF group was 46.74 (SD, ±17.713; P < .05). Soft tissue healing as evaluated by the healing index of Landry et al also was found to be better at the PRF test site and it was statistically significant (P < .05). CONCLUSIONS: There was evidence for better osseous regeneration and soft tissue healing in response to PRF. Further investigations to evaluate the application of PRF in other areas of oral and maxillofacial surgery are imperative.

Intramuscular hemangioma of the masseter muscle- a case report and review of literature.

INTRODUCTION: Intramuscular hemangioma, is a distinctive type of vascular tumor occurring within the skeletal muscle. Most IMH are located in the lower extremity, particularly in the muscles of the thigh and rarely in head and neck region. PRESENTATION OF CASE: 35 years old male reported with a swelling in the left cheek region since 3 years. Clinical and radiological evaluation leads to the diagnosis of Intramuscular hemangioma. Surgical excision was performed and histopathology confirmed the diagnosis. DISCUSSION: Hemangiomas of skeletal muscle represent 0.8% of all benign vascular neoplasm Welsch and Hengerer, 1980 [4]. Of these 13.8% occur in the head and neck region, with the masseter muscle being the most common site, followed by the trapezius and sternocleidomastoid muscles respectively. The lesions previously described as deep infiltrating angiolipomas have now been recognized by the WHO as intramuscular hemangiomas. numerous theories proposed for ethiopathogenisis of vascular lesions have been discussed. CONCLUSION: In conclusion, angiolipomas are rare in the head and neck region, and it should be considered in the differential diagnosis of masses in these regions. Proper radiological and clinical examination will reveal the type of vascular lesion. Excellent results can be obtained with timely management and good surgical skills.

Lingual thyroid.

Lingual thyroid is an abnormal mass of ectopic thyroid tissue seen in base of tongue caused due to embryological aberrancy in development of thyroid gland. Most of the ectopic tissue is seen in the tongue. Their identification and proper management is essential since they may be the only functioning thyroid tissue occurring in the body. We report a case of lingual thyroid in a 40 year old female patient who was hypothyroid with posterior swelling of tongue. Tc-99 scintigraphy confirmed the clinical diagnosis and surgical excision of entire tissue was done by midline mandibular split osteotomy and patient was placed under lifelong thyroxine replacement. Follow up showed excellent results with minimum patient discomfort.

An interesting radiological picture of post traumatic TMJ ankylosis due to sagittal condylar fracture.

INTRODUCTION: In a condylar fracture whether to intervene or to go for conservative management still remains a dilemma. Studies and hypothesis suggests that it's medially dislocated condylar fracture segment that is more likely to ankylose, moreover no consensus have been put forth as to whether to remove the medially displaced fracture segment. PRESENTATION OF CASE: The current article describes a case of unilateral temporomandibular joint (TMJ) ankylosis, which resulted as a sequlae from conservative management of a bilateral condylar fracture of which, the ankylosed side had a sagittal fracture of condyle. In our case the post trauma CT shows the lateral segment abutting with the arch and that the area has become ankylotic in a span of 2 years. Here we report a case of posttraumatic unilateral TMJ ankylosis resulting from closed reduction of a bilateral condylar fracture with interesting radiological findings. DISCUSSION: We have tried to discuss a rather interesting radiological picture of posttraumatic TMJ ankylosis which resulted as a sequlae from conservative management of a bilateral condylar fracture. CONCLUSION: The dilemma for a clinician as to whether to intervene in a condylar fracture or to go for conservative management still remains at large. As in this case the medial fracture segment was intact and the lateral segment was resulting in ankylosis.

Intraoral lipoma: a case report.

Lipomas are rare in oral and maxillofacial regions although they are the most common tumours of mesenchymal origin in human body. The etiology remains unclear. Various different theories explain the pathogenesis of this adipose tissue tumour and also different histological variants of oral lipoma have been given in literature. A case of intraoral lipoma occurring in mental region in a 77-year-old male is reported along with review of the literature. Wide surgical excision was performed and two-year followup showed excellent healing without any recurrence. Lipomas are benign soft tissue neoplasm of mature adipose tissue seen as a common entity in the head and neck region. Intraoral lipomas are a rare entity which may be noticed only during routine dental examinations. Most of them rarely cause pain, resulting in delay to seek treatment. It is mandatory for a clinician to diagnose intraoral lipomas using latest diagnostic methods and conservatively treat them without causing much discomfort.