Analysis of the Changing Patterns of Midface Fractures Using 3D Computed Tomography: An Observational Study.

This article aims to analyze the changing Le Fort fracture patterns using computed tomography (CT) scans with three-dimensional (3D) reconstruction. A prospective observational study was conducted on 60 patients with midface trauma, who had reported to MS Ramaiah Group of Hospitals, Bangalore, between January 2015 and October 2016. CT scans using 1.6 mm axial, sagittal, coronal sections were taken and their 3D reconstruction was made. The images were studied and compared with the standard Le Fort lines. The deviations from the classical Le Fort lines were analyzed and recorded. A note was also made of any additional fixation that was required for these deviations. Descriptive analysis was done and the results expressed in numbers and percentages. Study revealed that the most common cause for the midface fractures was found to be road traffic accidents (81.7%) with a male preponderance (88.3%) and peak incidence in 21 to 30 years of age (40%). Among the 60 patients, 18 (30%) patients had fracture patterns similar to the ideal Le Fort lines, 4 (6.6%) had a combination of Le Fort patterns, and 38 (66.3%) patients had deviations seen from the ideal Le Fort lines. Four types of deviations were recorded, namely, D1(60%), D2(5.4%), D3(10.9%), and D4(23.6%). It was observed that D1 and D3 required additional fixation. Majority of the cases presented as a deviation from ideal Le Fort fractures. CT was a valuable tool in the assessment of these fracture patterns. Deviations, if any, could be better analyzed using the 3D reconstruction images. Proper diagnosis and detection of these deviations make the planning for fixation easier. Repetition of these deviations could propose a newer or modified classification system for Le Fort fractures.

Effect of Alveolar Segmental Sandwich Osteotomy on Alveolar Height: A Preliminary Study.

PURPOSE: Bone loss following extraction is maximum in horizontal dimension. Height is also reduced which is pronounced on the buccal aspect. Various surgical procedures are available to correct the bone volume viz. GBR, onlay bone grafting, alveolar distraction and sandwich osteotomy. Sandwich osteotomy has been found to increase the vertical alveolar bone height successfully. OBJECTIVES: The objective of the study was to assess the effect of alveolar segmental sandwich osteotomy on alveolar height and crestal width. MATERIALS AND METHODOLOGY: A prospective study was undertaken from December 2012 to August 2014. Seven patients with 12 implant sites with a mean age of 36 years were recruited. All seven patients with 12 implant sites underwent alveolar segmental sandwich osteotomy and interpositional bone grafting. Alveolar bone height was assessed radiographically preoperatively, immediate post-op, and at 3 months post-op. Alveolar bone width was assessed radiographically preoperatively and at 3 months post-op. Statistical significance was inferred at p < 0.05. RESULTS: The mean vertical augmentation at immediate post-op was 6.58 mm (p = 0.001). The vertical augmentation that was achieved 3 months post-op was a mean of 3.75 mm which was statistically significant (p = 0.004). The change in alveolar height from immediate post-op to 3 month post-op was a mean 1.69 mm. The mean change in alveolar crestal width at 3 months was a mean of -0.29 mm (p = 0.57). CONCLUSION: Sandwich osteotomy can be used as an alternative technique to increase alveolar bone height prior to implant placement. Moderate alveolar deficiency can be predictably corrected by this technique.

Cyanoacrylate for Intraoral Wound Closure: A Possibility?

Wound closure is a part of any surgical procedure and the objective of laceration repair or incision closure is to approximate the edges of a wound so that natural healing process may occur. Over the years new biomaterials have been discovered as an alternate to conventional suture materials. Cyanoacrylate bioadhesives are one among them. They carry the advantages of rapid application, patient comfort, resistance to infection, hemostatic properties, and no suture removal anxiety. Hence this study was undertaken to study the effect of long chain cyanoacrylate as an adhesive for intraoral wound closure and also to explore its hemostatic and antibacterial effects. Isoamyl-2-cyanoacrylate (AMCRYLATE) was used as the adhesive in the study. In conclusion isoamyl cyanoacrylate can be used for intraoral wound closure, as an alternative to sutures for gluing the mucoperiosteum to bone, for example, after impaction removal, periapical surgeries, and cleft repair. Its hemostatic and antibacterial activity has to be further evaluated.

Maxillary osteosarcoma masquerading as chondromyxoid fibroma: report of a case.

Osteosarcomas are highly malignant bone tumours. Its appearance in craniofacial bones is a rare entity and accounts for only 1% of all head and neck malignancies. We present an uncommon case report of a 42 year old male patient with osteosarcoma of left maxilla, which was successfully excised under general anesthesia. The patient reported to us with a history of pain, swelling, pus discharge and tooth extraction, which led to the differential diagnosis of suppurative osteomyelitis, dentoalveolar abscess, benign odontogenic tumour, an infected cyst etc. Histopathological examination of incisional biopsy was reported as chondromyxoid fibroma which is a rare benign tumour. However the excisional biopsy specimen was reported as osteosarcoma of maxilla. The clinical presentation, diagnostic challenges and its therapeutic approach are addressed. This case serves to emphasize the need to recognize osteosarcoma when it presents in unexpected locations, especially because of its rarity.

"A comparative evaluation between single noncompression titanium miniplate and three dimensional titanium miniplate in treatment of mandibular angle fracture"--a randomized prospective study.

PURPOSE: The aim of this study was to compare efficacy between the single non-compression titanium miniplate and single three-dimensional titanium miniplate in mandibular angle fracture treatment. METHOD AND MATERIALS: A prospective study of 20 patients with mandibular angle fractures. Patients were randomly categorized into two groups with 10 patients in each group. Group-I patients were treated with single 2.0mm conventional titanium miniplate, Group-II patients were treated with single 2.0mm three-dimensional titanium miniplate according to Champy's principles. Parameters such as stability of fracture fragments, occlusion, mouth opening, additional fixation required and complications were evaluated at different time intervals. RESULTS: In Group-I, about 40% (n=4) of patients showed unstable fracture fragments on immediate postoperative day whereas in Group-II only 10% (n=1) of patients with fracture instability. In Group-I, 30% (n=3) had mild occlusal derangement and 20% (n=2) had deranged occlusion on immediate postoperative day, where as in Group-II only 20% (n=2) of patients had mild occlusal derangement. Additional fixation required in 30% (n=3) of patients in group-I, and 10% (n=1) in Group-II. 20% (n=2) of patients in Group-I developed infection. All patients in both the groups had inadequate mouth opening on immediate post operative day, later resumed normal mouth opening. 10% (n=1) in group-I and 20% (n=2) of patients in group-II presented with postinjury/preoperative inferior alveolar nerve sensory disturbance with no incidence of postoperative sensory disturbance. None of the patients in both the groups had malunion, nonunion, plate fracture, and loosening of plates and screws. CONCLUSION: 3-D titanium miniplates showed more favorable results compared to single conventional titanium miniplate with respect to initial interfragmentary stability and complications.

Potential danger of toothbrushes for children.

Toothbrush, the innocent cleaning aid, has been reported to cause life threatening oropharyngeal injuries in pediatric literature. A case of a 4-year-old child reporting to an emergency department with a toothbrush impaled in her mouth while her father was forcefully brushing her teeth is reported here. Hemostasis was achieved by digital pressure and the impaled toothbrush was removed surgically. Uneventful recovery was noted. Parental anxiety and a lack of patient cooperation was noted. Such impaled objects fractured and left behind have been reported to cause serious space infections and mediastinitus. Advising parents to be careful with their children's toothbrush is important as prevention of injuries from such commonly used object could be easily achieved.

Buccal pad of fat and its applications in oral and maxillofacial surgery: a review of published literature (February) 2004 to (July) 2009.

This review of the literature was performed to study the frequency and preference of usage of the buccal fat pad (BFP) in oral and maxillofacial reconstruction and to determine its potential versatility in various clinical applications. A computerized literature search using Medline, the JGate@Helinet database, and the Google internet search engine was performed for all relevant articles with specific keywords from February 2004 to July 2009. Focus was on the use of BFP regarding size, location, and types of defects and success and failure rates for various applications. It was found that BFP has been used most commonly for closure of oroantral communications/fistula, followed by reconstruction of maxillary defects; with closure of primary clefts, coverage of mucosal defects, etc. being other uses. Studies suggested that owing to favorable anatomic location, high vascularity, ease of handling, and low failure rate, the BFP has become the flap of choice for reconstruction of various oral defects. The size limitation of the BFP must be known to permit successful outcome. The results have been encouraging for clinicians to make use of potential benefits of the BFP in closure of defects in the oral and maxillofacial region.

Analysis of in vitro and in vivo sensitivity of oral cancer cells to methotrexate.

AIM: The present study was directed on the assessment of the response of treatment-naive oral cancer cells to methotrexate (MTX) in vitro: and clinical response to MTX therapy. METHODS: A pilot study of in vitro: evaluation of MTX response of oral cancer cells from 10 patients was conducted using a cell viability assay to determine the sensitivity/resistance to MTX. Quantitative in vitro: data were correlated to the clinical outcome to MTX therapy. RESULTS: A positive correlation was observed between the effect of MTX on tumor cells in vitro: and clinical response for 7 out of 10 patients. CONCLUSIONS: Observations from the proof-of-principle pilot study suggests that oral cancer cells have intrinsically variable response to MTX. Confirmation of these findings with a larger cohort of patients could aid in the development of individualized therapies for this class of malignancy.

Expression of oncofoetal marker carcinoembryonic antigen in oral cancers in South India--a pilot study.

Expression of the oncofoetal glycoprotein, carcinoembryonic antigen (CEA), has been observed in a number of malignancies and is also being pursued as a target for anti-cancer therapy. This study explored the status of this biochemical entity in the oral squamous cell carcinoma (SCC) in South India caused by extensive chewing habits. Squamous cell carcinoma in the study belonged to grade I and grade II. Tumour staging of the patients recruited in the study ranged from T2N1M0 to T4N3M0. Of the grade II cases studied, 88% (7 out of 8) showed expression of CEA. The 2 cases of grade I SCC of buccal mucosa also showed positive anti-CEA staining. If the results from this pilot study can be validated with a larger sample size, a role can be attributed to this tumour marker in oral neoplasia, thereby opening up avenues for using CEA as an additional diagnostic marker in oral SCC in this population and as a possible target for anti-cancer therapy.

Giant cell tumor of the temporal bone--a case report.

BACKGROUND: Giant cell tumor is a benign but locally aggressive bone neoplasm which uncommonly involves the skull. The petrous portion of the temporal bone forms a rare location for this tumor. CASE PRESENTATION: The authors report a case of a large giant cell tumor involving the petrous and squamous portions of the temporal bone in a 26 year old male patient. He presented with right side severe hearing loss and facial paresis. Radical excision of the tumor was achieved but facial palsy could not be avoided. CONCLUSION: Radical excision of skull base giant cell tumor may be hazardous but if achieved is the optimal treatment and may be curative.