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Background: Oral and maxillofacial surgery deals with wide range of oral defects, wound closure, tissue resection, and tissue reconstruction. The purpose of our study is to use amniotic membrane for closure of post surgery defect in patient of oral submucous fibrosis to utilize its growth factor and scaffold nature for effective healing and to evaluate effectiveness of amniotic membrane in treatment outcome. The objectives are to compare post-operative mouth opening, healing of amniotic membrane and buccal fat pad. Material and Method: Diagnosed patients with OSMF are divided into two surgical site Group I (n = 5patients)-Left side buccal mucosa in which resection of fibrous band with coronoidectomy followed by reconstruction of the mucosal defect with BFP. Group II-Right side buccal mucosa in which resection of fibrous band with coronoidectomy followed by reconstruction of the mucosal defect with freeze dried irradiated amniotic membrane. Result: This study suggested that in comparison to buccal fat pad flap, the HAM graft is a better option for oral reconstruction in terms of infection, graft failure, MMO, inflammation, pain. Outcome indicated that the HAM is biologically ideal graft for oral wounds and could be used as clinical alternative for various repair surgery for oral defects. Conclusion: The amniotic membrane was found easy to handle and easy to use with inherent hemostatic property which is observed in all patients. No patients had shown any evidence of any complications. Good pain control observed in patients throughout postoperative period.
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INTRODUCTION: The temporo-mandibular joint (TMJ) is a complex anatomical structure that is concerned with mastication, deglutition, and speech. Ankylosis of the TMJ occurs when the condyle gets fused to glenoid fossa by bony or fibrous tissue. It is an incapacitating problem, commonly occurring in children and is usually associated with trauma or infection. MATERIALS AND METHODS: A total of ten patients with written informed consent having TMJ ankylosis (unilateral/bilateral) fulfilling the inclusion criteria were selected for the study and were operated under general anaesthesia with arthrectomy followed by reconstruction of ramal condylar unit with SCG (Group I) or CCG (Group II). Pre-operative and post-operative evaluation assessments were done at regular intervals for maximum mouth opening, range of mandibular movements, and height of ramus. RESULTS: Statistical analysis shows that the increase in maximum mouth opening was found 1.1% higher in Group II (75.9%) as compared to Group I (74.9%). The increase in lateral excursion at affected side was found 1.3% higher in Group I (84.6%) as compared to Group II (83.3%). The increase in lateral excursion at non-affected side was found 10.3% higher in Group I (76.9%) as compared to Group II (66.7%). The increase in protrusive movement was found 17.5% higher in Group II (88.9%) as compared to Group I (71.4%). Six months post-operative height of ramus was found 10.5% higher in Group II as compared to Group I. CONCLUSION: The present study concludes the superiority of costochondral graft over sternoclavicular graft in terms of growth and function. Continued deliberation between the two grafts with larger sample size and a longer follow-up with multicentric consensus will be required to draw definitive indications of the two grafts.
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Disarticulation resections are required for treatment of variety of pathologies of the jaws. These resections are mostly carried out through extraoral approach, which bear significant postoperative morbidity. The transoral approach may be used for this purpose in benign pathological cases of the mandible to limit the postoperative morbidity of extraoral approach, as it provides sufficient access not only for resection and disarticulation but also for immediate reconstruction. This article shares our experience with transoral approach for resection and disarticulation in a case of kerato cystic odontogenic tumor and simultaneous reconstruction. Excellent cosmetic and functional results were observed in 6-month follow-up.
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OBJECTIVE: Temporomandibular joint ankylosis (TMJa) is a distressing condition, but can be surgically managed by gap or interpositional arthroplasty, with an aim to restore joint function and prevent re-ankylosis. The aim of this paper is to compare two interposition materials used in management of TMJ ankylosis. METHODS: 15 patients with TMJa were randomly allocated to two groups: group A (n = 6), interposition material used was medical-grade silicon elastomer, and group B (n = 9) where the interposition material used was temporalis fascia. Patients were followed up at regular intervals of 1 and 2 weeks, 1 month, 3 months, and 6 months and were assessed on following parameters: pain by VAS Scale, maximal mouth opening (MMO), implant rejection, and recurrence. RESULTS: The results showed a loss of 4.6% and 7.9% in maximal interincisal mouth opening at 3rd and 6th months in Group A while Group B had a mean loss of 9% and 10% at 3rd and 6th months respectively without any significant difference. None of our cases showed recurrence or implant rejection. CONCLUSION: We conclude that silicone is comparable to temporalis fascia in terms of stability, surgical ease, and adaptability. It not only restores the function of mandible and ensures good maximum interincisal opening but also maintains the vertical ramal height. Also, it requires less operating time and is easy to handle but is not economical. It might be an effective way to restore function and prevent re-ankylosis.
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AIM: To evaluate the effectiveness of coronoidectomy in advanced (stage III-IV) oral submucous fibrosis (OSMF) and temporomandibular joint (TMJ) ankylosis. MATERIALS AND METHODS: Five patients clinically diagnosed as grade III/IV OSMF (group 1) and seven patients clinically and radiographically confirmed as TMJ ankylosis (group 2) underwent surgery entailing coronoidectomy in addition to conventional surgical procedures required in both the conditions followed by vigorous mouth opening exercises. The results were evaluated using the interincisal distance at maximum mouth opening as the objective outcome over a follow-up period of 2 months. RESULTS: OSMF patients (group I) showed a mean preoperative interincisal opening of 14.40 mm which increased to 24.60 mm after conventional procedures and showed further increment to 35 and 44.80 mm after unilateral and bilateral coronoidectomy, respectively; which was statistically significant (P = 0.043). Follow-up of 2 months showed a gradual increase in mean mouth opening compared to baseline which was also found to be statistically significant (P = 0.043). In TMJ ankylosis patients (group II), preoperative mean mouth opening of 6.71 mm increased to 24.29 mm after conventional procedures, and further to 37.29 mm after unilateral coronoidectomy which was statistically significant (P = 0.018). On subsequent follow-up of 2 months, a gradual increase in mean mouth opening compared to baseline was observed which was statistically significant (P = 0.018). CONCLUSION: Coronoidectomy is an effective adjunct in increasing intraoperative and stabilizing postoperative mouth opening.
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Osteomyelitis is an inflammatory disease of the bone that usually begins as an infection of the medullary cavity, rapidly involves the haversian system, and quickly extends to the periosteum of the area. It develops in the jaws after a chronic odontogenic infection or for a variety of other reasons such as trauma, inadequate treatment of fracture, or irradiation to the mandible. When antimicrobial agents or drainage prove unsuccessful, acute osteomyelitis may become chronic. Conventional radiography, culture, bone biopsy, radioisotope bone scan, laser Doppler flowmetry, computed tomography, and magnetic resonance imaging are used for its diagnosis. We present a case of chronic suppurative osteomyelitis associated with a draining extraoral sinus, which was successfully treated with surgical debridement and stabilization with a 10-hole reconstruction plate and bicortical screws using AO principles.
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Maxillofacial injuries in pediatric population warrant special attention because of anatomic considerations, potential for growth disturbances and rapidity of healing. We report a case of displaced mandibular fracture in a child who tested positive for hepatitis B surface antigen (HbsAg) and, therefore, was managed conservatively by closed reduction stabilized with acrylic dental splints fabricated on reduced dental models.
