Conservative Management of Odontogenic Keratocyst in a Tertiary Hospital.

INTRODUCTION: Odontogenic keratocysts (OKCs) are benign intraosseous odontogenic lesions that have a locally aggressive behavior and exhibit a high recurrence rate after the treatment. The most appropriate surgical approaches for the successful treatment of OKCs remain controversial. AIM: The aim of this study was to evaluate the conservative management of OKCs by enucleation along with peripheral ostectomy and chemical cauterization in terms of recurrence rates after the surgical procedure. MATERIALS AND METHODS: A retrospective study on 36 cases of OKCs treated at the Oral and Maxillofacial Surgery Department of a tertiary hospital from 2010 to 2017 was done. The demographic, clinical, radiographic, and histologic data were collected for each patient. All cases were surgically treated by enucleation followed by peripheral ostectomy and chemical cauterization using Carnoy's solution. The teeth that were involved in the lesion were extracted. The diagnosis was confirmed with excisional biopsy and histopathology reports. RESULTS: Most of the OKCs were found in the mandible, except three which were present in the maxilla. A significantly higher incidence was seen in males in the age group of 21-30 years. Most of the cases (30 out of 36 cases) were accessed intraorally. Patients were followed up for up to 5 years. Recurrence of the operated OKCs was observed in five cases which were managed by enucleation with peripheral ostectomy and chemical cauterization again with good results. CONCLUSION: The results suggest that proper enucleation followed by peripheral ostectomy and chemical cauterization using Carnoy's solution may be the best and optimal approach for the management of OKC.

A Retrospective Study of Condylar Fracture Management in a Tertiary Care Hospital-A 10-Year Experience.

INTRODUCTION: Since the advent of rigid fixation, there has been a paradigm shift in the management of condylar fractures from closed treatment options to open reduction and rigid internal fixation. MATERIALS AND METHOD: Sixty-eight cases of condylar fractures reporting to Vydehi Institute of Dental Sciences, Bangalore, between 2009 and 2018 were reviewed in terms of age, sex, type of fracture, position of the mandibular third molar and the treatment rendered. RESULTS: The majority of the patients were males (60). There was an involvement of the right side in 34, left in 21 and bilateral involvement in 13 cases. Forty-three of the fractures were subcondylar, and 25 were intracapsular. Significantly in most cases, the mandibular third molar was either fully erupted (42) or missing (12). Sixty-one cases were subjected to surgical management including 49 cases of rigid internal fixation, and 12 of the intracapsular fractures had the condylar stump/segment removed. Only seven cases were not treated surgically. Most of the cases (44) were in the age group of 21-40, 12 were in the age group of 41-60, 9 were in the age group of 1-20, and 3 patients were above 60. CONCLUSION: Condylar fractures more often do not require surgical intervention, and their incidence is more likely to occur when the third molar is either fully erupted or missing.

Synovial Chondromatosis of the Temporomandibular Joint.

Synovial chondromatosis is a rare condition characterized by the presence of loose cartilaginous bodies, due to the abnormal proliferation of synovial membrane. However, its manifestation in the temporomandibular joint is a rare finding, occurring predominantly in females. This case report describes the clinical features, diagnosis and management of a case of synovial chondromatosis.

Comparison of Ultrasonography with Conventional Radiography in Diagnosis of Zygomatic Complex Fractures.

INTRODUCTION: The diagnosis of zygomatic complex fractures is important in planning the treatment since the complex gives form to the projection, width and height of the midface. AIM: This study was carried out to assess the diagnostic sensitivity and utility of high-resolution ultrasonography in comparison with conventional radiography in the diagnosis of the zygomatic complex fractures. MATERIALS AND METHOD: Twenty-five cases of clinically diagnosed zygomatic complex fractures were subjected to conventional radiographs and USG study. RESULTS: The accuracy in terms of specificity and sensitivity of USG was comparable to conventional radiographs in the detection of the fractures of the zygomatic complex. CONCLUSION: This study points to the suitability of USG as an alternative to the use of plain radiographs in the diagnosis of zygomatic complex fractures. USG is safe, inexpensive and an accurate adjunct to conventional radiography in diagnosis of zygomatic complex fractures.

Ameloblastoma Management: "Horses for Courses" Protocol.

PURPOSE: The purpose of the article is to review 45 cases of ameloblastoma treated in a tertiary care centre depending on the extent of the pathology, in terms of recurrence and morbidity of the patients. MATERIALS AND METHOD: This was a retrospective study of patients who underwent treatment for ameloblastoma between 2009 and 2018 at Vydehi Institute of Dental Sciences, Bangalore. During the first phase of 4 years, the focus of the treatment was on avoiding any recurrence, and therefore, resection followed by reconstruction with reconstruction plates was the only modality used in ten patients. However, from 2014, it was decided to treat each patient based on the extent of the lesion and decide on either conservative management in the form of enucleation followed by peripheral ostectomy and chemical cauterisation or resection with safe margins and reconstruction with reconstruction plates. RESULTS: The study sample consisted of 45 patients, and the ages ranged from 12 to 65 years with an average of 36. There were 30 males and 15 females. In the first phase of treatment protocol adopted, ten patients underwent resection. In the later period, 18 patients were treated by conservative methods and 16 patients were treated by radical management. There were only three recurrences over a period of 3-year follow-up in the group treated conservatively. CONCLUSION: Considering the benign nature of the tumour and the morbidity after resection, patients, most of whom are in the younger age group, can still be subjected to conservative treatment provided they are followed up for a long period thus assuring them of a better quality of life.

Maxillofacial Fracture Patterns in Road Traffic Accidents.

OBJECTIVE: The objective of this study is to analyze the maxillofacial fracture pattern from road traffic accidents (RTAs) in cases treated surgically in a tertiary hospital during July 2008-June 2018. MATERIALS AND METHOD: Data available in the department of oral and maxillofacial surgery of the institution of patients with maxillofacial fractures sustained due to RTAs that were treated in the department between the period July 2008 and June 2018 were collected and analyzed. The variables analyzed for the study were etiology, gender, age, and type of fracture. All cases were treated by open reduction and rigid internal fixation. RESULTS: A total of 348 patients with maxillofacial fractures were diagnosed, of which 335 were male and 13 were female. The ages ranged from 7 to 70 years. The maximum cases were in the age group of 16-30 years with 181 fractures followed by 31-45 group with 133 fractures, 45-60 years with 21 fractures, 0-15 years with 8 fractures, and >60 years with five fractures. The maximum incidence of fractures was in the mandible with 168 cases followed by 92 in zygomatic complex, combination of fractures in 53 cases, 13 LeFort I fractures, nine frontal bone fractures, three fractures in other areas, five nasal fractures, and five LeFort II fractures. Males predominated the cases of mandibular fractures involving multiple sites and cases involving multiple bones. CONCLUSION: A maximum number of maxillofacial fractures cases were in the second and third decades of life, and the high-speed vehicles and lack of protective safety accessories such as helmets and seatbelts were responsible for the wide variety of pattern fractures of facial bones.