Analysis of Variation in Anatomy of Lower Limb Vasculature and Implications for Free Fibula Flap by Color Doppler Imaging.

Background: The free fibula flap (FFF) has proved to be an adequate adjunct tool in the reconstruction of defects following cancer ablation. Although various investigation tools in the past have been proved to be adequate to study the blood supply of the various trunks of arteries, for the survival of graft, the color Doppler flow study (CDF) can be done for the accurate examination of various perforators for the same in the lower limbs prior to its harvest. Materials and Methods: 40 patients were included in the study and were examined for free fibula flap tissue transfer via color Doppler study for the lower limb perforators. Results: In the study, the perforators that are musculocutaneous, septocutaneous and septomusculocutaneous were detected in 80 legs that were examined and all of them had adequate diameter to justify the fact that the graft can be taken for harvesting, except for only two cases where it was found that they were hypoplastic. Conclusion: CDF can be a reliable and informative tool in patients planned for free fibula tissue transfer. Also, the skin perforators can be mapped, so as to determine skin paddle inclusion.

Comparative Evaluation of Reconstructive Methods in Oral Submucous Fibrosis.

BACKGROUND: Oral submucous fibrosis is a chronic, progressive, scarring, precancerous condition of oral mucosa which on progression causes severe trismus. AIM AND OBJECTIVES: To compare and evaluate the efficiency of buccal fat pad, platysmal mucocutaneous flap, nasolabial flap, collagen membrane graft, split thickness skin graft and temporoparietal fascia in reconstruction of surgical defect created by excision of fibrous bands in oral submucous fibrosis. RESULTS: After 6 months of follow-up, the interincisal mouth opening was 40.0 mm in case of buccal pad fat, 24.5 mm in temporoparietal fascia flap group, 33.8 in collagen membrane graft group, 34.5 mm in platysma flap group, 34.7 mm in nasolabial flap group, 29.3 mm in split thickness skin graft. ANOVA statistical analysis for postoperative interincisal distance at various time intervals and between pre-, intra- and postoperative interincisal distances were carried out which showed the results were significant at p value < 0.05 in all groups. No postoperative complications were noted in buccal fat pad group, split thickness skin graft group and collagen membrane group. However, platysmal group had flap necrosis and temporoparietal flap group patients had to undergo a second debulking procedure after one month. CONCLUSION: From our study, we concluded buccal fat pad yields superior results with respect to postoperative mouth opening and related complications.

Evaluation of Postoperative Sensory and Motor Deficit Following Craniomaxillofacial Reconstruction Using Bicoronal Flap: An Evaluative Study.

INTRODUCTION: The ideal surgical approach to treat craniomaxillofacial skeleton should provide maximum exposure of the facial skeleton, ensure less potential for injury to facial structures and allow for good cosmetic result. Several designs have been described such as hemicoronal, preauricular, lateral eyebrow, and bicoronal approach. Although the bicoronal flap gives superior long-term cosmetic results, it has a few disadvantages. We conducted this study to assess neurosensory disturbances and motor deficit following craniomaxillofacial reconstruction using bicoronal flap. MATERIALS AND METHODS: A prospective study was carried out in the Department of Oral and Maxillofacial Surgery, North Karnataka, India. Forty patients with craniomaxillofacial trauma requiring fixation of fracture or reconstruction were included in the study. Postoperative neurosensory evaluation is carried out at intervals of 1 week, 1 month, 3 months, and 6 months clinically using mechanoreceptive and nociceptive testing. RESULTS: Among 40 cases, 11 (27.5%) had postoperative paraesthesia affecting the supraorbital region; 9 (22.5%) of them had return of normal sensation within 6 months and 2 (5%) patients became normal after one year. Four patients had unilateral frontalis weakness on the right side for a period of 6 months. DISCUSSION: The bicoronal flap is a preferred approach for access to the craniofacial skeleton and orbit with minimal sensory and motor complications. However, before choosing the same, the advantage of raising such a wide flap should be weighted comparing the benefits and complications.

Ultrasound guided drainage of submasseteric space abscesses.

BACKGROUND AND OBJECTIVES: The objective of this study was to evaluate the usefulness of ultrasound guided surgical drainage in submasseteric space abscess of odontogenic origin without incision. MATERIALS AND METHODS: Eleven patients (4 males and 7 females) aged 18 to 36 years were included in this study. Each patient had clinically and radiologically diagnosed submasseteric space abscesses of odontogenic origin. All the patients underwent ultrasound guided drainage by using 5.7 MHz B-mode, gray scale, ultrasound scanner. The aspirated pus was sent for microbiological culture and sensitivity tests. All the patients were given a prescription of antibiotics like Amoxicillin with Clavulanate in a dose of 625 mg 8 hourly daily, Metronidazole 400 mg 8 h daily and analgesic Diclofenac potassium in a dose of 50 mg 8 h daily. Infection was considered resolving when the following criteria were met like ceased or minimal drainage. RESULTS: There was successful resolution of abscess in 10 cases, 1 case underwent incision and drainage because of spread of infection to other spaces. CONCLUSION: This study on 11 cases supported ultrasonography as an intraoperative aid in the assessment of the abscess cavity and its real-time imaging facility will help in the location and drainage of the abscess cavity effectively. It avoids large, unsightly, postoperative facial scars and often eliminates the need of general anesthesia and hospitalization.

Swelling on lower lip not always a mucocele !!!

Schwannomas are well characterized uncommon neural neoplasms which may rarely present with variation in clinical manifestation. Oral Schwannomas clinically simulate other lesions like traumatic fibroma, pyogenic granuloma, mucocele and salivary gland lesions. The diagnosis of schwannoma is typically made at the time of surgery following biopsy and surgical resection is the mainstay of treatment with no chances of recurrence as they are well encapsulated. We present a case of schwannoma of lower lip occurring in a 21-year-old female patient.

Parapharyngeal ganglioneuroma of hypoglossal nerve in a 4 year old girl: a rare case report.

Parapharyngeal ganglioneuroma of hypoglossal nerve is very rare benign tumor arising from sympathetic nervous system producing mass and functional effect. We present a rare case in 4 year old girl with history of swelling and odynophagia in left side of neck. Extensive clinical, immunohistochemistry, and imaging of the swelling confirmed the diagnosis of ganglioneuroma after surgical excision.

Advancement genioplasty--cephalometric analysis of osseous and soft tissue changes.

BACKGROUND: Genioplasty is often performed to esthetically improve patient's profiles in the lower facial third. Many factors account for the variability in soft tissue response like dissection technique, magnitude and direction of movement and stability of the genial segment. Optimum treatment planning thus requires an understanding of the soft tissue response to various genial procedures. AIMS AND OBJECTIVE: To determine the stability, ratio of hard and soft tissues and changes in the lower facial profile after advancement genioplasty. MATERIALS AND METHODS: Ten patients were evaluated cephalometrically for the soft tissue changes in relation to hard tissues after advancement genioplasty. Pre operative, immediate post operative and 6 months post operative lateral cephalogram were taken. Pre operative tracings were superimposed with post operative cephalograms to produce a composite tracing. Changes in the osseous tissues are assessed and related to the net changes in the soft tissues. RESULTS: The ratio of horizontal changes of osseous to soft tissues was found to be 1:0.89. The mean resorption was 0.85 mm (10.7%). The vertical changes are minimal and non significant. There are significant changes in the soft tissue profile such as decrease in the soft tissue thickness, facial convexity angle, lower facial submental angle and increase in mentolabial sulcus depth. CONCLUSION: The standard advancement genioplasty procedure by inferior osteotomy of the chin with broadest musculo-periosteal pedicle with rigid internal fixation was followed. The soft tissue response is almost equal to the bony movement. The stability of the hard tissues is good with minimum amount of resorption so as to achieve more predictable results.

Cervical lymph node metastasis in oral squamous carcinoma preoperative assessment and histopathology after neck dissection.

BACKGROUND: The presence or absence of nodal metastasis has a great impact on the prognosis and survival of patients with head and neck cancer. The risk of occult metastasis is related to the method by which the lymph nodes are evaluated. It is possible to reduce the risk of undiagnosed metastasis with accurate imaging techniques and thus probably reduce the number of elective neck treatments. AIMS AND OBJECTIVES: To assess the accuracy of clinical palpation, CT Scan, Ultrasound and Ultrasound guided FNAC in prediction of lymph node metastasis in oral squamous cell carcinoma so that a suitable surgical neck dissection can be carried out. METHODS: Ten patients with oral squamous cell carcinoma who underwent 10 neck dissections (4 RND, 6 SOND) were included. All the patients underwent examination of neck pre operatively by palpation, Computed Tomography with contrast, Ultrasound and Ultrasound guided FNAC for no detection. The findings were correlated with the results of histopathologic examination of the neck specimen. The results were obtained after statistical analysis. RESULTS: Six neck dissection specimens showed metastatic lymph node involvement in postoperative histopathology. Lymph node involvement was identified preoperatively by palpation in 7 necks, CT in 3 necks, US in 9 necks and USFNAC was positive in 4 cases. The palpation showed 83% sensitivity, 50% specificity. CT showed sensitivity of 50%, specificity of 100%, US showed sensitivity of 100%, specificity of 25% and US-FNAC showed sensitivity of 67%, specificity of 100%. CONCLUSION: The palpation, CT Scan and US are equally accurate but the USFNAC is the most accurate technique in assessing metastasis in lymph nodes in patients with oral squamous cell carcinoma.