Prevalence of Neurologic Deficits in Combined Facial and Cervical Spine Injuries: A Retrospective Analysis.

STUDY DESIGN: A retrospective data analysis of maxillofacial trauma patients with combined cervical spine injuries. OBJECTIVE: This study is based on investigating the importance of timely diagnosis of patients who suffer with cervical spine injuries along with maxillofacial trauma by estimating the prevalence of neurologic deficits and its relation with etiology. METHODS: A database of 4460 patients suffering from maxillofacial injuries and admitted in specialized environment surgery of Government Medical College, Trivandrum, Kerala was taken under consideration. The prevalence and types of neurologic deficits and its relation with etiology were assessed in patients with combined facial and cervical spine injuries. RESULTS: Of 4460 patients, 48 were having cervical spine injury along with facial damage with the prevalence of 0.01%. Neurologic deficits were seen highest with etiology of road traffic accidents followed by falls from height. Most of the accidents occurred in bike riders and helmets were absent. CONCLUSIONS: It was concluded that most of the accidents engage bike riders and drivers, due to unethical and unsafe driving. There was no significant correlation found between facial and cervical spine injuries.

Comparative evaluation of bite force analytical study following mandibular osteosysthesis using three-dimensional and conventional locking miniplates.

AIMS AND OBJECTIVES: The aim is to study the effectiveness of 2 mm three-dimensional (3D) titanium miniplates and 2 mm conventional titanium miniplates in osteosynthesis of mandibular fractures by comparing the change in bite force. METHODOLOGY: The study comprised forty patients of age group 20-40 years, weighing 55-75 kg having mandibular fractures. Patients were randomly divided into two equal groups In Group A, twenty patients underwent osteosynthesis using 3D titanium miniplates (2.0 mm system), whereas in Group B, twenty patients underwent osteosynthesis using conventional titanium miniplates (2.0 mm system). After fixation of fracture segments with miniplates, the patients were assessed on the basis of evaluation of bite force at incisor, right molar and left molar region after 1, 3, 6 , and 8 weeks. Comparison of change in bite force was done between Group A and Group B at different follow-ups at incisor, right molar, and left molar. RESULTS: Bite force recordings showed increasing values at subsequent follow-ups, corresponding to the healing of the fracture in both groups. At follow-up III (6 weeks) and IV (8 weeks), bite force values reached near to those in healthy individuals. A significant difference was observed in change in bite force of Group A and Group B at incisor left molar and right molar on subsequent followups. 3D titanium miniplate requires less surgical exposure of the underlying fracture site, with a minimal traction of the surrounding soft tissue. INTERPRETATION AND CONCLUSION: 3D miniplates in mandibular fractures are efficacious enough to bear masticatory loads during the osteosynthesis of fractures. It gives the advantage of greater stability, increased bite force, reduced implant material, and 3D stability.

Neurosensory evaluation of inferior alveolar nerve after bilateral sagittal split ramus osteotomy of mandible.

Mandibular skeletal deformities are mostly corrected by Sagittal Split Ramus Osteotomy. One of the main complications of Bilateral Sagittal Split Ramus Osteotomy is impairement of sensory function of Inferior Alveolar Nerve. OBJECTIVES: To evaluate the occurrence of neurosensory disturbance by comparing the subjective and objective assessment of neurosensory responses after bilateral sagittal split ramus osteotomy.To assess the progress of recovery from the first post operative day till six months. To explain the factors causing neurosensory disturbances. METHOD: A series of 24 patients with clinically and radiographically diagnosed mandibular skeletal deformity were treated with Bilateral Sagittal Split Ramus Osteotomy. For evaluation of the neurosensory responses, the parameters consist of subjective and objective test in order to compare the subjective and objective assessment. RESULTS: On the first post operative day neurosensory disturbances were seen in all the patients. Recovery of sensation was seen in all the patients at the end of this study. CONCLUSION: The incidence of functional nerve disturbances is acceptable, since the progression towards recovery is inevitable. Prolonged neurosensory disturbance is greatly related to the degree of manipulation of the inferior alveolar nerve.

The impact of mandatory helmet law on the outcome of maxillo facial trauma: a comparative study in kerala.

INTRODUCTION: Motorcyclists comprise the majority of road-traffic victims in low and middle income countries,and consequently, the majority of the road-traffic victims globally. Simple measures can be taken to make safer on the roads, which include enforcement of safety measures like seat belt and helmets. The compulsory Helmet law was enforced in Kerala on 18/06/07. Resistance to legislation on motorcycle helmets still coexists world wide with debate on the effectiveness of helmets. In an attempt to analyze the protective effect of helmets on facial injuries a comparative study was conducted in Government Dental College, Calicut, which is a major trauma centre in northern Kerala. METHODS: Data for the present study was obtained from the patients who have reported to the Emergency Department of Oral and Maxillofacial Surgery, Government Dental College, Calicut, for a period of 6 months immediately after the implementation of strict helmet rule in Kerala. For the study all patients with a history of nonfatal motor cycle accident sustaining facial injuries were included. The results were compared with the study conducted in the same institution in the pre law period. RESULTS: The study demonstrates the protective effect of motorcycle helmets in decreasing the morbidity of maxillofacial trauma.There was a marked decrease in incidence of motorcycle-related injuries, remarkable increase in helmet usage and better outcome in helmeted individuals in the post law period. CONCLUSION: Road traffic injury control is a public health problem. Health and medical professionals have an ethical responsibility to educate and arrange for the safety of individuals. Helmets are effective in preventing or reducing the severity of motorcycle-related injuries and in a developing country like India, enforced mandatory motor cycle helmet law is potentially one of the most cost effective interventions available.

Peripheral and central aggressive form of Pindborg tumor of mandible - A rare case report.

INRODUCTION: The calcifying epithelial odontogenic tumor (CEOT), or Pindborg tumor, is a rare and benign odontogenic neoplasm that affects the jaw. Calcifying epithelial odontogenic tumor can be divided into 2 clinico-topographic variants: Intraosseous (central) or Extraosseous (peripheral), with an incidence of 94% and 6%, respectively. The intraosseous tumors have a predilection for the mandible, and most tumors arise in the molar and premolar region of the mandible. When present, extraosseous tumors are often located in the anterior jaw and involve the gingiva. PURPOSE: In this article we present a unique rare variety of Pindborg tumor of mandible with both intraosseous & extraosseous presentation and also locally aggressive behavior. CASE REPORT: A 35 year old man presented with Pindborg tumor (CEOT) of mandible with both intraosseous and extraosseous variant in a single lesion, extending from right premolar region to the left molar region. DISCUSSION: CEOT is an uncommon neoplasm accounting for less than 1% of all odontogenic tumors. Although CEOT is considered less aggressive clinically than typical infiltrating ameloblastoma, but our case is a rarity which was aggressive and also rapidly progressive in short duration, with intra and extraosseous presentation. Hence it was managed surgically similar to a malignant lesion. CONCLUSION: Presentation of two different variants of an odontogenic tumor in a single lesion and aggressive behavior of rather slow growing tumor, mimicking malignant lesion definitely shows possibility of rare variations in different magnitude. Hence proper diagnosis for management with better prognosis of these kinds of tumors is very much essential.

Results of primary versus salvage surgery in carcinoma of the buccal mucosa.

BACKGROUND: Of the oral cancer subsites, carcinoma of the buccal mucosa is commonest. Tumor size, tumor stage, nodal status, grade of tumor, performance status, site of primary, thickness, depth of invasion, tumor margin, etc. are reported to be predictors of survival. PATIENTS AND METHODS: A total of 142 patients treated with surgery were retrospectively studied. Patients were divided in 2 groups. Group I had 77 patients treated with primary surgery while Group II had 65 patients treated by salvage surgery. Survival analysis was carried out by Kaplan-Meier method and difference between survival was calculated by log rank test. Multivariate analysis was carried out by Cox regression model. RESULTS: The overall disease free survival was 54.3% at 5 years. The survival in males was better than females. However, there was no difference in survival by extent and grade of tumor, margins or type of surgical excision. Presence of lymph nodes, nodal stage of the disease, and perineural invasion was found to significantly reduce survival, while patients with lymphoplasmocytic infiltration had significantly better survival. Gender was the only predictor of survival on multivariate analysis. CONCLUSIONS: The results of present study show that there is no difference in survival between patients undergoing primary or salvage surgery. However, these results should be interpreted with caution in absence of randomized controlled trials.

Overexpression of COX-2 gene in oral cancer is independent of stage of disease and degree of differentiation.

The incidence of oral cancer is high in certain parts of the world including Southeast Asia. Smokeless tobacco and areca nut chewing is proposed as a possible factor. Cyclooxygenase 2 (COX-2) receptors are present on neoplastic cells and are proposed to participate in initiation, transformation, progression and metastasis of cancer. In a prospective case-controlled study, 42 cases of squamous cell carcinoma of the oral cavity, 13 cases of oral premalignant lesions, and oral mucosa from 32 normal subjects were evaluated for COX-2 gene expression using reverse transcriptase polymerase chain reaction. The mean age of the patients with oral cancer was 60.2 years. The majority of cancer patients were males while the majority of controls were females. A significantly higher expression of COX-2 was found in cancer patients compared to both normal controls (p=0.0001) and patients with premalignant lesions (0.015). The expression in premalignant lesions was higher compared to healthy subjects (p=0.05). COX-2 expression in oral cancer was found to be independent of grade of tumor and stage of disease. These results show up-regulation of the COX-2 gene in oral cancer and precancer. This suggests a role for COX2 receptors in oral cancer carcinogenesis, and provides the foundation for a large randomized trial to determine the role COX2 inhibitors may play in prevention of oral carcinogenesis.