Diagnostic tools in maxillofacial fractures: Is there really a need of three-dimensional computed tomography?

INTRODUCTION: Because of its functional and cosmetic importance, facial injuries, especially bony fractures are clinically very significant. Missed and maltreated fractures might result in malocclusion and disfigurement of the face, thus making accurate diagnosis of the fracture very essential. In earlier times, conventional radiography along with clinical examination played a major role in diagnosis of maxillofacial fractures. However, it was noted that the overlapping nature of bones and the inability to visualise soft tissue swelling and fracture displacement, especially in face, makes radiography less reliable and useful. Computed tomography (CT), also called as X-ray computed radiography, has helped in solving this problem. This clinical study is to compare three-dimensional (3D) CT reconstruction with conventional radiography in evaluating the maxillofacial fractures preoperatively and effecting the surgical management, accordingly. MATERIALS AND METHODS: Fifty patients, with suspected maxillofacial fractures on clinical examination, were subjected to conventional radiography and CT face with 3D reconstruction. The number and site of fractures in zygoma, maxilla, mandible and nose, detected by both the methods, were enumerated and compared. The final bearing of these additional fractures, on the management protocol, was analysed. RESULTS: CT proved superior to conventional radiography in diagnosing additional number of fractures in zygoma, maxilla, mandible (subcondylar) and nasal bone. Coronal and axial images were found to be significantly more diagnostic in fracture sites such as zygomaticomaxillary complex, orbital floor, arch, lateral maxillary wall and anterior maxillary wall. CONCLUSION: 3D images gave an inside out picture of the actual sites of fractures. It acted as mind's eye for pre-operative planning and intra-operative execution of surgery. Better surgical treatment could be given to 33% of the cases because of better diagnostic ability of CT.

Sub mucous cleft palate with fenestration.

Congenital fenestration in sub mucous cleft palate is not a common identity. This patient is a 16-year-old female who presented with nasal speech. On examination, she had associated microform cleft lip with nasal deformity. Successful palatoplasty with intra velar veloplasty was done.

Demographic profile of hand injuries in an industrial town of north India: a review of 436 patients.

There are not many injuries that rival the injured hand in complexity. A better understanding of biologic, behavioral, and socioeconomic risk factors potentially associated with hand injuries can help identify those individuals most at risk and define potential preventative measures to help reduce the incidence. We present a prospective study of 436 consecutive patients of hand and forearm injury treated over a period of 2 years. A serial recording of the demographic profile of the patient along with the type & cause of injury sustained, hand dominance, duration of hospital stay, time lag between injury and admission, type surgery preformed with intra-operative findings and the cost analysis was done. An expected male dominance in economically viable individuals of 21 to 30 years formed 50 % of the patients of which 22.9 % were labourers and students each. The malady was altercation (27.5 %) followed by industrial & road accidents. Post prandial period was most notorious with multiple neuro (27.05 %) vasculo (39.34 %) tendinous (60.66 %) injury common with even simple lacerations. Dominant hand injury was commonest. It is challenging to assess and treat an injured hand. This study defines the demography and the etiology behind the various cases of hand and forearm injury with the detailed trauma profile. The limitation of the study was absence of functional outcome. The necessity of hand trauma registry is a pre-requisite to quantify the burden of hand injuries and formulate a prevention strategy.

Incisor tooth in the nose: anecdotal sequel to dog bite in a 3-year-old child.

A 3-year-old male child presented to the casualty with history of unprovoked dog bite over the right lateral wall of nose. He was managed conservatively with antirabies prophylaxis and dressings. He presented after 3 months with a healed wound and the right upper central incisor projecting into the nostril. The Orthopantomogram showed a rotated temporary incisor with the roots of the permanent incisor placed normally. The tooth was extracted intranasally. Among the mutilating dog bite injuries referred to a plastic surgeon, this injury though thought provoking was also comical.

Role of negative pressure wound therapy in healing of diabetic foot ulcers.

INTRODUCTION: Foot disorders such as ulceration, infection and gangrene are the most common, complex and costly sequelae of diabetes mellitus.[1-3] Even for the most superficial wounds, treatment is often difficult with poor healing responses and high rates of complications. The purpose of this study is to compare the rate of ulcer healing with the negative pressure dressing technique to conventional moist dressings in the treatment of diabetic foot ulcers. MATERIALS AND METHODS: The study was conducted on 30 patients, which were divided into two groups. One group received negative pressure dressing while other group received conventional saline moistened gauze dressing. Results were compared for rate of wound healing. RESULTS: There was a statistically significant difference in the rate of appearance of granulation tissue between the two groups; with granulation tissue appearing earlier in the study group. The study group promised a better outcome (80% complete responders) as compared to the control group (60% complete responders). CONCLUSIONS: Negative pressure wound therapy has a definitive role in healing of diabetic foot ulcers.

Supernumerary nostril: A rare congenital anomaly.

We report the 23(rd) case of the world of one of the rare congenital anomalies, supernumerary nostril. The disease has a variable presentation and more than half of the reported cases are from Asian continent. This patient had a supernumerary nostril in the form of a accessory blind tract above the left ala. The tract was excised and raw areas approximated with a bolster dressing.

Pre-expanded epigastric flap cover for ventral hernia following fungal necrotizing fascitis of caesarian section wound: An unusual complication.

INTRODUCTION: Reconstruction of anterior abdominal wall after necrotizing abdominal wall infections is a challenge. MATERIAL AND METHODS: A 35-year-old lady presented with 20 × 18 cm sized defect of the anterior abdominal wall following fungal necrotizing fascitis. The defect was covered by an overlay prolene mesh and the soft tissue deficit was corrected by pre-expanded epigastric flap based on the superior epigastric artery. CONCLUSION: A concerted multi-specialty effort is needed to correct these defects.

Comparative evaluation of surface swab and quantitative full thickness wound biopsy culture in burn patients.

A total of 100 cases of burn were examined and screened bacteriologically for evidence of infection by surface swab culture, quantitative full thickness punch biopsy culture and blood culture. Gram negative organisms predominates the gram positive ones. Surface swab was found to correlate well with the biopsy as far the identification of causative organism is concerned. However, the latter technique was found to be more valuable as it also gives the critical load (>10(5)CFU/g of tissue) of the organism beyond which metastatic invasion of the organism takes place (p<0.01), thus obviating the repeated need for blood culture in burn patients.