Donor Site Morbidity in Patients Undergoing Maxillofacial Reconstruction Using Free Fibula Flap Versus Deep Circumflex Artery Flap-A Systematic Review.

Introduction: A systematic review of the literature on the donor site morbidity in patients undergoing Maxillofacial reconstruction was performed. The two widely used flaps namely free fibula flap (FFF) and DCIA flap were compared to answer the following questions: (1) Is donor site morbidity significantly different in patients undergoing maxillofacial reconstruction with FFF and DCIA flap? (2) Should donor site morbidity be considered as the criteria for choosing the flap for reconstruction. Materials and methods: The search strategy was based on PRISMA guidelines. Various electronic databases were searched. On reviewing the seven articles included in our systematic review, we found out oral squamous cell carcinoma to be the most common pathology leading to the defects in head and neck region requiring reconstruction with free flaps. Results: A total of 531 participants were investigated who underwent maxillofacial reconstruction using FFF and DCIA flap. The study included both the genders. The participants were assessed for short- and long-term donor site morbidity after the microvascular surgery. Mean age is 45-60 years. Three out of seven studies showed DCIA to have lesser complications at donor site than fibula group. While other two studies proved FFF to be better than DCIA. One study proved low donor site morbidity with regard to both the flap. Conclusion: The free fibula being the flap of choice in head and neck reconstruction has a comparable donor site morbidity to DCIA. The advantages of the iliac artery flap include natural curvature, abundant vertical and horizontal bone height for bone contouring and osseointegration, hidden scar, low incidence of wound healing problems and minimal effect on function and quality of life at long-term follow-up. Thus, it makes it the free flap of choice that one cannot avoid. This systematic review was registered at PROSPERO (CRD42021268949).

Unveiling rarity: Myoepithelioma in the minor salivary gland of buccal mucosa - A case report.

INTRODUCTION: Tumours of salivary glands are rare and have various histo-pathological subtypes. Myoepitheliomas were first classified by Sheldon et al. and the criterion to classify or diagnose it was first defined by Barnes et al. and Sciubba and Brannon. Myoepithelioma accounts for less than 1 % of all salivary gland tumours, 40 % of these tumours occur in the parotid gland while 21 % occur in the minor salivary glands. A case of myoepithelioma of a minor salivary gland of the cheek is described, emphasizing the problems of the differential diagnosis. PRESENTATION OF THE CASE: A 40-year-old female reported to the department with a complaint of a cheek bite on her right side for a few months. The physical examination showed a presence of lobulated whitish mucosa on the right buccal mucosa at the level of the occlusal plane, on palpation it revealed a non-painful mass approximately 1.5 cm in radius, mobile to bimanual palpation. An excisional biopsy was performed under local anaesthesia. Microscopic and immunohistochemistry confirmed the tumour to be a myoepithelioma of a minor salivary gland with the absence of definitive features of malignancy. DISCUSSION: Due to their infrequency and multiplicity of histopathology, myoepitheliomas present difficulties in diagnosis. Cellular varieties can be misdiagnosed as malignancies. A key to determining diagnostic criteria for myoepitheliomas is to study cellular morphology, cytoplasmic filament expression, and ultrastructural features of the tumour and apply this information to defining myoepitheliomas. CONCLUSION: Myoepitheliomas are rare tumours, utilization of immunohistochemical staining and electron microscopy are useful tools for the diagnosis of myoepitheliomas to ensure proper treatment and follow-up.

Comparative evaluation of use of reciprocating saw and bur in Le fort I osteotomy for superior repositioning of maxilla: A cross-sectional study.

Background: Traditionally bur has been used to carry out osteotomy. In a developing country like India, the cost of surgical treatment is the important factor in determining treatment plan. Although the use of bur is cost-effective and efficient, with the advent of newer technology, it is getting replaced with a saw. Aim: To evaluate and compare the use of reciprocating saw and bur in Le Fort I Osteotomy for superior repositioning of the maxilla. Materials and Methods: Patients referred from the Department of Orthodontics for the surgical correction of vertical maxillary excess (VME). They were divided into two groups. In group I, osteotomy was performed with Synthes Reciprocating Saw and in group II, bur was used. The parameters recorded in both the groups were time required for the completion of down-fracture, precision of the osteotomy cut (margins of the cut), and ease of superior repositioning. Data was collected from both the groups for comparison. Results: A total of 14 patients with VME were included in the study. They were divided into two groups. Seven study participants were allotted to each group. In group I, Synthes Reciprocating Saw was used while in group II, a bur was used to carry out the osteotomy cut. In group I, the average time required to complete the down-fracture of the maxilla was 3.5-4 min while in group II it was more than 8 min. The margins of the osteotomy cut were smooth and regular and there was bone-to-bone contact during superior repositioning in Group I. Conclusion: The combination of the use of a saw for inferior osteotomy and a bur for the superior cut would be more beneficial in the superior repositioning of the maxilla.

Autogenous bone chip interspersed in PRF and PRP as an augmentative bio material in autogenous tooth transplant - A case report.

INTRODUCTION: Autotransplantation technique involves extraction of tooth from the recipient site and donor tooth without damage, placing and stabilizing donor tooth within same individual. The use of autogenous bone combined with platelet rich fibrin (PRF) and platelet rich plasma (PRP) seems to be favorable to achieve stable alveolar bone. Thus we provide an innovative adjuvant method for enhancing bone formation using PRF and inter-radicular bone with PRP as autogenous graft. PRESENTATION OF CASE: A 26 year old healthy female individual reported university teaching hospital to outpatient department of oral and maxillofacial surgery, with complain of decayed tooth. On clinical and radiographic examination it was diagnosed was chronic irreversible pulpitis with to left maxillary first molar. Looking at clinical profile, age and health status an autogenous tooth transplant was advised. DISCUSSION: Periodontal ligament, interradicular bone autografts, PRF and PRP has potential to induce formation of alveolar bone and is recommended in cases of atrophy of alveolar process. CONCLUSION: The solution mentioned can be hypothesized to improve - quantity and quality of bone formed, reduce the chances of ankylosis of the tooth, bone loss, sinus perforation.

Various Treatment Modalities in COVID-19 Associated Facial Mucormycosis and the Need for its Surgical Management: A Systematic Review.

Introduction: Mucormycosis emerged as a wildfire in post-covid-19 infected patients. Most frequently involved sites of mucormycosis are rhino-orbital, rhino-sinusal and rhino-orbito-cerebral. The hallmark sign of mucormycosis is tissue necrosis, which is often a late sign. The fatality rate of mucormycosis is 46% globally. Despite early aggressive combined surgical and medical therapy, the prognosis of mucormycosis is poor. Methods: We searched the electronic database of PubMed, web of science, Embase, Scopus and Google Scholar from Jan 2020 until December 2021 using keywords. We retrieved all the granular details of original research articles, case reports/series of patients with rhino-orbito-cerebral mucormycosis (ROCM), and COVID-19 reported worldwide. Subsequently, we analyzed the patient characteristics, associated comorbidities, location of mucormycosis, treatment given and its outcome in people with COVID-19. (Prospero registration-CRD42021256830, June 4, 2021). Results: Overall, 544 rhino-orbito-cerebral mucormycosis patients were included in our review with a history of Covid-19 infection. Out of which 410 patients had diabetes mellitus which has proven to be major contributing immunocompromised disease. Other diseases like hypertension, chronic kidney diseases, hypothyroidism, etc., were also attributed as an immunocompromised disease causing increased number of covid associated mucormycosis cases. We found out that total number of patients alive after taking only antifungal drug treatment were 25 in number, whereas total number of patients alive when antifungal drugs were combined with surgical intervention were 428 which was significantly higher. Conclusion: Our systematic review concluded that surgical debridement should be performed whenever feasible in parallel to antifungal treatment in order to reduce the mortality rate of COVID-19 associated rhino-orbito-cerebral mucormycosis patients.

Role of distraction osteogenesis and flip genioplasty to correct sleep apnea and aesthetics in long standing TMJ ankylosis - A case report.

INTRODUCTION AND IMPORTANCE: Temporomandibular joint (TMJ) ankylosis triad includes TMJ ankylosis, micrognathia, and obstructive sleep apnea (OSA) which is common in long-standing cases of TMJ ankylosis. Unilateral long-standing cases of TMJ ankylosis also result in a severe discrepancy in the midline of the chin. CASE PRESENTATION: A young adult female presented with restricted mouth opening and daylight sleepiness. Her AHI was mild and there was excessive facial disfigurement. Right-side TMJ ankylosis was diagnosed with compromised posterior airway space and Ramal height was also short on the affected side. Chin has severely deviated to the affected side. CLINICAL DISCUSSION: Treatment protocols for TMJ ankylosis are different for different case scenarios. A proper protocol derivation is a must looking into the clinical and radiographical examination of the patient. As mentioned in previous literature, anti-Kaban's protocol has been shown to provide good results. A genioplasty improves the chin midline deviation. CONCLUSION: A careful assessment and a proper treatment plan should be selected for the management and early relief of the symptoms of the patient. Thorough knowledge and update should be available to the operating surgeon to choose the correct treatment plan for the management of a triad patient.

Effect of Formalin Fixation on Surgical Margins in Patients With Oral Squamous Cell Carcinoma.

PURPOSE: Formalin fixation causes shrinkage of surgical margins, which can result in the underestimation of tumor-free margins. The purpose of this study was to show the effect of formalin fixation on surgical margins. Another aim of this study was to evaluate surgical margin shrinkage after fixation of oral squamous cell carcinoma (OSCC) specimens of the gingivobuccal sulcus (GBS). MATERIALS AND METHODS: This was a cross-sectional study. The study sample consisted of OSCC specimens of the GBS after composite resection. The primary predictor variable was the length of the linear margin at various locations (anterior, posterior, medial, and lateral). The primary outcome variable was the percentage of change in each respective margin (anterior, posterior, medial, and lateral) after fixation in 10% formalin for 24 hours. Other variables were age, gender, use of smokeless tobacco, smoking status, and tumor staging. The difference between pre-fixation and post-fixation data was calculated using paired t test. RESULTS: The sample consisted of 15 patients (7 men and 8 women; age range, 55 to 65 yr) diagnosed with OSCC of the GBS. Shrinkage of surgical margins (decrease) occurred after fixation compared with margins before fixation. The average surgical margin shrinkages were 18.7% anteriorly, 14.9% posteriorly, 23.6% medially, and 23.9% laterally. This shrinkage was statistically significant (P < .001). CONCLUSION: Formalin fixation causes considerable shrinkage of surgical margins. This phenomenon should be considered by the pathologist before providing the final histopathology report.

Applications of coronoid process as a bone graft in maxillofacial surgery.

The coronoid process can be easily harvested as a donor bone by an intraoral approach during many maxillofacial surgery procedures. The purpose of this study was to evaluate the utility of autogenous coronoid process bone grafts for maxillofacial reconstructive surgery. Twelve patients, who underwent coronoid process grafts for reconstruction of maxillofacial deformities due to trauma, alveolar atrophy, or temporomandibular joint ankylosis, were included in the study. There were 3 orbital defects after extended maxillectomy, 1 blowout fracture of the orbit, 2 cases of reconstruction after temporomandibular joint ankylosis surgery, 1 case of additional chin augmentation following horizontal flip genioplasty, 1 defect of anterior wall of maxilla due to trauma, 2 mandibular defects, and 2 cases of bone augmentation for implants.We recommend the use of coronoid process of the mandible as a source for autogenous bone graft as it can provide sufficient bone in quantity and quality for selected maxillofacial reconstructions.