Treatment Modalities to Achieve Nasal Symmetry in Unilateral Cleft Lip/Nasal Deformity: An Objective and Comparative Evaluation.

Introduction: Primary cleft lip repair techniques do not address the nasal deformity adequately resulting in nasal asymmetry. Maneuvers employed to minimize this have varying degrees of success. Aim: To assess the outcome of different treatment modalities employed to establish nasal symmetry in unilateral cleft lip. Methods: 100 patients with complete unilateral cleft lip/ palate operated for primary cheiloplasty with modified Millard's rotation advancement technique were divided into five groups. Group 1: lip repair alone, Group 2: NAM followed by lip repair, Group 3: lip repair followed by placement of conformers, Group 4: NAM followed by lip repair and placement of conformers, Group 5: lip repair with semi-open rhinoplasty. Objective assessment was done using measurable parameters after 12 months post-operatively on a 1:1 standard photograph. Results: Group 5 showed statistical significance in all parameters assessed. Progressive improvement in nasal symmetry was noted from Group 1 to Group V. Conclusion: In our study, group V, i.e., modified Millard's repair with semi-open rhinoplasty improved the results in terms of all the objective parameters assessed. The results of the other groups showed improvement though not consistent in all parameters. Naso-alveolar molding is an effective adjunct. Additionally, nasal conformers proved to be of great value in retaining the results obtained post-surgery.

Efficacy of Fentanyl Transdermal Patch in Impacted Mandibular Third Molar Surgery-A Comparative Study.

Introduction: Removal of mandibular third molars surgically is one of the most frequently performed oral surgical procedures which are often accompanied with post-operative pain, swelling and trismus. Despite general progress in pain management, moderate to severe acute post-operative pain after removal of lower third molars remains a problem. Fentanyl is an extremely effective drug in the treatment of severe chronic pain such as cancer pain and post-operative pains which acts by increasing patient's tolerance to pain. Fentanyl Transdermal System (FTS) is a rectangular transdermal patch which contains high concentration of fentanyl, a potent short-acting Schedule II opiate. In this study the efficacy of transdermal fentanyl for management of post-operative pain after impacted mandibular 3rd molar surgery is evaluated. Methods: 20 patients within the age group of 18-40 years with asymptomatic impacted mandibular third molars were equally divided into 2 groups as group A & group B which underwent surgery in Local Anaesthesia. In every patient one side belonged to group A and other side belonged to group B. 50 µg FTS was applied in group A while placebo patch was applied in group B. Results: Patients in group A performed significantly better than group B in terms of mean pain intensity scores assessed by VAS and VRS along with minimum need of post-operative rescue analgesics. Conclusion: It was found that FTS resulted in significantly better pain relief, longer pain-free intervals, and lesser post-operative analgesic consumption.

An Analysis of the Viability of Nonvascular Iliac and Fibula Grafts in Mandibular Reconstruction in Patients with Circulatory Diseases: A Prospective Randomized Study.

Vascularized bone grafts are considered as the gold standard for mandibular reconstruction. However, there are certain limitations of them, such as they are contraindicated in patients with circulatory disturbances. Therefore, Non-vascular bone grafts become the viable option for reconstruction. Our study aims to prospectively compare the long-term viability of avascular iliac and fibula bone grafts in the reconstruction of mandibular defects. Objectives were to evaluate the difficulty in swallowing, mastication, speech problems, infection, wound dehiscence, restricted limb movement, and altered gait among the iliac and fibula group. A total of 14 patients, planned for the reconstruction of mandibular defects from 2016 to 2018 were randomly allocated into two groups; nonvascular iliac and fibula graft groups. Clinical assessment for improvement in function, esthetics, wound healing, pain, and donor site morbidity was done and was followed up for one year. Digital orthopantomogram was taken for radiographic evaluation for up to one year. Difficulty in swallowing, mastication, speech, infection, restricted limb movement, and altered gait was statistically significant and was seen more in the fibula group. Wound dehiscence with graft exposure was found in one subject. The overall success rate was 100% in the iliac group and 85.7% in the fibula group. Considering the long-term complications and success rate, the nonvascular iliac graft was found to be superior and can be used as an alternative to a nonvascular fibula graft for a defect length up to 7 cm.

Surgical Treatment of Recurrent Lower Eyelid Sebaceous Gland Carcinoma and Reconstruction with Pedicled Nasolabial and Non-vascularised Buccal Mucosal Flaps.

INTRODUCTION: Sebaceous gland carcinoma of the eyelid is an uncommon but highly malignant tumour. Post-tumour excisional defect reconstruction must aim in restoration of function and aesthetics. Prompt diagnosis and adequate treatment is of paramount for successful outcome of disease. CASE REPORT: A 61-year-old female patient underwent surgery for sebaceous gland carcinoma of right lower eyelid 3 years back and reported to us with recurrence. On examination, an exophytic mass was seen over right conjunctiva adjacent to the eyelid margin. With the objective of restoring form and aesthetics, immediate reconstruction was carried out using superiorly pedicled nasolabial flap to cover the lower eyelid defect and non-vascularised buccal mucosal flap for bulbar and palpebral conjunctival reconstruction. CONCLUSION: The tumour is notorious to cause local recurrence and metastases; hence, an early and accurate diagnosis, surgical and adjunctive chemoradiation and regular periodic follow-ups are of utmost importance for the successful management of sebaceous gland carcinoma of eyelids.

Superolateral Dislocation of Bilateral Intact Mandibular Condyles: A Rare Case Series.

BACKGROUND AND PURPOSE: The dislocation of mandibular condyle is a clinical condition in which the head of condyle has been displaced out of the glenoid fossa. Complete dislocation of the mandibular condyle can occur in anterior, posterior, lateral and superior direction. Among these dislocations, bilateral superolateral dislocation of mandibular condyles is quite rare and often misdiagnosed. Because of its rare occurrence and unusual clinical course, the best treatment is debatable. PATIENTS AND METHOD: We present the first case series of true bilateral superolateral dislocation of intact mandibular condyles (Type 2B) without fracturing the Zygomatic arch, associated with symphysis fracture. CONCLUSION: This article intends to provide information regarding the possible biomechanics and management of bilateral superolateral dislocation of mandibular condyles associated with symphysis fracture.

Ophthalmological Evaluation by a Maxillofacial Surgeon and an Ophthalmologist in Assessing the Damage to the Orbital Contents in Midfacial Fractures: A Prospective Study.

BACKGROUND AND PURPOSE: Midfacial fractures may often be associated with injuries to the orbit which may lead to notable dysfunction of the visual apparatus, if not detected early after injury. The purpose of this study is to evaluate the associated ophthalmic injuries in mid-face trauma and to emphasize the need for understanding the ophthalmic signs and symptoms by an attending maxillofacial surgeon. PATIENTS AND METHODS: A total number of 60 clinically and radiographically proven subjects with midfacial fractures were considered in the study that underwent complete ophthalmological evaluation at initial presentation. Referral to ophthalmologist was considered to determine the exact nature of injury and its implications. Results by a maxillofacial surgeon and ophthalmologist were evaluated. RESULTS: In our study, a male predominance with a mean age of 32 years was observed, with the most common etiology being Road Traffic Accidents. Forty-two of the 60 patients exhibited sub-conjunctival hemorrhage accounting for 70 % of ocular injuries recorded. While 28 of the 60 patients displayed peri-orbital edema (53.3 %), 8 patients experienced diplopia (13.32 %) and 8 patients showed relative afferent pupillary defect (13.32 %). CONCLUSION: From our study, it becomes imperative that the maxillofacial surgeon should have a thorough knowledge of the various ophthalmic injuries that could occur in association with midfacial trauma in order to prevent visual complications to the patient. Understanding of the subtle injuries to the ocular apparatus which may be undiagnosed by a maxillofacial surgeon but have significant grave outcomes is essential.