Assessment of complications of the open treatment of mandibular condylar fractures

The objective of our study was to analyze the complications of open treatment of mandibular condylar fractures operated via various surgical approaches. Thirtyeight patients with 42 fracture sides having moderate to severely displaced condylar fractures were studied. Open treatment was performed, and patients were assessed for complications of open treatment in terms of facial nerve paresis, unaesthetic scar, salivary fistula/sialocele. Facial nerve paresis was noted in 13 (31%) cases, mostly transient in nature (n=9, 69.2%), that recovered within 8 weeks. Furthermore, 5 (11.9%) patients had unaesthetic scar formation, while just 1 (2.4%) case of salivary fistula was observed. Facial nerve paresis was the most common complication of open treatment of mandibular condylar fractures and most of them were observed in cases operated by preauricular approach.

Gorlin-Goltz syndrome.

A 12 years old girl was presented with bilateral swellings on angle and body of mandible. On general physical examination, there were polydactyly and papular lesions on arm. Histopathology of mandibular lesions revealed odontogenic keratocysts. Marsupialization of the cysts followed by enucleation was done. The patient was reviewed every six months and there was no recurrence at the end of two years.

Frequency of p53 gene mutation and protein expression in oral squamous cell carcinoma.

OBJECTIVE: To determine the frequency of p53 gene mutation and protein expression in Oral Squamous Cell Carcinoma (OSCC) and to establish correlation between the two. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Histopathology Department and Molecular Biology Laboratory, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from May 2010 to May 2011. METHODOLOGY: Thirty diagnosed cases of OSCC were selected by consecutive sampling. Seventeen were retrieved from the record files of the AFIP, and 13 fresh/frozen sections were selected from patients reporting to the Oral Surgery Department, Armed Forces Institute of Dentistry (AFID). Gene p53 mutation was analyzed in all the cases using PCRSSCP analysis. DNA was extracted from the formalin-fixed and paraffin-embedded tissue sections and fresh/frozen sections. DNA thus extracted was amplified by polymerase chain reaction. The amplified products were denatured and finally analyzed by gel electrophoresis. Gene mutation was detected as electrophoretic mobility shift. The immunohistochemical marker p53 was applied to the same 30 cases and overexpression of protein p53 was recorded. RESULTS: Immunohistochemical expression of marker p53 was positive in 67% [95% Confidence Interval (CI) 48.7-80.9] of the cases. Mutations of the p53 gene were detected in 23% (95% CI 11.5-41.2) of the OSCC. No statistically significant correlation was found between p53 gene mutation and protein p53 expression (rs=-0.057, p=0.765). CONCLUSION: A substantial number of patients have p53 gene mutation (23%) and protein p53 expression (67%) in oral squamous cell carcinoma (OSCC).

Effects of pre-operative submucosal dexamethasone injection on the postoperative swelling and trismus following surgical extraction of mandibular third molar.

OBJECTIVE: To determine the effects of pre-operative submucosal dexamethasone injection on postoperative swelling and trismus following surgical extraction of mandibular third molar. STUDY DESIGN: Randomized controlled trial. PLACE AND DURATION OF STUDY: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry (AFID), Rawalpindi, from October 2009 to March 2010. METHODOLOGY: A total of 100 patients aged 18 - 40 years with good periodontal health and mesioangular impaction were divided in two treatment groups (50 in each group). Group-A received prophylactic 4 mg submucosal dexamethasone intraoral injection and Group-B acted as control group. Facial swelling and trismus were assessed at baseline, 2nd and 7th postoperative days. Data was analyzed using SPSS-10. RESULTS: There were 35 (70%) males and 15 (30%) females in group-A and 34 (68%) males and 16 (32%) females in group-B. Surgical time ranged from 30 - 50 minutes (mean = 40.62 ± 4.886 minutes) for group-A and 33 - 50 minutes (mean = 42.12 ± 4.543 minutes) for group-B. Administration of dexamethasone had statistically significant effect in reduction of swelling and trismus on second postoperative day (p < 0.05) in group-A. CONCLUSION: Pre-operative 4 mg submucosal dexamethasone injection was significantly effective in reduction of postoperative swelling and trismus.

Bioresorbable versus titanium plates for mandibular fractures.

OBJECTIVE: To compare bioresorbable plates with titanium plates for treatment of mandibular fractures. STUDY DESIGN: Randomized controlled trial. PLACE AND DURATION OF STUDY: Oral and Maxillofacial Surgery Department, Armed Forces Institute of Dentistry, Rawalpindi, from January to December 2010. METHODOLOGY: Patients with mandibular fracture were randomly divided in to two groups. The control group received titanium plates while the experimental group received the bioresorbable plates. All the procedures were carried out under general anaesthesia using standard surgical techniques. Frequency of plate/screw breakage or loosening, development of infection, malocclusion, malunion, wound dehiscence, the need for hardware removal and any other technical difficulties were compared between the two groups using chi-square test with significance at p < 0.05. RESULTS: A total of 34 patients were included in the experimental group where 53 resorbable plates were applied. The control group consisted of 35 patients and received 52 titanium plates. The mean age in the experimental group and the control group were 31.35 ± 11.16 years and 34.31 ± 10.69 years respectively. Breakage of 16 screws and 03 plates was seen in the experimental group while no screw or plate broke in the control group. The results showed significant association of screw breakage with resorbable plates and plate removal with titanium plates. CONCLUSION: Bioresorbable plates can be used as an alternative to titanium plates in mandibular fractures but with caution. They are a good means to stabilize fractures in patients where growth retardation and hardware removal may be a consideration.

Distraction osteogenesis for correcting maxillo-mandibular deformities.

OBJECTIVE: To determine the effectiveness of distraction osteogenesis (DO) for correcting maxillofacial deformities. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from June 2008 to November 2010. METHODOLOGY: Patients with diverse maxillofacial deformities were selected for the study. In all cases, intraoral distractors were used. Mandibular osteotomies were done using submandibular incision and maxillary osteotomy was done using standard vestibular incision. In paediatric patients, DO was started on third postoperative day while in adults, a 7-day latency period was followed. Distraction was carried out at a rate of 0.5 mm twice daily (1 mm/day). Distractors were removed after a consolidation period of 2 months. RESULTS: A total 7 cases were operated for DO. Out of these, 3 were males and 4 females. The age ranged from 2-24 years (mean 12.57 + 9.48 years). Five patients had their deformity owing to temporo mandibular joint (TMJ) ankylosis, one had congenital micrognathia and one patient had skeletal class-III deformity. Five patients underwent mandibular DO, one underwent maxillary DO and in one case simultaneous maxillo-mandibular DO was carried out. Amount of distraction varied from 9.0 mm to 19.2 mm (mean 15.04 + 4.33 mm). Mean follow-up was 18.14 + 5.39 months. CONCLUSION: Distraction osteogenesis can be employed satisfactorily to correct diverse maxillofacial deformities like retrognathia, facial asymmetry and skeletal class-III.

Correction of airway obstruction in congenital micrognathia by mandibular distraction osteogenesis.

Varying degrees of upper airway obstruction is almost universally present in patients of congenital micrognathia which needs to be corrected as early as possible. This allows appropriate feeding and growth and prevents long-term complications such as pulmonary hypertension and cor pulmonale. We report the case of a tracheostomy-dependent, 4-year-old child with congenital micrognathia who was treated with mandibular distraction osteogenesis. This is the treatment of choice for surgical correction of mandibular hypoplasia and for the challenging airway management in infants. Once a bone length of 2 cm was achieved through distraction osteogenesis, the child was completely relieved of respiratory obstruction and tracheostomy tube was removed through the process of decannulation.