Scope of PSI in Maxillofacial Region: Our Experience.

Introduction: Patient-specific implants aided by 3D virtual planning and CAD-CAM technology represents the next frontier in rehabilitation of complex maxillofacial defects slowly replacing the gold standard autografts as the preferred mode of reconstruction. Methods: In a first of its kind case series, we describe eight cases of complex maxillofacial defects managed by patient-specific implants at AFDC, New Delhi. All the designs went through stringent FEA analysis and GOM analysis to standardize the implant for achieving optimal functionality. We also added integrated dental implant component in the PSI to achieve immediate postoperative dental rehabilitation. Conclusion: This case series adds to literature the varying scenarios in which PSI's can be used in the maxillofacial region with functional dental rehabilitation thus paving a way for a new era in reconstruction.

Complications of Diagnostic TMJ Arthroscopy: An Institutional Study.

INTRODUCTION: The prevalence of using arthroscopy for the diagnosis of the TMJ disorders is increasing due to its superiority to conventional methods of imaging. Although considered to be safe, complications do occur. PATIENTS AND METHOD: A single operator single-institution retrospective study consisting of 50 patients taken up for diagnostic arthroscopy was analysed for complications. RESULTS: Lacerations of external acoustic meatus was found in 03 patients (6%); immediate partial hearing loss was seen in 01 patient (2%); transient facial nerve palsy was found in 05 patients (10%); sensory disturbances over the distribution of auriculotemporal nerve was evident in 01 patient (2%); haemorrhage as visualised by excessive bleeding through trocar skin puncture wound was seen in 05 patients (5%). Post-operative pain more than the pre-operative pain on assessment by visual analogue scale was noted in 05 patients (10%) on the immediate post-operative day. Reduction in spontaneous mouth opening was noted in 15 patients (30%). CONCLUSION: Though the complication rate was found to be higher than most of the other studies, they were minor which resolved without any intervention. The cases with complications were clustered at the beginning of the series which suggests the steep learning curve and the importance of surgeons' experience and skill involved in this procedure.

Evaluation of Total Alloplastic Temporomandibular Joint Replacement in TMJ Ankylosis.

INTRODUCTION: Total joint reconstruction using autologous or alloplastic materials is one of the treatment options for the reconstruction of the affected joint in TMJ ankylosis. The clinical results of alloplastic TM joint replacement (Biomet Microfixation system) that was carried out for the treatment and reconstruction of TMJ ankylosis have been summarised. MATERIALS AND METHODS: A retrospective analysis of eight cases clinically and radiographically diagnosed as TMJ ankylosis with minimal facial asymmetry presenting beyond the growth period and willing for at least 12 months of follow-up who have been taken up for gap arthroplasty and reconstruction using Biomet Microfixation TMJ replacement system was carried out. Follow-up of these patients was carried out at regular intervals and assessed on the following criteria: maximal interincisal mouth opening, TM joint pain on the affected side (on VAS), lateral mandibular excursions to the unaffected side deviation on mouth opening, occlusal discrepancy and neuromotor deficit of peripheral branches of facial nerve. RESULTS: The mean maximal interincisal mouth opening pre-surgery and 1 year post-surgery was 2 and 31.8 mm, respectively. The mean lateral excursive movement to the unaffected side was found to be 5.5 mm with mean deviation on mouth opening to be 4.6 mm. No pain, occlusal discrepancy or neurological deficit existed at the end of 1 year. CONCLUSION: Biomet Microfixation system is a viable treatment option for reconstruction of TMJ in cases of ankylosis with no major complications.

Management of Nonsyndromic Skeletal Dysgnathia by Distraction Osteogenesis Long-Term Follow-Up.

Distraction osteogenesis has been a paradigm shift in the field of orthognathic surgery. Majority of the published cases are those of syndromic patients that have been managed using varying treatment protocols. This communication describes a patient of 18-year-old male diagnosed with skeletal Class II malocclusion due to mandibular retognathism. The patient was taken up for mandibular corpus distraction of 10 mm. By this approach the patient was benefitted with good esthetic result and functional occlusion. Distraction protocol followed in this patient for lengthening of mandibular corpus has resulted in a stable outcome. The 2-year follow-up photographs show a stable result both esthetically and functionally.

Comparison of ultrasonography with conventional radiography in the diagnosis of zygomatic complex fractures.

PURPOSE: Zygomatic complex fractures have changed in patterns of occurrence, severity, and, more importantly, in the mode of injury. Protection of the globe and maintaining the width of the face are the more important roles of the complex. Diagnosis and treatment planning of such fractures become imperative in the sequencing of repair if and where indicated, especially in the case of isolated zygomatic complex fractures. Exploring the versatility of ultrasonography (US), in diagnosing zygomatic complex fractures in comparison to conventional radiography in a double-blind study, the objective of this study was to evaluate the efficacy of US and to explore the possibility of making US examination a mainstay in the primary diagnosis of such fractures. MATERIAL AND METHOD: The prospective, double-blind study design included 32 patients suspected of having sustained isolated zygomatic complex fractures. The patients underwent US examination and radiographic examination in the form of para-nasal sinus (PNS) and sub-mentovertex (SMV) views for comparison. RESULTS: A sensitivity of 100% was seen in favor of US in the areas of the fronto-zygomatic suture (FZ), arch, infra-orbital, and buttress areas. Statistically significant differences (p < .01) was seen in areas of the arch and buttress region and in the infra-orbital area. CONCLUSION: Although US showed 100% sensitivity in detection of fracture lines at three articulations of the four that make up the zygomatic complex, it lacked in quantifying the amount and degree of displacement of the fractured segments, which hampered accurate treatment planning.

Evaluation of facial nerve function following surgical approaches for maxillofacial trauma.

PURPOSE: The aim of this study was to report facial nerve injury following extraoral surgical approaches for the treatment of maxillofacial trauma, using the House-Brackmann facial nerve grading system (HBFNGS) as a means of classifying and measuring the degree and type of injury. MATERIALS AND METHODS: The sample comprised 100 consecutive cases of various maxillofacial trauma in which extraoral surgical approaches were used. Variety of surgical approaches such as coronal, preauricular, endaural, retromandibular, and submandibular approach and its modifications were used based on the anatomic location of the fracture and the accessibility required for its reduction and fixation. Facial nerve function of all patients was evaluated preoperatively and 24 hours after surgery. Patients who presented postoperative facial nerve injury were likewise examined using the HBFNGS at 24 hours, 1 week, 1 month, 3 months, and 6 months. RESULTS: Of the 100 patients, temporofacial branch involvement was seen in 11 cases, whereas cervicofacial branch involvement was seen in 6 cases. Complete recovery of the temporofacial branches was seen in a period of 3-4 months; whereas cervicofacial branches recovered in 5-6 months postoperatively. CONCLUSION: The frequency of facial nerve injury was related to various surgical approaches in maxillofacial trauma. Facial nerve impairment was found to be temporary in all cases, although the recovery of cervicofacial branches took a longer time. Moreover, there is a need to standardize the reporting of facial nerve recovery.