Aesthetic and Functional Rehabilitation of Postburn Maxillofacial Deformity.

Postburn maxillofacial deformities, although rare, are a significant cause of morbidity. Since contracture scars have a potential role in deforming the maxillofacial skeleton, the focus of treatment should be on growing patients, where scar contractures can drastically influence growth and morphology of the maxillofacial units. There are certain aspects of severe facial burns and deformities, especially of the jaws, that deserve sincere attention to overcome aesthetic and functional disabilities such as inability to masticate and incompetent lips. The purpose of this article, therefore, is to discuss these injuries, the mechanism of development of deformities of the jaws and associated structures and their management for better aesthetic, functional, and psychological health of patient. An interpretive clinical report is presented.

Is the routine practice of antibiotic prescription and microbial culture and antibiotic sensitivity testing justified in primary maxillofacial space infection patients? A prospective, randomized clinical study.

PURPOSE: The purpose of this prospective, randomized, comparative clinical study was to compare treatment outcome of removal of foci and incision and drainage, with or without oral antibiotic therapy, in the management of single primary maxillofacial space infection with a known focus. MATERIALS AND METHODS: A total of 40 patients with single primary maxillofacial space infection with a known infectious focus were divided into two groups, one treated with incision and drainage only, and the other with incision and drainage along with oral antibiotics. The focus of infection was addressed in both groups. Parameters evaluated included pain score, maximum mouth opening, swelling, purulent discharge and return to normal life, which were assessed on days 1, 2, 3, 5 and 7. The patients were followed up until they reported return to normal life as assessed by a questionnaire. RESULTS: All of the patients rapidly responded to treatment as observed by a reduction in pain, swelling, discharge, and improvement in mouth opening. Pus discharge stopped within first 3 days in 75% of patients. The patients who underwent immediate extraction showed a faster resolution of infection (mean return to normal life = 9 days) than others (mean = 11.2 days). There was no statistically significant difference between the two groups for the five study parameters (p < 0.05). Of the total pus specimens, 75% had no significant bacterial growth, or grew 'oral flora'/contaminants, while only 25% grew specific bacteria. CONCLUSION: This study questions the conventional practice by dental practitioners and surgeons of prescribing antibiotics to all patients with odontogenic infection. Microbial culture and antibiotic sensitivity is of little therapeutic value in selected patient groups.

Fate of the Coronoid Process After Coronoidotomy and Its Effect on the Interincisal Opening: A Clinical and Radiologic Assessment.

PURPOSE: Coronoidotomy (surgical detachment of the coronoid process from the mandibular ramus) is used to treat several conditions, including coronoid hyperplasia and temporomandibular joint (TMJ) ankylosis. The stability of the outcome, however, is considered questionable because of the risk of reattachment of the coronoid process. This study aims to radiographically and clinically evaluate the long-term anatomic and physiological outcome after coronoidotomy. MATERIALS AND METHODS: In 17 patients with unilateral TMJ ankylosis, 25 coronoidotomies were performed as an additional maneuver to relieve trismus after ankylosis release. Radiologic evaluation was performed immediately and 1 year postoperatively with panoramic radiography and computed tomography to assess changes at the coronoidotomy site. Clinical assessment included measurement of the interincisal distance at the 1-, 3-, 6-, and 12-month postoperative visits. RESULTS: A sharp osteotomy margin with a 3- to 10-mm gap between the ramus and coronoid process was observed immediately postoperatively in all cases. After 1 year, 23 cases (92%) showed partial (n = 5) or complete (n = 18) osseous union to the mandibular ramus, whereas in 2 cases, no evidence of fusion was observed radiographically. The mean interincisal opening achieved at 1 year was 33 mm. CONCLUSIONS: Coronoidotomy is an effective but more straightforward adjunct to arthroplasty than coronoidectomy (surgical excision of the coronoid process) in the management of TMJ ankylosis, with achievement and maintenance of adequate postoperative mouth opening.

Novel technique for harvesting the sternoclavicular graft.

PURPOSE: Originally introduced for mandibular reconstruction more than 40 years ago, the sternoclavicular graft (SCG) has gained widespread popularity for the reconstruction of the ramus-condyle unit (RCU) owing to its anatomic and histological likeness to the normal mandibular condyle. Conventional longitudinal osteotomy design for its harvest has been fraught with considerable complications at the donor site including fracture clavicle and major neurovascular injury. In an attempt to alleviate these ill effects, a new technique for procuring the sternoclavicular graft is presented. MATERIAL AND METHODS: A split-thickness cortico-cancellous graft was harvested form the sternal end of the clavicle along with the articular disk with the osteotomy cut oriented parallel to the coronal plane, with limited soft tissue dissection. Donor site complications were assessed in terms of incidence of clavicle fracture, neurovascular injury, pleural tear and radiographic healing as seen in the six-month postoperative chest radiograph. RESULTS: 17 patients suffering from unilateral temporomandibular joint ankylosis underwent SCG harvesting for RCU reconstruction following osteoarthrectomy. No adverse events were seen in the intra- and post-operative period in any patient and satisfactory radiographic osseous healing was observed after six months. CONCLUSION: The proposed harvest technique for SCG results in reduced donor site morbidity and favourable healing and greater patient comfort.

Comparative Evaluation of Er:Cr:YSGG, Diode Laser and Alvogyl in the Management of Alveolar Osteitis: A Prospective Randomized Clinical Study.

INTRODUCTION: Alveolar osteitis (AO) is a well-known complication following tooth extraction. Plethora of literature is available regarding its treatment modalities signifying that none of the treatment is as effective as any another treatment. LASER on the other hand, has been used to promote soft tissue healing. MATERIAL AND METHOD: In order to evaluate the effects of laser on healing of AO we undertook a randomized clinical trial. In the trial, sixty patients diagnosed with AO were randomly divided into three groups viz: alvogyl, diode laser and Er:Cr:YSGG laser (erbium chromium yttrium scandium gallium garnet). RESULTS: On analyzing the results, diode laser at 1.0 W power settings (energy: 20-25 J/cm2) in non-contact, continuous mode was found to be the most effective for both pain relief and healing improvement. CONCLUSION: The diode laser is an acceptable and effective non-dressing treatment modality for alveolar osteitis, which is the most common painful complication following extraction.

Osteochondroma of maxillofacial region: Tumor arising from two different developmental bones.

Osteochondromas are benign bony tumors which are commonly believed to originate by the proliferation of epiphyseal cartilage into the surrounding tissues. However, this hypothesis cannot explain the occurrence of this tumor in the intramembranous bones and soft tissue. Since most of the craniofacial bones have intramembranous origin, the occurrence of this lesion in this territory is considered rare. Contrary to the above hypothesis, Lichtenstein proposed that this entity arises from the metaplastic changes in the periosteum which explains the occurrence of this tumor in endochondral as well as intramembranous bones and also in soft tissues. Complying with Lichtenstein's hypothesis, the authors are presenting two cases of osteochondromas with one arising from the endochondral bone (the coronoid process of the mandible) and the other from an intramembranous bone (lateral pterygoid plate of the sphenoid).

Assessment of Mandibular Distraction Regenerate Using Ultrasonography and Cone Beam Computed Tomography: A Clinical Study.

Distraction osteogenesis (DO) is becoming a popular method of reconstruction for maxillofacial bony deformities or defects secondary to trauma or surgical tumor ablation. However, the technique is very sensitive in terms of the rate and rhythm of distraction. Because of this, there is a need for monitoring of the distraction regenerate during the distraction as well as the consolidation period. The present study was conducted to assess the regenerate using two imaging modalities, namely, ultrasonography (USG) and cone beam computed tomography (CBCT) to determine their relative efficacies and to weigh their clinical usefulness in assessment of DO regenerate. The study was conducted on 12 patients (18 sites) who underwent mandibular distraction for correction of facial deformities. The results showed that overall USG correlated better with the condition of regenerate (r = 0.606) as compared with CBCT (r = 0.476). However, USG was less effective as compared with CBCT in assessing the regenerate once corticomedullary differentiation occurred in the bone.

Post-operative acute circulatory collapse following craniofacial surgery: Rare event and rarer cause.

We are presenting a case of a 13-year-old female patient diagnosed and operated for maxillary odontogenic myxoma extending to the anterior cranial base. The postoperative complication occurred in the form of acute circulatory collapse. The patient was bailed out with cardiopulmonary resuscitation and return of spontaneous circulation occurred. Investigations into the cause of the event led to the finding of an uncommon syndrome. Meigs syndrome is a triad of ovarian tumor mass, pleural effusion and ascites. It has been the topic of interest for the gynecologic fraternity since 1934, when the first case was reported by J. V. Meigs. According to the best of our knowledge, this is the first case report of an acute circulatory collapse due to Meigs syndrome in a maxillofacial patient.

"Vanishing Bone Disease" in Maxillofacial Region: A Review and Our Experience.

Vanishing bone disease (VBD) is a rare disease of unknown etiology which is characterised by progressive replacement of bony framework by proliferation of endothelial lined lymphatic vessels. It has been given numerous names like massive osteolysis, Gorham's disease, phantom bone disease, and progressive osteolysis. It has no age, sex or race predilection. It may involve single or multiple bones and spread of the disease does not respect the relevant joint as boundary. The first report of the disease was published around two decades back but the mysterious nature of its etiology and ideal management strategy has still not been completely unfolded. The disease may functionally or aesthetically effect the patient and also has the potential to be life threatening. The first case of VBD in maxillofacial region was reported by Romer in 1924, Handbuch der speziellen pathologischen Anatomie and histology, Springer, Berlin. Since then, there have been few case reports of the same in maxillofacial region. We present a review of cases of VBD in maxillofacial region reported in literature along with our experience of a case.

Treatment of Oral Mucosal Lesions by Scalpel Excision and Platelet-Rich Fibrin Membrane Grafting: A Review of 26 Sites.

PURPOSE: One of the preferred treatment options for oral mucosal lesions (eg, leukoplakia and lichen planus) is excision, with or without the use of a coverage agent. Platelet-rich fibrin (PRF) membranes are popular fibrin scaffolds with entrapped platelets that release various growth factors and cytokines to support and enhance wound healing. The aim of the present report was to describe the technique, postoperative wound care, and clinical results of PRF membrane grafting after excision of superficial potentially malignant oral lesions. MATERIALS AND METHODS: Autologous PRF membrane was fabricated and grafted over 26 wounds created by excision of small, superficial, potentially malignant lesions of oral mucosa (or fiberotomy in cases of oral submucous fibrosis) and assessed clinically at 7, 15, 30, and 60 days. RESULTS: Healing was satisfactory in all cases, with minimal and manageable complication at 1 site. CONCLUSION: The results of the present study suggest that PRF membrane is a successful coverage agent that aids in the healing of superficial oral mucosal wounds. Additional comparative studies are required to establish its efficacy compared with that of other agents.

A simplified modification of a reconstruction plate into a mandibular transport distraction device: A technical note.

Transport distraction is nowadays gaining enormous popularity and is becoming a promising option for reconstruction of mandibular defects. However, the vast number of distraction device designs create huge confusion in the clinician's mind to choose the right one. Considering these complex and costly designs, the authors decided to find a simplified way of combining a modified conventional reconstruction plate and monofocal distraction device that can act as a transport distraction device for bridging of bony defects. A case performed by this technique and device has been presented along with the description of device design.

A rare case of an aggressive osteoblastoma of the squamous temporal bone: a unique presentation with literature review.

Aggressive osteoblastoma is a rare osteoid tissue forming tumour commonly affecting the spine with predilection for the posterior elements. Calvarial involvement is extremely rare with only two reported cases in the literature. Due to its overlapping clinical, radiographic and histological features with ossifying fibroma, benign osteoblastoma and osteosarcoma, it is very difficult accurately to diagnose this lesion at an early stage. A rare case of an aggressive osteoblastoma of the squamous temporal bone in a young male is presented here which was misdiagnosed twice before reaching the final diagnosis by correlating clinical, radiographic and histopathological features.

Platelet rich fibrin: A new covering material for oral mucosal defects.

In the current oral and maxillofacial surgery practice, the use of PRF membrane is limited to bony lesions and gingival defects. We have used it for reconstruction of benign hyperkeratotic lesion of oral mucosa in a healthy adult male and have found good healing clinically. It is suggested that the use of PRF membrane could be tried for various other superficial oral mucosal lesions.