Osteomyelitis of Jaw Bone due to Aspergillosis in Post-COVID-19 Patients: An Observational Study.

Background: In the second wave of COVID-19 pandemic, there has been an increase in number of cases with Post-COVID-19 fungal osteomyelitis of jaws. Aspergillosis was found to be one of the causes of osteomyelitis of jaw bones in these patients. Aim: To evaluate the incidence and pattern of osteomyelitis of jaw due to aspergillosis in post-COVID-19 patients and to discuss the management protocol of the same. Method: Data were obtained at our institution from the period of January 2021 to June 2021. Patients of all age groups with Post-COVID-19 osteomyelitis of jaw due to aspergillosis and those with combined aspergillosis and mucormycosis infection were included. Patients having rhino-orbito-cerebral fungal infection were excluded. Results: A total of 47 patients reported to our center. Demographically the average age of the patients was 49.11 years with 72% being males. All 47 patients (N = 100%) had received steroids. 21 of them (N = 44.7%) had diabetes mellitus and 14 (N = 29.8%) patients had other comorbidities. Out of 47 patients, 42 (N = 89.7%) patients were diagnosed with aspergillosis and the remaining 5 (N = 10.3%) cases had a mixed fungal infection of mucormycosis and aspergillosis. On fungal culture Aspergillus flavus was the most common species detected followed by Aspergillus niger and Aspergillus fumigatus. All patients were treated with oral Voriconazole and local surgical debridement. Prompt laboratory testing such as a timely KOH mount, galactomannan test, beta-D-glucan test, histopathology of tissue specimens could help to give an early and definitive diagnosis. The mortality rate we encountered in this study was nil. Conclusions: Early and definitive diagnosis and immediate initiation of antifungal drug therapy and surgical intervention will significantly reduce the rate of morbidity and mortality.

Management of bilateral condylar agenesis by distraction osteogenesis: a rare case report.

Condylar agenesis is a rare case involving developmental disturbances related to growth of mandible, facial aesthetics, dentition development, muscle deformation, and occlusal problems. As such, this is a rare condition, and there is no internationally accepted protocol for the same. Underdevelopment or defective formation of condyle may be congenital or acquired. Condylar agenesis is congenital non formation of condyle, while hypoplasia is poor development. We report a case of bilateral condylar agenesis in a 30-year-old female patient.

Comparison of Two Types of Patient Specific Implants (PSI) and Quad Zygoma Implant (QZI) for Rehabilitation of Post-COVID Maxillary Mucormycosis Defect (PCMMD): Finite Element Analysis.

Introduction: The residual post-COVID maxillary mucormycosis defect (PCMMD) were extensive, due to unilateral or bilateral maxillectomies. The Goal of rehabilitation of PCMMD is to deliver a prosthetically driven reconstruction. FEA was to evaluate the biomechanical response of PSI struts (PSI 1), PSI Screw retained (PSI 2) and QZI to masticatory load on virtual simulation to improve accuracy and enhance the design. Aim: To validate and compare the Biomechanical benefit of the PSI struts, PSI Screw retained, QZI in a case of rehabilitation of post-COVID maxillary mucormycosis defect (PCMMD) by FEA study. Methodology: The result of stress to masticatory load on virtual simulation for (1) Maximum and minimum stress (Von Mises stress); (2) the Displacement (in three positions) and (3) the Deformation (Plastic strain) was compared on virtual simulation for PSI 1 and PSI 2 and QZI. Conclusion: The FEA and comparative evaluation of PSI 1, PSI 2 and QZI showed a good resistance to displacement. The stress and strain values are low and acceptable. In comparison QZI shows more stress in the anterior region.

Zygomaticomaxillary Osteomyelitis due to COVID-19 Associated Mucormycosis (CAM): A Case Series of 10 Patients.

Aim: To highlight the incidence of osteomyelitis due to CAM and to elucidate the mode of spread of infection from maxilla to zygomatic bone, to highlight how that is distinct from other cases of zygomatic osteomyelitis due to other etiologies. Methods: A standard protocol of treatment of the cases of CAM with zygomatic involvement based on our own outcomes was furnished. All 10 patients were treated with dual antifungal therapy and aggressive surgical resection via extraoral approach, in conjunction with functional endoscopic sinus surgery (FESS). Results: Ten out of 116 patients of CAM reporting to our institute presented with zygomatic bone involvement with an incidence rate averaging at 8.6%, whereas in previous literature osteomyelitis of zygomatic bone was extremely rare with an incidence pattern of just 1.42%. Conclusions: The treatment protocol followed by the authors gave good outcomes to all patients treated, with no mortalities.

Anti-fungal therapy: An overview for maxillofacial surgeons in post-covid-19 fungal infections.

India is well known as the diabetes "capital" of the world but now it is also becoming the mucormycosis "capital" of the world. Indian Council of Medical Research has formed an "Evidence-Based Advisory in The Time of COVID-19 on Screening, Diagnosis, and Management of Mucormycosis." As per this advisory, an oral and maxillofacial surgeon forms an integral part of the team dedicated to fight this epidemic of mucormycosis. Also, there are other fungal infections such as aspergillosis which are getting reported in these patients affecting the paranasal sinuses and the jaws. Aggressive surgical debridement and a thorough knowledge of anti-fungal therapy are must in treating these fungal infections. The aim of this article is to give an overview on the available anti-fungal therapy required to manage the ever-increasing rise in fungal infections faced by maxillofacial surgeons in post-COVID-19 patients.

Assessment of postoperative discomfort and nerve injuries after surgical removal of mandibular third molar: A prospective study.

INTRODUCTION: The surgical removal of mandibular third molar (M3) teeth may result in a number of complications including pain, swelling, bleeding, alveolar osteitis or nerve dysfunction. Most of these problems are temporary, but in some cases, nerve paresthesia may become permanent and lead to functional problems. AIMS AND OBJECTIVES: This study aims at measuring the clinical severity of pain, swelling, muscle trismus, infection, dry socket and any nerve injury-related paresthesia after surgical removal of M3. It also assesses the validity of the postoperative symptom severity and identifies the most frequent occurrences and postoperative complications. MATERIAL AND METHODS: The prospective study data was collected from 163 patients visiting the Department of Oral and Maxillofacial Surgery, for surgical extraction of impacted M3. Postoperative assessment was done after 1 week at the time of suture removal for pain, swelling, wound closure, postoperative bleeding, dry socket, infection, paresthesia and trismus. Pain intensity in the form of visual analogue scale, clinical swelling determination using thread measure, trismus assessment by differences in mouth opening, paresthesia/anesthesia by questioning about tongue, chin and lip sensibility and performing neurosensory tests like 2-point discrimination, pin prick and light touch. Patients with neurosensory disturbance were followed for 6 months. RESULTS: This study confirmed the previously reported prevalence rates of neurological deficit and demonstrated 2% incidence of lingual nerve injury where no symptom lasted for more than 12 weeks. Inferior alveolar nerve paresthesia not reported in case series. Most of the patients reported with mild pain, mild swelling and trismus at seventh postoperative day at the time of suture removal. CONCLUSION: Although third molar surgery is a secure and low morbidity procedure, the risk of complications will always exist and it increases with increased surgical difficulty, hence the patient should always be educated about the risks and benefits of surgery in order to ensure adequate surgical management of impacted M3.

Simultaneous Placement of Endosseous Implants in Free Fibula Flap for Reconstruction of Mandibular Resection Defects.

Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. Large bone defects in the mandible due to ablation for tumors may generate a series of problems, as far as function and esthetics of the patient is concerned. The use of free bone flaps for mandibular reconstruction has the obvious advantage of being a well vascularized tissue that can withstand the hostile environment of the oral cavity. Fibular bone presents favorable conditions for implant-supported prosthetic rehabilitation, due to its diameter and the good quality of its cortical bone. The outcome of current study supports the use of simultaneous placement of endosseous implants in free fibula flap for reconstruction of mandibular resection defects with better clinical, aesthetic, and functional outcomes.

Rehabilitation of Unilateral Congenital Microtia by Implant-retained Prosthesis.

Microtia is a major congenital anomaly of the external ear. It includes a spectrum of deformities from a grossly normal but small ear to the absence of the entire external ear. These deformities account for three in every 10,000 births, with bilaterally missing ears seen in fewer than 10% of all cases. Extraoral implant-retained ear prosthesis has been proven to be a predictable treatment option for rehabilitation of such congenital anomalies. This paper aims to present principles of maxillofacial implants, review of literature, advantages, disadvantages, and considerations in treatment planning and treatment phases of an implant-supported auricular prosthesis and prospective developments for ear prosthesis are also discussed. Implant supported ear reconstruction provides excellent support, good retention, and esthetically acceptable appearance to the patient.

Utility of Vaccum Pressed Silicon Sheet as a Bite Raising Appliance in the Management of TMJ Dysfunction Syndrome.

INTRODUCTION: Temporomandibular disorders (TMDs) represent a group of painful conditions involving the muscles of mastication and the temporomandibular joint (TMJ) that frequently encountered in general clinical practice. This study is designed to assess the utility of vacuum pressed silicon sheet as a bite raising appliance in the management of TMJ dysfunction syndrome. METHODOLOGY: The patients for this study were selected from those with the chief complaint of TMJ disorder. Out of 200 patients, 104 patients were diagnosed with subluxation and 96 patients were diagnosed with internal derangement of temporomandibular joint. All the reported cases were managed conservatively with physiotherapy and muscle relaxant therapy for one week period and followed with silicon bite raising appliance over both the arches in the subsequent period. RESULTS: All the patients had pain relief within six months duration as graded over verbal analog scale. ANOVA scale was used for comparision of VAS scores. CONCLUSION: The use of vacuum pressed bite raising appliance in the management of TMJ disorder was found to be satisfactorily effective in alleviation of pain symptom in our study group.

Reconstruction of Orbital Floor Fractures with Autogenous Bone Graft Application from Anterior Wall of Maxillary Sinus: A Retrospective Study.

INTRODUCTION: Orbital wall fracture implies a situation where disruptions of the walls or floor have occurred. It is a blowout type fracture where bone fragments with torn periosteum are pushed outside of the original bony orbit. There is no intact bone even near the defect area except the thin bone rim surrounding the blowout fracture. The purpose of this defect repair is to support orbital contents, free entrapped tissue, and, especially, restore the original orbital volume. MATERIAL AND METHODS: Ten patients (seven males and three females) who underwent repair of orbital floor factures with maxillary sinus bone grafts were included in this study. Surgical procedure for harvesting graft and its fixation was almost same in all operated cases. CONCLUSION: The collection in the maxillary sinus due to fracture of floor of orbit, blood and bony fragments collected in the maxillary sinus can be easily drained and removed after removal of anterior wall of maxillary sinus and through the same approach you can reduce the floor of orbit manually to the proper position which helps to decease the orbital floor defect.