Non-Vascularized Autogenous Bone Grafts for Reconstruction of Maxillofacial Osseous Defects.

OBJECTIVE: To determine the outcomes of non-vascularized bone grafts for reconstruction of maxillofacial defects. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from January 2013 to December 2015. METHODOLOGY: Descriptive analyses of 30 patients, who underwent maxillofacial reconstruction with non-vascularized bone grafts, were conducted. The demographic information, diagnosis, and type of graft harvested to reconstruct the defect were statistically analyzed. Outcomes of reconstruction with non-vascularized bone grafts were analyzed in terms of mouth opening, success of dental rehabilitation, and postoperative complications, i.e. surgical site infection and hardware loosening. RESULTS: A total of 30 patients ranging from 8 to 60 years (33.57 ±14.74 years) had maxillofacial defects reconstructed mostly due to gunshot injuries, followed by post-resection defects. Overall 15 cases (50%) were reconstructed with iliac crest cortico-cancellous bone graft, 11 cases (36.7%) with rib; while in four cases (13.3%), costochondral graft was used for reconstruction. In 26 cases (86.7%), graft was found to be successful. In three cases, re-operation for onlay bone graft was required to provide optimal dental rehabilitation; while in just one case, postoperative surgical site infection was observed. CONCLUSION: Non-vascularized bone grafts provide a reasonable and effective modality for reconstruction of maxillofacial defects.

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.

Orofacial reconstruction with local flaps at AFID.

BACKGROUND: Reconstruction of oral cavity is often a difficult challenge as it involves the restoration of both the cosmetics and preoperative function. Understanding the oral cavity anatomy as well the functional capacities of its various subunits is required to achieve good results. The stage of the disease and extent of resection are the most significant parameters that must be kept in mind before planning for reconstruction. Aim was to evaluate the success rate of various local flaps in oral reconstruction as well as to conclude whether or not the reconstruction method influences postoperative quality of life. METHODS: This is a descriptive study carried out at Armed Forces Institute of Dentistry, (AFID) Rawalpindi. Sample size comprises of 24 subjects, 16 males and 8 females, who reported to the diagnostic department of AFID from 15 March 2007 to 15 March 2010. RESULTS: A total of 24 patients with oral squamous cell carcinoma were treated in 3 years, out of them 16 (66.7%) were male and 8 (33.3%) were female. The peak incidence was in the 6th and 7th decade of life (37.5%). The most common site involved was the alveolus 37.5% in the reported cases followed by tongue (25%) and buccal mucosa (25%). In 8 (33.3%) patients local resection was performed, in 4 (16.7%) patients resection along with neck dissection was done. In 12 (50%) patient tumour resection followed by neck dissection and immediate reconstruction was also done out of these 12 patients nasolabial flap reconstruction was done in 6 patient (25%), Karapandzic in 4 (16%) patients, and fan flap in 2 (8%) patients. No complication noticed other than wound dehiscence (2 patients), microstomia and circumoral scarring (1 patient). Mean hospital stay was 7 days.