Applications of coronoid process as a bone graft in maxillofacial surgery.

The coronoid process can be easily harvested as a donor bone by an intraoral approach during many maxillofacial surgery procedures. The purpose of this study was to evaluate the utility of autogenous coronoid process bone grafts for maxillofacial reconstructive surgery. Twelve patients, who underwent coronoid process grafts for reconstruction of maxillofacial deformities due to trauma, alveolar atrophy, or temporomandibular joint ankylosis, were included in the study. There were 3 orbital defects after extended maxillectomy, 1 blowout fracture of the orbit, 2 cases of reconstruction after temporomandibular joint ankylosis surgery, 1 case of additional chin augmentation following horizontal flip genioplasty, 1 defect of anterior wall of maxilla due to trauma, 2 mandibular defects, and 2 cases of bone augmentation for implants.We recommend the use of coronoid process of the mandible as a source for autogenous bone graft as it can provide sufficient bone in quantity and quality for selected maxillofacial reconstructions.

Mandibular subsigmoid access osteotomy in the management of parapharyngeal space tumors.

Primary parapharyngeal space tumors are rare presentation in the head, face, neck region. Most of these tumors are benign in nature and significantly cast a challenge in terms of diagnosis and their surgical management. Anatomical location of these tumors, either prestyloid or poststyloid, size of the tumor, and proximity to the vital structures determine the appropriate surgical approach. The surgical approach to the parapharyngeal tumors should provide adequate visibility and access for complete removal, preserving the adjacent vital structures and also preventing recurrence. We report our experience in diagnostic workup and management of a series of 18 primary parapharyngeal space tumors with long-term follow-up.

Incidence and Pattern of Cranio-Maxillofacial Injuries: A 22 year Retrospective Analysis of Cases Operated at Major Trauma Hospitals/Centres in Pune, India.

This study aims to retrospectively analyze the incidence and pattern of cranio-maxillofacial injuries in the developing world in a hope to emphasize on authorities the need of improvising infrastructural facilities, medical and other. Hospital medical records with available radiographs of 6,872 patients treated for cranio-maxillofacial injuries at major trauma centres in Pune, India over a 22 year period (from July 1989 to June 2010) were reviewed. Relevant data pertaining to patients' age, sex, cause of injury, sites of injury, associated injuries, anaesthesia, various treatment modalities and complications were recorded and analyzed statistically. A total of 6,872 patients sustained maxillofacial injuries of which 5,936 (86.4 %) were caused by road traffic accidents (RTA), followed by fall in 608 cases. Distribution pattern of sex revealed male predominance (M:F-2.5:1) and the third decade age group (2,416) sustained maximum cranio-maxillofacial injuries. Of 12,503 cranio-maxillofacial sites involved, mandible (6,456) predominated, while there was middle third involvement in 5,024 cases. Most of the patients (4,856) were treated with open reduction and internal fixation without maxillo-mandibular fixation and complications were noted in 320 patients. In comparison to similar recent studies reported in the literature, our findings show that RTA remains the most common cause of cranio-maxillofacial injuries with male preponderance. Also RTA remains the major preventable etiological factor of cranio-maxillofacial injuries, which should prompt authorities to take "Herculean effort" to implement rules and educate people.

Unusual intraorbital foreign body.

A case of a 41-year-old patient presenting late post-trauma with out any major signs or symptoms is presented herewith. On radiological investigation, a peculiar foreign body was identified in the orbital floor. To our surprise the point of entry of the foreign body was not proportionate with the size of it. Moreover, the trajectory and final location of foreign body did not concur with the symptom less presentation of patient. After what was thought to be adequate investigation, the patient was taken under general anaesthesia to reveal an additional foreign body that put most of the preoperative queries to rest. This case in retrospect emphasises the need for ruling out foreign body in the case of any penetrating injury of orbit with the help of not just radiographs and CT scans but also ultrasonography and MRI.

Progressive, massive osteolysis of mandible (Gorham's disease): report of a case.

A rare case of progressive osteolysis of mandible is discussed with clinicoradiological presentation. The purpose of the case report is to make the medical community aware of this rare and fascinating disorder in the maxillofacial region. The disease is characterised by spontaneous progressive osteolysis of one or more skeletal bones. Occurrence in maxillofacial region is rare with fewer than 35 reported cases affecting the facial and jaw bones. The present case report is about the mystery of bilaterally missing ascending rami. An attempt is made to draw attention of the medical fraternity to this unusual and rare entity which can induce instability, dysfunction and cosmetic disturbances.

Correlation of panoramic radiographs and spiral CT scan in the preoperative assessment of intimacy of the inferior alveolar canal to impacted mandibular third molars.

Iatrogenic origin of neurosensory dysfunction is a distressing sequel to the surgical removal of impacted mandibular third molars, which is frequently overlooked. According to various surveys, the rate of neurologic complications related to the surgical removal of impacted mandibular third molars varies between 0.5% and 1% for permanent damage and 5% and 7% involving temporary damage. Prevention always stands as the best modality to avoid patient's discomfort and lawsuits by sophisticated consumerism.Preoperative assessment of the topographic relationship of the impacted mandibular third molar to the inferior alveolar canal has been performed by different imaging modalities. However, none of the imaging techniques give cent percent information. The best available imaging modality in time and resources should be adopted by the surgeon to avoid complications and lawsuits. Orthopantomography has often been cited as the imaging modality of choice before surgical removal of impacted mandibular third molar. However, it depicts a two-dimensional view of an intricate three-dimensional anatomic relationship and also fails to accurately project the buccolingual relation between the tooth and the inferior alveolar canal. The current study was designed to evaluate the potential advantages of spiral computed tomography and compare its efficacy as a presurgical planning tool with orthopantomography in patients with impacted mandibular third molars showing proximity to the inferior alveolar canal on an orthopantomogram.