Concentrated Bone Marrow Aspirate-Coated Hydroxyapatite for Reconstruction of Small-to-Moderate-Sized Mandibular Defects Caused by the Removal of Benign Pathologies.

PURPOSE: The aim of this study was to evaluate the bone regeneration potential of concentrated bone marrow aspirate (BMA)-coated hydroxyapatite (HA) for reconstruction of mandibular defects caused by the removal of benign pathologies. PATIENTS AND METHODS: This prospective clinical study included ten patients with histopathologically proven benign pathologies of the mandible measuring <5 cm anteroposteriorly, who were treated with enucleation or marginal resection, followed by autologous concentrated BMA-coated synthetic biphasic HA (HA and beta-tricalcium phosphate) graft placement. Clinical and radiological evaluations of grafted sites of the mandible were done at 1 week, 1, 3, and 6 months postoperatively using Irwin's radiologic staging and grayscale histogram. RESULTS: All patients (10/10, 100%) had proper incorporation of the graft with the normal adjacent bone. Grayscale histogram revealed the initial stages of graft resorption, followed by formation of new bone-grafted sites. No complications such as infection and total graft loss were encountered except for one patient who had partial wound dehiscence that responded well to local wound care and resuturing. CONCLUSION: Concentrated BMA-coated synthetic HA effectively promotes bone regeneration in small-to-moderate-sized defects of the mandible.

Autogenous Bone Marrow Aspirate Coated Synthetic Hydroxyapatite for Reconstruction of Maxillo-Mandibular Osseous Defects: A Prospective Study.

PURPOSE: This prospective study was conducted to evaluate the bone regeneration capacity of synthetic hydroxyapatite mixed with autogenous bone marrow aspirate when used as a bone graft substitute in maxillo-mandibular osseous defects. METHODS: This study included nine patients with histopathalogically proven benign osteolytic lesions in maxilla and mandible that were treated with enucleation or marginal resection followed by bone marrow aspirate coated synthetic biphasic hydroxyapatite (hydroxyapatite and beta tricalcium phosphate) graft placement. Incorporation of graft was assessed based on Irwin's radiologic staging. The efficacy of graft to form new bone was radiologically evaluated by observing the sequential changes of density at grafted site using gray scale level histogram which was processed in adobe photoshop 7.0 elements. Clinical assessment of recipient and donor sites was done. RESULTS: Based on Irwin's radiologic staging, at 6 month follow up period, obvious incorporation of graft with new bone was observed. Sequential changes in bone density measured by gray scale histogram revealed initial resorption followed by replacement of BMA coated hydroxyapatite with new bone formation. None of the patients eventually had complications like infection, wound dehiscence, graft loss at recipient sites at 6 months follow up period. CONCLUSION: Autogenous bone marrow aspirate in combination with synthetic hydroxyapatite is an effective option for accelerating bone regeneration in small to moderate sized jaw bone defects. This mixture provides all the three critical elements needed for bone regeneration (osteogenesis, osteoinduction and osteoconduction) with an added advantage of obviating donor site morbidity.

A Clinician's Role in the Management of Soft Tissue Injuries of the Face: A Clinical Paper.

INTRODUCTION: Injuries of the facial soft tissues may be due to road traffic accidents, industrial injuries, domestic and interpersonal violence, dog bites, human bites, war injuries etc. They may be described depending on the depth of involvement of the soft tissue and/or region since it gives the clinician the method of treatment. The soft tissue injuries must take into the underlying skeletal injury into account since these injuries if carelessly handled they leave deformed scarring in the most precious and beautiful part of the body. MATERIALS AND METHODS: Various patients reporting to the department of Oral and Maxillofacial Surgery, Narayana Dental College and hospital, Nellore were included in the study. Injuries in the various aspects of face at various anatomical areas has been presented with the mode of management. CONCLUSION: The maxillofacial surgeon while attending these cases should avoid the need for revision by having a thorough knowledge of the anatomy, physiology of the soft tissues and treat them accordingly after following good clinical and radiological examination.

Sympathetic ophthalmia: a review of literature.

Sympathetic ophthalmia (SO), also known assympathetic uveitis, is a rare bilateral granulomatous panuveitis that occurs after a penetrating injury to an eye. After injury from either surgery or accident, a variable period of time passes before a sight-threatening inflammation develops in both the eyes. The disease usually responds rapidly to corticosteroid therapy, but recalcitrant cases may require the addition of other immunosuppressive agents. A severely injured eye with no prognosis for vision should be enucleated within 2 weeks of injury to prevent SO. The purpose of this article is to highlight the risks of SO associated with the orbital fractures involving soft tissue components of the orbit. Though unusual, a maxillofacial surgeon, while operating on the orbital walls involving the soft tissue disruption, has to be aware of this condition so that the postoperative complications related to vision can be avoided.

Cutaneous sinuses of cervicofacial region: a clinical study of 200 cases.

PURPOSE: To evaluate the sinuses in the cervicofacial region and to identify the focus of infection. It is also to help the clinician in differentiating the sinuses' of odontogenic and nonodontogenic focus of infection. MATERIALS AND METHODS: The study has been conducted in 200 patients, aged between 11 and 77 years for a period of 6 and a half years at Narayana Dental College and Hospital, Nellore. History of present illness, clinical, radiological and laboratory examinations were carried out on all the patients. RESULTS: Majority of the cervical sinuses are of odontogenic origin (80%) and non-odontogenic being (20%) of the cases. CONCLUSION: The literature reveals that many cases have been misdiagnosed and inappropriately treated by many specialties of Medicine and Surgery wherein the odontogenic foci of infection is the main etiological factor for cervicofacial sinuses. A proper diagnosis is important and forms a key to the successful management of these sinuses in the head and neck region.