Protocol for the management of ankylosis of the temporomandibular joint.

Ankylosis of the temporomandibular joint (TMJ) is a severely deforming, disabling condition as a result of craniomandibular fusion caused mainly by condylar fractures with displacement of the meniscus. Ankylosis may be fibrous, fibro-osseous, or bony, and unilateral or bilateral. The severity of the deformity is based on the onset, duration, and type of ankylosis. Various surgical techniques have been described for treatment, but no single treatment is recommended because of inconsistent results and the high rate of failure. While our total experience extends to 300 cases, we have developed a protocol using the most recent 193 patients to address our earlier high failure rate. The onset was during childhood in 168 patients, and 25 were adults. We describe the protocol that we developed for these two groups. Our management included gap arthroplasty, costochondral grafting, temporalis flaps, ramus osteotomies, and transport distraction.

Synovial chondromatosis of the temporomandibular joint with intracranial extension-report of two cases.

Synovial chondromatosis of the temporomandibular joint is a rare condition, and only 10 cases with intracranial extension have been reported in the literature. Two cases of synovial chondromatosis with intracranial extension, followed up for 3 to 9 years, are reported here. The surgical treatment modality is described for each case.

Skull base tumors: a kaleidoscope of challenge.

Resection of skull base lesions has always been riddled with problems like inadequate access, proximity to major vessels, dural tears, cranial nerve damage, and infection. Understanding the modular concept of the facial skeleton has led to the development of transfacial swing osteotomies that facilitates resection in a difficult area with minimal morbidity and excellent cosmetic results. In spite of the current trend toward endonasal endoscopic management of skull base tumors, our series presents nine cases of diverse extensive skull base lesions, 33% of which were recurrent. These cases were approached through different transfacial swing osteotomies through the mandible, a midfacial swing, or a zygomaticotemporal osteotomy as dictated by the three-dimensional spatial location of the lesion, and its extent and proximity to vital structures. Access osteotomies ensured complete removal and good results through the most direct and safe route and good vascular control. This reiterated the fact that transfacial approaches still hold a special place in the management of extensive skull base lesions.

Oral submucous fibrosis: a new concept in surgical management. Report of 100 cases.

Oral submucous fibrosis (OSF) is a collagen disorder commonly seen in the Indian subcontinent. A series of 100 patients is presented. All lesions were biopsied. The condition was staged into four categories. Very early and early cases were treated by local injection of triamicinolone acetonide, while advanced cases were treated by surgical intervention. A new surgical technique of a palatal island flap based on the greater palatine artery in combination with temporalis myotomoy and bilateral coronoidectomy was used in 35 cases. A follow-up ranging from 6 months to 31/2 year showed good results.

Giant ossifying fibroma. Case report on a bimaxillary presentation.

Ossifying fibroma is a slow-growing, benign neoplasm, but some lesions behave aggressively, reaching massive proportions, thus demanding special treatment. The following case report holds particular interest, because of the simultaneous occurrence of an active ossifying-cementifying fibroma in the maxilla and mandible with the maxillary lesion attaining enormous size.

Hemifacial hypertrophy. Report of two cases.

True hemihypertrophy involves not only the soft tissues of the body but the hard tissues as well. It may be classified as being total or partial. Total, if an entire side of the body is involved and partial, if only a portion. This report presents 2 cases of true hemifacial hypertrophy in an adult aged 29 years and a child of 12 years. Three-stage reconstruction is described in the older patient.

Cervical infection due to an unusual displacement of teeth as a result of trauma.

An unusual and extremely rare displacement of teeth due to trauma, resulting in cervical space cellulitis with probable secondary complications is presented.

Trigeminal neuralgia. Report of 140 cases.

140 patients suffering from trigeminal neuralgia are evaluated. 22 patients were treated by symphatholytic and parasympatholytic drugs and the remaining 118 were operated on by peripheral neurectomy and nerve avulsion. In case of involvement of the inferior alveolar nerve, Thoma's, Poppen's and Ginwalla's method were tried. All cases were critically evaluated and followed for a period of 6 months to 5 years. The objective was to assess the different techniques and to find out the most ideal method of management. Our study showed that an injection of atropine was quite promising in the third division involvement while peripheral neurectomy in second division involvement (Ginwalla's technique of nerve avulsion) was found to be more satisfactory than Thoma's or Poppen's method.