Clinical Evaluation of Modified Technique of Alar Base Cinch Suture to Prevent Widening of Alar Base.

Introduction: Following Lefort I osteotomy, widening of the alar base is the most common secondary postoperative change resulting in deepening of the alar facial groove, which may be unaesthetic. Therefore, various surgical techniques to control lateralization of the alar base have been widely described in the literature. The purpose of this study was to analyze the cause and to prevent the changes in the nasolabial region, especially excessive widening of the alar base following Lefort I osteotomy by using modified alar base cinch suture. Materials and Method: Twenty patients with the diagnosis of maxillary retrognathism or vertical maxillary excess requiring Lefort I osteotomy with superior repositioning or advancement were included in this prospective, non-randomized clinical study. Following Lefort I osteotomy, the widening of alar base was managed using modified alar base cinch suture. Result: The mean alar width preoperatively was 41.09 ± .38 mm, intra-operatively it was 43.69 ± .28 mm, and after 6 months, it was 41.93 ± .47 mm. Statistical analysis using paired t test revealed that there was a significant change in alar width after placing alar base cinch suture. Discussion: The results of the current study show that the modified alar cinch suture technique is effective in preventing flaring of the alar base in case of Lefort I osteotomies with superior repositioning or advancement.

Evaluation of Mini-Preauricular Incision in the Surgical Management of Condylar Fracture.

Introduction Mandibular fractures have the highest incidence next to nasal bone fractures of which condylar fractures account for one-third of it. Various approaches for condylar fracture include intraoral and extraoral approaches such as coronal, preauricular, postauricular, endaural, endoscopic, rhytidectomy, transparotid, submandibular, and retromandibular approaches. The purpose of this study was to evaluate the mini-preauricular incision in open reduction and internal fixation of condylar and subcondylar fractures of the mandible. Materials and methods Twenty patients with condylar fracture underwent open reduction and internal fixation under general anesthesia using a modified mini-preauricular incision and subdermal dissection approach. Parameters assessed were pain, mouth opening, occlusal derangement, accessibility of fracture site, duration of surgery, neurosensory deficit (facial nerve), postoperative edema, wound infection, wound dehiscence, and scar. Patients were followed up at an interval of one week, one month, three months, and six months. Results On comparing the parameters preoperatively and postoperatively, occlusal derangement, mouth opening, and pain showed statistical significance with a p-value of 0.01, while nerve weakness and scar assessment showed a high level of statistical significance with a p-value of 0.001. The anatomical reduction of the condyle and internal fixation with miniplates was easy when this approach was used. Patients showed transient facial nerve paralysis only. No permanent damage was noted. The resultant scar was aesthetically acceptable. Discussion The mini-preauricular approach is an effective and safe technique for open reduction and internal fixation of condylar and subcondylar fractures. This approach provided good access, good cosmetic results, and patient satisfaction. This approach resulted in very less morbidity to the facial nerve.

Langerhans Cell Histiocytosis of the Mandible.

The unusual disorder known as Langerhans cell histiocytosis, which is most frequently seen in children and young adults, is caused by the clonal proliferation of Langerhans cells. Even if clinical signs and radiographic evidence of destructive bone lesions may raise suspicion of the disease, a reliable diagnosis without a thorough pathological examination is challenging. This report describes a case of eosinophilic granuloma of the mandible in a nine-year-old child with characteristic radiological, histopathological, and immunohistochemical features.

Evaluation of 3D Trapezoidal Plates in Open Reduction and Internal Fixation of Subcondylar Fractures of Mandible: A Clinical Trial.

Background  Fractures of the mandibular condyle are common and account for 25% to 50% of all fractures of the mandible. Various methods exist for open reduction and internal fixation (ORIF) of condylar fractures. This study was done to explore three-dimensional (3D) plates as a viable option. Aim  This study aims to evaluate the effectiveness of 3D trapezoidal plates in open reduction and internal fixation of subcondylar fractures. Materials and methodology This was a non-randomized clinical trial conducted on 20 patients who reported at the Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, India. The ORIF was done under general anesthesia. A retromandibular transmasseteric approach was used to expose the fracture site, and the fracture was stabilized using 3D titanium trapezoidal plates. Parameters, such as mouth opening, mandibular deviation, occlusion, surgical accessibility, fracture reduction, adaptability, the difference in ramal height, angulation of the fractured condyle, operative time, facial nerve weakness, implant failure, complications, and scar formation were assessed. Statistical analysis was done using Statistical Package for Social Sciences (SPSS), version 21 (IBM SPSS Statistics for Windows, Armonk, NY). Results  There was an improvement in mouth opening and occlusion in the immediate postoperative period. The surgical accessibility ranged from good to excellent. The fracture reduction was excellent in 60% of patients and good in 40%. In one patient, there was a transient weakness of the marginal mandibular nerve which recovered by three months. Another patient had a wound infection that subsided within the first postoperative week. None of the patients had a device failure during the six-month follow-up period. Conclusion  The trapezoidal 3D plates could be considered as a viable option for treating subcondylar fractures of the mandible in terms of surgical accessibility, stability, ease of device placement, stability of reduced fracture, reduced osteosynthesis material requirement, and minimal damage to the surrounding tissues.