Evaluation of the Sternoclavicular Graft for the Reconstruction of Temporomandibular Joint After Gap Arthroplasty.

INTRODUCTION: Ankylosis may be defined as the fusion of the articular surfaces with bony or fibrous tissue. The treatment of temporomandibular joint ankylosis poses a significant challenge because of the high incidence of recurrence. A number of interpositional materials have been used including alloplastic materials (acrylic, proplast-teflon, silastic), and autogenous tissues (temporalis muscle flaps, buccal fat pad, dermis, costochondral grafts, metatarsal, fibula, tibia, iliac crest, cranial bone and Sternoclavicular graft SCG and cartilage). Literature suggests that rather than growth centre, we need adaptive centre. SCG is presumed to be a more suitable material for interpositional arthroplasty because Sternoclavicular Joint (SCJ) and TMJ are very similar developmentally, histologically and morphologically throughout the growth period. MATERIAL AND METHOD: Patients with TMJ ankylosis (8 males, 2 females) underwent release of the ankylosed joint by the senior author, between June 2013 and Novemeber 2015. The age of the patients ranged from 10 to 19 years. Pre- and post- operative assessment included a thorough history and physical examination to determine the cause of ankylosis, the maximal incisal opening, etiology and type of the ankylosis, recurrence rate. RESULT: MIO at 6 months follow up was 37.4±2.633 mm (range 32-40 mm), greater than MIO achieved in immediate postoperatively {34.4±2.22 mm (range 30-38 mm). After reconstruction of temporomandibular joint with sternoclavicular graft in the growing child there was a significant increase in the growth of mandible which was stunned due to ankylosis. And the ramal height also increased. CONCLUSION: The articular reconstruction with alloplastic or autogenous grafts, or gap arthroplasty for the treatment of ankylosis is shown to be efficient in relation to the post-operative maximal incisal opening, recurrence and articular function.

6-0 nylon versus 6-0 vicryl rapide in chieloplasty.

CONTEXT: Facial cosmetic result is one of the most concerning issues for the parents who get their children operated for cleft lip. Moreover, the discomfort associated with the suture removal encourages one to use any new technology that may replace the need for suture placement. The type of suture material used in surgery has been a long-standing debate among surgeons. In this study, we compared rapidly absorbable suture material (Vicryl Rapide™) with nonabsorbable suture material (nylon). AIMS: The aim of this study is to compare the appearance and course of scar, wound infection, and patient's parent perception using Vicryl Rapide and nylon in nonsyndromic congenital cleft lip repair. SETTINGS AND DESIGN: This was a randomized prospective controlled clinical trial. MATERIALS AND METHODS: Twenty patients, in the age group of 3-18 months treated for unilateral congenital cleft lip deformity, were included and randomly allocated to two groups with ten patients each. Skin suturing was done with 6-0 polyamide and 6-0 irradiated polyglactin in Groups A and B, respectively. Patients were evaluated at 1 week, 1, 3, 6 months, and 1 year postoperatively in person by the observer as well as by the patient's parent. STATISTICAL ANALYSIS USED: Descriptive statistical analysis was done using SPSS 20, and Student's t-test was applied. RESULTS: It was found that Vicryl Rapide showed more hypopigmented scars and raised scars than nylon at the end of 1 year though overall appearance was comparable between the groups. CONCLUSIONS: Vicryl Rapide showed poorer cosmetic outcomes in terms of height and pigmentation of car as compared to nylon suture of same thickness. However, since scars tend to improve with time, a bigger sample size and a longer follow-up are required to generalize this statement.

Use of training dentures in management of gagging.

Gagging is a frequent impediment to the performance of dental procedures. This stimulation of the gagging reflex, or more accurately, the vomiting reflex, is a special problem in prosthodontic service. A hypersensitive gagging reflex often prevents the dentist from carrying out critical procedures or causes them to perform at a less than satisfactory level. In addition, once having suffered an unpleasant gagging experience in a dentist's office, the patients develop a fear of further visits to dentists. The purpose of this paper is to describe methods of managing the gagging patient that has a sound rationale based on modified treatment approaches starting from impression making to design of the prosthesis aided by training dentures to help the patient to tolerate prosthesis in mouth before fabrication of definite prosthesis.