Anthropometric Analysis of Indian Faces: A Systematic Review.

Objective: Facial anthropometric data vary significantly within the Indian population due to the racial, ethnic and geographic diversity. The anthropometric data of a given ethnic community may not match the other due to diverse ethnic variations, and hence, this study is intended to review the facial anthropometric data pertaining to the diverse Indian populace through a systematic literature survey. Materials and Method: An electronic search done on Medline, Embase and Central databases was utilized to conduct a systematic review of literature. The available data were analyzed based on the various esthetic subunits of the face. The following inclusion criteria were considered: (1) studies depicting the anthropometric data of any ethnic group identified as belonging to India, (2) studies originating from Indian subcontinent, (3) studies which included data of male and female subjects separately and (4) articles in English language only. The following exclusion criteria were considered: (1) atudies conducted on participants with severe malocclusion, developmental craniofacial anomalies, post-traumatic facial deformities or with a history of previous craniofacial or cosmetic surgery, (2) studies which did not specify the anthropometric landmarks used to obtain the measurements, (3) studies in which the statistical analysis was not provided, or if data were grouped across genders and (4) editorials, commentaries, case reports, systematic reviews, meta-analyses and articles not available in English language. Results: Twenty-one articles met the inclusion criteria. Majority of the Indians, particularly men, seem to have a mesoproscopic facial phenotype. The vertical and horizontal facial dimensions of the Indian male are comparably larger than the Indian female. There is sexual dimorphism among the Indian population with regard to the upper and lower thirds of the face, with little or no gender difference as regards the middle third of the face. It was observed that the nasal dimensions of the Indian race were not compatible with that of the occidental, oriental or the western race. The overall facial structure and the upper half of the face were critical in determining facial attractiveness in Indian males while the lower half of the face and the mandibular contour were critical in determining facial attractiveness in females. Conclusion: It is observed that there is a paucity of facial anthropometric data for the Indian population considering the ethnic, racial and geographic diversity. Since the prevalence of craniofacial anomalies and dentofacial deformities in India is high and thus the scope for corrective surgery, it is important to compile baseline facial anthropometric data based on the ethnic diversity of the Indian population.

Is There a Need for Greater Emphasis on Clinical Facial Analysis than Cephalometrics & 3D Software Solutions in the Diagnosis and Treatment Planning of Patients with Dentofacial Deformities?

Purpose: This study is designed to evaluate the need for a greater emphasis on clinical facial analysis over cephalometrics in the diagnosis and treatment planning of patients with dentofacial deformities. Materials and Method: A predetermined questionnaire study was designed to get the thought process of surgeons and consultants involved in orthognathic surgery from various parts of southern India. Two hundred and twenty-eight maxillofacial consultants were involved in the survey. Demographic information, type of professional practice, preferred tool in the diagnosis & treatment planning: Cephalometrics or 3D software solutions and flaw in the available tools were evaluated. Results: The results of this study revealed that only 36.8% of the consultants felt that cephalometrics is the prime tool and 73.3% of the consultants felt that 3D software solutions were superior to cephalometrics in the diagnosis and treatment planning of patients with dentofacial deformities. However, 46% of the consultants preferred facial analysis as the prime tool with cephalometrics as an adjunct. Pertaining to the clinical outcome of their treated cases of dentofacial deformities, 61.8% of the consultants felt the need to address additional cosmetic issues following an orthognathic procedure. It was observed that 92.1% of the participants felt the need for greater emphasis on clinical facial analysis than cephalometrics. Conclusion: Human faces should always be evaluated taking into consideration the various esthetic units of the face. Performing corrective jaw surgery merely based on cephalometric values inevitably fails to address the various other innate imbalances of the face. Hence, cephalometric data should only be considered as an adjunct to clinical judgment in the diagnosis and treatment planning of dentofacial deformities.

Patient Satisfaction Following Orthognathic Surgery: A Systematic Review.

Objective: This study is intended to review data pertaining to patient satisfaction following orthognathic surgery through a systematic literature survey. Methods and Materials: An electronic search was done on Medline, EMBASE and CENTRAL databases. The inclusion criteria considered were as follows: (1) assessment of patients' satisfaction, (2) one-stage orthognathic surgery, and (3) follow-up period of 8 weeks or more in English literature. The exclusion criteria considered were as follows: (1) presence of craniofacial syndromes, cleft lip and palate or traumatic injuries, (2) previous facial surgery, and (3) psychological problems before surgery. The data were extracted and analyzed under three categories: function, esthetics and overall satisfaction. Results: Eighteen studies met the inclusion criteria. Esthetic and function were improved in majority of patients; however, it was not possible to assess the overall satisfaction levels statistically. Overall satisfaction analysis revealed that 70-87% of patients were satisfied, while nearly 15% of patients were dissatisfied with the treatment outcome. Conclusion: Most of the patients were satisfied with the surgical outcome. However, satisfaction seemed to be multifactorial and it was not possible to predict satisfaction prior to the surgery.

The Nuances of Temporomandibular Joint Ankylosis Surgery: Tips and Tricks.

INTRODUCTION: A plethora of surgical options have been described in the literature for the management of temporomandibular joint (TMJ) ankylosis, but one cannot subscribe to a modality that is infallible in regard to recurrence. The incidence of recurrence is attributed to poor surgical technique and poor patient compliance. This article proposes incorporation of subtle modifications into the surgical techniques that could prove to be helpful in the management and prevention of reankylosis. MATERIALS AND METHODS: Twenty-one patients with TMJ ankylosis with an age range of 10-29 years (mean age 19 years) were operated, of whom six (28.5%) were bilateral and 15 unilateral (71.5%), and 14 (66.6%) had a history of previous surgery for ankylosis. The preoperative and intraoperative mean inter-incisal opening (MIO) was 4.4 mm and 43.2 mm, respectively. All patients fared well at the late postoperative evaluation at 24 months with a mean MIO of 36.9 mm. CONCLUSION: The subtle modifications address various aspects such as the adequacy of the preauricular approach, the use of a wide flame-shaped bur, the obliquity of the arthroplastic osteotomy, burnishing the residual ramal stump devoid of irrigation, temporalis muscle release and coronoidectomy, aggressive intermittent intraoperative jaw physiotherapy, mandatory use of a vacuum drain and rigorous postoperative jaw physiotherapy.

As atuais políticas de saúde mental no Brasil: reflexões à luz da obra de Cornelius Castoriadis / Current mental health policies in Brazil: reflections in light of the work of Cornelius Castoriadis / Las actuales políticas de salud mental en Brasil: reflejos a lae luz de la obra de Cornelius Castoriadis

Esse artigo é o recorte de um projeto de pesquisa apresentado no Programa de Pós-graduação Mestrado em Psicologia da Universidade Federal do Mato Grosso do Sul (UFMS) que visa a estudar aspectos das atuais políticas de saúde mental no Brasil, sobretudo no que se refere à eficácia do que elas trazem como um de seus principais objetivos, que é a inclusão social de sujeitos psicóticos. Apresentamos os pressupostos básicos da Reforma Psiquiátrica no Brasil e, em seguida, fizemos uma breve exposição de algumas elucidações de Cornelius Castoriadis. Utilizamos a metodologia qualitativa e os recursos da pesquisa bibliográfica permeada pelos pressupostos metodológicos do autor que nos embasou. Como resultado dessa investigação, destacamos a impossibilidade de se pensar os aspectos psíquicos e social-históricos e, portanto, as políticas de saúde mental - dentro dos limites da lógica-conjuntista identitária -, emergindo questionamentos sobre as possibilidades de um projeto de autonomia dentro das diretrizes dessas políticas. Por fim, como a pesquisa está em andamento, informamos que, além dos materiais teóricos, faremos uma análise do conteúdo de documentos que expressam as principais ações dessas políticas, buscando elucidações para as interrogações levantadas.

This article is a part of a research project within the Master’s in Psychology Program of the Universidade Federal do Mato Grosso do Sul (UFMS), aiming at studying aspects of the current policies of Mental Health in Brail, above all, the efficacy that they bring in the case of one of their principal objectives, the social inclusion of psychotics. The basic presuppositions of the Psychiatric Reform in Brazil are presented and, following this, a small exposition of some of the elucidations of Cornelius Castoriadis are presented. Qualitative methodology was used, as well as the recourse to bibliographical research permeated with the methodological bases of the author we used. Results permitted us to point out the impossibility of projecting psychical and social-historical aspects, ie., the policies of mental health, within Ensemblistic-Identitary logic, raising interrogations on the possibilities of a project of autonomy within the directives of these policies. Finally, since the research is still in progress, besides theoretical data collection, an analysis of the contents of the documents expressing the principal actions of these policies will be done, in search of elucidations of the interrogations raised.

Este artículo es parte de un proyecto de investigación presentado en el Programa de Pos-graduación de Maestría en Psicología en la Universidad Federal do Mato Grosso do Sul (UFMS), el cual tiene como objetivo estudiar los aspectos de las actuales políticas de salud mental en Brasil, especialmente, en lo que se refiere a la eficacia de lo que traen como uno de sus principales objetivos: que es la inclusión social de los pacientes psicóticos. Se presentan los presupuestos básicos de la Reforma Psiquiátrica en Brasil y, luego, un breve resumen de algunas aclaraciones de Cornelius Castoriadis. Nosotros utilizamos la metodología cualitativa y los recursos de la búsqueda bibliográfica permeados por los presupuestos metodológicos del autor que fue la base de nuestro trabajo. Como resultado de la investigación, destacamos la imposibilidad de considerar los aspectos psicológicos y sociales históricos - y, por lo tanto, las políticas de salud mental - dentro de los límites de la lógica-conjuntista identitaria, permitiendo el levantamiento de preguntas sobre las posibilidades de un proyecto de autonomía dentro de las pautas para estas políticas. Por último, ya que la investigación está en curso, informamos que, además de material teórico, vamos a hacer un análisis del contenido de los documentos que expresan las principales acciones de estas políticas, en busca de aclaraciones a las preguntas planteadas.

Musculoskeletal Changes as a Sequel to Advancement Genioplasty: A Long-Term Cephalometric Prospective Study.

AIMS: The aim of this study was to evaluate cephalometrically the stability of hard tissues and soft tissue changes of advancement genioplasty 2 years after surgery. METHODS: A prospective study was conducted which comprised of 25 patients, who underwent advancement genioplasty alone with no other orthognathic surgical procedures. Immediate pre-operative, 6 months postoperative, and 2 years postoperative lateral cephalograms were compiled and assessed. RESULTS: The mean surgical advancement planned was around 8 mm. Six months post-surgery, the relapse rate was 15% of the surgical advancement which was considerably reduced in the following 18 months to 7%. The ratio of soft tissue to bony advancement at pogonion was 0.9:1. There are significant alterations in the soft tissue profile in terms of decrease in the soft tissue thickness, facial convexity angle, deepened mentolabial sulcus and minimal increase in the lower lip height. CONCLUSION: Advancement genioplasty was considered as a relatively stable procedure, if adequate muscular pedicle and internal rigid fixation were maintained. The present study was of 2 years, and we can expect further changes in the hard and soft tissues, which are clinically irrelevant.

The versatility of spandex photographic retractor for transoral surgical procedures.

The trend toward transoral access, be it for pathology or facial cosmetic surgery, has become increasingly popular over the last two decades with facial incisions being used more and more sporadically than otherwise. Transoral access because of its inherent limitations, retraction of the oral and perioral tissues without inducing physical or thermal injury makes it a daunting task for the operating surgeon. The use of conventional retractors in conjunction with surgical instruments can lead to inadvertent injury to the perioral tissues resulting in untoward postoperative sequelae leading to patient discomfort and delayed recovery. This article elucidates the versatility of a simple photographic retractor (spandex) as a useful adjunctive tool in the retraction and protection of the perioral tissues for almost all transoral surgical procedures.

Coronal/Hemicoronal Approach - A Gateway to Craniomaxillofacial Region.

AIMS: The coronal incision with its various modifications provides the most versatile approach to various areas in the craniomaxillofacial region coupled with excellent exposure. The aesthetic advantage of a hidden scar in the hairline, accounts for its continued popularity. The aim of this study was to review the surgical anatomy, technique and problems of post-operative morbidity pertinent to coronal approach in various clinical situations such as craniofacial trauma, tumour resections and reconstructive craniofacial procedures. MATERIALS AND METHODS: In this study, ten patients who presented to Oral and maxillofacial surgery department with various craniofacial problems requiring the use of coronal and hemicoronal approach for treatment were evaluated over a period of two years. Five patients needed coronal approach and another five underwent the surgical procedures through hemicoronal approach. This was an observational study. RESULTS: It was observed that a well-planned and carefully designed coronal/hemicoronal incision with strict adherence to surgical principles posed minimal complication during surgery as well as post-operatively. None of the patients developed infection or heamatoma in the postoperative period. Sensory nerve deficits along the distribution of supraorbital nerve was observed in four patients of bicoronal approach and three patients of hemicoronal approach which completely resolved at the end of six months. Motor nerve weakness was observed in four patients in immediate postoperative period which gradually improved. But it persisted in one patient even after six months who had pathology of temporo-orbital region. All the patients had transient alopecia along the line of incision which improved at the end of six months. No other significant disadvantages or complications were noted. CONCLUSION: This approach offers widest accessibility and visibility to the entire upper and middle one third of the face in less than twenty minutes as observed in our study. The postoperative complications are minimal, minor and outweigh the advantages for surgical treatment in any given clinical situation as observed in this study. This proves the brilliance of coronal approach in solving an array of surgical problems pertinent to craniomaxillofacial region with superior aesthetic outcomes. ABBREVIATIONS: ZMC-Zygomatico maxillary complex, NOE-Nasoethmoidal complex, LF-Lefort, ORIF-open reduction internal fixation.

Paramedian unilateral Le Fort I osteotomy.

A novel maxillary osteotomy is designed which is a technical modification of the standard Le Fort I osteotomy, termed the paramedian unilateral Le Fort I osteotomy. This technique has been used to correct an anterior open bite in a given patient based on the current clinical scenario as described, secondary to post ankylosis surgery. Its use may be extrapolated to various clinical situations to correct occlusal discrepancies including distraction osteogenesis.

Clinical and Histological Basis for the Use of Nasolabial Tissues in the Surgical Management of Oral Submucous Fibrosis.

PURPOSE: The authors planned a clinical and histopathologic study to examine the behavior of nasolabial tissues (full-thickness skin flap) after being inset into the oral cavity for oral submucous fibrosis (OSMF) under the premise that skin that is foreign tissue to the oral cavity would be devoid of pathologic changes. MATERIALS AND METHODS: Fourteen patients with OSMF and mouth openings with an interincisal distance shorter than 28 mm were included. The flap was evaluated clinically for 10 years, during which biopsy specimen was obtained from the mucocutaneous junction of the inset flap for histopathologic examination. RESULTS: In this series, complications such as flap loss, infection, flap necrosis, obstructive sialadenitis, and damage to facial nerve branches were not observed. However, intraoral hair growth and extraoral scar at the donor site were seen in all patients, 3 of whom subsequently underwent scar revision. Histopathologically, the inset flap showed decreased keratinization and loss of adnexal structures. A mean mouth opening of 43.2 mm was achieved at 10 years postoperatively (mean increase, 24.4 mm). No relapse was encountered, even at the last follow-up. CONCLUSION: The nasolabial island flap or any other full-thickness skin flap could be a viable and reliable option for reconstruction of intraoral defects from OSMF.

Comparison of clinical efficacy of methylprednisolone and serratiopeptidase for reduction of postoperative sequelae after lower third molar surgery.

BACKGROUND: Surgical removal of mandibular third molars results in some degree of post-operative pain, swelling and trismus. These can be controlled by proper administration of local anesthesia, careful bone removal, minimal trauma to adjacent soft tissues and administration of methylprednisolone and serratiopeptidase drugs. The aim of the present study was to compare the efficacy of methylprednisolone and serratiopeptidase in controlling post-operative pain, swelling and trismus after surgical removal of impacted mandibular third molars. MATERIAL AND METHODS: The subjects were divided into two groups of 50 patients each undergoing surgical removal of mandibular third molars. Group A was given methylprednisolone 4mg orally every 8th hourly and Group B was given serratiopeptidase 10 mg every 12th hourly orally. Post-operatively pain, swelling and trismus were evaluated at the end of 1st, 3rd and 5thday. RESULTS: The results of this study showed that methylprednisolone is an effective analgesic, while serratiopeptidase has moderate analgesic activity. Serratiopeptidase is more effective than methylprednisolone in controlling post surgical swelling and trismus. Hence combination of these two drugs would be very effective than individual drug when widespread post-operative sequelae are expected after surgical removal of impacted lower third molars. CONCLUSIONS: We conclude that methylprednisolone affords better pain relief while serratiopeptidase exerts better anti-inflammatory and anti-swelling effects in the post-operative period. Synergistic combinations of these two drugs would however prove to be more effective when extensive post-operative sequelae are expected. Key words:Methylprednisolone, serratiopeptidase, pain, swelling, trismus, third molar.

Confounding factors and diagnostic accuracy of imprint cytology.

BACKGROUND: Eradication of malignant tumors at the primary site with oncological safe margin is a critical requirement for obtaining better survival rate and less recurrence. Touch imprint cytology (TIC) has proven itself as a quick, simple, inexpensive, highly accurate and reliable intraoperative technique to assess surgical margins in squamous cell carcinomas of the oral cavity. However, it is still unclear how the mode of excision, i.e. by scalpel (SC) and electrocautery (EC), or the method of staining, i.e. Papanicolaou (PAP) and cytohaem, affect the diagnostic accuracy of TIC. OBJECTIVE: To study the influence of confounding factors like mode of excision (EC/SC) and staining (PAP/cytohaem) on the diagnostic accuracy of intraoperative TIC technique for assessing surgical margins in oral squamous cell carcinoma in comparison to paraffin-embedded HE-stained sections. MATERIALS AND METHODS: Thirty patients underwent surgical treatment for primary oral squamous cell carcinoma. Three hundred and forty-eight touch imprint slides were prepared from 174 margins of 30 resected tumor specimens. Two adjacent tissues from the margin to be evaluated were imprinted to observe differences between surfaces excised by EC and SC. The set of imprint from each margin tissue was stained with PAP and cytohaem. The TIC results of 180 EC-excised margins and 168 SC-excised margins were compared. Results of 174 imprints stained with RAPID-PAP were compared to their counterpart comprising of 174 cytohaem-stained imprints. The slides were diagnosed as positive, negative or suspicious for tumor. Finally, TIC results were checked against their respective histopathological sections. RESULTS: No statistically significant difference was found between the results of imprints from EC/SC-excised margins (Z = 0.44, p = 0.70) or the imprints stained with PAP/cytohaem (Z = 0.44, p = 0.70). CONCLUSION: Confounding factors like mode of excision and staining procedure do not significantly influence the results of imprint cytology.

Temporalis myofascial flap transfer into the oral cavity without zygomatic arch osteotomy.

Among plethora of options, the temporalis myofascial flap remains a workhorse for the maxillofacial reconstruction. The inherent advantages include reliable vascularity, adequate size, and proximity to the defect. Although contemporary surgical techniques provide fair surgical results with low rate of complications, their intraoral transposition involve additional surgical trauma by intentional fracturing of the zygomatic arch. We have proposed herein a simpler technique of temporalis myofascial flap transposition into the oral cavity without zygomatic arch osteotomy.

Intraoperative imprint evaluation of surgical margins in oral squamous cell carcinoma.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is a multifactorial malignant epithelial neoplasm. Tumor clearance at the surgical margins in OSCC is a critical factor which strongly influences both the local recurrence and overall survival rate. A quick and accurate intraoperative diagnostic procedure can make a significant difference to the survival rate. Touch imprint cytology (TIC) has commonly been used in the past for the diagnosis of tumors and the detection of sentinel lymph node metastasis. It is routinely applied for intraoperative margin analysis of breast lumpectomy specimens, where it has been proven to have a good success rate. The effectiveness and reliability of TIC in the intraoperative margin evaluation of OSCC, however, has not been established so far. OBJECTIVE: To investigate the diagnostic accuracy of the intraoperative TIC technique for assessing surgical margins in OSCC in comparison to paraffin-embedded hematoxylin and eosin-stained sections. MATERIALS AND METHODS: Thirty previously untreated, biopsy-proven OSCC patients undergoing surgical treatment between December 2008 and September 2010 were included. Patients diagnosed with histological variants of squamous cell carcinoma (SCC) or recurrent tumor were excluded. Three hundred forty-eight touch imprint slides were prepared from 174 margins of 30 resected tumor specimens. Imprints from tumor proper were taken as positive controls. The slides were reported as positive, negative or suspicious for tumor. After all cytological interpretation was completed, the results were compared with the corresponding histological diagnosis. RESULTS: This pioneer study showed that TIC has an overall accuracy of 83%, sensitivity of 91.1%, specificity of 74.4%, positive predictive value of 79.2% and a negative predictive value of 88.6%. The false-positive margins evaluated by TIC were 43 (12.3%) and the false-negative ones were 16 (4.6%). CONCLUSION: TIC is a quick, simple, inexpensive, highly accurate and reliable intraoperative technique to assess surgical margins in SCC of the oral cavity.

Congenital zygomatico-mandibular fusion (pseudo-syngnathia?) in conjunction with unilateral anophthalmia: review of terminology and classification.

Syngnathia per se is a rare congenital disorder. A literature survey reveals a total of 26 cases of syngnathia in the English literature since 1936, of which only seven cases involved fusion of the ascending ramus of the mandible to the posterior portion of the maxilla and zygomatic complex. The remaining 19 involved fusion of the alveolar ridges of the maxilla and mandible. This is a unique case of fusion of the mandible to the zygomatic complex presenting with a unilateral anophthalmic orbit in an 18-day-old neonate. The use of the term syngnathia has been reviewed and a modification in classification has been suggested.

Unusual presentation of Kimura's disease involving the parotid gland in an Indian male: a case report and review of literature.

Kimura's disease (KD) is a rare chronic inflammatory disorder that involves the subcutaneous tissues and occurs predominantly in the head and neck region, frequently associated with regional lymphadenopathy or salivary gland involvement. Although, not an uncommon condition in the Asian countries, it is quite rare among the occidental civilization and in the western countries is more commonly diagnosed among Asian migrants. Kimura's disease is sometimes confused with angiolymphoid hyperplasia with eosinophilia, which occurs in the superficial skin of the head and neck region. The classical features of angiolymphoid hyperplasia with eosinophilia are characterized by a triad of painless subcutaneous masses in the head and neck region, blood and tissue eosinophilia, and markedly elevated immunoglobulin E (IgE) levels. Here, we report a case of a 33-year-old Indian male with KD who presented with unilateral nodular swelling in the right parotid region. The diagnosis was based on characteristic histopathologic findings in conjunction with peripheral eosinophilia and elevated serum IgE levels.

Establishment of Cephalometric Norms for the South Indian (Karnataka) Population Based on Burstone's Analysis.

UNLABELLED: PRIMARY AIM: Variability is characteristic of different faces and facial types, and normative data based on one population group does not represent all. Hence, this study was undertaken to establish skeletal cephalometric norms for the South Indian (Karnataka) population utilizing the norms laid by Burstones's analysis for Caucasians. METHODS: The sample comprised of lateral cephalograms taken in natural head position of 100 participants (50 men, 50 women). The cephalograms were traced, analyzed and interpreted using the landmarks and values given by Burstone's analysis (Cephalometric analysis for Orthognathic surgery). The student's t test, standard deviation and mean deviation were calculated to compare between two groups. RESULTS: Statistically significant skeletal differences were found between men and women of the South Indian origin in comparison to Caucasian origin. Men had decreased facial divergence, anterior maxillary dental height and proclined upper incisors. Women had marginally increased cranial base, increased midfacial height and proclined upper incisors. CONCLUSION: Statistically significant differences were found between South Indian men and women when compared with Caucasians in certain key parameters. These differences need to be considered when analyzing the cephalogram for orthognathic surgeries. The values derived from this study may be considered to make the deformity assessment and plan surgery to get optimal results for people of south Indian origin conclusive results can be derived after conducting a study with an eager sample size.

Superolateral dislocation of the mandibular condyle: report of a case with review of literature and a proposed modification in the classification.

Anteromedial fracture dislocation of the mandibular condyle is common but a superolateral dislocation of an intact condyle is quite rare. Only ~19 cases of such dislocation have been reported in the world English literature. This type of dislocation is often misdiagnosed or completely overlooked and hence inadequately addressed. A case of superolateral dislocation of the condyle associated with a symphyseal fracture is presented. We discuss the dynamics, diagnostic features and clinical management of such dislocations with the review of literature and propose a modification in the existing classification.