Comparison of the efficacy of bleomycin over sodium tetradecyl sulfate (STS) when given intralesionally in the treatment of oral and maxillofacial venous malformation.
16 patients with venous malformation in craniofacial region were randomly divided into two groups of eight. Group 1 was given intralesional injection of bleomycin and group 2 was injected with STS. All the cases were evaluated for a minimum period of two and a maximum of 3 years.
Efficacy of bleomycin was found to be superior to STS, when used as intralesional sclerotherapic agent. Most of the vascular lesions of group 1 resolved after first dose giving a cure rate of 87.5% and no recurrence was observed. Group 2 patients however, required 4–6, a mean of five repeated dosage of intralesional STS before their lesions started to resolve and three patients reported with recurrence within 2 years, giving an overall effective response rate of 62.5%.
Bleomycin under selected conditions appears to be an excellent therapy for treating soft tissue vascular lesions of low flow nature in craniofacial region. Predictable results were obtained with a high success rate. No systemic or pulmonary complications occurred.
Vascular; Venous malformation; Maxillofacial
Background and Objectives
Self-tapping miniscrews are commonly being used as a temporary anchorage device for orthodontic purpose. A prerequisite for the insertion of these screws is the preparation of a pilot hole, which is time consuming and may result in damage to nerves, tooth root, drill bit breakage and thermal necrosis of bone. On the other hand the design of drill-free screws enables them to be inserted without drilling. The aim of this prospective study was to compare the stability and clinical response of the soft tissue around the self tapping and drill free screws when used for orthodontic anchorage for en mass retraction of maxillary anterior teeth.
Materials and Methods
The study sample consisted of 20 patients requiring retraction of maxillary anterior teeth. The screws were placed in the alveolar bone between maxillary 2nd premolar and 1st molar bilaterally at the junction of attached gingiva and moveable mucosa. Pilot hole was drilled on the side which was selected for insertion of the self tapping screw under copious irrigation, after which it was inserted. Drill free screw was inserted on the contralateral side without predrilling. All screws were immediately loaded with 150–200 gm of retraction force. Patients were recalled for regular follow up for a period of 6 months. If the screws became mobile or showed any signs of inflammation during the course of the study, they were considered to be a failure.
After a period of 6 months an overall success rate of 77.5% was noted. Four self tapping and five drill-free screws failed during the study. There was no statistically significant difference between the two types of screws with respect to success/failure. Mobility was found to be the major cause for the failure.
Both self-tapping and the drill-free screws are effective anchorage units. But the latter have an edge over the conventional self-tapping screws because of decrease in operative time, little bone debris, less thermal damage, lower morbidity, and minimal patient discomfort as predrilling is not required, thus they can be used as a viable alternative. But self-tapping screws are still recommended for areas with high bone density and thick cortical bone.
Orthodontic anchorage; Mini implants; Self-tapping screw; Drill-free screws
To evaluate the morbidity associated with iliac crest harvest for alveolar cleft grafting.
Patients and Methods
18 patients treated for alveolar clefts in oral and maxillofacial surgery unit at SRM dental college and Hospital were included. Patients were interviewed to fill a questionnaire on postoperative recovery. The donor site was evaluated for the following factors: Pain, neuropraxia, abnormal gait and scar evaluation.
The scars were evaluated, according to the satisfactory score—eleven patients (61.11%) had a score 2, Four patients (22.22%) had score 3 and three patients (16.66%) had score 1. The pain score after the first week—thirteen patients (72.22%) had score 2, five patients had score 3 (27.77%). After the first month—four patients (22.22%), had score 2, twelve patients (66.66%), had score 1 and Two patients (11.11%) had score 0. And when evaluated after 3 months, two patients (11.11%), had score 1 and sixteen patients (88.88%) had score 0. The gait was examined by asking the patient to walk and evaluated; in the first week, all eighteen patients had abnormality in gait; in the first month, five patients had abnormality in gait (27.77%), and in the third month, none of the patients had any abnormality in gait.
Harvesting cancellous bone from anterior iliac crest in young patients is well tolerated, allows early resumption of normal activities, has no effect on growth, has minimal morbidity and a reasonable aesthetic outcome.
Secondary alveolar bone grafting; Cleft alveolus; Anterior superioriliac spine (ASIS)
Diathermy is used widely in surgical procedures, mainly for subcutaneous and deeper layers dissection. The use on craniomaxillofacial skin has been precluded by the fear of scar formation, alopecia and wound dehiscence. The aim of this study was to clinically evaluate the safety of Colorado Microdissection needle (Stryker) for skin opening in craniomaxillofacial surgery.
Materials and Methods
117 skin incisions for craniomaxillofacial procedures were performed using the Stryker Colorado microdissection needle (CMN). The incisions included Coronal, Hemicoronal, Preauricular, Subciliary, Lateral brow’s, Submandibular, Retromandibular, Risdon’s, Modified Blair’s and Schoebinger’s incision. The reason for the craniomaxillofacial operative intervention included: Craniofacial trauma, removal of benign and malignant pathology, craniofacial reconstruction and Temporomandibular joint surgeries. 115 incisions were performed in patients in the adult age group and 02 in the pediatric age group.
All the patients tolerated the procedures well, with no increased risk from the use of the CMN. Only one incision had wound infection and dehiscence. All other patients had usual wound healing. At 6 months follow-up postoperative scar and alopecia was evaluated. Only on close up inspection minimal area of alopecia was noticed along the incision line. The postoperative scar was healthy in all the cases.
The findings of this study recommend the use of the CMN in all craniomaxillofacial procedures.
Colorado microdissection needle; Craniomaxillofacial; Subcutaneous
The aim of this study is to compare and evaluate the clinical outcome of early loaded and unloaded implants in the interforaminal region of anterior mandible.
Materials and Methods
Five completely edentulous patients aged between 45 and 65 years were selected satisfying certain criteria. Four implants were placed in 33, 43, 35 and 45 regions; implants in 33 and 43 regions were loaded by a Dolder bar supported overdenture at 7th day. The implants at 35 and 45 regions were connected to 33 and 43 regions, respectively after 4 months. The implants were divided into two groups. Group I consisted of early loaded implants (implants in the region of 33 and 43) and Group II consisted of delayed loaded implants (implants in the region of 35 and 45). The implants were evaluated for various clinical parameters at 2, 4 and 6 month intervals after initial placement.
There was significant increase in the bone to implant contact for unloaded implants as compared to early loaded at the end of 6 months of implant placement. There was increased marginal bone loss around early loaded implants as compared to unloaded implants at the end of 6 months. Clinical stability of early loaded implants was lower as compared to the unloaded implants at the end of 6 months. Survival rate for early loaded and unloaded implants was 100% at the end of 6 months with all implants in function.
Early loading of interforaminal mandibular implants demonstrated a highly acceptable clinical success at the end of 6 months. However, the bone density, marginal bone level and clinical stability were significantly lower for the early loaded implants as compared to unloaded implants.
Early loaded implants; Unloaded implants; CT scan; Periotest
Soft tissue augmentation by hyaluronic acid filler injections has become the most commonly done cosmetic procedure in the last 10 years. These are now being widely used for improvement of the nasolabial folds. The present study was done to evaluate the patient satisfaction after these injections.
Materials and Methods
The study was conducted on 10 consenting patients. Hyaluronic acid filler (22.5 ml cross linked), 1 ml on each groove was injected under an infraorbital block. Patient satisfaction was evaluated at 0, 14, 30, and 180 days. Photographic record was maintained. Any side effects experienced by the patients were recorded.
All the patients were satisfied immediately after the procedure. More than 50% were not happy at 14 days. Majority of the patients were happy at 30 days and the satisfaction was maintained at 6 months.
Fillers are a very safe and effective modality for improving the nasolabial fold. This could prove to be a very useful tool in dental practice. Setting the patient expectations before the procedure is performed can lead to satisfied and happy patients.
Hyaluronic acid fillers; Nasolabial folds; Patient satisfaction
The cephalometric prediction of orthognathic treatment outcome is an important part of the surgical planning and the process of informed consent. The orthodontic and surgical changes must be described accurately prior to treatment in order to assess the treatment’s feasibility, to optimize case management and to increase patient’s understanding and acceptance of the recommended treatment. The aim of the present article was to investigate on the factors that could influence the accuracy of cephalometric prediction in planning orthognathic surgery. Review of the literature revealed that, besides factors directly related to the prediction method and its use, there exist a considerable number of factors which could affect significantly the accuracy of soft tissue response. These factors could be biological ones such as relapse, centre of mandibular rotation and individual variation in response to treatment and others such as gender, race, pre-operative soft tissue thickness and data bases for mean ratios of soft to hard tissue movement changes. Some of the factors affecting the accuracy of prediction of soft tissue response following orthognathic surgery are inevitable and there are others, difficult to control and predict. However, patients should be informed that predictions are only a guide, may not represent the actual result of the surgical outcome, and as such they should be implemented.
Prediction; Accuracy; Validity; Orthognathic surgery; Cephalometrics
Objectives of the Study
To evaluate improvement in symptoms following arthrocentesis: Pain, Maximum Mouth Opening, Clicking/Crepitation.
Eleven patients who reported to the department of Oral and Maxillofacial Surgery, M S Ramaiah Dental College, Bangalore clinically diagnosed to have Internal Derangement of the TMJ underwent Arthrocentesis. Patients were evaluated at the end of 1 week, 1 and 3 months and results tabulated.
11 patients with clinically diagnosed Internal Derangement underwent Arthrocentesis and were followed up for 3 months. There was significant improvement in Pain, Maximum Mouth Opening and Clicking/Crepitation. All the results were statistically significant. There was no serious post operative complication.
Arthrocentesis can be recommended as a simple chair-side procedure for the treatment of TMJ Internal Derangement refractory to conservative management.
TMJ; Arthrocentesis; Internal derangement
Total auricular reconstruction in congenital lobule type microtia is one of the most challenging problems faced by a reconstructive surgeon as it demands precise surgical technique combined with artistic creativity. Ear reconstruction requires carefully planned procedures.
We present a simple method for auricular reconstruction consisting of three stages. The first stage is carving the cartilage framework from the costal cartilages of 6th, 7th and 8th ribs, lobule transposition and insertion in a skin pocket. The second stage is performed 5 months later to elevate the ear framework using a full thickness skin graft and a cartilage spare part. The third stage is done after 3–4 months later to give finer detail to the reconstructed ear. This method was used in 27 patients with lobule type microtia.
The results of the reconstructed auricles in 27 patients were satisfactory with good aesthetic balance. The complications ranged from small localized skin infection treated with topical and oral antibiotics to catastrophic loss of the skin pocket and the framework.
Although various donor sites have been used for harvesting the cartilage, only costal cartilage provides a substantial source for fabricating total ear framework. The cosmetic outcome and least complication results in our series support this conclusion.
Auricle; Microtia; Costal cartilage
The present study was under taken to evaluate the efficacy of various local and regional soft tissue flaps used for reconstruction after excision of various malignant lesions of the mouth and also to evaluate complications with length of hospital stay after the reconstruction.
Materials and Methods
The study was a record based retrospective analysis of 127 patients who were histologically proven squamous cell carcinoma of the oral cavity for which excision of the lesion along with segmental mandibulectomy and primary reconstruction with local or regional flaps was the treatment modality.
The male:female mean age is 48.27:48.79. The Z-proportionality test for intra oral reconstruction showed 5% level of significance (P < 0.05) between pectoralis major myocutaneous flap (PMMC) and other flaps. Difference between deltopectoral (DP) and PMMC, PMMC and primary closure at 1% level of significance, i.e. P < 0.01 was found for extra oral defects. The mean stay was found to be 31.31 days. Recurrence rate of 11% was reported.
A total of 127 patients formed the study group. In the absence of bone reconstruction PMMC still continues to be the “work horse” of reconstruction following wide excision and hemimandibulectomy.
Oral malignancies; Hemimandibulectomy; Pectoralis major myocutaneous flap; Complications
Management of patients with syndromal craniosynostosis is probably one of the greatest challenges. They usually present with variable deformities yet share common characteristics. Patients with Crouzon and Aperts syndrome present with exorbitism and midface hypoplasia. Exorbitism is a protrusion of the eyeball due to a decrease in the capacity of the orbital container, and it may lead to drastic consequences if left untreated.
Material and methods
Four cases with exorbitism and midface hypoplasia. Three presented with Aperts syndrome and one with Crouzon syndrome. They all underwent an intraoral modified Le Fort III osteotomy followed by midface distraction osteogenesis.
Distraction osteogenesis of the midface is a safe and highly effective method in managing exorbitism associated with midface deficiency.
Distraction osteogenesis; Exorbitism; Le fort III; Cruzon; Aperts
Tuberculosis is a chronic granulomatous disease that rarely affects oral cavity. Tuberculous lesions of the oral cavity are frequently overlooked in the differential diagnosis of oral lesions. The oral clinical presentation of tuberculosis may take many forms as ulcers, nodules, tubercular fissure, tubercular papilloma and tuberculomas. Diagnosis is confirmed by histopathology.
Tuberculosis; Buccal mucosa; Squamous cell carcinoma
There are essentially six types of aggressive cysts of the jaws that require special attention, so as to avoid recurrence, or even worse, widespread disease. They include, botryoid cysts, cysts in which carcinoma’s arise, glandular odontogenic cysts, calcifying cystic odontogenic tumour, previously called calcifying odontogenic cyst and unicystic ameloblastoma and keratocystic odontogenic tumor, previously called odontogenic keratocysts. The estimated incidence of these cysts, based on some review studies has been discussed. The main issue, however, when treating a cyst of the jaws is; how sure can one be that the lesion is benign or potentially aggressive? In order to answer this question it is important to know how these cysts commonly present. The clinical presentation, frequency of occurrence and suggested modes of treatment has been addressed.
Aggressive odontogenic cysts; Keratocyst; Glandular odontogenic cyst
Nasal fractures may occur in association with other facial injuries like Le-forte II and III and also severe comminuted midface fractures or by themselves. Bony fractures of the nose may involve one or both nasal bones, the frontal process of the maxilla, the bony septum, and in severe trauma the nasal–orbital–ethmoid complex. Treatment of these fractures range from closed reduction and support to open reduction and miniplate osteosynthesis. Purpose of this article is to describe a technique of managing nasal bone fractures associated with midface fractures.
Patients and Methods
Four consecutive patients who sustained nasal bone fracture associated with multiple midfacial fractures were included in the study.
Postoperatively, results showed symmetry in the intercanthal to lateral canthal width. Nasofronal angle and nasal prominence was established to the expected position in most of the cases.
This technique can be used for Le forte II and III cases where nasal bones to be addressed. This method has shown predictive results with minimal intervention.
Naso-orbito-ethmoid fracture (NOE fracture); Le forte II and III fractures; Transnasal wiring
Two cases of peripheral odontogenic myxoma with a verifiable location in gingival soft tissue and without bone involvement were compared with those reported in the literature. This study showed that they form a distinct albeit rare clinical entity with a potential to grow into large disfiguring lesions. The probability that small peripheral odontogenic myxomas are interpreted as edematous irritation fibromas may contribute to the small number of peripheral odontogenic myxomas recorded in the literature. The differential diagnosis of soft tissue myxoid proliferations is discussed.
Odontogenic myxoma; Peripheral odontogenic tumor; Irritation fibroma
The aim of the present study is to evaluate the C-reactive protein (CRP) levels pre-operatively and post-operatively following a surgical intervention of mandibular fracture with osteosynthesis by rigid fixation using AO/ASIF principles and to try and correlate the prognosis of the convalescent period.
Twenty five patients with trauma were surgically treated. The blood samples are collected pre-operatively, immediate post-operatively, after 24 h and on the seventh post-operative day.
The CRP levels were high pre operatively due to body’s initial response to trauma. An increase was noticed immediately after the surgery (mean value 1.96 ± 0.56 mg/dl). After 24 h of surgery, CRP levels were raised markedly (mean value of 2.3 ± 0.58 mg/dl). On the seventh day after the surgery CRP levels were significantly decreased to attain normal level (mean value of 1.58 ± 0.52 mg/dl), indicating normal healing at the surgical site.
In cases of patients with mandibular fracture the CRP concentration increases directly after the trauma and the surgical procedure. Then it undergoes a gradual normalisation which ensures non complicated healing post operatively.
C-reactive protein; Trauma; Acute phase protein; Mandibular fractures; Infection; CRP
We report a case of retained wooden foreign body in the zygomatic region which posed a considerable diagnostic difficulty and was the source of persistent draining sinus and other distressing symptoms. The patient was not aware of the foreign body in the maxillofacial region. In such cases a thorough history of the patient is of utmost importance. The case has been described to highlight the problems associated in managing unlikely foreign bodies at unusual facial sites when there is a possibility that radiolucent material is embedded in the wound.
Foreign body; Maxillofacial region; Trismus
Labial and nasal deformities have always been a fundamental problem in the treatment of cleft lip, alveolus and palate patients. The primary surgical treatment of nasolabial area is of paramount importance in order to obtain both an esthetical correction of the deformity and a progressive and a balanced development of mid-face. In this study the nasal deformities in patients with cleft lip, alveolus and palate (CLAP) were analyzed and the relevant role of the perinasal, perioral muscular balance and the inborn dislocation of the alar cartilages are presented.
Patients and Methods
50 CLAP patients were analyzed, 40 UCLP and 10BCLP. The lip repair was done by modification of Millard’s technique. The severity of the cleft appearance was evaluated pre and post operatively, according to a pre-agreed visual rating scale. There are 4° of severity of the deformity pre operatively (mild, moderate, severe and very severe) and post operatively 5 categories of outcome (excellent,very good, good, satisfactory and poor), depending on the scores obtained by summing up the points corresponding to different types of deformity. This scale is closely related to the American Cleft Palate classification of clefts.
In the 40 UCLP patients, 8 excellent, 10 very good, 16 good and 6 satisfactory results were obtained following primary cheiloplasty. In 10 BCLP patients 1 very good, 7 good, 1 satisfactory and 1 poor result were obtained.
During the primary repair, it is important to correct the abnormal position of ala nasi, the nasal floor and the base of the columella. Abnormalities in the insertion of the nasolabial muscles with their abnormal function contribute to the cleft nose deformities. Therefore the reconstruction not only the orbicularis muscle but also of the paranasal muscles is therefore important for a symmetrical growth of the nose. Separate suture of intrinsic orbicularis oris provide a better shape to the vermillion. The position of the alar cartilage plays an important role for the symmetry of the nose. It is necessary to place the alar base symmetrically in three dimensions.
Cleft lip; Palate; Rating scale; Secondary deformities; Cheiloplasty
To retrospectively analyze all patients who were diagnosed with Osteomyelitis of jaws in our unit.
31 patients with Osteomyelitis of jaws were analyzed retrospectively from 2002 to 2008 at the Department of Oral & Maxillofacial Surgery, S.D.M College of dental sciences and hospital, Dharwad, India. Parameters considered were age, gender, jaws involved, clinical features, surgical management & complications.
Of the 31 patients, maxilla was involved in 16 patients and mandible was involved in the remaining 15. 11 out of the 16 patients with maxillary osteomyelitis were immuno-compromised. The predominant etiology noted was odontogenic infection. With the treatment protocol we have adopted, all our patients showed satisfactory resolution of the condition by 6 weeks.
Incidence of maxillary osteomyelitis & their association with diabetes mellitus was higher in our series compared to others. The cause for this high incidence was analyzed in our study. Based on our results we conclude that a conservative surgical method with an attempt to preserve vital bone and an appropriate antibiotic therapy with the correction of the underlying medical problems is adequate to treat Osteomyelitis of jaws.
Osteomyelitis; Maxilla; Mandible; Diabetes mellitus
Osteopetrosis (OP) is a rare congenital disorder (present at birth) in which the bones become over dense. This results from an imbalance between the formation of bone and the resorption of the bone. Thickening of the bones which become abnormally dense due to an inherited defect in bone resorption, the process in which old bone is broken down and removed so that new bone can be added to the skeleton. Osteoclasts are the cells responsible for bone resorption. In osteopetrosis the osteoclasts do not perform normally. This flaw in bone resorption results in bones that are abnormally dense, yet are fragile and easily broken. Osteopetrosis is also known as Albers–Schonberg disease, generalized congenital osteosclerosis, ivory bones, marble bones, osteosclerosis fragilis generalisata. In this article, we have described about the diagnosis and medical and surgical management of osteopetrosis reported case to our hospital.
Osteomyelitis; Osteopetrosis; Marble bone disease
To compare the efficacy of cyanoacrylate (tissue glue) placement after surgical removal of impacted mandibular third molars.
Materials and Methods
Thirty patients with bilaterally impacted mandibular third molars were studied in this controlled clinical trial. One side closure after surgical removal of third molar was done with conventional sutures and other side with cyanoacrylate.
The data analysis showed that postoperative bleeding with cyanoacrylate method was less significant than with suturing on the first and second day after surgery. There was no significant difference in the severity of pain between the two methods.
This study suggested that the efficacy of both, cyanoacrylate and suturing in wound closure were similar in the severity of pain, but use of cyanoacrylate showed better hemostasis.
Amcrylate; Medicated tissue glue; Polymerization; Hemostasis; Pain
Genioplasty is often performed to esthetically improve patient’s profiles in the lower facial third. Many factors account for the variability in soft tissue response like dissection technique, magnitude and direction of movement and stability of the genial segment. Optimum treatment planning thus requires an understanding of the soft tissue response to various genial procedures.
Aims and Objective
To determine the stability, ratio of hard and soft tissues and changes in the lower facial profile after advancement genioplasty.
Materials and Methods
Ten patients were evaluated cephalometrically for the soft tissue changes in relation to hard tissues after advancement genioplasty. Pre operative, immediate post operative and 6 months post operative lateral cephalogram were taken. Pre operative tracings were superimposed with post operative cephalograms to produce a composite tracing. Changes in the osseous tissues are assessed and related to the net changes in the soft tissues.
The ratio of horizontal changes of osseous to soft tissues was found to be 1:0.89. The mean resorption was 0.85 mm (10.7%). The vertical changes are minimal and non significant. There are significant changes in the soft tissue profile such as decrease in the soft tissue thickness, facial convexity angle, lower facial submental angle and increase in mentolabial sulcus depth.
The standard advancement genioplasty procedure by inferior osteotomy of the chin with broadest musculo–periosteal pedicle with rigid internal fixation was followed. The soft tissue response is almost equal to the bony movement. The stability of the hard tissues is good with minimum amount of resorption so as to achieve more predictable results.
Genioplasty; Soft tissue changes; Cephalometry; Prediction
Epidermoid cyst occurring within the tongue is rare. The aim of this article is to discuss the management of an adult patient who presented with respiratory obstruction due to this congenital epidermoid cyst within the tongue. A 32-year-old male patient who was brought to the accident and emergency department of the University of Port Harcourt Teaching Hospital, Port-Harcourt, Rivers State, Nigeria was presented. He came with a history of difficulty in breathing as a result of a slow growing swelling of the tongue which started from birth. There was associated pain, difficulty in speech and mastication as the swelling increased in size. Detailed physical examination, sonographic imaging and histopathology were carried out. On examination, patient was acutely ill-looking, in severe respiratory distress, febrile, mildly pale and dehydrated but anicteric. Extra-oral examination revealed mildly protruded upper and lower dento-alveolar arch as well splaying and recession of the anterior and posterior teeth of the upper arch. Intra-oral examination revealed moderately tender, fluctuant and grossly enlarged tongue obstructing the oro- and nasopharyx. A diagnosis of dermoid cyst was made and the patient was booked for surgery after resuscitation. Excision of the cyst was done under general anaesthesia/naso-tracheal intubation by an intra-oral approach. Ultrasound was able to give a thorough assessment of the cystic nature of the swelling while post-operative histopathology was used to confirm the specific type of teratoma. The relationship of the cyst to the intrinsic and extrinsic muscles of the tongue and mylohyoid muscle was relevant to the surgical approach to the lesion.
Epidermoid cyst; Intralingual; Airway obstruction