Anshul Rai

Are maxillomandibular fixation screws a better option than Erich arch bars in achieving maxillomandibular fixation? A randomized clinical study.

PURPOSE The aim of this study is to see the efficacy of maxillomandibular fixation (MMF) screws with arch bars and to compare the plaque index in between 2 methods of MMF. MATERIALS AND METHODS This study is a randomized clinical trial. The study sample was derived from the population of patients who reported to Department of Oral and Maxillofacial Surgery, Wardha, Maharasthra, India between October 2006 and September 2008 and who required MMF. The patients were assessed for the time required in minutes for the placement and removal of screws and arch bar. Postoperative stability after achieving the MMF of both groups was analyzed and the plaque that was accumulated in both groups was evaluated by using TURESKY-GILMORE-GLICKMAN modification of the QUIGLEY-HEIN plaque index. Statistical analysis was performed with SPSS statistical software for Windows, version 8.0 (SPSS, Inc, Chicago, IL) using the χ(2) test and Student t test. RESULTS The average working time for placement and removal of MMF screws is 18.67 minutes and 10.20 minutes, respectively, and for arch bars is 95.06 minutes and 29 minutes, respectively. The mean value of plaque index in group I is 1.88 and in group II is 2.69. It signifies that plaque deposition was more in group II. No occlusal disturbance was seen in both groups. Incidence of MMF screws causing damage to tooth root is 5.81% and incidence of screw breakage was seen in 3.33% of patients. CONCLUSIONS Oral hygiene maintenance is better in patients with MMF screws than with arch bars with fewer complications and less operating time. Erich arch bars are the preferred choice in patients who require long-term MMF, because the screws start loosening after 5 to 6 weeks.

Custom-Made Implant for Maxillofacial Defects Using Rapid Prototype Models

Historically, reconstruction of the hard tissue of the facial skeleton has been sought as the holy grail of maxillofacial surgery. Limited visualization of closed internal structures, influence of surgery on airway, presence of teeth and their relationship with the bone, and interference with occlusion often make the surgery complex and unpredictable. Trends in reconstruction have undergone a myriad of changes in the past, varying from the use of pedicled flaps to free grafts and from the use of microvascularized flaps to vascularized bone grafts. These techniques are sensitive, associated with donor site morbidity, and may have limitation in the shape and size of the material, which often precludes their use. Preformed and prefabricated reconstruction plates are common methods of reconstruction after ablative surgery of themaxillofacial region. They often fail to reproduce the anatomical structures for which they are placed and necessitate a significant amount of time to be spent in the operating room to recontour them. Rapid prototype models have high dimensional accuracy and have been increasingly used for diagnosis and treatment planning. The investigators hypothesized that the same rapid prototype models can be harnessed to design a custom-made implant. Barker et al made distance measurements of a dry skull and a geometric phantom and compared the distance measurement between the anatomical landmarks of both. They reported that the results for the geometric phantom showed a mean difference of +0.47 mm, representing an accuracy of 97.7% to 99.1%. Measurements of the skull produced a range of absolute differences (maximum +4.62 mm, minimum +0.1 mm, mean +0.85 mm).

Customised screw for intermaxillary fixation of maxillofacial injuries

owadays screws are commonly used for intermaxillary xation (IMF). They are quick and easy to use, relatively inexensive, and reduce the risk of needle-stick injuries associated ith using wires. They do not injure the gingival margins, nd gingival health is easier to maintain than when arch bars r eyelets are used.1 A minimum amount of hardware is eeded for intermaxillary fixation2; one screw in each quadant is usually enough, but more can be inserted if required.

Utility of High Density Porous Polyethylene Implants in Maxillofacial Surgery

The aim of this paper was to determine the utility of high density porous polyethylene implants (HDPE) in a variety of facial skeletal deformities. Sixteen patients (age range 14–28 years) with facial deformities requiring skeletal defect reconstruction or augmentation, treated between January 2008 and December 2010. The follow-up of the patients ranged from 6 months to 2 years.The types of deformities and defects treated include: one patient each with hemifacial microsomia and nasal tip correction, two patients each with malar deformities and orbital floor reconstruction, three patients with paranasal deformities and mandibular hypoplasia and four patients with chin augmentation. A total of 24 implants were placed. The complications included infection and wound dehiscence in one patient. The implants were palpable extraorally in two patients. It is concluded that HDPE is an excellent alternative to autogenous grafts for facial skeletal augmentation. Its porous nature, excellent soft tissue growth and coverage are the advantages and disadvantages include its rigidity and sometimes it is palpable extraorally.

Comparative Assessment Between Eyelet Wiring and Direct Interdental Wiring for Achieving Intermaxillary Fixation: A Prospective Randomized Clinical Study

PURPOSE The intention of this study was to compare the efficacy of eyelet wiring and direct interdental (Gilmer) wiring for achieving intermaxillary fixation (IMF). MATERIALS AND METHODS This study was a prospective randomized clinical trial. The study sample was derived from the population of patients who underwent IMF at the Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Wardha, India, between October 2008 and September 2010. The time required for placement and removal (in minutes) was compared between the eyelet wiring and direct interdental wiring techniques. Postoperative stability after achieving IMF was analyzed in the 2 groups. The plaque accumulation in both groups was evaluated using the Turesky-Gilmore-Glickman modification of the Quigley-Hein plaque index. Complications in the form of soft tissue injury, glove puncture, and trauma to the operators finger were also recorded. Statistical analysis was performed with SPSS statistical software for Windows, version 8.0 (SPSS, Chicago, IL) using the χ(2) test and Student t test. RESULTS The mean working time for placement and removal of eyelet wiring (group I) was 18.00 minutes and 9.67 minutes, respectively. For direct interdental wiring (group II), it was 30.50 minutes and 23.12 minutes, respectively. The mean plaque index values were 1.78 and 2.54 for groups I and II, respectively, which signifies a higher plaque deposition in group II. No occlusal disturbance was seen in either group. The incidences of glove perforation, soft tissue trauma, and trauma to the operators finger were higher in group II. CONCLUSIONS Eyelet wiring is preferable to direct interdental wiring as evidenced by fewer complications, and requires a shorter operating time in patients with minimally displaced fractures.

A Simple Method of Preventing Needle Stick Type Injury to the Operator’s Finger While Performing Intermaxillary Fixation

Erich arch bars and other wiring techniques were commonly used for closed reduction of many maxillofacial fractures. These wires can cause inadvertent finger puncture of the operator’s finger and can increase the risk of spread of blood borne diseases like HIV and Hepatitis. To avoid this complication we recommended the use of dynaplast adhesive tape (Johnson and Johnson Ltd., Mumbai, India) over all the finger tips, before wearing the gloves, while performing IMF.

Modified Weber-Fergusson incision with Borle's extension

he Weber–Fergusson maxillectomy incision was first escribed by Weber in German and later modified by ergusson1 in English. It is one of the most commonly used ransfacial approaches to the midface for the resection of axillary tumours. The modified incision is required for the exposure of iseases of the maxilla. When the primary tumour that nvolves the maxilla and maxillary sinus is large, then the eber–Fergusson incision is required with a Lynch, Diffen-

Use of Kerrison Rongeur for safe and effective removal of bone in temporomandibular joint ankylosis

Temporomandibular joint ankylosis (TMJA) is the formation of fibrous, bony, or fibro-osseous tissue between the glenoid fossa and the mandibular condyle. TMJA is characterized by limitation of jaw movements leading to inability to open mouth. It is associated with functional impairments with mastication, speech, breathing, swallowing, and nutrition. It also results in esthetic deformity with disturbance in mandibular growth [1]. The most frequently implied surgical procedures for the management of TMJA are gap arthroplasty, interpositional gap arthroplasty, and total joint reconstruction arthroplasty. However, irrespective of the technique being used, the basic procedures essential for management of TMJA are resection of the ankylotic lesion, ipsilateral/bilateral coronoidectomy, and early mobilization with aggressive postoperative physiotherapy [2, 3]. In order to carry out the resection of the ankylotic mass surgical drills and burs, surgical saws, chisels, and osteotomes are being used traditionally. The biggest disadvantage of using these modalities is the inherent risk of damaging soft tissue structures underlying the ankylotic mass including major vessels. To overcome this complication, we propose the use of Kerrison Bone Rongeur (KBR) for safe and effective removal of bone in TMJA. Use of KBR prevents the vital blood vessels mainly the internal maxillary artery and the ascending pharyngeal artery from getting injured during resection of the ankylotic mass. We have effectively used KBR in the management of 32 TMJA cases, with no incidence of any injury to underlying soft tissue structure. The initial resection of ankylotic mass is carried out with traditional bur till a thin bone is left to be removed. This bone is then removed using KBR without injuring the underlying structures (Fig. 1). KBR is an instrument (Fig. 2) with 4′′ long shaft facilitating its use in smaller areas. It has a blade which holds the bone and cuts it, with a guard saving the underlying structures. The handle of the instrument can be held comfortably and a controlled force can be delivered for osteotomy. This instrument is being used effectively in pediatric surgeries, neurosurgeries, and cardiac surgeries. It was Dr. Robert Masters Kerrison, an English physiologist and physician who first designed this instrument, and it took more than 100 years to modify the original design of the instrument to bring it to its current form with a purpose to make it more effective and operator friendly. Use of piezoelectric device for resection of ankylotic mass has also been emphasized upon in the literature [4]. It works effectively without injuring adjacent and underlying soft tissue. The only disadvantage of using

A Simple and Effective Scalp Tourniquet for Controlling Scalp Hemorrhage

The scalp is supplied abundantly with blood with a peculiar arrangement of vessels running in the dense connective tissue layer. The amount of blood scalp receives is larger than any other potion of the skin of equal area [1]. The main source of blood is from supraorbital, supratroclear arteries and branches of external carotid artery, viz., superficial temporal artery, posterior auricular artery and occipital artery. Such high volume of hemorrhage during scalp surgeries is highly disturbing to the operating surgeons and also puts the patient at risk. A bloodless operative field facilitates the surgical procedure hence shortening operating time subsequently reducing the anesthetic risk to the patient, furthermore the necessity for blood transfusion. Various devices have been tried in the past which includes use of rubber bands [2], soft rubber tubing and various inflatable cuffs, including bicycle tire inner tubes [3] not only to control hemorrhage but also to prevent hair loss by diminishing the contact of chemotherapy drugs in the scalp hair [4]. All these measures require preoperative preparations and are time-consuming. We suggest use of sterile surgical glove as a scalp tourniquet which is a simple, less time-consuming technique and provides adequate control of hemorrhage intraoperatively. A sterile glove is cut from its wrist portion (Fig. 1) and is stretched and tied over scalp just above eyebrows, external auricle and just below the external

A technique for intraoperative maxillomandibular fixation

Nowadays, open reduction and internal fixation (ORIF) is preferred technique for the management of most of the maxillofacial fractures. However, meticulous ORIF is not possible without achieving proper intraoperative maxillomandibular fixation (MMF). There are varieties of techniques highlighted in the literature for achieving intraoperative MMF, unfortunately, most of them requires use of wires or screws which are harmful to the patients as well as the surgeon since they are associated with a high risk of glove puncture and needlestick injury [1]. We recommend zip tie (Novoflex Marketing Pvt. Ltd. Kolkata, India) for intraoperative MMF to eliminate all the drawbacks of wires and screws (Fig. 1). The zip tie is a beltlike plastic self locking device which has a flexible tape sectionwith teeth which gets engaged with the pawl in the head to form a ratchet. Once the free end of the tape section is pulled through the head, the tie-wrap tightens and does not allow loosening (Fig. 2). It cannot be removed without cutting using a blade.