Indranil Deb Roy

Comparative evaluation of autogenous calvarial bone graft and alloplastic materials for secondary reconstruction of cranial defects.

Objective: To do a comparative study and evaluate the outcome in healing of reconstructed cranial defects with an autogenous bone graft vis-à-vis alloplastic materials. Methods: A total of 22 patients with cranial defects were selected for this study. All the subjects were men; mean age was 27 years. Secondary reconstruction was done to obturate the defects. Of the 22 patients, 11 underwent cranioplasty with autogenous calvarial bone graft, 6 patients with a titanium mesh and 5 with a polymethylmethacrylate plate. Results: The follow-up period ranged from 18 to 24 months. The 11 patients who were operated on with autogenous calvarial bone grafts did not develop any postoperative infection or complications. Graft uptake was complete, and the contour of the skull was improved in all the patients. Of the 5 patients operated on for secondary reconstruction with polymethylmethacrylate plates, 3 had exposure of the implant and 1 reported with secondary infection. Of the patients where secondary reconstruction was carried out with a titanium mesh only, 1 reported with secondary infection and 2 reported with thermal sensitivity. No graft resorption was detected. Conclusions: In our study, we concluded that autogenous calvarial bone grafts have better mechanical, biologic, and immunologic properties. This procedure allows the surgeon to reconstruct moderately large cranial defect with ease of access within single or adjacent incision to the operating site with minimal postoperative morbidity and discomfort.

Selecting reconstruction option for TMJ ankylosis: a surgeon's dilemma.

Objectives The aim of this study was to compare the outcome of reconstruction options adopted for the management of temporomandibular joint (TMJ) ankylosis. Patients and Methods This retrospective cohort study consisted of a sample of patients with TMJ ankylosis diagnosed clinically and radiologically. Depending upon the reconstruction provided, the cases were divided into 2 groups. Group I includes the cases treated by excision of ankylosed mass and interposition of temporalis myofascial flap. In group II, the cases were treated by excision, temporalis myofascial flap interposition, and reconstruction of ramus condylar unit (RCU). Two different methods of reconstruction were used, costochondral graft (CCG) (group IIa) and distraction osteogenesis (group IIb). The outcome variables were range of jaw motion, overgrowth of CCG, reankylosis, and other complications. Data analyses included appropriate univariate and bivariate statistics. Results The average mouth opening achieved in both groups was 36 mm. Failure was observed in 3 patients, 1 from group I and 2 from group IIa. One case of bilateral ankylosis and 2 cases of unilateral ankylosis had recurrence. No overgrowth of CCG was observed. Conclusions In cases with no or minimal mandibular deformity, interpositional arthroplasty with temporalis myofascial flap is a good option without a second surgical wound. However, in younger patients, joint reconstruction with both costochondral graft and distraction osteogenesis of RCU is more appropriate and had similar results. The failure of treatment was due to noncompliance to postsurgical physiotherapy rather than the selection of reconstruction options.

Distraction Osteogenesis for Management of Severe OSA in Pierre Robin Sequence: An Approach to Elude Tracheostomy in Infants

BackgroundSevere obstructive sleep apnoea (OSA) is a life threatening condition associated with Pierre Robin sequence (PRS) due to mandibular micrognathia and glossoptosis. Often these patients require tracheostomy at an early age which has high morbidity. Distraction osteogenesis (DO) is an accepted method of treatment for patients with hypoplastic mandible to achieve mandibular lengthening without need for a bone graft. It has also been used in respiratory distressed neonates and infants to avoid tracheostomy.Case reportAn eight month old baby, a diagnosed case of PRS with severe OSA and recurrent episodes of aspiration pneumonia and on nasogastric tube feeding since birth was referred to us for evaluation and possibility of therapeutic augmentation of the mandible by DO. After a thorough clinico-radiological assessment the child was operated for bilateral extraoral placement of horizontal corpus distractor. A total distraction of 12 mm was carried out and consolidation of callus was monitored by USG. Postoperatively the patient was followed up for 12 months. Presently she has normal respiratory and feeding function without any episode of aspiration pneumonia.ConclusionMandibular corpus DO is a safe and effective technique that can be applied to predictably relieve severe upper airway obstruction in selected PRS cases. In order to avoid the limitations of alternative surgical procedures and the tracheostomy-associated morbidity, DO should be considered among the routine treatment modalities.

Oro-Nasal Communication.

INTRODUCTION Breach in the palatal vault leading to an abnormal communication between oral and nasal cavity is known as oro-nasal communication. It is an uncommon presentation in day-to-day clinical practice except in some patients of cleft lip and palate.Etiology may be congenital or acquired. Alveolar and palatal cleft defects are the most common etiological factor. The acquired causes may be trauma, periapical pathology, infections, neoplasms, postsurgical complications, and radio and chemo necrosis.Clinical features like nasal regurgitation of food, defective speech, fetid odor, bad taste, and upper respiratory tract and ear infection are associated with oro-nasal communication.Management depends upon the size and site of defect, age of patient, and associated comorbidity. The definitive management is always surgical. Two layered closure provides greater support and stability and reduces the risk of failure. Palatal rotational flaps are suitable for smaller defects. The other local flaps are buccal mucosal flap, tongue flap, and facial artery myomucosal flap. Temporoparietal galeal flap, turbinate flap, free radial forearm flap, and scapular flap have also been successfully used for closure of oronasal communication. Newer procedures like the use of bone morphogenic protein, acellular dermal matrices, human amniotic membrane, and distraction osteogenesis have been tried successfully. The rate of recurrence is high.Unsuccessful surgical attempts and larger defects associated with compromised medical conditions are better managed nonsurgically with obturator incorporating the missing teeth.

Role of intraoral distractors in management of cranial synostosis: An initial experience

Objective: The objective of the following study is to evaluate the results of strip craniectomy with distraction osteogenesis, using the intraoral distractor devices, as a modality of treatment for craniosynostosis. Materials and Methods: Two cases of cranial synostosis were selected for this study. The cases were operated for strip craniectomy with distraction osteogenesis using a pair of miniaturized intraoral distractor devices. Distraction was carried out after a latency period of 4 days at a rate of 0.5 mm twice a day. Total separation of osteotomized segments achieved was in the range of 25-28 mm. Results: Both patients were evaluated clinico-radiologically at 3, 6 and 12 months postoperatively. There was an increase in the occipital frontal circumference with improvement in the contour of the skull. Both the cases showed marked improvement of bowel habits, bladder control and cognitive behavior. Radiologically copper-beaten appearance reduced considerably suggesting improved intracranial pressure. Conclusion: Combination of distraction osteogenesis with strip craniectomy for the management of craniosynostosis is an effective treatment modality with promising results.

Is Delayed Release of Superior Oblique Muscle Entrapment in Orbital Roof Fracture Worth Correcting

Acquired Browns syndrome is a rare entity. Delay in treatment can cause fibrosis or scarring with questionable prognosis of vertical diplopia. To the best of the knowledge of the authors the present case of 22-year-old male is the first in existing literature where delayed release of superior oblique muscle entrapment in orbital roof fracture was found to be an effective technique.

Use of Superficial Temporal Fascia Flap for Treatment of Postradiation Trismus: An Innovation.

Post radiation trismus severely reduces the quality of life. Radiation causes fibrosis of muscles of mastication resulting in severe restriction of mouth opening. Treatment options are limited as most of the local flaps are in the radiation zone. The present case is the first case in existing literature where, following the release of fibrosis secondary to radiation, superficial temporal fascia (STF) was used to cover the defect with excellent results and no recurrence after a year of follow up.

Near-Total Pediatric Parotidectomy for Refractory Chronic Sialadenitis.

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