Krushna Bhatt

Review of osteochondroma of mandibular condyle and report of a case series.

PURPOSE To present a retrospective analysis of 10 cases of osteochondroma of the mandibular condyle (operated between 1993 and 2009) with respect to age, gender, site of the pathology, treatment modality and recurrence, with review of literature. MATERIALS AND METHODS Medical records with x-rays, computed tomography scans, and bone scans of all histologically proven osteochondroma of mandibular condyle cases operated between 1993 and 2009 were retrieved and examined. The data were tabulated and analyzed. RESULTS There were 8 males and 2 females, with a right:left ratio of 2.3:1. Age range was 18 to 45 years with a mean of 29.4 years. Seven of 10 were superomedial in location. Six patients were treated by conservative condylectomy, whereas 4 required total condylectomy. In all cases, a preauricular with extended temporal approach was used. In the follow-up period ranging from 1 year to 13 years, there was no recurrence. CONCLUSION Mandibular condylar osteochondroma is thought to be a relatively rare lesion with only 90 cases documented in the English language literature to date. Gradual facial asymmetry over the years is the most striking feature. Two types are identified: those causing growth potential in mandible causing bowing of ipsilateral body and requiring gnathic correction after excision of tumor, and others growing as tumors superior or superomedial to condyle without causing much growth in the mandible, requiring only excision and automatic swing back to correct asymmetry. Both the procedures---conservative condylectomy and the total condylectomy---are curative. The decision, however, depends on how much swing of mandible is required postsurgery for correction of asymmetry and occlusion.

Equivalence Randomized Controlled Trial of Bioresorbable Versus Titanium Miniplates in Treatment of Mandibular Fracture: A Pilot Study

PURPOSE The present study was undertaken to test bioresorbable fixation versus titanium for equivalence in terms of clinical union and complications using the American Association of Oral and Maxillofacial Surgeons parameters of care. The study design was a randomized, controlled, equivalence trial. MATERIALS AND METHODS A total of 40 patients were enrolled and allocated to the titanium group and bioresorbable group using a computerized randomization table. All were plated using standard plating principles. In the bioresorbable group, 2 weeks of maxillomandibular fixation was also used. Evaluation of the study endpoint was done at 8 weeks postoperatively. For statistical analysis, the upper limit of the 95% confidence interval was calculated for failure to achieve the primary outcome variable and compared with the maximal clinically acceptable difference between the standard and test modalities in the failure to achieve clinical union (delta). Delta was predetermined as 2%. The other complications were tested for significance using Fishers exact test. RESULTS Of the 40 patients, 21 were in the titanium group and 19 were in the bioresorbable group, with 20 men and 1 woman in the titanium group and 18 men and 1 woman in the bioresorbable group. The mean age was 28.7 years in the titanium group and 26.6 years in the bioresorbable group. In the titanium group, the complications noted were nonunion in 0%, malocclusion in 7.7%, continued postoperative swelling in 0%, chronic pain in 2%, infection in 5.2%, an inability to chew hard food after 8 weeks in 7.7%, the need for alternative treatment in 0%, and the need for reoperation in 31%. In the bioresorbable group, the complications were nonunion in 4.17%, malocclusion in 11.1%, swelling in 8.3%, chronic pain in 37.5%, infection in 0%, an inability to chew hard food in 11.1%, the need for alternative treatment in 11.1%, and need for reoperation for plate removal in 0%. CONCLUSIONS The small sample size did not allow any meaningful conclusion to be drawn from the present study in terms of the primary question of achieving union. Both groups matched in outcomes when evaluated only on a clinical basis. The avoidance of repeat surgery for plate removal is a definite advantage of using resorbable plates. However, the results are inconclusive in favor of any particular plating system.

Functional Outcomes of Gap and Interposition Arthroplasty in the Treatment of Temporomandibular Joint Ankylosis

PURPOSE Recurrence is a major concern in management of temporomandibular joint ankylosis. In this study functional outcomes of gap arthroplasty (group I) and temporalis myofascial interposition arthroplasty (group II) are compared. MATERIALS AND METHODS Preoperative, intraoperative, and follow-up data were noted from our departmental database. Outcome variables were postoperative mouth opening, open bite, recurrence, and facial nerve dysfunction. The χ2 test, Fisher test, t test, 2-sample Wilcoxon rank sum test, and logistic regression analysis were used. RESULTS Group I comprised 207 patients, and group II comprised 55 patients. The mean age was 12.9 years (SD, 7.0 years). There were 220 nonrecurrent and 42 recurrent cases. The mean follow-up period was 3.78 years (SD, 3.0 years). In first time-operated cases, the recurrence rate was 14.7% in group I and 4.8% in group II. In recurrent cases, the recurrence rate was 34.5% and 30.8%, respectively. The differences were statistically insignificant. CONCLUSIONS In first-time operated temporomandibular joint ankylosis cases, both treatments are satisfactory in preventing recurrence, but the recurrence rate increases with previous recurrences.

Temporomandibular joint ankylosis: Is hypercoagulable state of blood a predisposing factor?

Temporomandibular joint (TMJ) ankylosis is a significant problem in Asian countries and the most common etiology is trauma to the mandibular condyle. Other less common etiologies are infection, forceps delivery trauma and rheumatoid arthritis. Many hypotheses are given to explain the pathogenesis. All the proposed hypotheses revolve around trauma to the joint and subsequent healing causing ankylosis. This is however true for only few patients, most of the others do not progress to ankylosis after trauma to TMJ irrespective of seeking treatment or not. In this paper, we try to answer the question that why only a minor subset of condylar injuries progress to ankylosis and why others do not? The hypothesis follows a report of 4 cases that had bilateral TMJ ankylosis with extrahepatic portal venous obstruction (EHPVO) secondary to protein C deficiency. It is postulated that hypercoagulability/reduced fibrinolytic activity in these as well as non-EHPVO patients with TMJ ankylosis cases may have predisposed them to the development of joint ankylosis. The possible mechanism is explained and correlated with other causes of TMJ ankylosis and known facts of protein C deficiency/activated protein C resistance.

Use of indomethacin as an adjuvant to surgery for recurrent temporomandibular joint ankylosis in adults

Two cases with multiple recurrences of temporomandibular joint ankylosis and multiple failed interposition/gap arthroplasty procedures are presented here. Heterotopic bone formation was thought to be the reason. Indomethacin prophylaxis for prevention of heterotopic new bone formation at the osteoarthrectomy site was used as an adjuvant to surgery, in dosages of 75 mg/day for six weeks. Indomethacin is used frequently in hip and elbow arthroplasties to prevent heterotopic ossification, but its use in temporomandibular joint is not routine. The presented cases did not develop further recurrence and attained stable mouth opening over two-year follow-up after osteoarthrectomy and oral indomethacin.

Traumatic bone cyst of the mandible in Langer-Giedion syndrome: a case report

IntroductionLanger-Giedion syndrome (trichorhinophalangeal syndrome type II) is an extremely rare disorder characterized by dysmorphic facial features, multiple exostoses, mental retardation and digit deformities. We report the first case of any maxillofacial pathology in such a syndromic patient.Case presentationA 22-year-old Indian woman with mild intellectual disability presented with malaligned teeth. Routine radiographic screening demonstrated a large multilocular lesion in her right mandible. She had peculiar features such as short stature, short limbs, brachydactyly, and dysmorphic facial characters, which prompted us to evaluate her further. After findings of multiple bony exostoses she was diagnosed with Langer-Giedion syndrome. On surgical exploration of her right mandibular lesion an empty cavity was found suggestive of traumatic bone cyst. The lesion healed completely after 1 year without loss of vitality of any teeth.ConclusionsAlthough diagnosis and management of any maxillofacial pathology can be challenging in syndromic patients, our report suggests a possible correlation between traumatic bone cyst and Langer-Giedion syndrome. Clinicians should routinely screen these patients for any undetected maxillofacial pathology. In future cases of this syndrome, one should consider the possibility of traumatic bone cyst which may not require aggressive surgical management.

Literature review of 86 cases of mandibular ameloblastic carcinoma

Ameloblastic carcinoma is considered to be a rare epithelial malignant neoplasm of odontogenic origin occurring mainly in the mandible. Ameloblastic carcinoma has been a topic of controversy regarding management from past many years. We reviewed 86 cases of mandibular ameloblastic carcinoma from 1981 to 2014, on the basis of the electronic search of peer-reviewed journals in MEDLINE (PubMed) database. Age, sex, tumor size, treatment delivered, recurrence, metastasis, follow-up period, and dead/alive status are tabulated, and the data are analyzed. The mean age was 43.47 years with standard deviation ± 21.09. The age range was between 15 and 91 years, and male to female ratio was 2.18:1. Knowledge gained from the present review would help in establishing the best therapeutic options for ameloblastic carcinoma, and it also encourages the further reporting of ameloblastic carcinoma.

Retrospective study of mandibular angle fractures treated with three different fixation systems.

Aim: To evaluate the outcomes of mandibular angle fractures treated with metal 2.0 mm locking, metal 2.0 mm nonlocking, and 2.5 mm resorbable systems. Study Design: Retrospective cohort study. Materials and Methods: Trauma records were screened for linear angle fractures treated with open-reduction and internal semi-rigid fixation with single metal/bioresorbable plates, and baseline variables were tabulated. The outcome variable was the presence or absence of any complication. Statistical Analysis Used: The Fishers exact test and analysis of covariance (ANCOVA) using STATA 11. Results: A total of 60 case records of over four years were included. The mean age of the patients was 27.4 (SD 9.7) years. Fifty-five were male and five female. There were 20 nonlocking and 16 locking metal miniplates and 24 bioresorbable plates. In 55 (91.6%) cases there was a third molar in the fracture line. In 51/55 (92.7%) cases the third molar was retained. In seven patients postoperative complications were seen. There was no difference between the complication rates of the three treatment groups. Infection was the most common complication followed by delayed union and hardware failure. Conclusions: This retrospective study found no difference in the complication rate when fractures of the mandibular angle were treated with locking or nonlocking miniplates or bioresorbable plates.