N. K. Sahoo

Mid Versus Late Secondary Alveolar Cleft Grafting Using Iliac Crest Corticocancellous Bone Graft

BackgroundMid-secondary alveolar cleft repair performed at ages 9–12, in the mixed dentition stage, prior to eruption of the permanent canine, is generally accepted as the ideal time for residual alveolar cleft closure in cleft lip and palate cases with a cleft alveolus.MethodsIn our study, four cases of mid-secondary and five cases of late–secondary alveolar cleft grafting were carried out using iliac crest corticocancellous bone graft. Clinical defect closure and radiographic bone fill were compared.ResultsAll the nine cases performed in the two different age groups showed excellent results, clinically, with complete closure of the cleft defect and achievement of continuity of the dental arches. One case was planned for a two-stage procedure owing to the large bilateral maxillary defects. Good bone fill was visualized radiographically in all nine cases.ConclusionPrecise timing for undertaking alveolar cleft repair may not be all that crucial for a successful alveolar cleft grafting procedure.

Clinical Evaluation of Early Loaded and Unloaded Implants in Edentulous Mandible

ObjectivesThe 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 MethodsFive completely edentulous patients aged between 45 and 65xa0years 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 4xa0months. 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 6xa0month intervals after initial placement.ResultsThere was significant increase in the bone to implant contact for unloaded implants as compared to early loaded at the end of 6xa0months of implant placement. There was increased marginal bone loss around early loaded implants as compared to unloaded implants at the end of 6xa0months. Clinical stability of early loaded implants was lower as compared to the unloaded implants at the end of 6xa0months. Survival rate for early loaded and unloaded implants was 100% at the end of 6xa0months with all implants in function.ConclusionEarly loading of interforaminal mandibular implants demonstrated a highly acceptable clinical success at the end of 6xa0months. However, the bone density, marginal bone level and clinical stability were significantly lower for the early loaded implants as compared to unloaded implants.

Efficacy of Autogenous Split Thickness Calvarial Graft in the Management of Residual Cranial Defect

IntroductionThe patients with cranial deformity suffer from headache, dizziness, irritability, loss of concentration, depression, anxiety, intolerance to noise and vibration and neuromotor weakness. It is therefore essential to restore the calvarium.Material and Method This study was conducted in the Department of Oral and Maxillofacial Surgery, Armed Forces Medical College, Pune between Oct 2010 and Mar 2012. The study population was selected from the outpatient department and from the referred cases. The aim was to study the uptake of split thickness calvarial graft in the management of residual cranial defect. After applying the inclusion and exclusion criterions, ten cases were selected with residual cranial deformity, operated for cranioplasty using split thickness calvarial graft and evaluated.Conclusion It was concluded that cranioplasty using autogenous split thickness calvarial graft for restoring cranial defects is a useful technique and this procedure allows the surgeon to reconstruct a moderate-to-large cranial defect, without breaching the inner cortical plate.

An Unusual Case of a Recurrent Seborrheic/Epidermal Inclusion Cyst of the Maxillofacial Region

A Seborrheic or epidermal inclusion cyst is basically an epidermoid cyst resulting from the traumatic implantation of epidermal elements into the dermis with their subsequent cystic transformation. A case of an epidermal inclusion cyst of the chin region is described in a 72xa0year old male, whose features were rather unusual, in that it presented as a fixed, indurated, inflamed, and extremely painful swelling associated with two draining extraoral sinuses, mimicking a submental space infection. The cyst was particularly persistent and recurred within a month of its excision and had to be re-excised along with the overlying epithelium.

Tension Pneumocephalus—A Rare Complication of Craniofacial Fracture: Report and Review

The term tension pneumocephalus (TP) means raised intracranial pressure due to air in the cranial cavity. This presentation is a rare case report and review on TP. Decompressing this raising intracranial pressure is a surgical emergency. Therefore, this presentation emphasises the importance of timely identification and management of TP in saving life. In this case, the acute signs of raising intracranial pressure were identified and promptly addressed surgically along with the maxillofacial injury management. This restored the deteriorating neurological status as well as his facial form and function. The etiological factors, pathophysiology and various treatment options are reviewed.

Collision Tumor of Maxilla: A Diagnostic Dilemma

Most malignant tumors arise from the primary tissue except when showing extreme dedifferentiation. This can be identified by examination of tumor cells and their products. Occasionally two distinct tissues are recognized within a malignant tumor. In mixed malignant tumors both carcinomatous and sarcomatous elements are present either because of simultaneous malignant change occurring in the epithelium and its nonepithelial stroma or there is a sarcomatous transformation of stroma of a carcinoma. Willey’s in 1960 stated that in these circumstances the resulting tumor must be classified as a “carcino-sarcoma”. These separate tumors arise in nearby structures and may grow to infiltrate in each other resulting in a tumor mass. The present article is a report of a diagnostic dilemma in an extremely rare carcinosarcoma of maxilla in a 24xa0year old male which was first on biopsy reported as odontogenic myxoma. After resection (right maxillectomy under GA using Weber Fergusons approach with Diffenbach’s extension) was diagnosed as Squamous Cell Carcinoma arising from lining of the maxillary antrum associated with Osteogenic Sarcoma (chondroblastic differentiation) of maxilla with negative margins. The tumor was restaged to T2NoMx and further managed as per National Comprehensive Cancer Network Guidelines. Immunohistochemistry later re-diagnosed it to be an Osteogenic Sarcoma maxilla with chondroblastic differentiation. ‘T’ stage remains the most reliable predictor of survival and loco-regional control. Complete surgical resection for all ‘T’ stages (except T4b, any N) followed by postoperative therapy remains a corner stone of treatment of maxillary sinus tumors.

Rehabilitation of a Maxillectomy Case with Telescopic Crowns: A Case Report

Prosthodontic rehabilitation of acquired defects of the maxilla is a challenge in terms of reestablishing oronasal separation. Most of the times these goals are met by means of obturator prosthesis. Preservation of the remaining hard and soft tissues in such patients is very much essential in order to have a good retention, stability and support for the prosthesis. It is very much imperative to fabricate a prosthesis to provide proper function to the patient. Various techniques have been developed to enhance the retention and stability of the prosthesis, some of them being extension of the obturator bulb into the undercuts within the defect, use of magnets, implants etc. Telescopic crowns have been an adjunctive utility to prosthetic dentistry since a very long time. The biomechanics of telescopic crowns aid in providing a good retention and stability to the prosthesis. In the following clinical report a patient with a status of Subtotal Hemi Maxillectomy is presented in whom telescopic copings were incorporated into the cast hollow bulb obturator to enhance the retention and stability of the prosthesis.