Nanda Kishore Sahoo

Role of split calvarial graft in reconstruction of craniofacial defects.

Abstract The aim of this study was to evaluate the clinical applications, graft uptake, and complications of split-thickness calvarial graft for the reconstruction of craniofacial defects. This retrospective study included 26 patients with craniofacial defects treated between January 2008 and December 2009. This included 17 male and 09 female patients between 9 and 45 years. Depending on the treatment provided, the patients were divided into 3 groups. Group 1 included 11 patients with cranial defect operated on for cranioplasty. Group 2 included 7 patients with orbital floor defect operated on for orbital floor reconstruction, and group 3 included 8 patients with alveolar cleft defect operated on for secondary alveolar grafting. Clinicoradiologic follow-up ranged from 18 to 24 months. In group 1, the symmetry of the calvarium was restored with good cosmesis. Improvement in neurologic function was observed in 7 patients. In group 2, the orbital volume and ocular function was maintained. In group 3, graft uptake was satisfactory with increase in bone density, and continuity of the alveolar bone was maintained. Cuspid eruption was aided orthodontically. Split calvarial grafts are suitable materials for craniofacial reconstruction. Their embryological origin, thickness, and shape are ideal for the restoration of craniomaxillofacial defects.

Evaluation of upper airway dimensional changes and hyoid position following mandibular advancement in patients with skeletal class II malocclusion.

Background Class II skeletal malocclusion due to mandibular deficiency is considered a risk factor for sleep disorders due to oropharyngeal airway deficiencies. In view of the above, a prospective interventional study was undertaken to evaluate upper airway dimensional changes and position of hyoid bone by comparing pretreatment and posttreatment lateral cephalograms. The objective also included the establishment of the ratio of mandibular advancement to increase in airway dimensions. Patients and Methods Pretreatment and posttreatment lateral cephalograms of 20 adults (13 females and 7 males) with skeletal class II malocclusion treated by combined orthodontics and bilateral sagittal split ramus osteotomy was evaluated for changes in posterior airway space (PAS), superior airway space (SAS), minimum airway space (MAS), hyoid bone position (MP-H), effective mandibular length (Co-Gn), mandibular corpus length (Go-Pg), and pogonion position (N perpendicular-Pg). The cephalograms were manually traced by a single operator and the data analyzed using MINITAB 13.2 version software. Results There was a statistically highly significant (P = 0.0001) increase in PAS, SAS, MP-H, Co-Gn, and Go-Pg. The mean ratio of mandibular advancement to increase PAS, SAS, and MAS was 1:0.35, 1:0.34, and 1:0.24, respectively. Hyoid bone moved superiorly and in an anterior direction by 2.1 ± 2.8 mm and was found to be statistically highly significant (P = 0.0001). Conclusions The study showed an overall increase in airway dimension and improvement in hyoid position. Thus, the procedure may be considered beneficial in reducing upper airway collapsibility and preventing sleep disorders due to oropharyngeal airway deficiencies in skeletal class II malocclusion.

Pleomorphic adenoma palate: Major tumor in a minor gland.

Pleomorphic adenoma (PA) is the most common benign mixed salivary gland neoplasm that accounts for 60% of all benign salivary gland tumors. It has diverse histological presentation and occurs in both major and minor salivary glands. PA of minor salivary gland in the palate is a common entity. We report the case of a 45-year-old female who presented with a painless slow growing swelling of palate over the last 20 years. The mass was extending to oropharynx causing mechanical obstruction of airway. Magnetic resonance imaging (MRI) depicted an oval-shaped mass occupying oropharynx and displacing the tongue inferiorly. Fine needle aspiration cytology (FNAC) was suggestive of PA. The entire tumor mass was excised along with overlying mucosa. Histopathological examination confirmed diagnosis of PA of minor salivary gland. There has been no recurrence of the lesion since 1 year.

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.

Radiographic Assessment of Changes in Articular Tubercle After Dautrey's Procedure

PURPOSE The aim of this retrospective study was to evaluate the increase in height and change in position of neo-articular tubercle in cases treated by Dautreys procedure. METHOD 10 cases of Tempromandibular joint (TMJ) disorders satisfying the inclusion criteria were included in this study, out of which 8 had bilateral chronic recurrent dislocations (CRD) and remaining 2 were suffering from bilateral symptomatic TMJ subluxations. Clinical and radiographic finding were recorded. Bilateral Dautreys procedure was done under general anaesthesia (GA). Post operative clinical findings and radiographic parameters were compared. RESULTS Data analysis showed mean age in this study group was 40.9 years. Out of 10 patients 7 were females and 3 males.The procedure resulted in statically significant stable decrease in mouth opening after 12 months. In radiological evaluation using orthopantomograph (OPG), average increase in articular tubercle height was 3.65 mm on right side and 3.52 mm on left side. The mean anterior shift of articular tubercle lowest point was 4.56 mm on right side and 4.51 mm on left side which were statically highly significant. CONCLUSION Dautreys procedure is simple, effective procedure to prevent anterior excursion of condyles. In this study it was found that down fractured zygomatic arch significantly increases the articular tubercle height and relocates the lowest point anteriorly thereby preventing excessive anterior excursion of condyles.

Mucormycosis of the frontal sinus: A rare case report and review

Mucormycosis of the frontal sinus are rarely seen in day to day clinical practice. Although this fungus is commonly found in the environment, the disease is usually prevented by the immune system and is hence rare. Well-recognized risk factors for the disease include diabetes mellitus, leukemia, aplastic anemia, myelodysplastic syndrome, blood dyscrasias, and immunosuppressive therapy in organ transplantation, renal disease, sepsis, and severe burns. The disease is primarily found in those who are immunocompromised, but it may also manifest in immuno competent persons. Current therapy for the invasive disease includes early surgical debridement, antifungal therapy management of underlying predisposing factors. Early recognition of the disease and treating the underlying cause of mucormycosis, such as diabetes, are key to improving outcomes. The antifungal treatment of choice for mucormycosis is amphotericin B, although very high doses are required because of the relative resistance of the fungus to the drug. Here, we present a case of rhinocerebral mucormycosis of frontal sinus in a diabetic patient, who was managed by systemic antifungals, surgical debridement, and obliteration procedures.

Classification of the Residual Cranial Defects and Selection of Reconstruction Materials

Abstract The cranial defects are complex in nature and are due to various causes. Therefore, there is a need for a common term of reference to these defects. This requirement stood as a prime reason for proposing a classification system for cranial defects. The classification is based on 2 decades of experience in cranioplasty. This efficient and simple way of representation would fill the existing lacunae for a systematic communication on cranial defects. Over the ages the evolution of reconstruction and grafting had undergone a massive progress. Therefore, it is essential to enumerate all available graft and bio-materials for restoring the cranial defects. The aetiology for these defects, age and sex of the patient, site and size of the defect, associated systemic conditions, cost factor, and operators choice are the factors that play key role in the selection of the reconstructive material. This article discusses on these factors in cranioplasty. High success rate with excellent function and cosmetic outcome in using a variety of materials, as shared in this article. The advantages of autografts cannot be matched by any existing alloplast. However, in case of larger defects, for a better cosmetic outcome and to reduce the donor site morbidity, alloplasts are the most widely preferred material of choice.