P. Suresh Menon

Use of Buccal Fat Pad for Treatment of Oral Submucous Fibrosis

PURPOSE The aim of this study was to clinically evaluate the application of pedicled buccal fat pad (BFP) in the surgical management of stage III and IV oral submucous fibrosis (OSMF). MATERIALS AND METHODS Twenty-eight cases of clinically and histologically diagnosed cases of OSMF were divided into 2 groups: group I (n = 15) and group II (n = 13), corresponding to clinical stage III and stage IV, respectively. All the patients underwent incision of fibrotic bands and coverage of the buccal defect with a pedicled BFP flap. Both groups were analyzed separately for mouth opening (interincisal distance in millimeters) preoperatively and 1 year postoperatively, time taken for epithelialization of BFP, time taken for establishment of normal contour, and changes in symptoms (painful ulcerations, burning sensation, and intolerance to spices) 1 year after grafting. RESULTS The mean preoperative mouth opening was 19.6 mm (SD, 2.43) in group I and 12.92 mm (SD, 1.21) in group II. The mean postoperative mouth opening after 1 year was 35 mm in group I (SD, 1.96) and 31.76 mm in group II (SD, 1.97). The time taken for epithelialization of BFP was 4 weeks in group I and 5 weeks in group II. The mean time taken for establishment of normal contour after grafting was 12.25 weeks (SD, 1.42) in group I and 15.07 weeks (SD, 1.26) in group II. In 2 cases in group II, there was remission of painful ulcerations, burning sensation, and intolerance to spices. CONCLUSION BFP is reliable for the treatment of OSMF.

Etiology and Management of Zygomaticomaxillary Complex Fractures in the Armed Forces

BACKGROUND The nature of duties in the Armed Forces predisposes its personnel to various kinds of injuries. The rise in violence coupled with an exponential increase in motorized population has contributed towards maxillofacial injuries. The aim of this study was to determine the incidence, cause and pattern of various injuries resulting in fracture of the zygomaticomaxillary complex in Armed Forces personnel and their families. METHODS A study was conducted between January 2001 - December 2002 in maxillofacial surgical wing of an Army Dental Centre with specific regard to age, sex, location and etiology of zygomaticomaxillary complex fracture. Out of 201 maxillofacial injuries received, 87 individuals were treated for zygomaticomaxillary fractures. Majority of the individuals were in their third decade of life and road traffic accident was the leading cause of the fractures. RESULTS Uneventful recovery was there in 81 individuals (93.10%). Six patients (6.89%) had post operative complications in the form of enophthalmos, hypophthalmos, paraesthesia, diplopia and facial asymmetry. These complications were subsequently treated successfully as a secondary procedure for all the patients. CONCLUSION Facial bones, especially of the middle third of the face, are composed of a network of fragile bones which give way in case of force to a lesser extent than other parts of the body. It is imperative to educate people regarding the importance of restraints and use of protective headgears/use of seat belts while travelling in motorized transport.

Superficial Temporal Fascia Pedicled V-Y Advancement Flap for Scalp Reconstruction

Repair of scalp defects using local hair bearing scalp is technically challenging. Transposition or rotation of local flaps to close the defect has its own disadvantages. Reconstruction of scalp defect using superficial temporal fascia pedicled V-Y advancement flap using both frontal and parietal branches of superficial temporal artery following the excision of a benign and a malignant pathology is reported here. It is possible to reconstruct the defect with hair bearing scalp in a single stage along with primary closure of the donor site using this technique.

Desmoplastic Trichilemmoma of the Facial Region Mimicking Invasive Carcinoma

Trichilemmoma is a hamartomatous proliferation arising from cells of hair follicle. Its desmoplastic variant simulates an invasive carcinoma. In this tumor, the cell of origin seems to be located in the superficial level of the hair follicle just below the basement membrane at the sebaceous gland level. We present a similar case which presented with an asymptomatic nodular lesion in the region above the upper lip on left side. Fine needle aspiration cytology raised the cytological possibility of a malignancy for which the lesion was excised. On histopathology the lesion was diagnosed as desmoplastic trichilemmoma. The case highlights the difficulty encountered in differentiating a benign adnexal tumor from malignant lesion based on cytology alone. Moreover, the extensive desmoplasia on histopathology raises the suspicion of invasive malignancy which requires to be carefully excluded. The superficial features of trichilemmoma and lack of cellular atypia is a useful diagnostic clue in such a situation. Positivity of CD34 can also be used to differentiate from basal cell carcinomas. The case reported here had a solitary lesion, but follow up is required for development of more lesions or multiple hamartomas in other organs as a part of Cowden’s disease.

Reconstruction of a Large Posterior Scalp Defect Using Occipital Artery Based Pedicled Island V–Y Advancement Flap: A Case Report

Repair of scalp defects using local hair bearing scalp is technically challenging. Transposition or rotation of local flaps to close the defect has its own disadvantages. Reconstruction of a large posterior scalp defect using occipital artery based pedicled V–Y advancement flap following the excision of a recurrent fibrolipoma of epicranial aponeurosis is reported here. It is possible to reconstruct the defect with hair bearing scalp in a single stage along with primary closure of the donor site using this technique.

Meniscopexy for Internal Derangement of Temporomandibular Joint

The term internal derangement was first adopted to describe any pathologic entity that interfered with the smooth function of the temporomandibular joint (TMJ). The term is currently used exclusively to describe alterations in disc–fossa relations. Internal derangement of the TMJ does not always cause pain, although when the disc becomes displaced, noises and locking can occur and ligamentous, capsular or retrodiscal pain may dominate the clinical picture. Meniscopexy of TMJ was done in ten patients where clinical features suggest true internal derangement of the TMJ refractory to conservative treatment with restricted movement and pain identified as arising primarily from the joint. Magnetic resonance imaging was done to identify the cause of problem.

A clinical evaluation of midface advancement using intraoral distractors in management of bone stock deficiencies.

BACKGROUND Cleft lip and palate patients present large osseous defects of the alveolus and midface hypoplasia. Traditional orthognathic surgery has limitations of relapse and limited age group. Distraction osteogenesis (DO) as a modality for midface advancement is relatively new. Modular internal distractor (MID) offers the advantage of patient compliance and minimal discomfort. The purpose of this study was to evaluate the versatility of intraoral distractors in midface advancement. METHOD Nineteen patients with midface bone stock deficiency were selected for maxillary advancement. At the first surgery under general anaesthesia, after the osteotomy (Le Fort I/II), MID system was used. After distraction, evaluation was done for ease of the procedure, stability, and complications. Lateral cephalograms were evaluated at three stages: T1, pre-distraction; T2, post-distraction; and T3, one year post-distraction. RESULTS Significant changes showed 13.3 mm mean midface advancement bone formation at the pterygomaxillary region. The results were stable even at one year follow-up. CONCLUSION Maxillary position improved in relation to the cranial base. This study showed that the MID was versatile in midface advancement in stability and patient compliance with minimal complications.

Palatal perforation secondary to tuberculosis: a case report.

Palatal perforation though rarely seen in adults but may have infectious, inflammatory, neoplastic, or traumatic cause. We present here a case of palatal perforation due to tuberculosis which was managed successfully using greater palatine artery pedicled flap closure at our centre.

Endosseous alveolar distractor (LEAD™) in the management of residual alveolar ridge resorption

BackgroundLack of sufficient alveolar bone height or width is one of the most frequent problems in the dental rehabilitation of the edentulous patient.MethodsA prospective study to evaluate the efficacy of an endosseous alveolar distractor (LEADTM) in managing residual alveolar ridge resorption was carried out. The complications related to the surgical procedure and the quantitative changes in the regenerate over a 6 month period following distraction were studied in 13 cases with alveolar ridge atrophy.ResultDesired ridge augmentation was achieved in 11 cases. In 2 cases the distraction failed. Some unusual complications were encountered.ConclusionThe LEAD™ alveolar distractor produces consistent augmentation of the alveolar bone but is confronted with stability issues.