Pk Menon

Fractures in the maxillofacial region: a four year retrospective study.

INTRODUCTIONnThe incidence of maxillofacial injuries is on the rise due to motor vehicle accidents and increased incidence of violence in recent times. The aim of this retrospective study was to determine the incidence, aetiology, the pattern of fractures, their management with open reduction and internal fixation (ORIF) and complications, if any.nnnMETHODSnA retrospective analysis of 621 fractures in 361 patients managed by ORIF over a four year period was carried out.nnnRESULTnThe average age of patients was 24.3 years with a male to female ratio of 21.2:1. Panfacial fractures comprised 4.7%, frontal bone fractures 8.9%, orbital fractures 0.7%, naso-orbito-ethmoid complex (NOE) fractures 0.7%, zygomatic complex fractures 23.5%, fracture maxilla 11.5% and mandibular fractures 52.2% of all facial fractures. All the cases were successfully managed by ORIF under general anaesthesia (GA). Complications were noticed in 6.8% of cases in the form of reactive implants in 3.6%, deranged occlusion in 1% and infection at operated site in 1% cases which were managed satisfactorily.nnnCONCLUSIONnThe findings of this study reveal sharp annual increase in the number of cases of maxillofacial trauma. Road traffic accidents (RTA) were the commonest cause and the age group most affected was between 20-25 years. ORIF of these fractures was chosen for its obvious advantages of direct anatomical reduction, early return to function and minimal complications.

Management Protocol for Anaphylaxis

There is no universal agreement on the definition of anaphylaxis or the criteria for establishing its diagnosis, although it has been known to the field of emergency medicine for more than 100 years. Two meetings were convened by the National Institute of Allergy and Infectious Disease and Food Allergy and Anaphylaxis Network in April 2004 and July 2005. Representatives from 16 different organizations and government bodies, including representatives from developed nations, continue working toward a universally accepted definition, criteria for diagnosis, and management of anaphylaxis. This article presents the latest concepts on anaphylaxis in the literature including the research needs in this area.

Text book of Oral and Maxillofacial Surgery

This book presents a detailed and authoritative exposition of basic principles of Oral and Maxillofacial Surgery. From basic oral surgical procedures encountered by general practitioner to advance and complex surgical procedures that need to be referred to oral and maxillofacial surgery specialists, all are covered in sufficient detail with judicious mix of text and illustrations. n nThe features includes exodontia, dental implantology, management of medical emergencies, medicolegal consideration in oral surgery. It covers recent advances on alloplastic materials, bioresorbable plates, distraction osteogenesis, lasers in dentistry, peizoelectric surgery. Complete coverage of all important topics from examination point of view for both undergraduates and postgraduate students is included. Case photographsillustrate the concepts and help the in grasping their significance, Practical and pictographic approach to explanation of surgical procedures provide an edge over the conventional method of learning. Colour illustrations, photographs, pathological pictures, flow charts, boxes and tables are profusely used throughout the text to make relevant clinical situations self explanatory. The emphasis is laid upon the language that is simple, understandable and exclusively designed for the students whilst maintaining its international standards. n nThis book is a must for undergraduate and postgraduate dental students and will prove to be useful for general practitioners also.

Management of Mandibular Fractures

BACKGROUNDnTo evaluate the cases of mandibular fractures treated by open reduction and rigid fixation at the Armed Forces Medical College, Pune.nnnMETHODSnTwo hundred and thirteen mandibular fractures cases were treated by open reduction and rigid fixation from Jun 1998 to Jun 2006. These were retrospectively analyzed based on the following patient related factors i.e. mode of injury, age and sex distribution, site of injury, associated injuries and surgical treatment.nnnRESULTnThe significant finding was that the most common etiology for fracture mandible was road traffic accidents (RTA), [196 (92%)]. Of the patients who reported, 147 (95.4%) were males in the third decade of life. 96 (45%) patients had parasymphysis fractures, 65 (30.5%) had angle fractures, 33 (15%) subcondylar fractures, 17 (7.9%) body fractures and 2(0.9%) had ramus fracture. Early intervention using open reduction and internal fixation was the protocol followed which resulted in minimum morbidity and complications.nnnCONCLUSIONnAs RTA especially two wheelers accidents appeared to be the most common cause of mandibular fractures, use of suitably designed protective head gear (crash helmets) is advisable. Moreover open reduction and rigid internal fixation appears to be the suitable treatment modality in successful treatment of mandibular fractures in reducing morbidity and complications and ensuring early return to normalcy.

An objective assessment of proximal and distal facial nerve exploration during superficial parotidectomy

Aim: This study was undertaken to compare the proximal and distal facial nerve exploration approach during superficial parotidectomy. Materials and Methods: A retrospective analysis of patients who underwent superficial parotidectomy at our center was conducted. Cases were divided into those who underwent superficial parotidectomy using distal facial nerve exploration and those who underwent standard proximal facial nerve exploration. Statistical comparisons of intraoperative blood loss and margin status (negative, focally, positive) were conducted between these two approaches. Results: A total of 39 patients underwent superficial parotidectomy at our center between 2008 and 2010. The technique used in most of the cases was conventional proximal nerve exploration technique (29 cases). Distal exploration of the buccal branch was undertaken only in 10 cases, on account of difficulty in locating the main trunk intraoperatively due to the presence of postinflammatory fibrosis. The average patient age was 48 years with a female preponderance (67%). Both the techniques consumed almost same average operative time (2.4 hours) and average intraoperative blood loss (68.0 cc vs 25.4 cc) was more in the cases where proximal nerve exploration was resorted (S.E (d) = 0.89). No significant difference in surgical margin status was noticed between the two techniques (P > 0.05). Conclusion: Both the techniques are efficient without compromising the surgical margins, but the average intraoperative blood loss is less in distal facial nerve exploration technique.

Vitoss Synthetic Cancellous Bone (Void Filler)

No abstract available nKeywords: Beta tricalcium phosphate; Hydroxyapatite; Synthetic bone substitute.

Secondary and Delayed Bone Grafting in Alveolar and Anterior Palatal Clefts

BACKGROUNDnSurgical repair with suitable bone graft / substitutes plays an important role in rehabilitation of individuals with residual anterior palatal or alveolar defects associated with an oronasal fistula.nnnMETHODSn52 cases were treated by secondary or delayed bone grafting of the alveolar defects in isolation or associated with defects of the anterior palate from July 2002 - Nov 2004. Dimension and the extent of the defects were assessed with the help of radiographs & maxillofacial CT. Cephalometric analysis, presurgical orthodontics and dentofacial orthopedics preceded surgical repair with cancellous graft from the iliac crest, followed by post surgical orthodontics and prosthetic rehabilitation.nnnRESULTnSatisfactory results were achieved in 49 cases with three cases showing failure of graft acceptance. Postoperative clinical and radiological evaluation for all the patients was done at an interval of one, three and six months. Bone density and trabeculation was comparable to the adjacent bone within six months.nnnCONCLUSIONnRecreating the bony continuity of the maxillary arch followed by orthodontic correction of dental discrepancies achieves a comprehensive orthosurgical correction.

Actinomycetoma of hand and foot.

Mycetoma refers to the chronic suppurative pathological process in which exogenous etiological agents generate pus and sulphur like granules. These agents belong to two groups: true fungi and the actinomycetes. Eumycetoma (caused by fungi) and actinomycetoma (caused by actinomycetes) must be distinguished as their treatment is different. These causative agents are introduced into the skin by minor trauma. Most cases of mycetoma occur in tropical regions such as Asia, Africa and Central and South America but this disease is endemic in India. Nocardia brasiliensis is the most common isolate found in India [1]. The pathologic process is characterized by tumefaction, subcutaneous nodules and in most cases discharging sinuses that drain exudate containing granules. It gradually invades the tissues and bones causing a functional disability. Bone involvement depends on the duration of the disease and the causative agent. Here we present two cases of actinomycetoma, one affecting the hand and the other the foot. The pathogenesis, radiological features and the therapeutic management of this entity are reviewed. n nCase Report nA 32-year old individual, tailor by profession reported with a gradually increasing painless swelling of the left hand associated with progressive development of multiple discharging sinuses, of 8 years duration. He did not give any positive history of direct prick or any injury. Local examination revealed a diffuse swelling of the left hand involving mainly the palm and the dorsum, sparing the fingers and thumb. The feel of the swelling was woody and there were multiple discharging sinuses present all over the dorsum and palmar aspect of the hand (Fig 1). The granules contained in the discharge were yellowish in colour. 1–2 mm in size, multiple and discharging intermittently. The surrounding skin was thickened, unhealthy and hyperpigmented. Systemic examination was normal. There was no evidence of any distant spread. Gram stain of the granules showed gram positive branching bacillary filaments (1μ in diameter) having a distinct sunray appearance, diagnostic of actinomycetoma. Repeated culture both under aerobic and anaerobic conditons did not grow any organism.(the patient gave history of prior antibiotic treatmment). X-ray of the left hand showed a patchy resoiption of all the metacarpal bones with lucent filling defects and thickened cortex with partial destruction of the carpal bones (Fig 2). There was no involvement of the small joints. He was managed with high dosage of penicillin along with dapsone (DDS) and rifampicin to which he responded well. The chemotherapy was then switched over to dapsone (DDS) and trimethoprim-sulfamethoxazole combination at the time of discharge, for the patients convenience. He is under close follow up. n n n n nOpen in a separate window n n nFig. 1 n n nPalmar view of the left hand showing massive soft tissue swelling, subcutaneous nodules and multiple discharging sinuses.

Maxillofacial Imaging: Larheim TA, Westesson PL

Maxillofacial imaging has evolved dramatically over the past two decades with development of new cross sectional imaging techniques. Traditional maxillofacial imaging was based on plain films and dental imaging. However, advanced imaging techniques like CT and MRI have only been partially implemented for maxillofiacial questions. This book bridges the gap between traditional maxillofacial imaging and advanced medical imaging. The authors have applied CT and MRI to a variety of maxillofacial cases and these are illustrated with high quality images and multiple planes. A comprehensive chapter on imaging anatomy is also included. This book is useful for oral and maxillofacial radiologists, oral and maxillofacial surgeons, dentists, radiologists, plastic surgeons, head and neck surgeons and others who work with severe maxillofacial disorders. This book is also useful for clinicians who are dealing with maxillofacial region.

A STRATEGY FOR RAPID IDENTIFICATION OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS NASAL CARRIER STATUS

Methicillin Resistant Staphylococcus aureus (MRSA) is a multi drug resistant organism responsible for severe outbreaks of life threatening infections in hospitals which are difficult to treat They are spread by nasal carriage among the hospitalised patients, staff and visitors. Mannitol cloxacillin salt agar (MCSA) is a single tube method to identify MRSA. However, tubes showing growth and change in colour on biochemical characterisation often do not prove to be MRSA. In this study we have combined two strategies for the rapid identification and isolation of MRSA by culture in MCSA and multiplex PCR for mecA and femB genes. Anterior nasal swabs obtained from nursing staff and patients admitted to a large referral hospital, were inoculated into MCSA. Of the 100 tubes inoculated, 8 tubes showed change in colour and growth. On conventional testing 4 were MRSA, 3 were methicillin sensitive S aureus (MSSA) and 1 was Methicillin Sensitive Coagulase Negative S aureus (MSCNS). Genotyping by multiplex PCR revealed 5 MRSA, 2 MSSA and 1 MRCNS. The Multiplex PCR technique to rapidly identify presence of mecA and femB genes showed presence of both mecA and femB bands in all MRSA. The methicillin sensitive organisms showed absence of mecA gene while coagulase negative organisms showed absence of the fern B gene. Combining MSCA with multiplex PCR for mec A and fem B genes made the test both rapid and specific. Use of this strategy would enable rapid screening of nasal carriers and early implementation of hospital infection control measures.