Rahul Yadav

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.

Distraction osteogenesis for management of obstructive sleep apnoea in temporomandibular joint ankylosis patients before the release of joint

AIM To evaluate the effects of distraction osteogenesis in management of obstructive sleep apnoea patients secondary to temporomandibular joints ankylosis. METHODS Fifteen patients were included in study. Preoperatively the patients were worked up for polysomnography and CT scans. Only those patients with Apnoea-hypopnoea index >15 events/h denoting moderate to severe obstructive sleep apnoea were included in the study. Distraction osteogenesis was followed with 5 days latency period in adult patients and 0 days for children. Rate of distraction was 1 mm/day for adults and 2 mm/day for children till the mandibular incisors were in reverse overjet. After 3 months post distraction assessment was done using polysomnography and CT scan. TMJ ankylosis was released by doing gap arthroplasty after distraction osteogenesis. RESULTS Post distraction improvement was seen in clinical features of OSA like daytime sleepiness and snoring. Epworth sleepiness scale improved from a mean of 10.25 to 2.25. Polysomnographic analysis also showed improvement in all cases with apnoea-hypopnoea index from 57.03 to 6.67 per hour. Lowest oxygen saturation improved from 64.47% to 81.20% and average minimum oxygen saturation improved from 92.17% to 98.19%. Body mass index improved from a mean of 18.26 to 21.39 kg/m2. CONCLUSION Distraction osteogenesis is a stable and beneficial treatment option for temporomandibular joint ankylosis patients with obstructive sleep apnoea.

Application of indigenous continuous positive airway pressure during one lung ventilation for thoracic surgery

During one lung ventilation (OLV) hypoxemia may occur due to ventilation-perfusion mismatch. It can be prevented with application of ventilation strategy that prevents atelectasis while minimally impairing perfusion of the dependant lung. Here, two cases are reported who required OLV and in whom hypoxemia could be prevented with the application of continuous positive airway pressure to the deflated or non-dependant lung, using an indigenous technique. We suggest use of this technique which is easy to be employed during the intraoperative period.

Difficult airway leading to carbon dioxide narcosis in a case of fixed cervical spine

Inability to secure the airway of a patient after induction of anaesthesia may lead to serious consequences including permanent brain damage and even death. Hypoxia is quite common in difficult intubations especially when it is difficult to ventilate the patient. However, carbon dioxide retention severe enough to cause carbon dioxide narcosis and delayed recovery is a rare occurrence. Here, we report a case of a craniovertebral junction anomaly where inadequate ventilation after induction of anaesthesia resulted in carbon dioxide narcosis and delayed awakening. A 54-year-old, American Society of Anesthesiologists II female patient weighing 70 kg with a diagnosis of craniovertebral junction was scheduled for implant removal for dislodged occipital screw. Fibreoptic intubation was attempted after induction of anaesthesia and muscle paralysis. Even after multiple attempts, intubation could not be done and ventilation by face mask became difficult. Though oxygen saturation could be maintained with the insertion of a laryngeal mask airway (LMA), ventilation was not adequate. The patient remained unresponsive long after discontinuation of anaesthetic agent and reversal of muscle paralysis. Subsequent blood gas analysis showed severe carbon dioxide retention and respiratory acidosis. Patient was given assist control mechanical ventilation through LMA. LMA was removed after improvement in sensorium and the blood gas picture.