Ramen Sinha

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.

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

INTRODUCTION The 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. METHODS A retrospective analysis of 621 fractures in 361 patients managed by ORIF over a four year period was carried out. RESULT The 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. CONCLUSION The 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.

Scalar modes and coupling characteristics of eight-port waveguide couplers

The scalar modes and the coupling characteristics of an eight-port waveguide coupler consisting of four parallel single-mode waveguides are discussed. The analysis is based on a rectangular waveguide model which has been known to give accurate results in the case of two waveguide directional couplers. A classification of its various scalar modes is also given. >

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.

Low-Grade Osteosarcoma of the Mandible

Osteosarcoma (OS), a rare malignant bone tumour arising from primitive bone forming mesenchyme, most often arises in the metaphyses of long bones of the extremities. Bone or osteoid formation within the tumour is characteristic of an osteosarcoma. Craniofacial osteosarcoma (CFOS), most often located in the mandible or maxilla, accounts for only 5–13% of all osteosarcomas. In general, OS of the jaw is a high-grade lesion. Low-grade lesions are rare and represent less than 2% of all osteosarcomas reported in the literature. Because of its rarity and well differentiation, Low-grade OS is usually misdiagnosed as a benign lesion. The clinical and radiographic presentation does not correlate well with the subtle histology picture of a low-grade osteosarcoma which makes the diagnosis difficult.

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. The 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. This book is a must for undergraduate and postgraduate dental students and will prove to be useful for general practitioners also.

Gap Arthroplasty for Mandibular Condyle Dislocation and Impaction Into the Middle Cranial Fossa

The anatomic basis of the mandible ensures the dissipation of forces along the mandible, allowing the weakest part at the condylar neck to fracture, thus preventing transfer of forces to the cranium. 1 This is the reason for the high incidence of condylar fractures. They account for approximately 25% to 30% of mandibular fractures. 2 In an adult mandible the distance between the lateral and medial pole tends to be larger in dimension than the fossa, preventing direct penetration of the fossa. However, a rounded condyle as seen in children would predispose to direct penetration into the middle cranial fossa. Other predisposing factors include a thin neck, 3 hyperpneumatized temporal bone, lack of dentition in the posterior region, or an open mouth position during impact. 4 Treatment of this injury should be individualized and should take into account the age of the patient, growth potential, the degree of glenoid fossa destruction, the risk of ankylosis, and the risk of further cranial injury.

Retrospective Study on Efficacy of Intermaxillary Fixation Screws

BACKGROUND We evaluated the efficacy of intermaxillary fixation (IMF) screws in the treatment of mandibular fractures. METHODS Two hundred patients with mandibular fractures, treated by IMF using these screws, were evaluated by pre and postoperative panoramic radiographs. Clinical testing was carried out for vitality and abnormal mobility of teeth adjacent to the site of screw insertions. Other factors such as possible iatrogenic dental injuries, loss, breakage or screw cover by oral mucosa and postoperative occlusion were also studied. RESULT The most important complication noticed was iatrogenic damage to dental roots. CONCLUSION Use of intraoral cortical bone screws for IMF is a valid alternative to arch bars in the treatment of mandibular fractures. Iatrogenic injury to dental roots is the commonest problem which can be minimized by an experienced surgeon.

Evaluation of facial nerve function following surgical approaches for maxillofacial trauma

Purpose: The aim of this study was to report facial nerve injury following extraoral surgical approaches for the treatment of maxillofacial trauma, using the House–Brackmann facial nerve grading system (HBFNGS) as a means of classifying and measuring the degree and type of injury. Materials and Methods: The sample comprised 100 consecutive cases of various maxillofacial trauma in which extraoral surgical approaches were used. Variety of surgical approaches such as coronal, preauricular, endaural, retromandibular, and submandibular approach and its modifications were used based on the anatomic location of the fracture and the accessibility required for its reduction and fixation. Facial nerve function of all patients was evaluated preoperatively and 24 hours after surgery. Patients who presented postoperative facial nerve injury were likewise examined using the HBFNGS at 24 hours, 1 week, 1 month, 3 months, and 6 months. Results: Of the 100 patients, temporofacial branch involvement was seen in 11 cases, whereas cervicofacial branch involvement was seen in 6 cases. Complete recovery of the temporofacial branches was seen in a period of 3–4 months; whereas cervicofacial branches recovered in 5–6 months postoperatively. Conclusion: The frequency of facial nerve injury was related to various surgical approaches in maxillofacial trauma. Facial nerve impairment was found to be temporary in all cases, although the recovery of cervicofacial branches took a longer time. Moreover, there is a need to standardize the reporting of facial nerve recovery.

Soft tissue changes and its stability as a sequlae to mandibular advancement.

Purpose of the Study: To predict the changes and evaluate the stability that occurs in the soft tissues following the skeletal movement subsequent to surgical advancement of the mandible through bilateral sagittal split osteotomy and to provide the patient reliable information with regard to esthetic changes that can be expected following the treatment. Materials and Methods: Twenty adult patients diagnosed with skeletal class II malocclusion and underwent bilateral sagittal split osteotomy for mandibular advancement by a mean of 8 mm using rigid fixation were included in the study. Soft tissue changes brought about by the surgical procedure and their stability over a period of time were evaluated prospectively using 12 linear (4 vertical and 8 horizontal) and 4 angular measurements on profile cephalograms which were taken preoperatively after the pre-surgical orthodontics (T1) and postoperatively with duration of 1 month (T2) and 6 months (T3) respectively. Results: It was observed that compared to the linear measurements, the angular measurements showed significant changes. The improvement in the esthetic outcome is a direct reflection of the angular changes whereas the linear changes played a contributing role. Following mandibular advancement surgery the profiles of the patients was perceived to have improved with reduction in the facial convexity, an increase in the lower facial height, decrease in the depth of the mentolabial sulcus and improvement in the lip competency with lengthening, straightening and thinning of the lower lip. Conclusion: The soft tissue response and its stability depends on the stability of the surgical procedure itself, postsurgical growth and remodeling of the hard tissues and soft tissue changes as a result of maturation and aging.