Saikrishna Degala

Fixation of zygomatic and mandibular fractures with biodegradable plates

Context: In this prospective study, 13 randomly selected patients underwent treatment for zygomatic–complex fractures (2 site fractures) and mandibular fractures using 1.5 / 2 / 2.5-mm INION CPS biodegradable plates and screws. Aims: To assess the fixation of zygomatic-complex and mandibular fractures with biodegradable copolymer osteosynthesis system. Materials and Methods: In randomly selected 13 patients, zygomatic-complex and mandibular fractures were plated using resorbable plates and screws using Champys principle. All the cases were evaluated clinically and radiologically for the type of fracture, need for the intermaxillary fixation (IMF) and its duration, duration of surgery, fixation at operation, state of reduction at operation, state of bone union after operation, anatomic reduction, paresthesia, occlusal discrepancies, soft tissue infection, immediate and late inflammatory reactions related to biodegradation process, and any need for the removal of the plates. Statistical Analysis Used: Descriptives, Frequencies, and Chi-square test were used. Results: In our study, the age group range was 5 to 55 years. Road traffic accidents accounted for the majority of patients six, (46.2%). Postoperative occlusal discrepancies were found in seven patients as mild to moderate, which resolved with IMF for 1-8 weeks. There were minimal complications seen and only as soft tissue infection. Conclusions: Use of biodegradable osteosynthesis system is a reliable alternative method for the fixation of zygomatic-complex and mandibular fractures. The biodegradable system still needs to be refined in material quality and handling to match the stability achieved with metal system. Biodegradable plates and screws is an ideal system for pediatric fractures with favorable outcome.

Orthopaedic Protraction of the Maxilla with Miniplates: Treatment of Midface Deficiency

Class III malocclusion is a consequence of maxillary deficiency and/or mandibular prognathism, resulting in an anterior crossbite and a concave profile. Early class III malocclusion treatment with reverse pull headgear generally results in maxillary skeletal protraction but is frequently also accompanied by unfavourable dentoalveolar effects. Titanium miniplates used as temporary anchorage device might permit equivalent favourable skeletal changes without unwanted dentoalveolar effects. We report two cases having class III malocclusion with maxillary deficiency treated by using titanium miniplates. Cephalometric tracings were done pre and post treatment to determine the anatomic changes during the course of treatment.

A study on orthomorphic correction of mandibular dysmorphology.

Purpose: To evaluate the usefulness of orthomorphic surgery in correcting mandibular dysmorphology. Materials and Methods: This is a prospective study in which five patients having mandibular dysmorphology were treated using orthomorphic surgery. The patients were evaluated for outcome in terms of duration of surgery, assessment of mandibular split, mental nerve paresthesia/ neurosensory changes after surgery, assessment of mouth opening before and after surgery, postoperative assessment of mandibular symmetry, and postoperative complications. Statistical Analysis Used: Descriptive statistics, frequencies, contingency coefficient test (cross tabs). Results: Our study has revealed results in support of the technique mentioned, showing good success rate in terms of mandibular dysmorphology correction when used in mild to moderate dysmorphology cases. Conclusion: Orthomorphic surgery will play an increasingly important role in the repertoire of the maxillofacial surgeon in correcting mandibular dysmorphology.

“Tension Band Wiring” A Simplified Approach for Fracture Reduction and Intermittent Stabilization

IntroductionDevelopment in plating systems and technical knowledge regarding the osteosynthesis has made open reductions and rigid internal fixation as the most frequently used mode of treatment in facial skeleton fractures. Various modalities for fracture reduction/stabilization during fixation have been mentioned in literature, describing the use of custom made instruments or reduction forceps etc.Material and MethodWe have used a method of “TENSION BAND WIRING” as a means of reducing and temporarily stabilizing the fracture segments in the mandible during rigid fixation. TENSION BAND WIRING method has been used in eighty patients having fractures in relation to mandibular symphysis, parasymphysis and body region.Conclusion In our opinion, this method is quick, simple and effective way of achieving initial reduction and stabilization of bone prior to final rigid fixation. The added advantages are reduced operating time, reduced instrumentation and assistance which in turn provide clear and more accessible surgical field.

To Evaluate the Efficacy and Effectiveness of N-butyl-2-cyanoacrylate glue (TRU SEAL) in Closure of Oral and Maxillofacial Laceration and Surgical Incisions

AbstractIntroductionEffective wound closure is critical for minimizing wound complications and preventing wound dehiscence. The various wound closure techniques include staples, traditional nylon and skin sutures, subcuticular sutures, and skin adhesives. Currently topical skin adhesives are frequently being used. It offers countless advantages: short application time, easy execution as well as possessing hemostatic character. N-butyl-2-cyanoacrylate is bacteriostatic and biodegradable and exhibits suitable tensile strength. Materials and MethodsUnder nasoendotracheal intubation, the reduction in fracture and plating was done. In 80% of the patients, subcutaneous sutures were placed. Skin closure was done with N-butyl-2-cyanoacrylate glue.ResultsIn this study, REEDA scale was used to assess healing. Redness, edema, and ecchymosis were seen in all 10 patients, which subsided by the second week postoperatively. None of the patients had discharge from surgical site on the first postoperative day but was noted in two patients the first week postoperatively. There was evidence of wound gaping in one patient on the first postoperative day and two patients at end of the first week postoperatively. Stony Brook Scar Evaluation was used to evaluate postoperative cosmesis. No significant cosmetic impairment was found in all patients at the end of the study.ConclusionThe study reflects qualitative assessment of cyanoacrylates which is simple to use and proper application which resulted in uniform and everted closure of wound. It is cost-efficient as compared to other wound closure materials.

A NEW DESIGN TITANIUM MINIPLATE VERSUS CONVENTIONAL 4-HOLE TITANIUM MINIPLATE FOR MANAGEMENT OF MANDIBULAR ANGLE FRACTURES: A COMPARATIVE STUDY.

...................................................................................................................... Introduction:Orofacial trauma surgery is the foundation from which the speciality of maxillofacial surgery arose, and has significantly expanded and developed over the last 50 years [2].The mandible is the largest and strongest facial bone, by virtue of its position on the face and its prominence; it is commonly fractured when maxillofacial trauma has been sustained [3].The causes of fracture of the mandible are chiefly road traffic accidents, interpersonal violence, falls, sports injuries and industrial trauma [4]. Mandibular angle fractures account for 23-42% of all cases of mandibular fractures. The frequent involvement can be attributed to changes in the lines of calcification and strength from horizontal body to vertical ascending ramus, the thinner cross-sectional area, and the presence of impacted or partially erupted third molars. In addition, the mandibular angle is subjected to heavy muscle forces [10]. Fractures of the mandibular angle represent an important clinical challenge because their treatment is plagued with the highest post-surgical complication rate of all mandibular fractures. Not all mandibular fractures require operative treatment, but all successful treatment of mandible fractures depends on undisturbed healing in the correct anatomic position under stable conditions. Failure to achieve these conditions of healing results in infection, malocclusion, nonunion, or malunion [6-9]. Mandibular angle fractures are associated with the highest complication rates of all mandibular fractures, yielding an incidence as high as 32% [12-15]. Various techniques for treatment of mandibular angle fractures have been described in the literature; open reduction with non-rigid fixation by means of trans-osseous wires, cicum-mandibular wires, or small positional bone plates; AO reconstruction plates; dynamic compression plates; mini-dynamic compression plates; lag screws; and non-compression plates. Optimal treatment for angle fractures remains controversial. Various plate and screw systems that are used for treatment of mandibular angle fractures have been evaluated [11]. This in-vivo study was done to compare the results of two methods of fixation (open reduction and internal fixation) of mandibular angle fractures i.e., comparative evaluation between new design titanium miniplate and standard 4-hole titanium miniplate.

Juvenile ossifying fibroma of the mandibular ramus in a five-year-old boy

Juvenile ossifying fibromas (JOF) are benign central lesions occurring in children. Two variants of this entity have been recognized - trabecular and psammomatoid. These lesions are usually asymptomatic and present only as a growing swelling. We hereby report a case of a trabecular variant of a juvenile ossifying fibroma in a five-year-old boy.