Sunil Yadav

Cavernous hemangioma--uncommon presentation in zygomatic bone.

Hemangiomas are benign vascular neoplasms characterized by an abnormal proliferation of blood vessels. They may occur in any vascularized tissue including skin, subcutaneous tissue, muscle, and bone. Intraosseous hemangiomas are uncommon, constituting less than 1% of all osseous tumors. The most frequent sites are the calvaria and the vertebral column. Involvement of the facial bones is rare and occurs most commonly in the maxilla, mandible, and nasal bones. In literature, only 20 cases of zygomatic involvement have been reported. We report a case of an intraosseous hemangioma of the zygoma with the history and physical findings of slowly growing, bony, hard tumor causing facial and ocular deformity. The typical clinicopathologic and radiologic findings helped to set up the correct diagnosis. Early recognition and excision are recommended to preserve facial contour. Operative blood loss is minimal, and there is no need for preoperative angiography.

Facial necrotizing fasciitis from an odontogenic infection

Necrotizing fasciitis (NF) is defined as rapidly progressive necrosis of subcutaneous fat and fascia. It is a rare but life-threatening infection characterized by a progressive, usually rapid, necrotizing process of the subcutaneous tissues and fascial planes. The condition is commonly described in the extremities, abdominal wall, and perineum but rarely seen in the head and neck. The diagnosis of NF depends mainly on clinical features, which are not always observable, so that the disease is often diagnosed late in its course, resulting in high mortality. Broad-spectrum antibiotics, aggressive surgical treatment and supportive therapy are the most widely accepted modalities of successful treatment. We describe a case of necrotizing fasciitis of the head and neck, arising from odontogenic origin.

Buccal injection of 2% lidocaine with epinephrine for the removal of maxillary third molars.

The aim of the study was to demonstrate if 2% lidocaine hydrochloride with 1:200,000 epinephrine could provide palatal anesthesia in maxillary tooth removal with a single buccal injection. The subjects included in the clinical study were those requiring extraction of the maxillary third molar of either side. For the purpose of comparison, the sample was randomly divided into 2 main groups: group 1 (study group) included 100 subjects who were to receive a single injection before extraction, and group 2 (control group) included 100 subjects who were to receive a single buccal injection and a single palatal injection before extraction. After 5 minutes the extraction was performed. All patients were observed for Faces Pain Scale during extraction and asked for the same on a 100-mm visual analog scale after extraction. According to visual analog scale and Faces Pain Scale scores, when maxillary third molar removal without palatal injection (study group) and with palatal injection (control group) were compared the difference was not statistically significant (P > .05). Removal of maxillary third molars without palatal injection is possible by depositing 2 mL of 2% lidocaine hydrochloride with 1:200,000 epinephrine to the buccal vestibule of the tooth.

Assessment of lingual nerve injury using different surgical variables for mandibular third molar surgery: a clinical study.

The objective of this study was to investigate the incidence of sensory impairment of the lingual nerves following lower third molar removal and to compare the outcome with various operative variables. A total of 1200 mandibular third molars were removed under local anaesthesia. Predictor variables were categorized as lingual flap retraction, tooth sectioning, and buccal guttering. The outcome variable was the presence or absence of lingual nerve impairment. Different operative techniques were performed to identify independent predictors. Of the 1200 patients, 67 (5.6%) experienced transient sensory impairment at the 1-week follow-up. In all cases this resolved completely during the study period, except for four (0.3%) patients who suffered permanent impairment of lingual nerve function. Factors that predicted lingual nerve injury were lingual flap retraction, tooth sectioning, and buccal guttering. The incidence of lingual nerve injury was greater when combinations of these operative variables were used.

Necrosis of maxilla, nasal, and frontal bone secondary to extensive rhino-cerebral mucormycosis

Mucormycosis is an opportunistic fulminant fungal infection caused by zygomycetes. This fungus can cause a variety of infections in human beings, particularly in the uncontrolled diabetes mellitus. Zygomycetes impinge into the vascular network, resulting in thrombosis and necrosis of the surrounding hard and soft tissues. The infection begins in the nose and paranasal sinuses due to inhalation of fungal spores and spread to orbital and intracranial structures either by direct invasion or through the blood vessels. Sinus mucormycosis is often accompanied by a poor prognosis and a high mortality rate. Hence, aggressive surgical intervention with antifungal therapy is usually necessary. Early diagnosis and prompt treatment can reduce the mortality and morbidity of this lethal fungal infection. We report a case of aggressive rhino-cerebral mucormycosis in a 58-year-old female patient with uncontrolled diabetes mellitus.

A New Simplified Technique for Intermaxillary Fixation by Loop-Designed Wire

In the treatment of maxillofacial fractures, Inter-maxillary fixation (IMF) is an important. The upper and lower arch bars or Ivy eyelet wiring is secured by wires and IMF is done with the help of box wiring. Here, we present a new type of IMF technique, using 26-gauze stainless steel ‘loop-design’ wire, which is a simple, quick, economical and minimally invasive technique without using arch bars. Typical indications for its use are minimally displaced fractures, deep bite cases, stabilization of fracture during open reduction and internal fixation, orthognathic surgeries and in tumor resection surgeries.

Overgrowth of costochondral graft in temporomandibular joint ankylosis: An unusual case

Costochondral graft (CCG) replacement of the mandibular condyle was first described by Gilles in 1920. Since then CCGs have gained increasing popularity in reconstruction of the TMJ and condyle in children. The influence of CCGs on mandibular growth and function is not known in detail. Adaptation of the graft has been observed to be better in children, but CCGs have also been shown to grow in adult patients. One of the major disadvantages of the CCGs is its growth pattern, which is extremely unpredictable and may manifest as excessive growth or no growth at all. A mandibular overgrowth on the grafted site can actually be more troublesome than lack of growth. Furthermore, maxillary growth is proportionality influenced by vertical mandibular growth of the graft. This is a report of such a case in which a bizarre overgrowth of the graft was seen following a reconstruction of TMJ by CCG and the devastating outcomes of the treatment. He required one further resection because the grafted tissue had overgrown five years later.

Odontogenic cutaneous draining sinus.

AbstractThe aim of the present article was to discuss an unusual case report of the odontogenic cutaneous sinus with emphasis on diagnosis and treatment. The causative factor in this case was diagnosed intraoperatively due to infected follicular space in absence of any sign and symptoms. Timely diagnosis of the case could have prevented significant morbidity due to mistreatment medically and surgically with eventual recurrence.

A retrospective study of 72 cases diagnosed with idiopathic trigeminal neuralgia in indian populace.

Context: Trigeminal neuralgia is as a chronic, debilitating condition, which can have a major impact on quality of life. There are few reports of trigeminal neuralgia in oriental populations. Objectives: To evaluate the retrospective data of the patients diagnosed with idiopathic trigeminal neuralgia and to understanding the disorder in the Indian populace. Methods: The retrospective data of 72 patients with typical idiopathic trigeminal neuralgia regarding age of onset, gender, site of involvement, clinical presentations and treatment received during three years of the follow up was collected and analyzed. Results: In the present retrospective study, the mean age was 54.9 years; female to male ratio was 2.13:1; rural to urban ratio 1.76:1 with 62.5% suffered trigeminal neuralgic pain on the right side. Carbamazepine was found to be highly effective in 60.8% of the cases on long-term basis with maintenance doses. Other treatment modalities were employed in more refractory cases including add-on of gabapentin, which relieved the symptoms for an additional duration of 13±3months. The neurolytic alcohol bloc was given in 30% of patients who stopped responding to combination of carbamazepine and gabapentin and relieved pain for a mean duration of 17.25±2.95 months. Twenty three percent of the patients (23%) required peripheral neurectomy. Conclusions: Carbamazepine was found to be highly effective in trigeminal neuralgia. Other treatment modality includes add-on of gabapentin, neurolytic alcohol blocs and peripheral surgical intervention in more refractory cases. Only limited cases needed further neurological consideration. Key words:Trigeminal neuralgia, carbamazepine, gabapentin, alcohol bloc, peripheral neurectomy.

Chronic suppurative osteomyelitis of posterior maxilla: A rare presentation.

Thin cortical bone rich in vascularity makes the maxilla scarcely vulnerable to osteomyelitis as compared to mandible. Moreover, the introduction of newer antibiotics, understanding of pathogenesis and improved medical support lead to reduction in incidence of osteomyelitis. Local factors like continuous irritation, smoking and suppressed immune system contributes to the occurrence of suppurative osteomyelitis. We hereby, report an exceptional case of chronic suppurative osteomyelitis of posterior maxilla in a 42-year-old healthy male who was managed successfully by combination of antibiotics, surgical sequestrectomy and debridement.