Syed Saeed Ahmed

Trauma of facial skeleton in children: An indian perspective

AimsBoth children and adults are subject to similar types of injuries but fractures of facial bones in children are relatively uncommon. The aim of this study was to evaluate the epidemiology of facial bone fractures among children of <12 years, their management and outcome in an Indian city.Material and methodsThis retrospective study included children of <12 years of age with facial bone fractures admitted over a span of 3 years. In order to compare our results we reviewed the existing literature related to pediatric facial bone fractures.ResultsA total of 45 children were admitted for facial bone fractures. Forty (89%) of them were above 5 years of age and male to female ratio was 2:1. About 53.33% of these injuries were because of fall from height. Mandible fracture was the most common facial bone fracture among admitted patients. Symphysis and para-symphysis was the commonest site of mandibular fractures, seen in 49% cases. Majority of these fractures were managed by Inter-maxillary fixation and inter-osseous wiring. Mini-plates were used for widely displaced compound fractures. For un-displaced fractures observation alone was sufficient.ConclusionMandible is the commonest facial bone fracture in children, more often caused by accidental fall from height. The high osteogenic potential of pediatric mandible allows non-surgical management to be successful in an increased proportion of younger patients.

Prevention and management of antineoplastic therapy induced oral mucositis.

With the scientific advancements in the management of malignant diseases, the treatment is expensive and bears high morbidity in term of oral mucositis. It is a debilitating condition and has been researched extensively for its pathogenesis and treatment. Various treatment options include barrier forming, mucosal protectants, mouth rinses, growth factors, lasers and midline-sparing procedures. Some agents are used locally while others are administered systemically. Despite the availability of a wide range of treatment options for mucositis, a cost-effective treatment is yet to be evolved.

Metastatic adenocarcinoma of the mandible-a rare entity.

Metastasis of the liver and lung malignancies to the jaw bones is very rare and the mandible is the commonest site of involvement. The frequent primary sites for metastasis to jaw bones are breast in females and lungs in males. This is a case report of the metastatic adenocarcinoma of the mandible which originated from liver or lung. Diagnosis of such metastatic lesions is difficult and challenging to identify the primary site.

Congenital giant melanocytic nevi

Nevi are common skin tumors caused by abnormal overgrowth of cells from the epidermal and dermal layers of the skin. Most nevi are benign, but some pre-cancerous nevi must be monitored or removed. The giant congenital nevus is greater than 10 cm in size, pigmented and often hairy. Between 4% and 6% of these lesions will develop into a malignant melanoma. Since approximately 50% of the melanoma develop by the age of two, and 80% by the age of seven, early removal is recommended. The objective of this paper is to present a unique case of giant nevi and their surgical management.

Malignant myoepithelioma of the maxilla posing a diagnostic dilemma

Malignant myoepithelioma is an extremely rare tumor of the salivary glands. Myoepitheliomas make up less than 1% of all salivary gland tumors. We report of a case of malignant myoepithelioma of the upper jaw in a 55-year old man. The tumor primarily arose from the maxillary sinus and secondarily involved the palate. A diagnosis of pleomorphic adenoma was interpreted, following fine needle aspiration cytology and spindle cell tumor, following incision biopsy with a dilemma. The surgery consisted of subtotal maxillectomy preserving the infra orbital rim and posterior wall of the maxillary sinus, with wide local resection. Neck dissection was not carried out. The final histologic diagnosis of the tumor proper was made out to be malignant myoepithelioma. Three different diagnoses were made in dilemma to reach out the final diagnosis, which was confirmed by immunohistochemistry. The case presented and discussed, underscores the importance of diagnosis and treatment of this rare clinicopathologic entity.

Forehead flap in maxillofacial surgery: Our experiences

The forehead flap is a commonly used technique to reconstruct the deep and large nasal defects. It can be conveniently performed under local or general anesthesia and provides a very good color and texture matching to the nasal skin, which makes it a suitable graft harvesting site for nasal reconstruction. It has only single disadvantage disadvantagethat it is a two-stage procedure and “finishing” surgeries are needed occasionally for best surgical and cosmetic outcome. In this paper, we describe three different applications of forehead flaps.

Bilateral Transverse Facial Cleft as an Isolated and Asyndromic Deformity

ABSTRACT Congenital macrostomia or transverse facial cleft is a rare congenital craniofacial anomaly, which affects the esthetics and functions of oral cavity. It is usually associated with deformities of other structures developed from the first and second branchial arches. Bilateral transverse cleft, occurring alone is uncommon. Since the deformity is rare, its treatment has not been commonly described in the literature. We report a case of congenital bilateral macrostomia as an isolated, asyndromic deformity to add one more case in the literature and surgical technique has been discussed here.

Unusual Superolateral Dislocation of Bilateral Mandibular Condyles

We describe a case of maxillofacial trauma in a paediatric patient in which the left mandibular condyle was superolaterally displaced into the temporal fossa, medial to the zygomatic arch which was intact and the right condyle was also displaced similarly but the zygomatic arch was also fractured on this side. Also, there was an associated mandibular symphyseal fracture.

Management of Odontogenic Fascial Space Infection in Hemophilia Patients: A Proposed Protocol

PurposeThe purpose of this study was to suggest a protocol for the management of odontogenic space infections in patients with hemophilia which is often incompletely addressed by clinicians because of the fear of excessive bleeding leading to prolonged morbidity.Methods and ResultsSix diagnosed cases of hemophilia (four cases of hemophilia A and two cases of hemophilia B) with odontogenic fascial space infection were included in the study. Apart from routine investigations, assessments were also done to identify inhibitors to factor VIII/IX. Factor VIII/IX was replaced along with infusion of factor eight inhibitor bypass activity (FEIBA) one hour before incision and drainage. All the cases were treated by incision and drainage along with removal of foci under local anesthesia. The postoperative outcome was uneventful in all cases except one in which postoperative bleeding was noted from the extraction site on the third day which was again managed following the designed protocol.ConclusionMaintaining good oral hygiene and seeking early dental care are of prime importance in patients with hemophilia to avoid invasive procedures. However, if odontogenic infection develops in these patients, performing timely incision and drainage using our protocol will minimize the complications and give successful outcome.

Comparative study of detection of bacteremia after different oral surgical procedures.

Introduction: The purpose of this study is to compare the efficiency of culture methods in detecting microorganisms appearing in the bloodstream after various oral surgical procedures and effect of preoperative antibiotics and antiseptic rinses on bacteremia. Materials and Methods: The prevalence of bacteremia at various intervals of time (pre- and post-surgical) was studied in three different groups presenting with indications to surgical intervention. Two of the groups were given presurgical prophylaxis (systemic antibiotic and antiseptic rinse) while, in one group, no prophylactic measure was adopted. Blood samples were withdrawn from the subjects at specifi c pre- and post-surgical time intervals, and microbiological analysis was done. The fi ndings were compared with a control group involving healthy individuals and a group involved in maxillofacial trauma where the breach of oral mucosal integrity was not surgically planned. Results: The presence of bacteremia was not observed in all five groups at baseline while postsurgery (30 min, 60 min, and 90 min) in only three groups (preoperative antibiotic, without prophylaxis, and 1% Povidone iodine rinse). At all postsurgery periods (30 min, 60 min and 90 min), the presence of bacteremia was evident highest in without prophylaxis group followed by 1% Povidone iodine rinse and preoperative antibiotic the least.