Modified Placement of C-flap in Unilateral Cleft Lip Repair to Avoid Alar Base Scar - A Retrospective Study

Introduction

In spite of several techniques, Millard's approach for the correction of cleft lip still is widely used. Although versatile, it has certain drawbacks including scar contraction, short lip and notching. A modification of the 'C' arm helps to address this drawback. The purpose of this study was to describe the qualitative and quantitative outcomes of the author's modification of Millard's C flap.

Materials and Methods

Archival photographic records of cleft lip repairs and post-operative photos of cases treated by author were screened. Anthropometric measurements of the height and width of the lip, the height of the vermilion and the width of the alar base were considered. The outcome was quantified by comparing the ratio of each feature between the cleft and normal sides. The quality of cleft lip repair was assessed using the Steffensen criteria. Appropriate statistical tests were performed.

Results

In all, 233 cases with a mean age of 4.46 ± 0.91 years and 106 (45.5%) males formed the study group. The mean lip height ratio was 0.936 ± 0.04, the mean lip width ratio was 0.938 ± 0.037, the mean vermillion height ratio was 0.9433 ± 0.35 while the mean alar base width ratio was 0.932 ± 0.35. The physical parameter ratios' mean difference between the normal side and the cleft side was below 0.06 mm.

Discussion

The mechanism behind the drawback of the classical Millard's technique is discussed and compared with present modification. The authors' modification shows that modified Millard's technique produces better aesthetic outcomes.

A comprehensive review on polylactic acid (PLA) - Synthesis, processing and application in food packaging

Plastics play an essential role in food packaging; their primary function is to preserve the nature of the food, ensure adequate shelf life and ensure food safety. Plastics are being produced on a global scale in excess of 320 million tonnes annually, with demand rising to reflect the material in wide range of applications. Nowadays, the packaging industry is a significant consumer of synthetic plastic made from fossil fuels. Petrochemical-based plastics are regarded as the preferred material for packaging. Nonetheless, using these plastics in large quantities results in a long-standing environment. Environmental pollution and the depletion of fossil fuels have prompted researchers and manufacturers to develop eco-friendly biodegradable polymers to replace petrochemical-based polymers. As a result, the production of eco-friendly food packaging material has sparked increased interest as a viable alternative to petrochemical-based polymers. Polylactic acid (PLA) is one of the compostable thermoplastic biopolymers that is biodegradable and renewable in nature. High-molecular-weight PLA can be used to produce fibres, flexible, non-wovens, hard and durable materials (100,000 Da or even higher).The chapter focuses on food packaging techniques, food industry waste, biopolymers, their classification, PLA synthesis, the importance of PLA properties for food packaging, and technologies used to process PLA in food packaging.

Median mandibular cleft in SAMS syndrome - A rare case report

Rationale

SAMS syndrome is a rare genetic disorder characterized by midline facial clefting, skeletal anomalies, and other defects.

Salient Features

Among the craniofacial manifestations of SAMS syndrome is the presence of a median mandibular cleft (MMC). MMC is a rare occurrence and in this syndrome, it poses a complex challenge for both functional and aesthetic reasons. Patient.

Findings

This rare case report describes the successful correction of an MMC in an 18-month-old child diagnosed with SAMS syndrome.

Treatment

This report describes the presentation, diagnosis and treatment. The surgical intervention involved a meticulous, single stage, osseous reconstruction. The mechanism of MMC in SAMS syndrome is discussed.

Outcomes

Early intervention for MMC in SAMS syndrome patients can offer promising outcomes.

'Frozen eye' - Post blowout fracture surgical correction - A case report

The Rationale

"Frozen Eye" is a very uncommon sequel after treatment of orbital blowout fractures requiring implant placement.

Patient Concerns

The implant may faultily impinge on the ocular and extra-ocular muscle(s), causing the abnormality in the movement of the eye.

Diagnosis

We present a 56-year-old male whose ocular implant impinged on muscle, causing "frozen eye" and had an infected implant.

Treatment Outcomes

The same was removed and surgically corrected. The manuscript describes the details and discusses the possible mechanism that led to the "Frozen Eye".

Idiopathic bilateral mandibular condylar resorption causing anterior open bite - A case report

Introduction

Mandibular condylar resorption (MCR) is a rare pathological entity, often affecting young females.

Patient Concerns

It is accompanied by pain, malocclusion and compromised quality of life including aesthetic perception. Due to this multiplicity of features, the diagnosis, treatment and management of MCR are always a challenge.

Diagnosis

This article reports a 25-year-old female suffering from progressive temporomandibular joint pain and compromised aesthetics. This article describes the clinical and radiological findings of this case.

Treatment

The possible aetiopathogenesis and treatment are described.

A CBCT Study to Evaluate the Root and Canal Morphology of Permanent Maxillary First Molars in Children

Introduction

For the correct diagnosis and endodontic therapy, a complete understanding of root canal morphology is required. One of the causes of endodontic failure is the inability to identify every canal in the root canal system; the second mesiobuccal canal (MB2) in the permanent maxillary first molar is the most commonly missed canal. Studies examining the root canal differences in pediatric Indian populations' permanent maxillary first molars are somewhat uncommon.

Aim

Cone-beam computed tomography (CBCT) will be used to assess the root and canal morphology of permanent maxillary first molars in the pediatric Indian population.

Materials and methods

In the age range of 7-13 years, 25 children's CBCT pictures (50 images) were gathered from the institutional database and private diagnostic facilities. SCANORA® software was used to reconstruct the CBCT pictures, and Statistical Package for the Social Sciences (SPSS) for Windows was used to evaluate and analyze the data.

Results

The roots of each permanent maxillary first molar were distinct. And all of the palatal and distobuccal roots were found to have a single root canal (100%), whereas the mesiobuccal roots were found to have a single root canal in 80% of cases and a double root canal in 20% of cases. The Vertucci type II structure, followed by types IV and V, was the most prevalent in roots with two channels.

Conclusion

Within the constraints of this investigation, we came to the conclusion that the permanent maxillary first molar root canal configuration varied among the patients from the pediatric Indian population.

How to cite this article

Krishnamurthy NH, Athira P, Umapathy T, et al. A CBCT Study to Evaluate the Root and Canal Morphology of Permanent Maxillary First Molars in Children. Int J Clin Pediatr Dent 2022;15(5):509-513.

Accessory Maxilla in a Tessier 07 Cleft - A Case Report

The Rationale

Accessory maxilla is a rare condition often associated with Tessier type-7 clefts with fewer than 25 cases recorded in the literature. This manuscript reports a unilateral accessory maxilla with six supernumerary teeth.

Patient Concerns

A 5-1/2-year-old boy, a treated macrostomia case, on follow-up visit showed evidence of accessory maxilla with teeth on radiological examination. The structure was interfering with growth, and hence, surgical removal was planned.

Diagnosis

Based on clinical history, diagnosis and imaging, accessory maxilla with supernumerary teeth was diagnosed.

Treatment and Outcomes

The accessory structures and teeth were removed surgically via an intraoral approach. Healing was uneventful. The growth deviation was arrested.

Take-Away Lessons

Intraoral approach is a good option to remove an accessory maxilla. Tessier type-7 cleft may be accompanied by type-5 clefts and such accessory structures when impinging on vital structures such as temporomandibular joint or facial nerve should be immediately removed to facilitate proper form and function.

Hemifacial hypertrophy - Report of 2 cases

Hemifacial hyperplasia (HH) is a rare congenital condition involving enlargement of one or more tissues of the face. The treatment is surgically challenging and requires expertise. This manuscript aims to report two similar appearing HH but warranting different surgical treatment. A 19-year-old female and a 14-year-old boy presented with right facial asymmetry since birth and sought correction of the same. Surgical treatment was planned. Based on clinical history, diagnosis and imaging, HH was diagnosed. The first case was entirely a soft tissue abnormality that was treated with debulking while the second case had involvement of facial bones, necessitating surgical recontouring. The facial asymmetry was addressed. Healing was uneventful. Though the aesthetical concern and appearance of the two cases of HH were same, the treatment vastly differed. This was based on the source of asymmetry. Proper diagnosis and informed decision are a key for successful surgical outcome.

Rare case of granular cell tumour at 16 years - A case report

RATIONALE

Granular cell tumours (GCTs) of the tongue are a rare, soft tissue pathological entity at young ages. This case report aims to present one such case.

PATIENT CONCERNS

A 16-year-old female patient sought treatment for a small, slow-growing, painless nodule in the dorsum of the tongue since six months. She underwent successful orthodontic treatment in recent past and is in the retention phase.

DIAGNOSIS

Excisional biopsy revealed the lesion to be a GCT under histopathology.

TREATMENT

The patient was treated for an abnormal, small, slow-growing, painless nodule in the dorsum of the tongue.

OUTCOMES

The patient had satisfactory esthetics and early diagnosis. The active intervention dispelled the confusion about the role of trauma and orthodontics appliance in the etiology of GCT in this particular case to the patient.

TAKE-AWAY LESSONS

GCT can occur at any age. Early diagnosis and corrective surgery would help to avoid late complications.

Hexavalent chromium removal from aqueous solutions using biogenic iron nanoparticles: Kinetics and equilibrium study

Green mediated biosynthesis of iron oxide nanoparticles utilising Rosa indica flower petal extracts (RIFP-FeONPs) was used in this investigation. The RIFP-FeONPs were evaluated by the UV-Visible Spectroscopy, FTIR, SEM, EDX, XRD, Zeta potentials, and DLS, and been engaged than for the elimination of Cr (VI) from the contaminated environments. At 269 nm, the RIFP-FeONPs surface plasmon vibration bands were observed, which attributed to the Fe³⁺. XRD patterns of RIFP-FeONPs depicted the intense diffraction peak of face-centered cubic (fcc) iron at a 2θ value of 45.33° from the (311) lattice plane indisputably revealed that the particles are constituted of pure iron. The fabricated nanomaterials are spherical and polydisperse with a diameter of 70-120 nm, and various agglomeration clusters are attributable to intermolecular interaction. Zeta potential measurement and particle size distribution of RIFP-FeONPs showed a mean average size of 115.5 ± 29 nm and a polydispersity index (PDI) of 0.420. The study aims to analyse the appropriateness of RIFP-FeONPs for removing hexavalent chromium from the aqueous environment and the application of adsorption isotherm and statistical models in the experiment. The sorption of Cr (VI) on RIFP-FeONPs was observed to fit well with the isothermal models (R² = 0.98). The linear correlation between processing parameters and time demonstrated that the adsorption efficiency of Cr (VI) well correlated with the pseudo-first order kinetic model and isothermal adsorption with the Langmuir and Freundlich isothermal models, so that the RIFP-FeONPs could be a prospective nanosorbent for hexavalent chromium removal from industrial waste.

Toxicity evaluation and oxidative stress response of fumaronitrile, a persistent organic pollutant (POP) of industrial waste water on tilapia fish (Oreochromis mossambicus)

The study was designed to determine the impact of acute toxicity of fumaronitrile exposure through tissue damaging, oxidative stress enzymes and histopathological studies in gills, liver and muscle cells of freshwater tilapia fish (Oreochromis mossambicus). In gill, liver, and muscle cells, biochemical indicators such as tissue damage enzymes (Acid Phosphatase (ACP), Alkaline Phosphatase (ALP), and Lactate Dehydrogenase (LDH)) and antioxidative enzymes (Superoxide Dismutase (SOD); Catalase (CAT); Glutathione-S-transferase (GST); Reduced Glutathione (GSH); Glutamate oxaloacetate transaminase (GOT) and Glutamate pyruvate transaminase (GPT) were quantified in the time interval of 30, 60 and 90 days exposure to the fumaronitrile. After 90 days, under 6 ppb exposure conditions, the acid phosphatase (ACP) levels of fish increased significantly in the gills (3.439 μmol/mg protein/min), liver (1.743 μmol/mg protein/min), and muscles (2.158 μmol/mg protein/min). After 90 days of exposure to the same concentration and days, ALP activity increased significantly in gills (4.354 μmol/mg protein/min) and liver (1.754 μmol/mg protein/min), but muscle cells had a little decrease in ALP activity (2.158 μmol/mg protein/min). The LDH concentration in gills following treatment with fumaronitrile over a period of 0-90 days was 3.573 > 3.521 > 2.245 μmol/mg protein/min over 30 > 60 > 90 days. However, at the same dose and treatment duration, a greater LDH level of 0.499 μmol/mg protein/min was found in liver and muscle cells. Histopathological abnormalities in the gills, liver, and muscle cells of treated fish were also examined, indicating that fumaronitrile treatment generated the most severe histological changes. The current study reveals that fumaronitrile exposure has an effect on Oreochromis mossambicus survival, explaining and emphasising the risk associated with this POP exposure to ecosystems and human populations.

Statistical optimization of silver nanoparticle synthesis by green tea extract and its efficacy on colorimetric detection of mercury from industrial waste water

For the optimization of silver nanoparticle production, a central composite design was used with three parameters: AgNO₃ concentration, green tea extract concentration, and temperature at three different levels. The size of the synthesized silver nanoparticle, its UV absorbance, zeta potential, and polydispersity index were set as the response parameters. Silver nanoparticles obtained in the optimization process were characterized and its efficacy on colorimetric detection of mercury was evaluated. The response variables were significant for the factors analyzed, and each variable had a significant model (P < 0.05). The ideal conditions were: 1 mM AgNO₃, 0.5% green tea extract, and 80 °C temperature. To analyze the produced AgNPs under certain ideal conditions, Fourier transform infrared spectroscopy (FTIR), dynamic light scattering (DLS), transmission electron microscopy (TEM), scanning electron microscopy (SEM), and X-ray diffraction (XRD) were used. The UV-visible spectra of AgNPs revealed an absorption maxima at 424 nm. The XRD pattern reveals a significant diffraction peak at 38.25°, 44.26°, 64.43°, and 77.49°, which corresponds to the (111), (200), (220), and (311) planes of polycrystalline face-centered cubic (fcc) silver, respectively. The TEM and SEM analyses confirmed that the particles were spherical, and dynamic light scattering study determined the average diameter of AgNPs to be 77.4 nm. The AgNPs have a zeta potential of -62.6 mV, as determined by the zeta sizer analysis. The AgNPs detects mercury at a micromolar concentration. Furthermore, the environmentally friendly generated AgNPs were used to detect mercury in a colorimetric method that was effectively employed for analytical detection of Hg²⁺ ions in an aqueous environment for the purpose of practical application.

Unusual Number of Phleboliths in a Lip Vascular Malformation - A Case Report

Rationale

Vascular malformation (VM) associated with jaws may cause jaw size discrepancy. Multiple phleboliths in VM are relatively rare. This case report aims to present one such case.

Patient Concerns

A 33-year-old female patient sought surgical correction of her abnormally sized jaw and on examination, she was identified with VM.

Diagnosis

Subsequent imaging tests revealed the presence of several phleboliths.

Treatment

The patient was treated for an abnormal-sized mandible as well as partial removal of the superficial part of VM.

Outcomes

The patient had satisfactory esthetics and there was less bleeding than anticipated.

Take-away Lessons

VMs could cause jaw size discrepancy and the extent of the malformation could cause blood flow abnormalities leading to multiple phlebolith formation. Proper surgical planning and education of the patient are essential for successful treatment.

Rigid versus resorbable plate fixation in fronto-orbital advancement in unicoronal stenosis - A retrospective study

Introduction:

Rigid plating fixation (RPF) and resorbable plating systems (RPS) advanced the field of reconstruction in craniomaxillofacial region. However, their performance in patients, particularly the effect on bone remodeling at site of hardware placement is not much documented. This manuscript aims to compare the performance of RPF and RPS in a cohort using a retrospective audit of case records.

Methods:

Archival records were searched for patients who had undergone cranial metal-RPF or RPS or combination for the correction of craniofacial deformities following inclusion-exclusion criteria. From records, data of the quality and quantity of bone formed along the site of plate fixation as compared with the adjacent site, accommodating or facilitating brain growth, and persistence of bone deformity at the site of hardware placement were collected at the end of the follow-up period. A total of 128 sites from 18 individuals (6 with exclusive metal-RPF and 12 with RPS) mean age of 7.45 ± 7.28 (Median 4; IQR of 8.88;2.6–11.5) who underwent cranial bone remodeling surgery formed the study group.

Results:

There was a statistically significant difference between the RPF and PRS system at the fronto-orbital suture (P = 0.002) and coronal suture (P = 0.036) with bone quality and quantity.

Discussion:

The RPF system was rigid but had a set of issues, while RPS has advantages and limitations. The qualitative difference in between the two systems is different. Due to inherent dissimilarity, the two systems cannot be interchanged and due diligence has to be exercised while deciding on the system. More prospective studies are needed to validate the findings.

Production, partial purification and characterization of ligninolytic enzymes from selected basidiomycetes mushroom fungi

In recent years, many research on the quantity of lignocellulosic waste have been developed. The production, partial purification, and characterisation of ligninolytic enzymes from various fungi are described in this work. On the 21st day of incubation in Potato Dextrose (PD) broth, Hypsizygus ulmarius developed the most laccase (14.83 × 10⁻⁶ IU/ml) and manganese peroxidase (24.11 × 10⁻⁶ IU/ml), while Pleurotus florida produced the most lignin peroxidase (19.56 × ⁻⁶ IU/ml). Laccase (Lac), lignin peroxidase (LiP), and manganese peroxidase (MnP), all generated by selected basidiomycetes mushroom fungi, were largely isolated using ammonium sulphate precipitation followed by dialysis. Laccase, lignin peroxidase, and manganese peroxidase purification findings indicated 1.83, 2.13, and 1.77 fold purity enhancements, respectively. Specific activity of purified laccase enzyme preparations ranged from 305.80 to 376.85 IU/mg, purified lignin peroxidase from 258.51 to 336.95 IU/mg, and purified manganese peroxidase from 253.45 to 529.34 IU/mg. H. ulmarius laccase (376.85 IU/mg) with 1.83 fold purification had the highest specific activity of all the ligninolytic enzymes studied, followed by 2.13 fold purification in lignin peroxidase (350.57 IU/mg) and manganese peroxidase (529.34 IU/mg) with 1.77-fold purification. Three notable bands with molecular weights ranging from 43 to 68 kDa and a single prominent band with a molecular weight of 97.4 kDa were identified on a Native PAGE gel from mycelial proteins of selected mushroom fungus. The SDS PAGE profiles of the mycelial proteins from the selected mushroom fungus were similar to the native PAGE. All three partially purified ligninolytic isozymes display three bands in native gel electrophoresis, with only one prominent band in enzyme activity staining. The 43 kDa, 55 kDa, and 68 kDa protein bands correspond to laccase, lignin peroxidase, and manganese peroxidase, respectively.

A rare case report of perioral sarcoidosis

The Rationale

Sarcoidosis is a multisystemic granulomatous disease of unknown aetiology that usually presents with systemic lesions including the skin. Isolated cutaneous lesions are very rare.

Patient Details

We present a middle-aged female patient, a known systemic lupus erythematosus patient, in remission developing an isolated, single sarcoidosis lesion in the perioral labial mucosa. The lesion was a rapidly growing nodular lesion with a papillary surface near the philtrum of the upper lip.

Diagnosis

A biopsy revealed that to be a granulomatous lesion with large multinucleated giant cells. Using a panel of tests, by excluding tuberculosis and establishing the immunoprofile, the diagnosis was established. Although infrequent, perioral and oral lesions may constitute the first signs of systemic sarcoidosis.

Outcomes and Take-away Lessons

For this reason, the oral health care provider needs to be watchful and when there is a suspicion of sarcoidosis, systemic sarcoidosis must be included in the differential diagnosis of oral and perioral granulomatous lesions.

Management of Large Dural Defect with CSF Leak in Hypertelorism Correction

The Rationale

Dural tear is a serious complication during hypertelorism corrective surgeries. Identifying the tear and managing requires considerable expertise. Managing large dural tears correctly is necessary to prevent cerebrospinal fluid (CSF)-related complications in craniofacial surgery.

Patient Concerns

The patient presented with hypertelorism as a part of the Tessier Cleft 0 and sought to correct the widely placed eyes.

Diagnosis

Large critical-sized dural tear during modified box osteotomy surgery.

Treatment

Besides successful modified box osteotomy surgery, the critical-sized dural tear was managed with fascia lata and fibrin glue.

Outcomes

There was no CSF leak or related complication postsurgically indicating successful sealing and healing of the dural tear.

Take-Away Lessons

The synergistic mechanism by which fascia lata graft and fibrin glue help to hermetically seal the critical-sized defect, especially when there are variable amounts of hydrostatic-hydrodynamic forces of CSF exerting pressure on the patched area, is discussed.

Kabasura Kudineer (KSK), a poly-herbal Siddha medicine, reduced SARS-CoV-2 viral load in asymptomatic COVID-19 individuals as compared to vitamin C and zinc supplementation: findings from a prospective, exploratory, open-labeled, comparative, randomized controlled trial, Tamil Nadu, India

INTRODUCTION

Despite several ongoing efforts in biomedicine and traditional medicine, there are no drugs or vaccines for coronavirus disease 2019 (COVID-19) as of May 2020; Kabasura Kudineer (KSK), a polyherbal formulation from India's Siddha system of medicine, has been traditionally used for clinical presentations similar to that of COVID-19. We explored the efficacy of KSK in reducing viral load and preventing the disease progression in asymptomatic, COVID-19 cases.

METHODS

A prospective, single-center, open-labeled, randomized, controlled trial was conducted in a COVID Care Centre in Chennai, India. We recruited reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 of 18 to 55 years of age, without clinical symptoms and co-morbidities. They were randomized (1:1 ratio) to KSK (60 mL twice daily for 7 days) or standard of care (7 days supplementation of vitamin C 60,000 IU morning daily and zinc 100 mg evening daily) groups. The primary outcomes were reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR], prevention of progression of asymptomatic to symptomatic state, and changes in the immunity markers including interleukins (IL-6, IL-10, IL-2), interferon gamma (IFNγ), and tumor necrosis factor (TNF α). Siddha clinical assessment and the occurrence of adverse effects were documented as secondary outcomes. Paired t-test was used in statistical analysis.

RESULTS

Viral load in terms of the CT value (RdRp: 95% CI = 1.89 to 5.74) declined significantly on the seventh day in the KSK group and that of the control group, more pronounced in the study group. None progressed to the symptomatic state. There was no significant difference in the biochemical parameters. We did not observe any changes in the Siddha-based clinical examination and adverse events in both groups.

CONCLUSION

KSK significantly reduced SARS-CoV-2 viral load among asymptomatic COVID-19 cases and did not record any adverse effect, indicating the use of KSK in the strategy against COVID-19. Larger, multi-centric trials can strengthen the current findings.

TRIAL REGISTRATION

Clinical Trial Registry of India CTRI2020/05/025215 . Registered on 16 May 2020.

A critical review on different harvesting techniques for algal based biodiesel production

The fuels retrieved from renewable sources which are usually employed as both carbon and energy sources are termed as neutral based biofuels. The most promising feedstock from renewable sources with great potentiality in contributing to the inclining energy demand is microalgae. These microalgae can be harnessed readily in terms of obtaining qualitative biodiesel with greater energy consumption under limited operational cost. The process of harvesting or dewatering microalgae could be carried under single or sequential combinations of operations. The major drawback of harvesting such as huge operational cost could be lowered by increasing the level of automation than cost of investments. The present review concentrates and explores on the techno-economic analysis of the microalgal harvesting and dewatering processes on a large scale. Along with these advanced techniques enclosing the utilization of nanoparticles for harvesting has also been explored. And it also adds with the impacts of concerning facts on energy consumption, processing cost and recovery of resources during harvesting.

Large odontome compressing inferior alveolar nerve - A case report

A young female sought treatment for a painful swelling in the right mandibular posterior region for the past 1 month with severe halitosis and paresthesia of right lower lip. Past history revealed that #46 was impacted due to an odontogenic tumor and an unsuccessful attempt was made to remove the impacted teeth and the tumor. A warm, tender, mild extra-oral diffuse swelling with right side cervical lymphadenopathy present. Intra-orally, there was a missing crown of 46 with a diffuse, tender buccal cortical expansion with a draining sinus. Imaging studies revealed a radiopaque lesion with a well-defined and rounded radiolucent halo. A provisional diagnosis of acute suppurative osteomyelitis was made and the remaining roots along with the radio-opaque material removed in toto via an open approach method and the entire area reconstructed with autograft harvested from rib. Histopathologically lesion was diagnosed to be a complex composite odontome. The challenges of diagnosis and the implication are discussed.

Recurrent ossifying fibroma of the orbit - A case report

Rationale

Ossifying fibromas are mainly found in the jaws and are rare in other parts of the cranium. Orbital involvement is relatively rare.

Patient Details

A case of an otherwise healthy 38-year-old overseas patient with gradual onset of a large growth in the right ocular area involving adjacent bone and operated twice over the last eight years is being presented. The lesion is involving the entire medial wall.

Treatment

Considering the complex loco-regional anatomy as well as the restriction of overseas residence, preservation of a thin margin of bone was performed.

Take-Away Lessons

The need for repeat radiological surveillance was stressed.

Large hemangioma of the tongue

Hemangiomas are the most common benign vascular tumours, often reported in very young. Though the head and neck regions have high predilection, intra-oral hemangiomas (IH) are very rare. In spite of numerous treatment options, the IH are ideal candidates for surgical exoneration. The reasons for this are manifold. This manuscript intends to present a case of IH arising in the tongue along with subsequent macroglossia. The treatment and surgical strategy based on cardinal principles of macroglossia corrections are described. A note on the challenges associated with treatment is presented.

Post-traumatic pseudo joint formation at the angle of mandible - A case report

Nonunion post-mandibular fractures are relatively uncommon. They pose severe challenge in terms of treatment and quality of life. The cause for pseudo-union is multi-dimensional. Removal of the cause or treating the same is an absolute need to provide correct treatment. Successful correction of a case of pseudo-union of fractured mandible occurring after two previous treatment attempts is presented. The possible explanation for the pseudo-union as well as the precautions to be taken to prevent such occurrence is discussed.

Isolated medial orbital wall fracture correction with revision of levator plication - A case report

The Rationale:

Treatment options for isolated medial orbital wall fractures (IMOWF) vary. In young and favourable situations, most of the times, the fracture is left to heal spontaneously. If not properly monitored, it may improperly fuse causing poor form and function.

Patient Concerns:

A 24-year-old male presented for correction of his sunken left eye. The patient had a blunt trauma 10 years back and had left upper eyelid as well as ptosis correction elsewhere. Since that surgery, the patient noticed that the eye had been slowly and progressively “sinking” with time.

Diagnosis:

An IMOWF with periorbital fat entrapment and detachment of levator palpebrae superioris was identified.

Treatment and Outcome:

The fracture site was reached via a transcaruncular approach, the fracture corrected and orbital defect corrected with a mesh. One week later, in a second-stage surgery, under local anaesthesia, the muscle was repositioned. Recovery was uneventful and the desired aesthetic-functional results were achieved.

Take-Away Lessons:

An untreated IMOWF in young adolescents could persist and subsequent growth could amplify the enophthalmos. A careful diagnosis and treatment is warranted.

Plication of Neck Strap Muscles and Platysma for Double Chin Correction - A Retrospective Study

Introduction:

There is an increased need for recontouring chin and submental areas for esthetic reasons. Reports of such surgeries across the world are present in the literature. India too has its share of chin and neck reconstruction needs. This study was carried out to document a single-center experience of authors' approach in isolated submentoplasty.

Materials and Methods:

A retrospective analysis of case records of submentoplasty during 2012–2017 was collated. Cases fulfilling inclusion and exclusion criteria were selected for this study. A qualitative assessment of the outcomes was performed.

Results:

Sixteen cases who had undergone isolated submental lipectomy with platysma plication formed the study group. The mean age was 44.38 ± 5.49, with a range of 37–54 years. There were 9 females and 7 males. The mean age of females was 42.89 ± 4.01, while for males, it was 46.29 ± 6.79 years. The mean follow-up ranged for 16.2 ± 3.4 months (14–20 months). None of the patients had major complications.

Discussion and Conclusion:

The modified mini-neck lift approach for an isolated submental lipectomy and strap muscles of suprahyoid group with platysma plication is presented. Careful manipulation of the fat removal, plication of platysma, strap muscle and positioning of incision would help to a greater extent. The anatomical challenges for this variation are discussed.

Cicatricial ectropion correction for a case of amniotic band syndrome

Background

Amniotic band syndrome (ABS) or amniotic deformity, adhesions and mutilations (" ADAM" ) is a spectrum of rare congenital malformations related to an early phase of organogenesis. In the craniofacial region, ABS could manifest in several forms. A rare form of ABS with Tessier Cleft-9 associated with atypical Cleft-2 presenting with a cicatricial ectropion is reported and management of the condition is discussed.

Key Points

ABS causing oro-facial deformities is increasingly being reported. Surgical management requires staged correction and is often challenging. As growth is dynamic, evolving problems should be anticipated. Frequent follow-up and early intervention could prevent unfavourable complications.

Main Lessons Learnt

ABS has craniofacial components and it requires an adequate understanding of principles of growth and healing to plan corrective surgeries for such complicated and rare conditions.

The efficacy of Siddha Medicine, Kabasura Kudineer (KSK) compared to Vitamin C & Zinc (CZ) supplementation in the management of asymptomatic COVID-19 cases: A structured summary of a study protocol for a randomised controlled trial

OBJECTIVES

The primary objectives of this study are to determine efficacy of Siddha medicine, Kabasura kudineer in reduction of SARS-CoV-2 viral load and reducing the onset of symptoms in asymptomatic COVID-19 when compared to Vitamin C and Zinc (CZ) supplementation. In addition, the trial will examine the changes in the immunological markers of the Siddha medicine against control. The secondary objectives of the trial are to evaluate the safety of the Siddha medicine and to document clinical profile of asymptomatic COVID-19 as per principles of Siddha system of Medicine.

TRIAL DESIGN

A single centre, open-label, parallel group (1:1 allocation ratio), exploratory randomized controlled trial.

PARTICIPANTS

Cases admitted at non-hospital settings designated as COVID Care Centre and managed by the State Government Stanley Medical College, Chennai, Tamil Nadu, India will be recruited. Eligible participants will be those tested positive for COVID-19 by Reverse Transcriptase Polymerase Chain reaction (RT-PCR) aged 18 to 55 years without any symptoms and co-morbidities like diabetes mellitus, hypertension and bronchial asthma. Those pregnant or lactating, with severe respiratory disease, already participating in COVID trials and with severe illness like malignancy will be excluded.

INTERVENTION AND COMPARATOR

Adopting traditional methods, decoction of Kabasura kudineer will be prepared by boiling 5g of KSK powder in 240 ml water and reduced to one-fourth (60ml) and filtered. The KSK group will receive a dose of 60ml decoction, orally in the morning and evening after food for 14 days. The control group will receive Vitamin C (60000 IU) and Zinc tablets (100mg) orally in the morning and evening respectively for 14 days.

MAIN OUTCOMES

The primary outcomes are the reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR] from the baseline to that of seventh day of the treatment, prevention of progression of asymptomatic to symptomatic state (clinical symptoms like fever, cough and breathlessness) and changes in the immunity markers [Interleukins (IL) 6, IL10, IL2, Interferon gamma (IFNγ) and Tumor Necrosis Factor (TNF) alpha]. Clinical assessment of COVID-19 as per standard Siddha system of medicine principles and the occurrence of adverse effects will be documented as secondary outcomes.

RANDOMISATION

The assignment to the study or control group will be allocated in equal numbers through randomization using random number generation in Microsoft Excel by a statistician who is not involved in the trial. The allocation scheme will be made by an independent statistician using a sealed envelope. The participants will be allocated immediately after the eligibility assessment and informed consent procedures.

BLINDING (MASKING)

This study is unblinded. The investigators will be blinded to data analysis, which will be carried out by a statistician who is not involved in the trial.

NUMBERS TO BE RANDOMISED (SAMPLE SIZE)

Sample size could not be calculated, as there is no prior trial on KSK. This trial will be a pilot trial. Hence, we intend to recruit 60 participants in total using a 1:1 allocation ratio, with 30 participants randomised into each arm.

TRIAL STATUS

Protocol version 2.0 dated 16^th May 2020. Recruitment is completed. The trial started recruitment on the 25^th May 2020. We anticipate study including data analysis will finish on November 2020. We also stated that protocol was submitted before the end of data collection TRIAL REGISTRATION: The study protocol was registered with clinical trial registry of India (CTRI) with CTRI/2020/05/025215 on 16 May 2020.

FULL PROTOCOL

The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).

Square Face Correction by Gonial Angle and Masseter Reduction

Introduction

The association of mandibular gonial angle, facial height, and jaw relationship in masseteric hypertrophy (MH) has not been adequately described for the typical Indian population. The aim of this study was to report the gonial angle relationship with facial height parameters in cases diagnosed with bilateral MH and its possible influence on the treatment plan.

Materials and Methods

This is a retrospective study based on archival records of bilateral MH cases surgically treated over a 10-year period at the author's center. Patients' records fulfilling inclusion and exclusion criteria were considered for the study. Age, gender, upper anterior facial height (UAFH), lower anterior facial height (LAFH), upper posterior facial height (UPFH), ramus height (also a reflection of the lower posterior facial height), and gonial angle were collected along with the type of bite (open/normal/deep), surgical procedure (debulking with/without bone removal), and concomitant jaw bone corrections (yes/no). These were subjected to statistical analysis using SPSS, and P ≤ 0.05 was taken as statistically significant.

Results

Overall, 21 patients formed the study group comprising 9 females and 12 males. Gender influenced the UAFH, LAFH, UPFH, ramus height, and gonial angle significantly. Males had higher values than females. Normal bite had an obtuse gonial angle than the deep bite, and the difference was statistically significant (P = 0.036). When the gonial angle was acute or square faced, the need for other surgical procedures was high and the difference was statistically significant (P = 00.048).

Discussion and Conclusion

The results are discussed in the light of Indian skeletal anthropometry. The relationship of the gonial angle with facial height parameters in bilateral MH cases in this part of the world is presented.

Comparative evaluation of direct sinus lift with bone graft and zygoma implant for atrophic maxilla

Introduction

Implant rehabilitation of atrophic maxilla is challenging. The aim of this manuscript is to compare the clinical outcome of rehabilitation of atrophic maxilla (long span) by zygomatic implants (ZI) versus conventional sinus lift with augmentation procedures dental implants (SLAP-DI).

Materials and Methods

A retrospective record analysis of a cohort of 25 patients fulfilling the inclusion and exclusion criteria, over a period of 6 years were performed. The patients had been either treated with ZI or SLAP-DI. The outcome measures were: prosthesis, implant and augmentation failures, any complications, patients' number of days with total or partial impaired activity, time to function and number of dental visits, assessed by independent assessors from records. The data was analyzed using SPSS with P ≤ 0.05.

Results

There were 16 (64%) men and 11 (44%) had ZI while 14 (56%) underwent SLAP-DI. There were no prosthesis or implant failures in this cohort. Between ZI and SLAP-DI, there was no gender difference (P = 0.648), border line significance in minor complication (P = 0.075), with less complication encountered in SLAP-DI than the ZI. None of the cases had major complications that required hospitalization or severe medical therapy. Of the 14 cases that underwent SLAP, 11 (78.6%) had no augmentation failure (resorption <10%). ZI had older age (P = 0.000), with greater number of teeth missing (P = 0.002), with lesser time for functional loading (P = 0.000), required less number of visit to dentist (P = 0.000), and lesser bone loss at insertion site (P = 0.005).

Discussion & Conclusion

The results are discussed in light of previous pertinent literature. This short term (~ 1 year follow-up) suggest that SLAP-DI and ZI have certain similar features. There is no statistical difference in outcome barring the time needed to functional loading (1.3 days vs. 444.3 days). Relatively more complications were reported for ZI, but had no statistical significance. Long-term and multi-center data are needed to confirm the results.

Impacted wisdom tooth in the floor of the orbit

Identification and management of ectopic supplemental tooth in anatomically complex areas such as the floor of orbit are challenging. This arises from the rarity and lack of consensus over management. The situation gets complex when there is an evidence of follicular pathology such as dentigerous cyst. In this report, a case of maxillary third molar associated with maxillary sinus and a distomolar in association with the floor of orbit medially to the inferior-orbital canal is presented. The surgical management of the condition is presented.

Reconstruction of moustache and ala of the nose with a single forehead flap

Reconstruction of critical-sized defects of composite facial units is a challenging one. This is amplified when facial hair-bearing areas are included. A case of reconstruction of multiple midfacial defects is presented. Initially, defective jaws were addressed. Later, appropriate modification of existing extended paramedical forehead flap to sequentially reconstruct defective lip, moustache, and parts of alae are described. The flap design was such that hair-bearing areas were used to reconstruct moustache while the nasal alar defect was reconstructed using the non-hair-beating forehead skin. Finally, dental implants were also placed. The technique was reliable, giving minimal donor site deformity but with maximum result. However, it is a multi-stage procedure. The paper also describes the challenges of midfacial unit reconstruction as handled in this case.

Evaluation of antidiabetic activity of Pleurotus pulmonarius against streptozotocin-nicotinamide induced diabetic wistar albino rats

The current research aims to evaluate the antidiabetic properties of Pleurotus pulmonarius, an edible basidiomycetes mushroom fungi in diabetic induced wistar albino rats. Mycelial Hot Water Extracts (HWE) and Acetone Extracts (AE) of Pleurotus pulmonarius was orally administrated to STZ-NA induced (55 mg/kilogram body weight) diabetic wistar albino rats at a concentration of 200 and 400 mg/kg for 4 weeks. The outcomes revealed that the HWE of Pleurotus pulmonarius resulted in a significant (p < 0.001) reduction in blood glucose level. A noteworthy (p < 0.001) reduction in serum lipid profile and elevation in High-Density Lipoprotein Cholesterol (HDL-C) after administration with HWE, also demonstrating the protective effects of HWE in diabetes-related complications. Besides all antidiabetic parameters, pathological morphology of the pancreas, liver and kidney are regularised. This observation indicated that HWE of Pleurotus pulmonarius possessed higher antidiabetic activity than AE. Besides, HWE also promoted a significant control of alpha amylase enzyme in a concentration-dependent manner with a maximum activity of 99.23% inhibition at 1000 µg/ml. The outcomes of the present study indicated that the HWE possesses a potential antidiabetic activity both in vitro and in vivo. Thus, it can be used as a nontoxic complementary drug in the controlling of diabetes and related complications, thus providing scientific authentication of its use as an antidiabetic agent.

Nasolabial cyst in buccal mucosa

Nasolabial cysts are a rare non-odontogenic, soft-tissue, developmental cyst reported till date in the sublabial area and anterior maxillary region. The cyst is a slowly enlarging asymptomatic swelling and non-painful. The cyst is believed to be associated with remnants of the nasolabial duct. In this report, we report a nasolabial cyst of a 48-year-old man in whom the cyst occurred in the buccal mucosa. To the best of our knowledge, this is the first case of nasolabial cyst occurring entirely in the buccal mucosa without involving vestibule. The etiopathogenesis of the cyst is reviewed in light of this case.

Maxillary rehabilitation after complete destruction by fungal osteomyelitis

Treatment of uncommon fungal infection such as Rhinosporidiosis is challenging, especially when occurring in a non-immunocompromised patient in non-invasive form. Extensive involvement, extending into maxillary jawbone would need aggressive, chemotherapeutic and surgical approach. There are few reports of successful rehabilitation of maxillary jaw with dental implants after treatment of such fungal infection. After adequate medical treatment, the iliac graft and recombinant bone morphogenetic protein-2 was effectively utilized to reconstruct the lost maxillary bone. Later, dental implants were placed, that osseointegrated well.

Tracheostomy and mandibular distraction in acute sleep apnea

Severe restriction of airway volume in the orofacial region, caused by temporomandibular joint (TMJ) ankylosis, may lead to obstructive sleep apnea (OSA). If the TMJ ankylosis is progressive, rarely, the caregivers may fail to notice the problem. Such patients may have only symptoms of snoring, daytime sleepiness, fatigue, inability to concentrate, and irritability. At times, emergency tracheostomy may be needed to increase the oxygen supply. Distraction osteogenesis (DO) is a less invasive surgical technique in the management of such OSA by correcting the reduced airway space. In DO, the angulation of the distractors and the pace of activation determine the success of the neo-generation of segments of bone. The formation of a well-corticated mandibular canal (MC) in the newly generated bone is an evidence of the success of the procedure. Such bilateral formation of the MC is not reported from this part of the world. We report a case of a 4-year-old boy who was struggling with OSA due to TMJ ankylosis. He was successfully treated by bilateral mandibular DO. The formation and cortication of the MC is discussed with emphasis on the neural regeneration.

Epiphora drainage by DCR - Long-term results

Background

Dacryocystorhinostomy (DCR) refers to the surgical procedure that is used to relieve the chronic obstruction of the nasolacrimal duct obstruction (NLDO). In a maxillofacial setting, NLDO may arise subsequent to a facial trauma or orthognathic surgery. There is a dearth of literature from this part of the world. This article intends to provide a single maxillofacial center experience in DCR.

Materials and Methods

This is a retrospective, noncomparative, noninterventional, record audit type of study of all consecutive patients fulfilling inclusion and exclusion criteria. All patients with epiphora and diagnosed with lacrimal apparatus damage between 1 January 2008 and 31 December 2017 requiring DCR were considered for the study. Details of demographics, phase of treatment (primary/retreatment), types of bones involved, age, complications, period suffering from epiphora, and follow-up were obtained. All data were entered and analyzed using the Statistical Package for the Social Service (version 16; IBM). Descriptive statistics of the frequency and mean ± standard deviation (SD) as appropriate were presented. Chi-square test and one-way analysis of variance were used appropriately. P ≤ 0.05 was taken to be statistically significant.

Results

In all, 83 patients fulfilled the inclusion and exclusion criteria. It is more common in males (n = 56, 67.47%) with a mean ± SD of 32.24 ± 10.80 (18-59 years) with 27 (32.53%) of them presenting primarily after fractures. Fracture was the most common pathology seen in 81.93% (n = 68) of cases, while the rest were as a result of orthognathic cases. Le Fort II and III set of bones contributed to 59% of cases, while the orbitonasal complex contributed to only three cases. NLD obstruction was seen in 68 (81.9%) of cases. On an average, the patients suffered for 9.3 ± 6.74 months (range 0.5-22 months) before seeking treatment and the average follow-up was 31.07 ± 11.69 months (range 15-54 months).

Discussion and Conclusion

Fractures and surgeries involving nasal bones carry an innate risk of damaging the NLD system. The pattern of need for DCR and occurrence of NLDO in this part of the world have been described. The extent of the anatomical variations and need for proper surgical planning are highlighted.

Transzygomatic, transcondylar excision of the sarcoma of infratemporal fossa

Malignant peripheral nerve sheath tumor (MPNST) is a rare pathologic lesion in a patient with solitary neurofibroma. A 32-year-old man presented with a firm and slightly tender mass in the right infratemporal region involving the right preauricular and temporomandibular joint area. The patient has a history of removal of a solitary neurofibroma 22 years back in the same region. The lesion had enlarged rapidly over the past 3 months, and a spindle cell lesion was diagnosed through a superficial incisional biopsy. Surgical removal of the lesion using modified preauricular transzygomatic approach was done. Histopathologically, it was diagnosed as an MPNST.

Central giant cell granuloma - A case report

Central giant cell granuloma (CGCG) of the jaws is a benign, intraosseous, osteolytic lesion of debatable etiology. CGCG lacks in clinical and radiographical pathognomonic features to distinguish from common lesions occurring in this region. Histopathology still remains the predominant diagnostic modality to identify the disorder. Clinically aggressive lesions and atypical lesions can lead to early damage and may necessitate aggressive therapy to prevent recurrences. A case of an aggressive type of CGCG of the maxilla in a young adult male patient with diagnostic and treatment challenge is presented.

Psychological Desire of Facial Esthetics in Males

Background:

Males have specific facial esthetic priorities for a variety of reasons. There exists a common perception that expectations from male facial cosmetic surgery are similar globally. The possibility of different esthetic requests of males at a single Indian center is not widely reported. This investigation aimed to identify the facial esthetic expectations and requests among males.

Materials and Methods:

The study was based on in-house, qualitative survey regarding facial esthetics conducted during the clinical interview among males seeking facial esthetics in a single Indian center. Preferences regarding the hairline, forehead periorbital region, nose, lip, and jaw features, were surveyed.

Results:

Facial esthetic preferences among males were identified. Despite the geographical and anthropological variation, the demand was largely correction of the lower eyelid, entire midfacial region – alteration of zygomatic prominence, nose, and premaxillary unit. There is a high demand for a sharp, long, straight nose as well as prominent jawline and gonial angle. The expectations of the patients appear to be influenced by the biopsychosocial constructs including race, age, and personality traits.

Conclusion:

The results demonstrate that there is a wide variation in facial esthetic expectation, especially one that has typical “metrosexual male” ideations. This possibly stems from their deep-seated psychological desire for a facial and personality trait. Only an in-depth clinical interview and detailed discussion would help the surgeon to understand the patient's concepts of beauty, their expectations, and surgical outcome reality.

Surgical Correction of Diplopia in Orbital Fracture: Influence of Material and Design

Purpose

The purpose of this study is to compare the association of diplopia after orbital fracture repair using titanium mesh and high-density polyethylene-coated titanium mesh.

Materials and Methods

Retrospective review of records of consecutive patients who presented for primary/secondary correction of orbital fracture attending author's institute was done. Patients attending the institution between January 2013 and December 2017 (5 years' period) fulfilling the inclusion and exclusion criteria were included for this study.

Results

In all, 44 patients, who fulfilled the inclusion and exclusion criteria, were included in the study. The mean age was 31.86 ± 9.1 years and the mean period of follow-up was 9.37 ± 2.1 months postoperatively, with a range of 6.5-24 months. There were 65.91% males, and the most common etiology was road traffic accident (50%). In all, 11 (25%) cases had postoperative diplopia. Of the 11 cases that had diplopia, 6 had Class 1 and 5 had Class 2 diplopia. Of these 11 cases, 8 cases had completion or partial resolution of diplopia by the end of 8 weeks' period, and in 3 cases, it persisted even after 3 months of care. The occurrence of diplopia was compared by demographic factor using Chi-square test, and the mesh type was only statistically significant (P = 0.026).

Discussion

The present study indicates that both types of mesh provide reliable, clinically better results. However, with passage of time, it was clinically observed that removing uncoated mesh poses extreme difficulty by the adherences and growth penetrating the meshes. In certain instances, clinically, it was observed that such adhesions may be a cause of compromise of eyeball movement.

Conclusion

Noncoated titanium orbital implants may lead to the adherence of orbital and periorbital structures, resulting in restrictive diplopia. High-density polyethylene-coated titanium mesh shows better performance as compared to noncoated mesh in preventing adherence situations.

Rare granular cell tumor affecting a 13-year-old boy

Granular cell tumor (GCT) is a rare soft-tissue neoplasm, first described in 1926. GCT often manifests as a single, painless nodule that shows a slow enlargement in the cutaneous, subcutaneous, or submucosal tissues. It is commonly reported in adults in the third to sixth decade of life. This case report is of an incidental finding in a young boy, who was radiologically examined for orthodontic treatment purpose and found to have a radiolucent lesion in the mandible. The lesion was later diagnosed as GCT. Central GCT is rare, and the presentation in a child is even rare. Although GCT is reported to be benign, it can turn malignant in 2% of the cases and possibly metastasize too. The local recurrence within a year is characteristic for malignant GCT. The 1-year follow-up of the present case indicated no local recurrence. The case stresses the need for the frequent dental examination, specialist reference. GCT should be included in the differential diagnosis of head and neck masses, even when inside jaws. It shall be remembered that such tumors may arise in any atypical locations and there is a possibility of malignancy.

Surgical management of chronic temporomandibular joint dislocations

Introduction

Temporomandibular joint dislocation is described as the movement of mandibular condyle out of the fossa beyond its anatomical and functional boundaries causing pain and discomfort. It is often managed by conservative methods, but in long-standing, chronic conditions, surgical treatment is the only option. The goal of surgical treatment is to reposition the condyle and prevent further recurrences.

Materials and Methods

This retrospective analysis involving a single center and a surgeon with 19 patients and 23 joint surgeries performed over a 10-year period. Patients who fulfilled inclusion and exclusion criteria and had earlier undergone surgical correction with hook-shaped miniplates and miniscrews fixed with or without bone grafts formed the study group.

Results

In all, 12 were female (mean age, 41.9 ± 12.07 years) and the rest 9 were male (mean age, 39.8 ± 13.6 years), ranging from 32 years to 58 years. All patients had the dislocation for an average period of 19.26 ± 12.6 months before the surgery. The mean maximal mouth opening (without pain) preoperatively was 17.78 ± 2.13 mm (12-25 mm) while postoperatively it was 32.28 ± 3.17 mm (27-37 mm). There were no immediate or late surgical complications in the follow-up period that ranged from 8 to 37 months.

Discussion

When proper case selection is employed and properly done, using hook-shaped miniplates with or without bone graft is more cost-effective, giving excellent short- and long-term effects.

Conclusion

The results in this Indian population are very similar to that reported from other parts of the world.

Comparison of Midface Advancement by External and Internal Craniofacial Distraction Osteogenesis

BACKGROUND

Distraction osteogenesis (DO) is employed to address the midface abnormalities using either an external DO (EDO) or an internal DO (IDO) device. There are few studies that have reported EDO and IDO outcomes through cephalometric evaluation. The aim of this retrospective, record-based study is to compare the change in position of the midface resulting from distraction of noncomplicated cases of Le Fort III osteotomies with EDO as well as IDO and compare the groups using standard right facing lateral cephalometry. We hypothesized that there would be no difference between EDO and IDO in terms of displacement (of point of reference) as well as complications.

MATERIALS AND METHODS

Retrospective analyses of cases fulfilling inclusion and exclusion criteria were retrieved from archives. Using two sets of right-side cephalometry, preoperative and after consolidation (at the end of the treatment), the changes in Point A and Orbitale (O) as described by Lima et al. were used for the study. Movement in X-axis and Y-axis was noted down and subjected to statistical analysis. Descriptive statistics, the coefficient of variability (expressed as percentage), and the interquartile range (maximum and minimum values) were presented. P ≤ 0.05 was taken as statistically significant.

RESULTS

Significant midface advancement was achieved with the procedure. There were five cases of EDO and eight cases of IDO. The age at which patients were operated ranged from 9 to 18 years (mean: 13 years). The mean follow-up time was for 14 ± 8 months. There were eight females (3 - EDO and 5 - IDO) and five males in total. There was no complication in the entire study group. The difference in total bone length gain along the horizontal axis was as follows: 12.19 and 12.84 along the Point A for EDO and IDO and 3.89 and 4.65 along the Point O for EDO and IDO, respectively. The difference was not statistically significant (P = 0.833 and 0.622, respectively). The total movement along the vector at Point A in EDO and IDO was 13.08 and 12.56, respectively, the difference of which was not statistically significant (P = 1); while along the vector at Point O in EDO and IDO, the total movement was 10.98 and 11.48, respectively, the difference of which was not again statistically significant (P = 0.833).

DISCUSSION

The significance of the difference in EDO and IDO is discussed using the biomechanical principles and the results deliberated based on the existing literature.

CONCLUSION

The positioning of the devices plays a significant role in deciding the outcome. Both the distractors have their distinct advantages and their applications have to be customized.

Overgrowth of costochondral graft in temporomandibular joint ankylosis reconstruction: A retrospective study

BACKGROUND

Temporomandibular joint (TMJ) ankylosis is a situation in which the mandibular condyle is fused to the glenoid fossa by bone or fibrous tissue. The management of TMJ ankylosis has a complicated chore, and it is challenging for the maxillofacial surgeon because of technical hitches and high rate of reankylosis. Costochondral graft (CCG) is a common treatment modality for TMJ ankylosis. One of disadvantages of CCG is unpredictability of growth pattern and risk of overgrowth. This report illustrates the fate of CCG used in the TMJ reconstruction and also the management of patients with CCG overgrowth.

MATERIALS AND METHODS

A retrospective evaluation of 14 patients presented with unilateral TMJ ankylosis reconstructed using CCG treated in our hospital from 2000 to 2013 was done. Only patients with unilateral ankylosis treated by CCG with at least 2-year follow-up and complete case records with clinical and radiographic details were included in the study. Patients with bilateral ankylosis, reankylosis, missing details, and the patients with <2-year follow-up were excluded from the study. The patients were selected based on the specified inclusion/exclusion criteria. All the patients were analyzed clinically and radiographically. Facial appearance, jaw motion, occlusion, contour, and linear growth changes were documented preoperatively, immediately postoperatively, and long term (>2 years).

RESULTS

Totally 14 unilateral temporomandibular ankylosis cases were reconstructed using CCG from the period of 2000-2013. The mean age of the patients is 5.2 years with the standard deviation of 1.48 ranging from 3 to 9 years. Follow-up of the patients ranges from 2 to 6 years with mean follow-up of 3 years. Out of 14 patients, 2 patients had normal growth of CCG after the mean follow-up of 3 years, whereas 5 patients presented with moderate growth, 4 patients with CCG overgrowth, and 3 patients presented with no growth of CCG following surgery. Overgrown CCG was treated with condylar shaving, and orthodontic elastic was maintained to stabilize the occlusion. Moderately grown and nongrowing CCG was treated by internal distractor for the management of facial symmetry. Facial asymmetry and malocclusion were successfully corrected in all patients with altered growth pattern.

CONCLUSION

The growth pattern of the CCG is extremely unpredictable, which can be in the form of no growth at all or excessive growth, and mandibular overgrowth on the grafted site can actually be more troublesome than the lack of growth. Care should also be taken to ensure proper postoperative functional therapy and to examine the role of cartilage thickness on future growth in young patients.