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The diagnosis and management of giant cell lesions of the jaws
Anthony M Pogrel
July-December 2012, 2(2):102-106
DOI:10.4103/2231-0746.101325  PMID:23482697
This article will review current thoughts with regard to the etiology, histopathology, diagnosis, and management of giant cell lesions of the jaws. It will attempt to point out the differences between these lesions and giant cell lesions elsewhere in the body and also the current techniques for medical management of these conditions including steroid injections, calcitonin treatment, and alpha interferon treatment.
  31,781 5,786 23
Total avulsion of mandible in maxillofacial trauma
Deepak Passi, Hari Ram, Geeta Singh, Laxman Malkunje
January-June 2014, 4(1):115-118
DOI:10.4103/2231-0746.133083  PMID:24987613
Mandibular trauma are a frequent injury of maxillofacial skeleton due to the mandible's prominence and relative lack of support. Maxillofacial injuries can be complex and can involve the skin and soft-tissues as well as bones resulting in fractures. Although, several cases of severe crush injury of the lower jaw have already been presented but total avulsion of mandible has rarely been reported. As with any facial fracture, consideration must be given for the need of emergency treatment to secure the airway or to obtain hemostasis if necessary before initiating definitive treatment. We presents a case report of completely avulsed mandible along with soft-tissue of midface region in pediatric patient following trauma, which was attempted to manage or repaired by successful microvascular surgical technique. Unfortunately, we lost the patient in next postoperative day due to cardiac complication. Avulsion of the lower jaw may further complicate the obstructive nature of the upper airway. Multi-specialty involvement in their management may be needed for management of such type of avulsion injury.
  27,880 1,149 2
Platelet-Rich fibrin: A second generation platelet concentrate and a new friend of oral and maxillofacial surgeons
Harish Saluja, Vipin Dehane, Uma Mahindra
January-June 2011, 1(1):53-57
DOI:10.4103/2231-0746.83158  PMID:23482459
To assess the potential use and benefits of Platelet-Rich Fibrin (PRF) over Platelet-Rich Plasma (PRP), for wound healing post oral and maxillofacial surgeries. This article describes the evolution of this second generation platelet concentrate and its multiple uses in various surgical procedures. Around 5 ml of whole venous blood is collected from the patients in each of the two sterile vacutainer tubes of 6 ml capacity without anticoagulant. The vacutainer tubes are then placed in a centrifugal machine at 3000 revolutions per minute (rpm) for 10 minutes, and the middle fraction containing the fibrin clot is then collected 2 mm below lower dividing line, to obtain the PRF. Cavities filled with PRF post oral and maxillofacial surgical procedures, at the institute, showed faster healing in half the time as compared to physiologic healing. PRF, which belongs to a new second generation of platelet concentrates, with simplified processing, and not requiring biochemical blood handling, has several advantages over traditionally prepared PRP, which has been widely used for accelerating soft tissue and hard tissue healing. However, the preparation being strictly autologous, the amount of PRF obtained is limited.
  23,531 3,641 66
Management of patients with condylar hyperplasia: A diverse experience with 18 patients
Ahmed Alyamani, Sondos Abuzinada
January-June 2012, 2(1):17-23
DOI:10.4103/2231-0746.95311  PMID:23483790
Purpose: The purpose was to report the clinical experience with patients diagnosed with Condylar Hyperplasia (CH). Materials and Methods: Eighteen patients with CH underwent condylar growth assessment using clinical and radiographic examinations. Seven patients with suspected active condyles underwent single photo emission computed tomography (SPECT) examination. A total of patients with asymmetry and malocclusion were treated with orthognathic surgery. Three patients with intact occlusion; underwent inferior border osteotomy with nerve repositioning. All patients were followed up for 3 years without any complications. Conclusion: There is great diversity in the clinical and radiographic presentation in cases with CH. Assessment of condylar growth activity is the cornerstone in managing these cases. After that each case has its own diverse treatment plan to achieve a satisfactory facial symmetry.
  19,749 1,701 23
3D modeling, custom implants and its future perspectives in craniofacial surgery
Jayanthi Parthasarathy
January-June 2014, 4(1):9-18
DOI:10.4103/2231-0746.133065  PMID:24987592
Custom implants for the reconstruction of craniofacial defects have gained importance due to better performance over their generic counterparts. This is due to the precise adaptation to the region of implantation, reduced surgical times and better cosmesis. Application of 3D modeling in craniofacial surgery is changing the way surgeons are planning surgeries and graphic designers are designing custom implants. Advances in manufacturing processes and ushering of additive manufacturing for direct production of implants has eliminated the constraints of shape, size and internal structure and mechanical properties making it possible for the fabrication of implants that conform to the physical and mechanical requirements of the region of implantation. This article will review recent trends in 3D modeling and custom implants in craniofacial reconstruction.
  17,906 3,168 175
Intermaxillary fixation screws versus Erich arch bars in mandibular fractures: A comparative study and review of literature
Ahtesham Ahmad Qureshi, Umesh K Reddy, NM Warad, Sheeraz Badal, Amjad Ali Jamadar, Nilofar Qurishi
January-June 2016, 6(1):25-30
DOI:10.4103/2231-0746.186129  PMID:27563602
Objective: Various techniques have been employed from time to time to achieve maxillomamdibular fixation. Although arch bars provide an effective and versatile means of maxillomandibular fixation, their use is not without shortcomings. However the introduction of intermaxillary fixation screws (IMF) has eliminated many of these issues of arch bars. The aim of the present study was to compare the advantages and disadvantages of intermaxillary fixation screws over the Erich arch bars in mandibular fractures.Materials and Methods: Sixty dentulous patients who reported to Department of Oral and Maxillofacial Surgery, Al-Ameen Dental College and Hospital, Bijapur with mandibular fractures and required intermaxillary fixation as a part of treatment plan followd by open reduction and internal fixation under GA were selected and randomly divided into 2 groups of 30 patients each that is Group A and Group B. Group A included patients who received intermaxillary fixation with Erich arch bars. Group B includes patients who received intermaxillary fixation with IMF Screws. The parameters compared in both the groups included, surgical time taken, gloves perforation, post-operative occlusion, IMF stability, oral hygiene, patient acceptance and comfort and non-vitality characteristics. Results: The average surgical time taken and gloves perforations were more in Group A,the patient acceptance and oral hygiene was better in Group B, there was not much statistically significant difference in postoperative occlusion and IMF stability in both groups. Accidental root perforation was the only limitation of IMF screws. Conclusion: Intermaxillary fixation with IMF screws is more efficacious compared to Erich arch bars in the treatment of mandibular fractures.
  18,932 1,394 18
Giant recurrent aneurysmal bone cyst of the mandible
Khurshida Banu, Mohammed Ehtaih Sham, Sri Hari, Veena Sharad
July-December 2012, 2(2):174-177
DOI:10.4103/2231-0746.101352  PMID:23482322
The Aneurysmal bone cyst (ABC) is an infrequent but well defined lesion occurring most commonly in the long bones, the pelvis and vertebrae. Only 1-2% of the lesions are known to occur in the maxillofacial region. Clinically, the lesion usually occurs in young adults below 20 years of age. Though there does not seem to be any marked gender predilection and slight preponderance towards females has been reported. Here we present a case of giant recurrent aneurysmal bone cyst in a 19 year old male patient treated by segmental resection and reconstruction with vascularized fibular graft.
  16,968 719 1
Enlarged lymph nodes in head and neck cancer: Analysis with triplex ultrasonography
Vivek Sathyanarayan, K.S.N Siva Bharani
January-June 2013, 3(1):35-39
DOI:10.4103/2231-0746.110077  PMID:23662257
Background: Presence of cervical metastasis is one of the factors influencing the outcome of patients with carcinoma of the head and neck, its early detection is potentially very important. Triplex ultrasonography technology have definitive role in detecting clinically undetectable involvement of lymph nodes (LNs). The purpose of this study was to evaluate, whether triplex ultrasonography characterization of cervical LNs could, with an acceptable degree of certainty, differentiate malignant from benign/reactive LNs, in order to prevent invasive diagnostic procedures. Materials and Methods: A total of 50 patients with oral cancer, were subjected to ultrasonographic investigation of the neck for grayscale, color flow imaging, and pulsed Doppler. All the parameters were compared with histopathologic examination. Correlation was then made between ultrasound and Doppler investigation and histopathology results to evaluate the sensitivity specificity, positive predictive value (PPV) and negative predictive value (NPV) of color Doppler ultrasonography in detecting metastatic neck nodes. Results: Study results showed that malignant LNs, especially metastatic nodes, are accompanied with significantly high resistive index (RI) and pulsatility index (PI) values, rounded shape, size, loss of central hilar echogenicity and peripheral vascularity. Among these sonographic findings, nodal shape (longitudinal nodal diameter to transverse diameter ratio or L/T ratio), RI and PI values were more accurate for differentiating benign from malignant LNs. Conclusion: In this study, triplex sonographic findings had relatively high accuracy in differentiating benign from malignant cervical LNs. Ultrasound hence can be recommended for initial non-invasive evaluation of the neck in patients with oral cancers with or without palpable cervical lymph nodes.
  16,321 688 1
Craniofacial fibrous dysplasia: Surgery and literature review
Suresh Menon, Srihari Venkatswamy, Veena Ramu, Khurshida Banu, Sham Ehtaih, Vinay M Kashyap
January-June 2013, 3(1):66-71
DOI:10.4103/2231-0746.110088  PMID:23662263
Objective: To highlight the clinical and radiologic features and management of craniofacial fibrous dysplasia with review of literature. Materials and Methods: A retrospective review of 6 patients who underwent surgical treatment in a tertiary healthcare centre was done using the parameters of patients' details, clinical features, radiological findings, management and postoperative review. Results: Of the six patients, 3 females and 2 males were in the 2 nd decade of life and 1 male in the 1 st decade of life. The disease was restricted to maxilla in 3 patients, involved the temporal and frontal bones in addition to maxilla in one, involved the frontal bone in one patient and involved frontal and parietal bones in one patient. The primary reason for seeking treatment in all the 6 cases was facial deformity. There was absence of pain in all 6 cases. For surgical treatment in all three cases involving the maxilla, the approach was intraoral while bicoronal approach was used for the other three cases. Treatment consisted of surgical contouring and reshaping the area. All cases were followed up over a period of 2 years with no signs of recurrence. Conclusion: Treatment of craniofacial fibro-osseous lesions is highly individualized. Most cases of craniofacial fibrous dysplasia manifest as swellings that cause facial deformity and surgical recontouring after cessation of growth seems to provide the best results.
  14,770 1,995 24
Wound healing and bone regeneration in postextraction sockets with and without platelet-rich fibrin
Baratam Srinivas, Pradipta Das, Moumita Maity Rana, Abdul Qahar Qureshi, Kedar C Vaidya, Shaikh Junaid Ahmed Raziuddin
January-June 2018, 8(1):28-34
DOI:10.4103/ams.ams_153_17  PMID:29963421
Context and Aim: In today's world of advanced dentistry, there are various aspects of restorative, esthetic, and surgical processes. Healing of an extraction socket comprises of bone as well as soft-tissue remodeling with maximum dimensional changes occurring during the first 3 months. Platelet-rich fibrin (PRF) was first developed in France as a therapeutic alternative to platelet-rich plasma to overcome many of its limitations. The present study was planned to evaluate and compare wound healing and bone regeneration in extraction sockets with and without PRF. Materials and Methods: The present study was carried out on 30 patients selected from the outpatient department over a period of 2½ years starting from May 2013 undergoing extraction of maxillary or mandibular teeth simultaneously to conduct a split-mouth study. The research protocol was approved by the Institutional Ethics Committee governing the use of human subjects in clinical experimentation. Statistical Analysis Used: Descriptive and analytical statistics were calculated using Statistical Package for Social Sciences version 19. Chi-square test was used to assess wound healing score in the two groups while paired t-test was used to compare the bone density in the socket and periapical regions at different time intervals, and unpaired t-test was used for the intergroup comparisons. P < 0.05 was considered to be significant while P < 0.001 was considered highly significant. Results: Patients in PRF group had better healing index when compared to without PRF group. Use of PRF showed a comparable increase in bone density too. Conclusion: An appreciable wound healing and bone regeneration was seen in the experimental group when compared to the control sites where no PRF was used substantiating the use of PRF as an inexpensive autologous material for socket preservation and future rehabilitation. The present study, also, showed that minimal operator expertise was required to conduct the procedure of PRF preparation and grafting when compared to bone harvesting from distant sites. The shorter duration between extractions and further rehabilitation obviates the need for a second procedure.
  14,222 1,442 19
Direct v/s Indirect sinus lift in maxillary dental implants
SM Balaji
July-December 2013, 3(2):148-153
DOI:10.4103/2231-0746.119228  PMID:24205474
Introduction: Lack of sufficient bone height along maxillary sinus poses significant difficulty for placement of implants in edentulous maxillary jaw. Minimally invasive sinus augmentation is an effective solution for this problem. The manuscript intends to present long period results of such augmentation using direct (DSAT) and indirect (ISAT) minimally invasive sinus augmentation technique (SAT) from a single center. Materials and Methods: Records of patients who required minimally invasive sinus augmentation to increase residual bone height for implant placement fulfilling predetermined exclusion and inclusion criteria. Only patients with follow-up records for at least a year were considered. Both DSAT and ISAT were employed for sinus augmentation. The age, gender, period of edentulousness, alveolus thickness at crestal level during the pre- and postoperative assessment, implant length, and diameter of implants were collected from case histories. Descriptive statistics, Chi-square, paired test, and one way analysis of variance (ANOVA) was used appropriately. P ≤ 0.05 was considered as significant. Results: There were 197 implants placed and mean age of the group was 40.2 ± 10.7 years. There was a slight male predilection (54.3%). The gain in bone height as expressed in percentage after a year was 134.6%. On comparing the length of residual alveolar bone (RAB) at start and end of study, ISAT had a mean preoperative height of 7.88 mm while postoperative height was 13.22 mm. For DSAT, the mean height at start of treatment was 3.94 mm while at the end it was 10.13 mm. The mean increase in height was 6.19 mm. For both cases, P was 0.000. Discussion: Age, gender, and period of edentulism did not influence the outcome. The alveolar width appears to differ and influence the outcome. When alveolar width increases, wider diameter implants can be placed by compromising height. Thus it is a clinical acumen that would be extremely helpful to gauge the outcome of the condition.
  12,420 2,100 8
TMJ imaging by CBCT: Current scenario
Bhuvana Krishnamoorthy, NS Mamatha, Vinod AR Kumar
January-June 2013, 3(1):80-83
DOI:10.4103/2231-0746.110069  PMID:23662265
Radiographic examination forms an integral component of the clinical assessment routine in patients with temporomandibular joint disorders (TMJ). There are several imaging modalities to visualize the TMJ. Cone beam computed tomography (CBCT) is a developing technique that is being increasingly used in dentomaxillofacial imaging due to its relatively low-dose high-spatial-resolution characteristics. Research in TMJ imaging has been greatly inspired by the advent of CBCT. In this paper we aim to discuss the present scenario of the role of CBCT in TMJ imaging.
  12,484 1,748 29
Development and evolution of distraction devices: Use of indigenous appliances for Distraction Osteogenesis-An overview
Neelam Andrade, Trupti Gandhewar, Rinku Kalra
January-June 2011, 1(1):58-65
DOI:10.4103/2231-0746.83159  PMID:23482829
An attempt has been made to review various devices as well as the outstanding studies done in the past for understanding the methodology of distraction for regeneration of bone. Lengthening of underdeveloped bones inclusive of the maxillofacial complex has been obtained by distraction osteogenesis by many authors. This could be achieved by the use of various extraoral or intraoral devices. Devices used for distraction osteogenesis must have a minimum of 2 important characteristics - they should be able to transfer distraction forces directly to the bone and secondly, should offer adequate rigidity for osseous consolidation to occur. With advanced technology and biomechanical engineering, preformed intraoral distraction devices are now available worldwide. The introduction of these intraoral bone-bourne devices have eliminated the need for bulky, cumbersome extraoral distraction devices which had problems such as external scars, pin tract infections, nerve or tooth bud injuries and poor patient compliance. The design of completely internalized custom made appliance has opened new vistas in the field of Oral and Maxillofacial Surgery. Indigenous internal devices are also economical and locally available.
  11,995 2,007 12
Reduction glossectomy for large tongues
SM Balaji
July-December 2013, 3(2):167-172
DOI:10.4103/2231-0746.119230  PMID:24205477
Pathological enlargement of tongue is caused by several conditions and diseases. In several instances, surgery remains the only viable option for complete cure. Persistent bleeding, compromised neuro-motor-sensory functions during the postoperative period are the most common complaints encountered after macroglossia correction. The tongue is a muscular organ, whose complex neuroanatomy is being unraveled slowly. Various types of macroglossia resections in unique clinical situations have been proposed by several clinicians till date. There has never been unanimously accepted resection for the treatment of macroglossia. This review article attempts to preview the cosmetic and functional components for resection designs.
  12,448 1,424 30
Oral and maxillofacial surgery: Current and future
Guang-Yan Yu
July-December 2013, 3(2):111-112
DOI:10.4103/2231-0746.119209  PMID:24205468
  3,844 10,019 3
Modified facial bipartition
SM Balaji
July-December 2012, 2(2):170-173
DOI:10.4103/2231-0746.101348  PMID:23483335
Orbital hypertelorism is a craniofacial abnormality that arises on its own or as part of a number of syndromes. It is not uncommon to find the condition in association with maxillary hypoplasia. This manuscript reports an uncommon case of Tessier 2, 12 with orbital hypertelorism and dentoskeletal maxillary prognathism. To correct the condition, the first stage procedure was a modification of facial bipartition, according to the need of the case, followed by correction of alar cleft by Denonvilliers technique.
  13,127 647 -
Providing quality assurance for the Annals of Maxillofacial Surgery
Khursheed F Moos
July-December 2011, 1(2):99-100
DOI:10.4103/2231-0746.92762  PMID:23479556
  3,384 10,106 3
The syndromic multiple odontogenic keratocyst in siblings: A familial study
Vimal Kalia, Nitin Kaushal, Geeta Kalra
January-June 2011, 1(1):77-82
DOI:10.4103/2231-0746.83156  PMID:23483828
Purpose: Our aim is to demonstrate the importance of postoperative assessment and highlight the need for a lifetime follow-up of the patient and the siblings in cases of Nevoid Basal Cell Carcinoma Syndrome (NBCCS). Materials and Methods : Three siblings out of which two were of syndromic multiple odontogenic keratocysts, with multiple basal cell nevae were followed-up for manifestations of NBCCS from year 2001 till date. Two of the patients were treated for multiple bilateral odontogenic keratocysts (OKCs). Familial occurrence of the syndromic multiple odontogenic keratocysts was studied. Result: Although NBCCS is associated with multiple OKCs, it does not imply that a patient should have more than one cyst at a given point in time, rather it refers to the lifetime history of the patient. Early diagnosis will often make it possible to use conservative therapies rather than complex treatments. Conclusion: Recognition of the syndrome permits early treatment in other but possibly asymptomatic relatives. Close attention of the family and past medical history and physical examination will alert the clinician to its presence, allowing for appropriate genetic counseling and serial screening for the development of malignancies and other complications besides OKCs.
  12,530 690 3
The role of distraction osteogenesis in the management of craniofacial syndromes
Andrew A Heggie, Ricky Kumar, Jocelyn M Shand
January-June 2013, 3(1):4-10
DOI:10.4103/2231-0746.110063  PMID:23662252
Distraction osteogenesis (DO) has been established as a useful technique in the correction of skeletal anomalies of the long bones for several decades. However, the use of DO in the management of craniofacial deformities has been evolving over the past 20 years, with initial experience in the mandible, followed by the mid-face and subsequently, the cranium. This review aims to provide an overview of the current role of DO in the treatment of patients with craniofacial anomalies.
  11,865 1,338 12
Review of secondary alveolar cleft repair
Gui-Youn Cho-Lee, Eloy-Miguel García-Díez, Richard-Agostinho Nunes, Carles Martí-Pagès, Ramón Sieira-Gil, Alejandro Rivera-Baró
January-June 2013, 3(1):46-50
DOI:10.4103/2231-0746.110083  PMID:23662259
Introduction: The alveolar cleft is a bony defect that is present in 75% of the patients with cleft lip and palate. Although secondary alveolar cleft repair is commonly accepted for these patients, nowadays, controversy still remains regarding the surgical technique, the timing of the surgery, the donor site, and whether the use of allogenic materials improve the outcomes. The purpose of the present review was to evaluate the protocol, the surgical technique and the outcomes in a large population of patients with alveolar clefts that underwent secondary alveolar cleft repair. Materials and Methods: A total of 109 procedures in 90 patients with alveolar cleft were identified retrospectively after institutional review board approval was obtained. The patients were treated at a single institution during a period of 10 years (2001-2011). Data were collected regarding demographics, type of cleft, success parameters of the procedure (oronasal fistulae closure, unification of the maxillary segments, eruption and support of anterior teeth, support to the base of the nose, normal ridge form for prosthetic rehabilitation), donor site morbidity, and complications. Pre- and postoperative radiological examination was performed by means of orthopantomogram and computed tomography (CT) scan. Results: The average patient age was 14.2 years (range 4-21.3 years). There were 4 right alveolar-lip clefts, 9 left alveolar-lip clefts, 3 bilateral alveolar-lip clefts, 18 right palate-lip clefts, 40 left palate-lip clefts and 16 bilateral palate-lip clefts. All the success parameters were favorable in 87 patients. Iliac crest bone grafts were employed in all cases. There were three bone graft losses. In three cases, allogenic materials used in a first surgery performed in other centers, underwent infection and lacked consolidation. They were removed and substituted by autogenous iliac crest bone graft. Conclusions: The use of autogenous iliac crest for secondary alveolar bone grafting achieves all these several objectives: (1) to obtain maxillary arch continuity, (2) to maximize bone support for the dentition, (3) to stabilize the maxillary segments after orthodontic treatment, (4) to eliminate oronasal fistulae, (5) to provide nasal alar cartilage support, (6) to establish ideal alveolar morphology, and (7) to provide available bone with attached soft tissue for future endosteal implant placement in cases where there is a residual dental space. We advocate for the use of a minimal incision to obtain the iliac crest bone graft and for the use of a corticocancellous block of bone in combination with bone chips.
  11,305 1,714 29
Comparison of vestibular sulcus depth in vestibuloplasty using standard Clark's technique with and without amnion as graft material
Basavaraj C Sikkerimath, Satyajit Dandagi, Santosh S Gudi, Deeptha Jayapalan
January-June 2012, 2(1):30-35
DOI:10.4103/2231-0746.95313  PMID:23482953
Introduction: A number of materials are used as grafts in vestibuloplasty like mucosal and skin grafts with several advantages and disadvantages. To circumvent the disadvantages of these grafts, biological membranes such as amnion membranes are often recommended. Materials and Methods: The objective of this study was to clinically assess the vestibular sulcus depth in vestibuloplasty using Clark's technique with and without amnion as graft material. Twenty edentulous patients underwent mandibular labial vestibuloplasty using Clark's technique. Amnion was used as graft material in 10 patients (group I) and no grafts used in remaining 10 patients (group II). The vestibular depth was evaluated at time intervals of 1 week, 2 weeks, 1 month and 3 months, postoperatively. Results: Mean postoperative vestibular depth after 3 months in group I and II were 10.0 ± 3.13 mm and 7.8±0.63 mm, respectively. Mean of 2.2 ± 2.50 mm increase in depth was achieved after 3 months in Group I. Conclusion: Amnion graft is a viable and reliable option that promotes early healing and maintains postoperative vestibular depth.
  11,488 1,332 3
The nature of surgical education early in the 21 st century
Paul Sambrook
July-December 2014, 4(2):125-126
  2,756 10,048 -
Styloid-stylohyoid syndrome
Shivani Jain, Ashok Bansal, Samrity Paul, Deepti Vashisht Prashar
January-June 2012, 2(1):66-69
DOI:10.4103/2231-0746.95326  PMID:23483633
This is a case report of Eagle's syndrome due to osseous metaplasia of the stylohyoid apparatus treated conservatively by injection of a local anesthetic - steroid combination. The incidence, etiopathogenesis, classification, clinical picture and various approaches to treatment of ossified stylohyoid ligament associated with Eagle's syndrome have been discussed. Anterolateral glossodynia, which is a previously unreported finding in Eagle's syndrome, and its possible etiology, has also been discussed.
  11,897 682 1
Microsurgical free flaps: Controversies in maxillofacial reconstruction
Rinku K George, Arvind Krishnamurthy
January-June 2013, 3(1):72-79
DOI:10.4103/2231-0746.110059  PMID:23662264
Reconstructive microsurgery for oral and maxillofacial (OMF) defects is considered as a niche specialty and is performed regularly only in a handful of centers. Till recently the pectoralis major myocutaneous flap (PMMC) was considered to be the benchmark for OMF reconstruction. This philosophy is changing fast with rapid advancement in reconstructive microsurgery. Due to improvement in instrumentation and the development of finer techniques of flap harvesting we can positively state that microsurgery has come of age. Better techniques, microscopes and micro instruments enable us to do things previously unimaginable. Supramicrosurgery and ultrathin flaps are a testimony to this. Years of innovation in reconstructive microsurgery have given us a reasonably good number of very excellent flaps. Tremendous work has been put into producing some exceptionally brilliant research articles, sometimes contradicting each other. This has led to the need for clarity in some areas in this field. This article will review some controversies in reconstructive microsurgery and analyze some of the most common microvascular free flaps (MFF) used in OMF reconstruction. It aims to buttress the fact that three flaps-the radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and fibula are the ones most expedient in the surgeon's arsenal, since they can cater to almost all sizeable defects we come across after ablative surgery in the OMF region. They can thus aptly be titled as the workhorses of OMF reconstruction with regard to free flaps.
  11,274 1,273 9
Residual diplopia in treated orbital bone fractures
SM Balaji
January-June 2013, 3(1):40-45
DOI:10.4103/2231-0746.110078  PMID:23662258
Background: Residual diplopia (RD) is the main post-treatment complication of orbital bone fracture (OBF) reduction. The cause of RD is varied and often related to the degree of inflammation, surgical timing, graft requirement, and trauma to orbital musculature, fat, as well as nerves. The exact prevalence of these and the influence of these factors on RD is not widely reported in literature. Materials and Methods: This retrospective study was conducted from January 1, 2000 through December 31, 2011. Sixty nine patients fulfilling inclusion and exclusion criteria were enrolled in this study. The nature of the defect causing RD was identified. Demographics, nature of initial OBF, extent and type of treatment, and grafts were noted. Corrective surgeries were performed. Data entry and analysis were performed using SPSS. Descriptive statistics and Chi square tests were employed. P value ≤ 0.05 was taken as significant. Results: Inferior rectus muscle (71%) and other periorbital musculature (56.5%) was entrapped, leading to RD. Globe position abnormalities was observed in 52.1% of cases. Degree of inflammation, types of grafts (P = 0.000) were significantly related. Discussion: Preoperative swelling, musculature inflammation, and graft placement significantly influenced the surgical outcome of OBF. RD is related to these factors. Adequate control with OBF healing and remodeling needs to be considered while timing OBF. Author's modification with mesh and cartilage in secondary corrective surgery for RD provided an effective solution for immediate intervention.
  11,536 822 11