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   2013| July-December  | Volume 3 | Issue 2  
    Online since October 3, 2013

 
 
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GUEST EDITORIAL
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
  3,131 9,958 1
ORIGINAL CLINICAL STUDIES - COMPARATIVE STUDY: IMPLANTS
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.
  10,405 1,923 6
REVIEW ARTICLES
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.
  10,515 1,280 22
ORIGINAL CLINICAL STUDIES - COMPARATIVE STUDY: TRAUMA
Conventional 2.0 mm miniplates versus 3-D plates in mandibular fractures
Bipin S Sadhwani, Sonal Anchlia
July-December 2013, 3(2):154-159
DOI:10.4103/2231-0746.119231  PMID:24205475
Aim: To compare and evaluate the treatment outcome and postoperative complications in mandibular fractures using 2- and 3-dimensional miniplates. Materials and Methods: This study consisted of a sample of 28 patients (40 fracture sites) divided randomly but equally (single-blind control trial study) into two groups. Each group contains 14 patients (20 similar fracture sites in each group). Group 1 was treated with open reduction and internal fixation using 3-dimensional (3-D) miniplates. Group II was treated using 2-dimensional (2-D) 2-mm miniplates. Results: Out of 14 patients treated by conventional 2-mm miniplates, 2 patients developed occlusal discrepancy, another 2 had postoperative mobility at fracture site, and 1 developed plate failure and subsequent infection, which was treated by removal of the plate under antibiotic coverage. One patient treated by 3-dimensional plates had tooth damage. Statistical Analysis: Chi-square test. Conclusion: The results of this study suggested that the treatment of mandibular fractures (symphysis, parasymphysis, and angle) with 3-dimensional plates provided 3-dimensional stability and carried low morbidity and infection rates. The only probable limitations of 3-dimensional plates were excessive implant material due to the extra vertical bars incorporated for countering the torque forces.
  7,793 1,172 10
ORIGINAL RESEARCH - EMERGING TECHNOLOGY
GMP-level adipose stem cells combined with computer-aided manufacturing to reconstruct mandibular ameloblastoma resection defects: Experience with three cases
Jan Wolff, George K Sándor, Aimo Miettinen, Veikko J Tuovinen, Bettina Mannerström, Mimmi Patrikoski, Susanna Miettinen
July-December 2013, 3(2):114-125
DOI:10.4103/2231-0746.119216  PMID:24205470
Background: The current management of large mandibular resection defects involves harvesting of autogenous bone grafts and repeated bending of generic reconstruction plates. However, the major disadvantage of harvesting large autogenous bone grafts is donor site morbidity and the major drawback of repeated reconstruction plate bending is plate fracture and difficulty in reproducing complex facial contours. The aim of this study was to describe reconstruction of three mandibular ameloblastoma resection defects using tissue engineered constructs of beta-tricalcium phosphate (β-TCP) granules, recombinant human bone morphogenetic protein-2 (rhBMP-2), and Good Manufacturing Practice (GMP) level autologous adipose stem cells (ASCs) with progressively increasing usage of computer-aided manufacturing (CAM) technology. Materials and Methods: Patients' three-dimensional (3D) images were used in three consecutive patients to plan and reverse-engineer patient-specific saw guides and reconstruction plates using computer-aided additive manufacturing. Adipose tissue was harvested from the anterior abdominal walls of three patients before resection. ASCs were expanded ex vivo over 3 weeks and seeded onto a β-TCP scaffold with rhBMP-2. Constructs were implanted into patient resection defects together with rapid prototyped reconstruction plates. Results: All three cases used one step in situ bone formation without the need for an ectopic bone formation step or vascularized flaps. In two of the three patients, dental implants were placed 10 and 14 months following reconstruction, allowing harvesting of bone cores from the regenerated mandibular defects. Histological examination and in vitro analysis of cell viability and cell surface markers were performed and prosthodontic rehabilitation was completed. Discussion: Constructs with ASCs, β-TCP scaffolds, and rhBMP-2 can be used to reconstruct a variety of large mandibular defects, together with rapid prototyped reconstruction hardware which supports placement of dental implants.
  7,163 1,124 25
CASE REPORT - SURGICAL PATHOLOGY
Pleomorphic adenoma palate: Major tumor in a minor gland
Nanda Kishore Sahoo, Mohan N Rangan, Rajashekhar D Gadad
July-December 2013, 3(2):195-197
DOI:10.4103/2231-0746.119220  PMID:24205483
Pleomorphic adenoma (PA) is the most common benign mixed salivary gland neoplasm that accounts for 60% of all benign salivary gland tumors. It has diverse histological presentation and occurs in both major and minor salivary glands. PA of minor salivary gland in the palate is a common entity. We report the case of a 45-year-old female who presented with a painless slow growing swelling of palate over the last 20 years. The mass was extending to oropharynx causing mechanical obstruction of airway. Magnetic resonance imaging (MRI) depicted an oval-shaped mass occupying oropharynx and displacing the tongue inferiorly. Fine needle aspiration cytology (FNAC) was suggestive of PA. The entire tumor mass was excised along with overlying mucosa. Histopathological examination confirmed diagnosis of PA of minor salivary gland. There has been no recurrence of the lesion since 1 year.
  6,313 771 7
CASE REPORT - DEVELOPMENTAL DISTURBANCES
Congenital muscular torticollis
Kumar Nilesh, Srijon Mukherji
July-December 2013, 3(2):198-200
DOI:10.4103/2231-0746.119222  PMID:24205484
Congenital muscular torticollis (CMT) is a rare congenital musculoskeletal disorder characterized by unilateral shortening of the sternocleidomastoid muscle (SCM). It presents in newborn infants or young children with reported incidence ranging from 0.3% to 2%. Owing to effective shortening of SCM on the involved side there is ipsilateral head tilt and contralateral rotation of the face and chin. This article reports a case of CMT in a 3½-year-old male child successfully managed by surgical release of the involved SCM followed by physiotherapy.
  5,816 784 16
ORIGINAL RESEARCH - MATERIAL SCIENCE
Synthetic bone substitute material comparable with xenogeneic material for bone tissue regeneration in oral cancer patients: First and preliminary histological, histomorphometrical and clinical results
Shahram Ghanaati, Mike Barbeck, Jonas Lorenz, Stefan Stuebinger, Oliver Seitz, Constantin Landes, Adorján F Kovács, Charles J Kirkpatrick, Robert A Sader
July-December 2013, 3(2):126-138
DOI:10.4103/2231-0746.119221  PMID:24205471
Background: The present study was first to evaluate the material-specific cellular tissue response of patients with head and neck cancer to a nanocrystalline hydroxyapatite bone substitute NanoBone (NB) in comparison with a deproteinized bovine bone matrix Bio-Oss (BO) after implantation into the sinus cavity. Materials and Methods: Eight patients with tumor resection for oral cancer and severely resorbed maxillary bone received materials according to a split mouth design for 6 months. Bone cores were harvested prior to implantation and analyzed histologically and histomorphometrically. Implant survival was followed-up to 2 years after placement. Results: Histologically, NB underwent a higher vascularization and induced significantly more tartrate-resistant acid phosphatase-positive (TRAP-positive) multinucleated giant cells when compared with BO, which induced mainly mononuclear cells. No significant difference was observed in the extent of new bone formation between both groups. The clinical follow-up showed undisturbed healing of all implants in the BO-group, whereas the loss of one implant was observed in the NB-group. Conclusions: Within its limits, the present study showed for the first time that both material classes evaluated, despite their induction of different cellular tissue reactions, may be useful as augmentation materials for dental and maxillofacial surgical applications, particularly in patients who previously had oral cancer.
  4,916 1,055 25
TECHNICAL NOTE
Modified method of analysis for surgical correction of facial asymmetry
Terpsithea Christou, Chung How Kau, Peter D Waite, Nadia Abou Kheir, David Mouritsen
July-December 2013, 3(2):185-191
DOI:10.4103/2231-0746.119218  PMID:24205481
Introduction: The aim of this article was to present a new method of analysis using a three dimensional (3D) model of an actual patient with facial asymmetry, for the assessment of her facial changes and the quantification of the deformity. This patient underwent orthodontic and surgical treatment to correct a severe facial asymmetry. Materials and Methods: The surgical procedure was complex and the case was challenging. The treatment procedure required an orthodontic approach followed by Le Fort I osteotomy, bilateral sagittal split osteotomy, septorhinoplasty and chin advancement. The imaging devices used in this paper is the 3dMDface system (Atlanta, GA) and the Kodak 9500 Cone Beam 3D system device (Atlanta, GA). 3D digital stereophotogrammetric cameras were used for image acquisition and a reverse modeling software package, the Rapidform 2006 Software (INUS Technology, Seoul, Korea) was applied for surface registration. The images were also combined and analyzed using the 3dMD vultus (Atlanta, GA) software and InVivoDental 5.2.3 (San Jose, CA). All data gathered from previously mentioned sources were adjusted to the patient's natural head position. Results: The 3D images of the patient were taken and analyzed in three time frames; before orthodontics and surgical treatment (T 1 ), at the end of orthodontic therapy and before surgery (T 2 ) and about 2 months after surgery (T 3 ). The patient showed significant improvement of her skeletal discrepancy between T 1 and T 3 . In addition, there were some dentoalveolar changes between T 1 and T 2 as expected. The 3D analysis of surgical changes on the 3D models correlated very well to the actual surgical movements. Conclusions: The use of these 3D imaging tools offer a reliable accuracy to accessing and quantifying changes that occur after surgery. This study shows supportive evidence for the use of 3D imaging techniques.
  4,779 572 6
ORIGINAL CLINICAL STUDIES - EVALUATIVE STUDY
Stability of Cleft maxilla in Le Fort I Maxillary advancement
Pushpa Kumari, SK Roy, ID Roy, Prasanna Kumar, Sanjeev Datana, Serat Rahman
July-December 2013, 3(2):139-143
DOI:10.4103/2231-0746.119223  PMID:24205472
Context: Le Fort 1 maxillary osteotomy in operated patients of cleft lip and cleft palate (CLCP). Aims: To study stability of Le Fort 1 maxillary osteotomy in operated patients of CLCP by two-dimensional evaluation using cephalometric analysis. Settings and Design: Prospective study conducted at Army Dental Centre (Research and Referral) from May 2009-May 2012. Materials and Methods: Subjects included nine consecutively operated patients of CLCP with maxillary hypoplasia. Maxillary advancement by Le Fort 1 maxillary step osteotomy was performed. There were four males and five females with an age range of 16-18 years and follow-up range was 12-36 months. Presurgical and postsurgical changes were compared using cephalometrics for orthognathic surgery (COGS) system to determine stability of maxillary movement and quantify amount of relapse at 15 days and 12 months. Statistical Analysis: Student's t-test. Results: Mean linear horizontal advancement achieved along nasion (N) to anterior nasal spine (ANS) with reference to true vertical plane at 15 days and 12 months was 5.17 and 3.91 mm, respectively. The mean relapse in anteroposterior dimension was 21.63%. The mean vertical displacement observed along nasion and ANS with reference to true horizontal plane at 15 days and 12 months was 5.21 mm and 3.2, respectively with a resultant relapse of 41.54%. Conclusions: Based on clinical and COGS analysis, it is evident that Le Fort 1 advancement in operated cases of CLCP has inherent potential for relapse.
  3,906 919 10
TECHNICAL NOTE
The use of mandibular body distraction in hemifacial microsomia
Yoshiaki Sakamoto, Hideo Nakajima, Hisao Ogata, Kazuo Kishi
July-December 2013, 3(2):178-181
DOI:10.4103/2231-0746.119211  PMID:24205479
Objective: The goals of treatment for hemifacial microsomia include horizontalization of occlusal plane and acquisition of facial symmetry. Although horizontalization of occlusal plane can be easily achieved, facial symmetry, particularly in relation to mandibular contour, can be difficult to attain. Soft tissue is generally reconstructed to correct facial asymmetry, and no studies have described correction of facial asymmetry through skeletal reconstruction. Case: A 12-year-old girl presented with grade IIb right-sided hemifacial microsomia. She was treated using Nakajima's angle-variable internal distraction (NAVID) system for mandibular body distraction. Results: Following treatment, appropriate facial symmetry was achieved, and the patient was extremely satisfied with the results. Conclusions: Thus, we successfully treated the present patient by our novel method involving distraction osteogenesis. This method was effective and useful for several reasons including; the changes were not accompanied by postoperative tissue absorption, donor sites were not involved, and the treatment outcome could be reevaluated by adjusting distraction while the patient's appearance was being remodeled.
  4,147 469 6
EDITORIAL
To distract or not to distract
SM Balaji
July-December 2013, 3(2):113-113
DOI:10.4103/2231-0746.119210  PMID:24205469
  2,060 2,121 -
ORIGINAL CLINICAL STUDIES - SURGICAL INNOVATION
Oral reconstruction with submental flap
Amin Rahpeyma, Saeedeh Khajehahmadi
July-December 2013, 3(2):144-147
DOI:10.4103/2231-0746.119224  PMID:24205473
Background: Submental flap is a useful technique for reconstruction of medium to large oral cavity defects. Hair bearing nature of this flap in men makes it less appropriate. Therefore, deepithelialized variant is introduced to overcome the problem of hair with this flap. Recently, application of this flap has been introduced in maxillofacial trauma patients. Materials and Methods: Deepithelialized orthograde submental flap is used for the reconstruction of oral cavity mucosal defects. Results: Four cases including two trauma patients and two squamous cell carcinomas (SCCs) of oral cavity were treated using deepithelialized orthograde submental flap. There were no complications in all four patients and secondary epithelialization occurred in raw surface of the flap which was exposed to oral cavity. Conclusion: Deepithelialized orthograde submental flap is very effective in reconstruction of oral cavity in men. The problem of hair is readily solved using this technique without jeopardizing flap blood supply.
  3,318 706 8
REVIEW ARTICLES
Simultaneous options for cleft secondary deformities
Domenico Scopelliti, Flavia Maria Graziana Fatone, Orlando Cipriani, Piero Papi
July-December 2013, 3(2):173-177
DOI:10.4103/2231-0746.119229  PMID:24205478
Introduction: So much has been written by so many about secondary procedures in cleft surgery that testify not only the complexity and variable expression of cleft deformity itself but also the need to find methods of primary surgery that will reduce, if not avoid, adverse effects on all the structures and functions involved and affected. It must be the principal aim of cleft surgeon to restore the deformed and displaced regional anatomy to as close to normality as possible, whether or not true hypoplasia exists. The pathogenesis of secondary deformities is related to specific features as: the presence of scar tissues into the cleft basal bone area, that inhibits alveolar growth; scarring of palatal soft tissue, that inhibits growth and causes palatal orientation of dentoalveolar elements; and the exceeding lip tension, that may inhibits maxillary growth along dentoalveolar structures. Materials and Methods: From 2008 to 2011 at the Department of Cranio-Maxillo-Facial Surgery, Santo Spirito Hospital, Rome 25 patients (21 males and 4 females) who had undergone previous surgery for unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) were enrolled in our study. Diagnosis of deformity was made by means of a cephalometric and photographic analysis (Arnett), gipsometry and a radiological assessment (orthopantomography, lateral and frontal cephalometric X-rays). Moreover, every patient was studied with a temporomandibular joint (TMJ) tomography, TMJ magnetic resonance imaging (MRI) and a computerized gnatography to better evaluate potential TMJ dysfunctions. The surgical procedures adopted simultaneously were: Total or segmental maxillomandibular osteotomies, genioplasty, rhinoplasty, labioplasty, and application of facial prosthesis. Every patient received a postoperative questionnaire to evaluate his/her satisfaction with the surgery performed. Results: The surgical procedures adopted were Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) in 16 patients (65%) and only Le Fort I osteotomy in 9 patients (35%). A relapse of malformation occurred in 4.5% of cases. Concerning the patient questionnaire, 96% of patients were satisfied with the jaw surgery and favorable for combined surgery, 88% were satisfied with lip-nose surgery, and finally 76% would advise to a friend. Conclusions: Simultaneous correction of the deformities is indicated as to avoid several surgical distresses for the patient, to improve facial aesthetic and function in one surgical step, and to reduce risk of psychological consequences.
  3,407 466 3
Antidepressants relevant to oral and maxillofacial surgical practice
J Thomas Lambrecht, Christian Greuter, Christian Surber
July-December 2013, 3(2):160-166
DOI:10.4103/2231-0746.119233  PMID:24205476
Background: Depression is commonly associated with a high-carbohydrate diet, lack of interest in proper oral hygiene and xerostomia connected to the use of antidepressants. Patients often consult their dentists as a result of changes affecting the hard dental substance and the soft-tissues. Aim: The aim of this study was to identify adverse drug interactions between the antidepressants and medications commonly administered in dentistry in order to give practicing dentists an overview of the scientific literature. Objective: The objective is to identify the adverse drug interactions between antidepressants and medication commonly administered in dentistry. Study Design: The literature search was performed using PubMed, Cochrane and the specific search items. The review (1984-2009) focused on medicines used in dental practice (vasoconstrictors, non-opioid analgesics, non-steroidal anti-inflammatory drugs, antibiotics, antifungals and benzodiazepines). Results: There are various drug interactions between antidepressants and medicines used in dentistry. When two or more drugs are co-administered, a drug interaction must always be anticipated though many of the interactions are potential problems, but do not seem to be real clinical issues. Conclusion: The probability of a drug interaction can be minimized by careful history-taking, skillful dose adjustment and safe administration of the therapeutic agent.
  3,372 446 3
TECHNICAL NOTE
Parotid fistula from transparotid approach for mandibular subcondylar fracture reduction
SM Balaji
July-December 2013, 3(2):182-184
DOI:10.4103/2231-0746.119214  PMID:24205480
Injury and/or damage to the parotid salivary glandular element during mandible condylar fracture approach is a rare event that leads to accumulation of saliva in the gland, leading to formation of a sialocele. Huge sialocele often seeks drain through the most dependent area through an extraoral wound. A case of parotid fistula (PF) caused by damage to glandular elements during a transparotid approach for a subcondylar fracture reduction is reported. The mechanism of damage and all possible sequels for the condition is being discussed. The method of surgical intervention for this condition is also discussed.
  3,323 434 6
CASE REPORT - SURGICAL PATHOLOGY
Primary peripheral primitive neuroectodermal tumor of the mandible
Arvind Krishnamurthy, Vijayalakshmi Ramshankar, Urmila Majhi, Rinku George
July-December 2013, 3(2):192-194
DOI:10.4103/2231-0746.119219  PMID:24205482
Primitive neuroectodermal tumor (PNET) is a broad term that includes a wide array of lesions with varying differentiating potential affecting both the central and peripheral nervous system. Peripheral PNET (pPNET), a variant of PNET, is known to arise in many places throughout the body; involvement of the mandible is however rare. A review of the scientific literature describes only seven reports of pPNET to be arising from the mandible. Given their insidious clinical symptoms, variable locations and rarity, the accurate diagnosis of peripheral PNETs poses a challenge for clinicians. PNETs exhibits characteristic immunophenotypical and genetic features that distinguish them from other small round cell tumors. A multidisciplinary approach is necessary to manage patients affected by PNET. There is however no consensus about the best therapeutic strategy. We recently got to treat a young patient with mandibular PNET; the clinical course as well as the histopathology with immunohistochemistry correlation of this rare entity is discussed.
  2,119 295 -
LETTER TO THE EDITOR
Cleaning problems associated with diamond trephine drills in bone surgery
Peer W Kämmerer, Paul Heymann, Victor Palarie, Andreas Neff, Florian G Draenert
July-December 2013, 3(2):201-202
DOI:10.4103/2231-0746.119226  PMID:24205485
  830 75 -
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