The development of three-dimensional computer-aided surgical workflow has simplified the planning of complex reconstruction cases. It can also be helpful in planning distraction osteogenesis cases. This article examines the evolving role of three-dimensional computer-aided surgical workflow in maxillofacial surgery.

Purpose of the Study: To predict the changes and evaluate the stability that occurs in the soft tissues following the skeletal movement subsequent to surgical advancement of the mandible through bilateral sagittal split osteotomy and to provide the patient reliable information with regard to esthetic changes that can be expected following the treatment. Materials and Methods: Twenty adult patients diagnosed with skeletal class II malocclusion and underwent bilateral sagittal split osteotomy for mandibular advancement by a mean of 8 mm using rigid fixation were included in the study. Soft tissue changes brought about by the surgical procedure and their stability over a period of time were evaluated prospectively using 12 linear (4 vertical and 8 horizontal) and 4 angular measurements on profile cephalograms which were taken preoperatively after the pre-surgical orthodontics (T1) and postoperatively with duration of 1 month (T2) and 6 months (T3) respectively. Results: It was observed that compared to the linear measurements, the angular measurements showed significant changes. The improvement in the esthetic outcome is a direct reflection of the angular changes whereas the linear changes played a contributing role. Following mandibular advancement surgery the profiles of the patients was perceived to have improved with reduction in the facial convexity, an increase in the lower facial height, decrease in the depth of the mentolabial sulcus and improvement in the lip competency with lengthening, straightening and thinning of the lower lip. Conclusion: The soft tissue response and its stability depends on the stability of the surgical procedure itself, postsurgical growth and remodeling of the hard tissues and soft tissue changes as a result of maturation and aging.

Volunteer missions for cleft lip and palate (CLP) care in Indonesia (1991-1992), India (1994-2003), Bhutan (2005-2010), and Kenya (2011), took place always at the same Hospital in each country. Altogether over a thousand patients were operated using a conservative protocol: Safety first - no experiments. Five months and 5 kg were the basic rules. For the native doctors, training help for self-help was priority. In the announcements, patients with CLP were primarily addressed. Burns, contractions, tumors, and trauma-cases were the second priority. Fresh trauma was done in night shifts with the local surgeons in order not to interfere. Besides facial esthetics speech was the number one issue, following priorities fell into place. Cultural aspects played a certain role in the different countries and continents.

Objective: The treatment of comminuted mandibular fractures is challenging due to the severity of associated injuries and the need for a careful diagnosis with adequate treatment planning. Recently, open reduction and stable internal fixation (OR-IF) with a load-bearing reconstruction plate have been advocated for reliable clinical outcomes with minimal complications. This clinical prospective study evaluated OR-IF in the surgical management of comminuted mandibular fractures with a new low-profile, thin, mandibular locking reconstruction plate. Materials and Methods: We prospectively assessed OR-IF of comminuted mandibular fractures with a low-profile locking mandibular reconstruction plate in 12 patients (nine men, three women; mean age 32.2 [range 16-71] years) between April 2010 and December 2011. The clinical characteristics and associated clinical parameters of patients were evaluated over a minimum follow-up period of 12 months. Results: Traffic accidents caused 50% of the fractures, followed by falls (25%). Four patients (33.3%) had associated midfacial maxillofacial fractures, while five patients had other mandibular fractures. Seven patients (58.3%) needed emergency surgery, mostly for airway management. Anatomical reduction of the comminuted segments re-established the mandibular skeleton in stable occlusion with rigid IF via extraoral (33.3%), intraoral (50%), or combined (16.7%) approaches. Immediate functional recovery was achieved. Sound bone healing was confirmed in all patients, with no complications such as malocclusion, surgical site infection, or malunion with a mean follow-up of 16.3 (range 12-24) months. Conclusions: OR-IF using a low-profile reconstruction plate system is a reliable treatment for comminuted mandibular fractures, enabling immediate functional recovery with good clinical results.

Purpose: The host tissue reaction to the xenogeneic bone substitute Bio-Oss™ (Geistlich Biomaterials, Wolhousen, Switzerland) was investigated focusing on the participating inflammatory cells and implantation bed vascularization. Materials and Methods: Bio-Oss™ was implanted subcutaneously into CD1 mice for up to 60 days and analyzed by means of specialized histological and histomorphometrical techniques after explantation. Results: Bio-Oss™ induced within the first 15 days an early high vascularization combined with a marked presence of multinucleated giant cells. The latter cells were associated mainly with the smaller sized granules within the implantation bed. Toward the end of the study the number of multinucleated giant cells decreased while the tissue reaction to the larger granules was mainly mononuclear. Conclusion: The results of the present study showed that smaller xenogeneic bone substitute granules induce multinucleated giant cells, whereas the larger-sized ones became integrated within the implantation bed by means of a mononuclear cell-triggered granulation tissue. Obviously, the presence of multinucleated giant cells within biomaterial implantation beds is not only related to the type of synthetic bone substitute material, but also to the granule size of the "natural-based" xenogeneic bone substitute material.

Context: Oronasal fistula (ONF) following cleft palate (CP) repair are a challenging problem associated with high recurrent rates. Acellular dermal matrix allograft is an available tissue substitute. Aims: The aim of this study was to evaluate the effectiveness of acellular dermal matrix in the repair of ONF associated with CP that is recurrent or larger than 15 mm in any dimension. Settings and Design: This is a prospective study where 12 patients with repaired CP suffering from ONF of the hard palate >15 mm in diameter were included. Materials and Methods: Age ranged from 12 to 25 years. Acellular dermal matrix was firmly secured between repaired oral and nasal mucosal layers. Patients were clinically followed-up for 6 months postoperatively to assess total time for complete healing, dehiscence and/or refistulaization. Statistical Analysis Used: Fisher's exact test. Results: Acellular dermal matrix was integrated with successful fistula closure in all except 1 patient where failure of graft integration was noticed early postoperatively. In 6 patients, the oral mucosal layer showed dehiscence, through which the graft was exposed. Graft integration extended from 4 to 12 weeks postoperatively during which patients were instructed to follow a soft diet and meticulous oral hygiene measures. Conclusions: Acellular dermal matrix allografts are safe and effective adjuncts for use in closure of ONF in the hard palate that is recurrent or larger than 15 mm in any dimension.

Purposes: The purpose of this study was to compare the distraction forces and the biomechanical effects between two different intraoperative surgical procedures (down-fracture [DF] and non-DF [NDF]) for maxillary distraction osteogenesis. Materials and Methods: Eight patients were assigned into two groups according to the surgical procedure: DF, n = 6 versus NDF, n = 2. Lateral cephalograms taken preoperatively (T1), immediately after removal of the distraction device (T2), and after at least a 6 months follow-up period (T3) were analyzed. Assessment of distraction forces was performed during the distraction period. The Mann-Whitney U-test was used to compare the difference in the amount of advancement, the maximum distraction force and the amount of relapse. Results: Although a significantly greater amount of maxillary movement was observed in the DF group (median 9.5 mm; minimum-maximum 7.9-14.1 mm) than in the NDF group (median 5.9 mm; minimum-maximum 4.4-7.6 mm), significantly lower maximum distraction forces were observed in the DF (median 16.4 N; minimum-maximum 15.1-24.6 N) than in the NDF (median 32.9 N; minimum-maximum 27.6-38.2 N) group. A significantly greater amount of dental anchorage loss was observed in the NDF group. Moreover, the amount of relapse observed in the NDF group was approximately 3.5 times greater than in the DF group. Conclusions: In this study, it seemed that, the use of the NDF procedure resulted in lower levels of maxillary mobility at the time of the maxillary distraction, consequently requiring greater amounts of force to advance the maxillary bone. Moreover, it also resulted in a reduced amount of maxillary movement, a greater amount of dental anchorage loss and poor treatment stability.

Aim: The aim of this study was to evaluate the accuracy of 3D soft tissue predictions generated by a computer-aided maxillofacial planning system in patients undergoing orthognathic surgery. Methods and Materials: Twenty patients with dentofacial dysmorphosis were treated with orthognathic surgery after a preoperative orthodontic treatment. Fourteen patients had an Angle Class II malocclusion; three patients had an Angle class III malocclusion, and three patients had an Angle Class I malocclusion. Skeletal asymmetry was observed in six patient. The surgeries were planned using the Maxilim software. Computer assisted surgical planning was transferred to the patient by digitally generated splints. The validation procedures were performed in the following steps: (1) Standardized registration of the pre- and postoperative Cone Beam CT volumes; (2) Automated adjustment of the bone-related planning to the actual operative bony displacement; (3) Simulation of soft tissue changes; (4) Calculation of the soft tissue differences between the predicted and the postoperative results by distance mapping. Statistical Analysis and Results: Eighty four percent of the mapped distances between the predicted and actual postoperative results measured between -2 mm and +2 mm. The mean absolute linear measurements between the predicted and actual postoperative surface was 1.18. Our study shows the overall prediction was dependent on neither the surgical procedures nor the dentofacial deformity type. Conclusion: Despite some shortcomings in the prediction of the final position of the lower lip and cheek area, this software promises a clinically acceptable soft tissue prediction for orthognathic surgical procedures.

Background: Considering the clinical safety of acetaminophen over other nonsteroidal anti-inflammatory drugs, this clinical trial was formulated to assess the analgesic efficacy of acetaminophen for controlling postextraction dental pain when compared to commonly prescribed ibuprofen. Aim: The aim was to assess the analgesic efficacy of paracetamol/acetaminophen in postextraction dental pain. Settings and Design: Double-blind, randomized prospective clinical trial. Materials and Methods: A total of 30 patients requiring bilateral maxillary and mandibular premolar extraction for their orthodontic treatment were included in the study to evaluate the efficacy of acetaminophen in controlling postextraction dental pain. Statistical Analysis Used: Unpaired t-test. Results and Conclusions: Clinically, both the postoperative analgesics exerted similar pain control with minor variations of recorded visual analog scale scores by the patients in both the groups. It may be concluded from the findings of this study that paracetamol at a dosage of 500 mg thrice a day (1.5 g) is sufficient to achieve reliable pain control following exodontia provided the surgical trauma caused to the investing tissues is minimal.

Background: Fracture of the mandible is one of the most common fractures of the maxillofacial skeleton. However, the etiology, gender, and age distribution vary between different regions and countries, and the purpose of this study was to evaluate the current trend of patients with mandibular fractures at the Department of Oral and Maxillofacial Surgery, in Uppsala, Sweden. Aim: The aim of this retrospective study was to analyze patients with mandibular fractures treated in the University Hospital of Uppsala (the county capital of Uppland) Sweden during a 10-year period (1999-2008). Materials and Methods : This study was designed as a retrospective study of patients admitted to the Department of Oral and Maxillofacial Surgery at Uppsala University Hospital, Sweden. The location of fractures was evaluated clinically by the surgeon and on the X-rays. We classified the data according to gender, age, etiology, day of the week, month of the year, fracture site, and method of treatment of the fractures. Results: Records were collected from patient charts from 266 patients. One hundred eighty-seven patients (70%) with mandibular fractures were of male gender, and 132 patients (50%) were aged 16-30 years. Interpersonal violence constituted the most common etiological factor for mandibular fractures (24%), followed by falls (23%). Forty-nine percentages of the patients were treated surgically, and 51% were treated conservatively. There was an increase of the annual incidence of fractures toward the end of the period, even though not statistically significant. Conclusions: Mandibular fractures occurred primarily among younger men between 16- and 30-year-old. Condyle fractures were the most common fracture site and 50% of the patients required surgery. Summer months and weekends were the most common time of mandibular fractures.

Introduction: Widening of alar base width is often required in the postcleft lip/palate rehabilitation. This manuscript aims to present the author's design for such a procedure describing the qualitative outcome of such a correction. Materials and Methods: This is a retrospective study from the author's center. All cleft cases requiring alar base widening using author's approach were analysed, and the outcome presented at the baseline, end of 3 ^rd and 6 ^th month. Author used a typical superomedially placed nasolabial full thickness flap to correct the alar base width simultaneously replacing the nasal lining. Results: A total of nine cleft patients underwent the procedure. Qualitative observation of the outcomes and postoperative changes with the resultant nasal alar base width are presented. Discussion: The efficacy of this type of nasolabial flap for the alar basal widening and nasal lining reconstruction is presented. The esthetical, functional and anatomical consideration in such a flap design is presented with the experience gained from this cohort.

Complete restoration of facial asymmetry is always difficult to achieve. Facial asymmetry due to growth disturbances of the jaws almost requires orthognathic surgical correction, followed, in many cases, by soft tissue corrections. Mandibular hypoplasia is the earliest skeletal manifestation of Hemifacial microsomy and the clinical defect becomes worse with the time, due to asymmetric growth and secondary midface deformity accompanying. Despite correction of the occlusal plane, facial asymmetry can persist if the mandibular body differs in height. We designed a new technique for skeletal correction of the mandibular basal plane combined with orthognatic surgery that avoided the disadvantages and limitations of other techniques. A 20-year-old male patient with facial asymmetry due to Hemifacial microsomy Type I also requires preoperative orthodontic treatment to align and level their teeth. He showed a 2mm midline shift to the left in combination with a cross bite of the left side. We decide to do a vertical enlargement of the mandibular left border by mandibular Hemiwing osteotomy and unilateral split ramus osteotomy for dental lines alignment with 8 mm of advancement of the hemi - wing genioplasty. Modificated basal osteotomy combined with osteogenic distraction works better than the classic total basal osteotomy with autologous bone graft, if used for the correct indications. We advocate this technique for its efficacy, simplicity, and safety. This technique can be apply for correction of vertical and transverse discrepancies of the mandibular border and combined with sagittal ramus osteotomies for correction of asymmetrical dental lines and oclusal plane.

Osteoradionecrosis (ORN) is a noninfectious, necrotic condition of the bone occurring as a complication of radiotherapy. Most cases occur following trauma or surgical manipulation of the irradiated site. Mandible is the most common bone to be affected following head and neck irradiation. The aim was to develop a successful therapeutic approach for ORN. A spectrum of treatment modalities is practiced for ORN with variable success rate that includes simple irrigation of the affected bone to the partial or complete resection of the jaw bone. In this paper, we present two cases which had successful therapeutic approach for ORN of mandible with autologous bone marrow concentrate stem cells and allogeneic dental pulp stem cells (DPSC) with platelet rich plasma (PRP) following failure of conventional methods. Autologous bone marrow aspirate concentrate (BMAC) was injected around the socket and into the periosteum for one case, and DPSC were mixed with tricalcium phosphate and inserted at the site of the defect in one case. The patient treated with BMAC remained asymptomatic and complete bone remodeling was noticed after 1 year. The extraoral sinus was excised, and healing was uneventful without recurrence in the patient treated with allogeneic DPSC and PRP. Periodic panoramic radiographs revealed an appreciable bone formation from the 2 ^nd month onward. We have successfully treated two cases of ORN with BMAC and DPSC, respectively.

Multiple or supernumerary nostril is a rare congenital anomaly with unknown etiology. The first case was reported by Lindsay as bilateral supernumerary nostrils. Supernumerary nostril cases are mostly unilateral and isolated. They are also reported with other congenital malformations like facial clefts and congenital anomalies like congenital auricular hypoplasia, congenital cataracts, eusophageal atresia and patent ductus arteriosus. Here, we report a case of supernumerary nostril with congenital adrenal hyperplasia

Encephaloceles, especially in the frontoethmoidal region, are a form of neural tube defect affecting patients in Southeast Asia more commonly than those in western countries, where they are more common in the occipital regions. All patients with classical frontoethmoidal encephalocele had swelling over the bridge of nose or inner canthus of eye since birth, with varying degrees of hypertelorism. This paper emphasizes on the clinical features of this pathology and its surgical management, along with, reviewing the evolution of single-stage correction and fine refinements.

Maxillofacial reconstruction on a young child with huge aggressively growing lesion is a tough situation owing to several limiting factors. Besides the other factors, impact of the growing lesion on the psychology of the child also needs to be considered. This manuscript reports a case of an 18-month-old boy with juvenile cemento-ossifying fibroma in whom removal of a large portion of the jaws was required. The regeneration of the jaw bones with the help of protein signal guided reconstruction using bone morphogenetic protein-2 is described. Long-term follow-up of the patient with dental implants placed on the neo-osteogenic bone is reported.

Pseudoaneurysm of the internal maxillary artery is a rare occurrence. A well-organized pulsatile mass that develops after a traumatic event indicates a pseudoaneurysm. Such lesions are commonly misdiagnosed for an abscess or a hematoma. Pulsations and audible bruit are diagnostic features of an aneurysm. Rupture of such false aneurysms cause significant morbidity. Management is either surgical resection or embolization. Endovascular embolization is indicated in deep seated lesions or lesions with high morbidity. Though surgical resection is an invasive procedure, it is considered to be an alternative to embolization.

The maxillary sinus lifting procedure is an important preprosthetic surgical procedure for the creation of adequate bone volume in the edentulous posterior maxilla for the placement of dental implants. The presence of a maxillary sinus cyst has been considered a contraindication for this operation. Perforation of the membrane and hence the elongation of the healing time for implant placement is the most common complication in this type of procedure. The purpose of the case is to show the safely repair of the large sinus perforation during the sinus lifting with presence of the antral pseudocyst. In this case, we present a patient who had a maxillary sinus lifting procedure in the presence of antral pseudocysts. No complications were seen during follow-up periods and all implants are functioning successfully. Platelet-rich fibrin may be used safely when large perforation occurs during the sinus lifting with the presence of an antral pseudocyst.

Osteoma of the coronoid process is a rare, slow-growing tumor that can lead to restrictive mandibular movements. This paper describes a case of osteoma of the right coronoid process in a 45-year-old woman who reported progressive facial asymmetry and the loss of mandibular movements. Aspects regarding the differential diagnosis, treatment, surgical access, possible complications and postoperative follow up of the case are also discussed. The osteoma of the coronoid process is a benign tumor that can reach a significant size, causing an increase in volume, facial asymmetry, limited mouth opening and fracture of the zygomatic complex in some cases. The combination of extraoral and intraoral accesses is useful in the case of large tumors of difficult access, such as in this case reported.

Odontogenic fibroma is a benign ectomesenchymal tumor classified as central and peripheral on the basis of its location and as an epithelium rich or epithelium poor based on its histological features. Radiological findings consist of radiolucent areas with well-defined bony margins. The lesion is detected early because of its location and usually treated with surgical excision and curettage. We present a case of giant odontogenic fibroma of right maxilla presenting as gross facial deformity and posing a dual challenge of excising the tumor mass and reconstructing the ensuing defect.

Osteochondromas are common tumors of the long bones, but are rare in the craniofacial region. We detailed two different management of osteochondroma of the mandibular condyle treated utilizing three-dimensional (3D) imaging and computer-assisted planning. Simultaneous open temporomandibular joint and orthognathic surgeries were done to treat both the pathology and secondary facial asymmetry. An osteochondroma that presented as a bony mass at the lateral aspect of the left mandibular condyle of a 24-year-old Chinese female was treated with simultaneous orthognathic surgery and conservative excision. No recurrence was detected 7 months postsurgery. An osteochondroma that presented as a generalized enlargement of the right mandibular condyle of a 25-year-old Chinese male was treated with simultaneous orthognathic surgery and condylectomy. There were no significant issues 3 years postsurgery. Simultaneous orthognathic and temporomandibular joint surgeries are a viable option for the management of osteochondroma of the mandibular condyle. The availability of 3D imaging enabled better presurgical examination of the lesion, which directed treatment toward condylectomy or conservative excision.

Chondroma of the mandibular condyle is a rare benign tumor, with just a handful of cases reported in the literature. Chondromas are rare in the maxillofacial region, but are quite common in the bones of the hands and feet. So far only eight cases of true chondroma have been reported. Here, we present a case of true chondroma of the mandibular condyle of the right side, for which condylectomy was done. No signs of recurrence are noted at 2 years follow-up.

Schwannomas are benign tumors of neurogenic origin arising from the Schwann cells of peripheral, cranial, and autonomic nerves. Schwannomas in spite of constituting 25-40% of head and neck tumors the percentage of intraoral schwannomas is merely 1%. Among the intraoral schwannoma the occurrence of the variant "ancient schwannoma of the infratemporal fossa with an intraoral presentation is very rare. The purpose of this presentation is to highlight the rarity of this lesion, to stress the importance of an accurate diagnosis and to consider neurogenic lesions in the differential diagnosis of head and neck lesions.

Inflammatory myofibroblastic tumor (IMT) is a rare tumor of borderline nature that can clinically present as a malignant neoplasm. It commonly occurs in the lungs, and a very few oral IMTs have been reported in the literature. IMT consists of inflammatory cells and myofibroblastic spindle cells. The diagnosis of IMT requires histopathological examination with immunohistochemical staining to look for the expression of smooth-muscle actin for confirmation of the diagnosis. The objective of this paper is to report an IMT on the upper alveolus with clinic-a pathological similarity with a malignant lesion and its management. Though oral IMTs are rare, it should be considered in the differential diagnosis of tumors of the upper jaw. Complete surgical excision of alveolar IMT is the treatment of choice because of its unpredictable clinical behavior. The patients with oral IMTs require periodic post-surgical follow-up for recurrence.

A case of chronic, recurrent and asymptomatic facial swelling in a young male is presented. Swelling extended from lower midface to upper lateral neck and right commissure to anterior massetric border. History, clinical signs and symptoms and examination pointed towards the benign nature of the swelling. Fine-needle aspiration cytology tapered the diagnostic possibilities to a salivary cyst or pseudocyst. Ultrasonography identified the lesion to contain echogenic fluid with irregular borders. "Tail sign" was absent on contrast magnetic resonance imaging, excluding the involvement of the sublingual gland. Surgical excision of the lesion was done along with submandibular gland as both were in continuity via a bottle-neck tract. Final histopathological diagnosis was that of the submandibular gland extravasation phenomenon. As per the best of our knowledge, it is the first case report of a submandibular gland extravasation causing swelling in a retrograde direction onto the face.

Rhinosporidiosis is a chronic granulomatous infective disease caused by fungi, Rhinosporidium seeberi. It can occur universally, is endemic in India, Sri Lanka and in South Asia, mainly reported from Southern India and Sri Lanka. Rhinosporidiosis is a chronic disease classically involving nose and nasopharynx and presents as a localized polypoid mass. Rhinosporidiosis involving parotid duct is rare. We encountered two cases of rhinosporidiosis at extremely unusual extranasal site-parotid duct, presenting as a cyst without nasal manifestations, which was misdiagnosed clinically and on cytological examination.

This case highlights the use of a custom-made distractor (Synthes GmbH, Oberdorf, Switzerland), used to increase bone height prior to rehabilitation with implant placement, in a patient following excision of an ameloblastoma and reconstruction of her mandible with a fibular flap. A 27-year-old patient had her mandible reconstructed following wide resection of an ameloblastoma. Although a 2.0 LOCK reconstruction plate (Synthes GmbH, Oberdorf, Switzerland) was used for fixation of the fibular bone, the vertical deficiency between the reconstructed segment and the occlusal plane made oral rehabilitation impossible. To overcome this, the fibular bone segment was vertically distracted following a latency period of 4 days. Distractor was left in place for 20 weeks for bone consolidation. Following device removal implants were placed. The novelty of this approach included fixation of the lower arm of the distractor on the LOCK plate. The distractor was unidirectional with two arms of different length. The lower arm composed of a 2.0 mini-plate to fit exactly on the 2.0 LOCK plate whereas the upper arm used a standard 1.5 mini-plate. Advantages of this custom-made distractor included: (i) No need for removal of the reconstruction plate, (ii) no need for an extraoral surgical approach, and (iii) no need for additional drilling to fit the lower arm of the distractor. Technical details and limitations are presented.

Alveolar soft part sarcoma (ASPS) is a rare, aggressive malignancy of uncertain histological origin with propensity of vascular invasion and distant metastasis. ASPS demonstrates strong predilection for adolescents and young adults with a female preponderance. The head and neck region is the commonly affected region in the pediatric population with orbit and tongue being most common. The indolent clinical course and asymptomatic nature often leads to misdiagnosis and delayed treatment. Herein, we present a case of ASPS affecting the tongue in 14-year-old boy which clinically mimicked hemangioma, common benign vascular tumor of tongue.

Paget's disease of bone (PDB) is a progressive chronic disease of unknown etiology, manifested as initial increase in bone resorption, followed by a disorganized and excessive formation of bone, resulting in pain and skeletal deformities. Treatment of the disease primarily aims at reducing the altered bone turnover by pharmacotherapy, along with surgical intervention for deformed bones, to reduce morbidity and improve the quality of living. We present a case of PDB with craniofacial involvement in a 55-year-old female, diagnosed on the basis of clinical features, radiological assessment along with biochemical findings and histopathological report. Our management included medical treatment in the form of intravenous bisphosphonates which alleviated symptoms by reducing the abnormal bone activity, and normalized serum alkaline phosphatase. Patient morale, self-confidence and social acceptance were all boosted due to the surgical correction of the facial deformity.

Aspergillus species are commonly found in the soil and decaying organic matter. The spores can be typically inhaled or ingested, yet disease due to tissue invasion is rarely seen in the immunocompetent host. In the immunocompromised patient, there has been an increased incidence of invasive aspergillosis in the last 20 years. Invasive aspergillosis of the maxillary sinus with orbital and cranial spread can be lethal, therefore, necessitates early diagnosis and prompt treatment. The predilection of Aspergillus for infiltration of blood vessels can result in serious ocular complications which can lead to loss of vision. We present the case of an uncontrolled diabetic patient with invasive maxillary sinus aspergillosis and extension to the orbital contents. Our purpose was to emphasize the need of early recognition and prompt initiation of combined antifungal treatment and surgical intervention with the intent to preserve the involved vital structures.