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INVITED REVIEW ARTICLE
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.
  155 16,288 2,989
REVIEW ARTICLES
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.
  58 22,657 3,487
Role of macrophages in malignancy
Rishikesh C Dandekar, Amaar V Kingaonkar, Gauri S Dhabekar
July-December 2011, 1(2):150-154
DOI:10.4103/2231-0746.92782  PMID:23482819
Macrophages themselves are a heterogeneous mixture of cells which mediate their effects not only through phagocytosis but also through the production of various soluble factors such as cytokines and chemokines. The most important function of macrophages is the defense of the body against pathogen aggressions. However, when recruited within neoplastic tissues, tumor-associated macrophages polarize differently and do not predominantly exert their immune function but rather favor tumor growth and angiogenesis.
  32 4,912 723
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.
  28 7,839 1,166
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.
  27 5,498 1,100
ORIGINAL ARTICLE - RETROSPECTIVE STUDY
Review of secondary alveolar cleft repair
Gui-Youn Cho-Lee, Eloy-Miguel García-Díez, Richard-Agostinho Nunes, Carles Martí-Pagčs, 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.
  26 10,821 1,691
REVIEW ARTICLE - PRACTICE GUIDELINES
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.
  26 11,974 1,683
EMERGING TECHNOLOGIES
Tissue engineering of bone: Clinical observations with adipose-derived stem cells, resorbable scaffolds, and growth factors
George K. B. Sándor
January-June 2012, 2(1):8-11
DOI:10.4103/2231-0746.95308  PMID:23483030
Introduction: Tissue engineering offers a simple, nonallergenic, and viable solution for the reconstruction of human tissues such as bone. With deeper understanding of the stem cell's pathobiology, the unique properties of these tissues can be effectively harnessed for the benefit of the patients. A primary source of mesenchymal stem cells (MSCs) for bone regeneration is from adipose tissue to provide adipose-derived stem cells (ASCs). The interdependency between adipogenesis and osteogenesis has been well established. The objective of this article is to present the preliminary clinical observation with reconstruction of craniofacial osseous defects larger than critical size with ASC. Materials and Methods: Patients with large craniofacial osseous defects only were included in this study. Autogenous fat from the anterior abdominal wall of the patients was harvested from 23 patients, taken to a central tissue banking laboratory and prepared. All patients were reconstructed with ASCs, resorbable scaffolds, and growth factor as required. Vascularized soft tissue beds were prepared for ectopic bone formation and later microvascular translocation as indicated. Results: 23 ASC seeded resorbable scaffolds have been combined with rhBMP-2 and successfully implanted into humans to reconstruct their jaws except for three failures. The failures included one infection and two cases of inadequate bone formation. Discussion: The technique of ASC-aided reconstruction of large defects still remains extremely sensitive as it takes longer duration and is costlier than the conventional standard immediate reconstruction. Preliminary results and clinical observations of these cases are extremely encouraging. In future, probably with evolving technological advances, ASC-aided reconstruction will be regularly used in clinical practise.
  24 3,179 325
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.
  24 11,702 1,360
REVIEW ARTICLE
Success rate of implants placed in autogenous bone blocks versus allogenic bone blocks: A systematic literature review
Saeed Reza Motamedian, Moein Khojaste, Arash Khojasteh
January-June 2016, 6(1):78-90
DOI:10.4103/2231-0746.186143  PMID:27563613
The aim of this study is to review and compare survival/success rate of dental implants inserted in autogenous and allogenic bone blocks (ALBs). A PubMed search was performed from January 1990 to June 2014 limited to English language and human studies. Studies that reported treatment outcome of implants inserted in augmented alveolar ridges with autogenous or ALBs were included. Primary search identified 470 studies. For autogenous bone block (ABB) 36 articles and for ALB 23 articles met the inclusion criteria. Evidence on implant survival/success rate of both techniques was limited to observational studies with relatively small sample sizes. Study design, treatment methods, follow-ups, defect location, and morphology varied among studies. The range of implant survival and success rates in ABB was from 73.8% to 100% and 72.8% to 100%, respectively. The corresponding numbers for ALB were 95.3–100% and 93.7–100%, respectively. A definite conclusion could not be reached. Future studies with long-term follow-ups are required to further elucidate this issue.
  23 5,000 819
REVIEW ARTICLES
Lemierre's syndrome from odontogenic infection: Review of the literature and case description
Dani Noy, Adi Rachmiel, Dan Levy-Faber, Omri Emodi
July-December 2015, 5(2):219-225
DOI:10.4103/2231-0746.175746  PMID:26981474
Lemierre's syndrome (LS) is a rare potentially fatal sequel of head and neck infection, classically described as thrombophlebitis of the internal jugular vein (IJV) with cervical space infection extending into the thorax. Our objective was to answer the clinical question: “Does Lemierre syndrome (LS) from odontogenic infection differ from nonodontogenic LS in regard to clinical sequence, treatment, and survival.” We reviewed the literature on the management of LS over the last two decades, with a focus on LS from odontogenic infection. Such a case is presented in order to portray the clinical sequence. Only 10 cases met the inclusion criteria (including the case presented). The recorded data were analyzed in comparison to large case series reviewing LS. Our data reflect the moderate differences in regard to IJV thrombosis and bacteriogram. There is an overall rise in published LS cases in the last 20 years. Odontogenic infection leading to LS is scarce, yet with survival rates similar to nonodontogenic LS. Repeated surgical interventions and aggressive wide spectrum antibiotic therapy remain the treatment of choice.
  23 3,384 579
ORIGINAL ARTICLES - COMPARATIVE STUDY
Treatment of maxillary cleft palate: Distraction osteogenesis vs. orthognathic surgery
Adi Rachmiel, Michal Even-Almos, Dror Aizenbud
July-December 2012, 2(2):127-130
DOI:10.4103/2231-0746.101336  PMID:23483803
Purpose: The purpose of this paper is to compare the treatment of hypoplastic, retruded maxillary cleft palate using distraction osteogenesis vs. orthognathic surgery in terms of stability and relapse, growth after distraction and soft tissue profile changes.th Materials and Methods: The cleft patients showed anteroposterior maxillary hypoplasia with class III malocclusion and negative overjet resulting in a concave profile according to preoperative cephalometric measurements, dental relationship, and soft tissue analysis. The patients were divided in two groups of treatment : S0 eventeen were treated by orthognathic Le Fort I osteotomy fixed with four mini plates and 2 mm screws, and 19 were treated by maxillary distraction osteogenesis with rigid extraoral devices (RED) connected after a Le Fort I osteotomy. The rate of distraction was 1 mm per day to achieve Class I occlusion with slight overcorrection and to create facial profile convexity. Following a 10 week latency period the distraction devices were removed. Results: In the RED group the maxilla was advanced an average of 15.80 mm. The occlusion changed from class III to class I. The profile of the face changed from concave to convex. At a 1-year follow up the results were stable. The mean orthognathic movement was 8.4 mm. Conclusion: In mild maxillary deficiency a one stage orthognathic surgery is preferable. However, in patients requiring moderate to large advancements with significant structural deficiencies of the maxilla or in growing patients the distraction technique is preferred.
  21 8,720 1,313
ORIGINAL CLINICAL STUDIES
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.
  21 19,001 1,668
INVITED REVIEW
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.
  20 30,840 5,687
ORIGINAL ARTICLE - PRACTICE GUIDELINES
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.
  20 14,226 1,944
SYSTEMATIC REVIEW
Guided bone regeneration for the reconstruction of alveolar bone defects
Arash Khojasteh, Lida Kheiri, Saeed Reza Motamedian, Vahid Khoshkam
July-December 2017, 7(2):263-277
DOI:10.4103/ams.ams_76_17  PMID:29264297
Background: Guided bone regeneration (GBR) is the most common technique for localized bone augmentation. Purpose: The purpose of this review was to categorize and assess various GBR approaches for the reconstruction of human alveolar bone defects. Materials and Methods: Electronic search of four databases including PubMed/Medline, EMBASE, Web of Science, and Cochrane and hand searching were performed to identify human trials attempting GBR for the reconstruction of alveolar bony defects for at least 10 patients from January 2000 to August 2015. To meet the inclusion criteria, studies had to report preoperative defect dimensions in addition to outcomes of bone formation and/or resorption. Results: Twenty-five human clinical trials were included of which 17 used conventional technique that is the use of space maintaining membrane with bone grafting particles (GBR I). Application of block bone graft with overlying membrane and particulate fillers was reported in seven studies (GBR II), and utilizing cortical bone block tented over a defect preserving particulate fillers was reported by one study (GBR III). A wide range of initial defects' sizes and treatment results were reported. Conclusions: This review introduces a therapeutically oriented classification system of GBR for treating alveolar bone defects. High heterogeneity among studies hindered drawing definite conclusions in regard to superiority of one to the other GBR technique.
  20 7,076 1,282
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.
  18 7,173 961
ORIGINAL ARTICLES - PROSPECTIVE STUDY
Cleft lip and palate: Parental experiences of stigma, discrimination, and social/structural inequalities
Wasiu Lanre Adeyemo, Olutayo James, Azeez Butali
July-December 2016, 6(2):195-203
DOI:10.4103/2231-0746.200336  PMID:28299257
Background: Cleft lip and palate (CLP) are the most common craniofacial birth impairment and one of the most common congenital impairments in humans. Anecdotal evidence suggests that stigmatization, discrimination, and sociocultural inequalities are common “phenomenon” experienced by families of children with CLP in Nigeria. This study aimed to explore the stigmatization, discrimination, and sociocultural inequalities experiences of families with children born with CLP. Materials and Methods: The study was carried out at the surgical outpatient cleft clinic of the Lagos University Teaching Hospital, Lagos, Nigeria. This was a cross-sectional descriptive study among mothers of children born with CLP, using both interviewer-administered questionnaire and a semi-structured interview. Results: A total of 51 mothers of children with cleft lip and/or palate participated in the study. 35.3% of respondents believed cleft was an “act of God,” whereas others believed it was either due to “evil spirit” (5.9%), “wicked people” (9.8%). Seventy-three percent of the mothers were ashamed of having a child with orofacial cleft. Two of the respondents wanted to abandon the baby in the hospital. About a quarter of the respondent wished the child was never born and 59% of the fathers were ashamed of the facial cleft. Fifty-one percent admitted that their relatives were ashamed of the orofacial cleft, and 65% admitted that their friends were ashamed of the cleft. In addition, 22% of the respondents admitted that they have been treated like an outcast by neighbors, relatives, and friends because of the cleft of their children. When asked about refusal to carry the affected children by friends, relatives, and neighbors, 20% of respondents said “Yes.” Conclusions: Myths surrounding the etiology of orofacial cleft are prevalent in Nigeria. Parents and individuals with CLP experience stigma as well as social and structural inequalities due to societal perceptions and misconception about CLP. Public and health-care professionals must be equipped with necessary knowledge to combat stigma, discrimination, social and structural inequalities, and misconceptions associated with orofacial cleft. CLP should be considered a facial difference rather than a disability.
  18 3,817 464
EMERGING TECHNOLOGIES
Experience with craniosynostosis treatment using posterior cranial vault distraction osteogenesis
Leena P Ylikontiola, George K Sándor, Niina Salokorpi, Willy S Serlo
January-June 2012, 2(1):4-7
DOI:10.4103/2231-0746.95307  PMID:23482323
Background: Craniosynostosis compromises the cranial vault volume, severely impede growth, and may lead to increased intracranial pressure (ICP). Posterior cranial vault (PCV) distraction osteogenesis (DO) offers an excellent treatment opportunity for this condition. This article intends to describe the outcomes of PCV DO. Materials and Methods: Nine males and seven female children indicated for PCV DO were included in the study. The single vector distraction devices with quick-disconnect distraction rods, a type of miniaturized hardware, was used in all cases. Result: Seven of the 16 patients had a history of one or more prior cranioplasty. All reoperations in this series were performed for the indication of raised ICP including five of the scaphocephaly patients and the syndromic patients. Clinical signs of raised ICP were present in all patients with either measured raised intracranial pressure or those with clinical signs of raised ICP preoperatively. There was substantial decrease in the ICP postoperatively. Discussion: The outcomes of this study were encouraging. Placing the distractor stems as flat as possible against the outer layer of the cranial bone seems to be a very important maneuver. This keeps the distractor stem less proud and less likely to sustain future trauma. Removal of the distractor stems keeps the devices further away from the risk of later traumatic dislodgement. Moreover, miniaturized distractors allow precise control of the rate and the amount of distraction.
  17 8,188 615
EVALUATIVE STUDIES
Evaluation of bacterial spectrum of orofacial infections and their antibiotic susceptibility
Nagendra S Chunduri, Krishnaveni Madasu, Venkateswara R Goteki, Tanveer Karpe, Haranadha Reddy
January-June 2012, 2(1):46-50
DOI:10.4103/2231-0746.95318  PMID:23482901
Introduction: The inappropriate use of antibiotics has contributed to a worldwide problem of antimicrobial resistance. The objective of present study is to assess the most common microorganisms causing orofacial infections and their antimicrobial susceptibility to routinely used antibiotics in this part of India. Materials and Methods: Sixty eight patients with orofacial infection were selected on the basis of a series of predefined inclusion and exclusion criteria. Samples were collected under aseptic conditions and subjected to culture and antibiotic susceptibility testing. Descriptive statistics were provided. Results: A total of 64 aerobic and 87 anaerobic strains were isolated. The predominant bacteria were Streptococci viridans (64%), Prevotella (43%), Peptostreptococcus (26%), Porphyromonas (7%), and Fusobacterium (14%). The isolated strains seemed to be highly sensitive to the routinely used antibiotics such as amoxicillin - clavulanate and amoxicillin alone, clindamycin, and levofloxacin. In contrast, more resistance to erythromycin was observed. Conclusion: Amoxicillin still possesses powerful antimicrobial activity against major pathogens in orofacial odontogenic infections. Amoxicillin/clavulanate and clindamycin would also be advocated as being useful alternatives for the management of severe orofacial infections. However, the findings of this study indicate that erythromycin is of questionable benefit in the treatment of severe orofacial odontogenic infections.
  16 6,658 1,413
ORIGINAL ARTICLES - ANALYTICAL STUDY
The effects of face mask therapy in cleft lip and palate patients
Servet Dogan
July-December 2012, 2(2):116-120
DOI:10.4103/2231-0746.101332  PMID:23483763
Background and Aim: Children treated with cleft lip and palate often develops mid-facial retrusion. In this study 20 patients with unilateral cleft lip and palate (UCLP) were treated with face mask and studied for the effect of growth. Materials and Methods: The patients were treated by the same orthodontist using the same techniques and appliances. Mean pre- and posttreatment ages were 8.7 and 9.5 years, respectively. Each child was matched by ethnicity, age, sex, and the SN/MP angle to an untreated (noncleft) control. The treatment period with face mask was approximately 7 months and 5 days. Result: The study showed definite protraction of the maxilla for UCLP group (P < 0.001). The posterior maxilla of the UCLP group underwent anterior displacement while the maxillary incisors showed greater anterior movement than expected for untreated control group (P < 0.01). Vertical changes of the maxilla showed no significant differences in cleft group. The mandible of the UCLP group was rotated inferiorly and posteriorly (P < 0.05) while control group showed inferior and anterior changes. The lower incisors were stable in the two groups. Conclusion: From this study, it can be inferred that the UCLP group show significantly anterior maxillary movements when compared with the control group when face mask is used as per prescription.
  16 8,218 964
INVITED REVIEW ARTICLE
Biomimetic approaches to complex craniofacial defects
Chad M Teven, Sean Fisher, Guillermo A Ameer, Tong-Chuan He, Russell R Reid
January-June 2015, 5(1):4-13
DOI:10.4103/2231-0746.161044  PMID:26389027
The primary goals of craniofacial reconstruction include the restoration of the form, function, and facial esthetics, and in the case of pediatric patients, respect for craniofacial growth. The surgeon, however, faces several challenges when attempting a reconstructive cranioplasty. For that reason, craniofacial defect repair often requires sophisticated treatment strategies and multidisciplinary input. In the ideal situation, autologous tissue similar in structure and function to that which is missing can be utilized for repair. In the context of the craniofacial skeleton, autologous cranial bone, or secondarily rib, iliac crest, or scapular bone, is most favorable. Often, this option is limited by the finite supply of available bone. Therefore, alternative strategies to repair craniofacial defects are necessary. In the field of regenerative medicine, tissue engineering has emerged as a promising concept, and several methods of bone engineering are currently under investigation. A growth factor-based approach utilizing bone morphogenetic proteins (BMPs) has demonstrated stimulatory effects on cranial bone and defect repair. When combined with cell-based and matrix-based models, regenerative goals can be optimized. This manuscript intends to review recent investigations of tissue engineering models used for the repair of craniofacial defects with a focus on the role of BMPs, scaffold materials, and novel cell lines. When sufficient autologous bone is not available, safe and effective strategies to engineer bone would allow the surgeon to meet the reconstructive goals of the craniofacial skeleton.
  15 4,072 546
ORIGINAL ARTICLE - COMPARATIVE STUDY
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.
  15 12,741 1,320
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.
  15 8,457 1,231
ORIGINAL ARTICLES - ANALYTICAL STUDY
Management of obstructive sleep apnea in pediatric craniofacial anomalies
Adi Rachmiel, Omri Emodi, Dror Aizenbud
July-December 2012, 2(2):111-115
DOI:10.4103/2231-0746.101329  PMID:23483041
Introduction: Obstructive sleep apnea (OSA) is often associated with congenital craniofacial malformations such as Pierre-Robin Syndrome, Hemifacial Microsomia, Treacher Collins Syndrome resulting in decreased pharyngeal airway, which, in severe cases, leads to tracheostomy dependence. Some pediatric patients had tracheostomies done and others with severe respiratory distress were considered tracheostomy candidates. Materials and Methods: Twelve patients with severe respiratory distress without tracheostomy and ten patients with tracheostomy were treated by mandibular distraction osteogenesis using either external or internal devices. The expansion of mandibular framework was analyzed using bony cephalometric landmarks and computed tomography (CT). Results: The results demonstrated average mandibular elongation of 29 mm on each side using the external devices and 22 mm using the internal devices, and an increase in mandibular volume and pharyngeal airway. The group of patients with tracheostomies were decannulated and in the patients with respiratory distress there was improved airway with improvement of signs and symptoms of OSA with elimination of oxygen requirement. Conclusions: Mandibular distraction is a useful method in younger children with OSA expanding the mandible and concomitantly advancing the base of tongue and hyoid bone increasing the pharyngeal airway. The external devices permit greater distraction length, the removal is simple but the devices are uncomfortable for the patients. On the other hand, the internal devices are more comfortable for patients but permit shorter distraction length and require a second operation for removal.
  14 6,562 1,040
* Source: CrossRef
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