Fractures in the Maxillofacial Region: A Four Year Retrospective Study

Introduction

The incidence of maxillofacial injuries is on the rise due to motor vehicle accidents and increased incidence of violence in recent times. The aim of this retrospective study was to determine the incidence, aetiology, the pattern of fractures, their management with open reduction and internal fixation (ORIF) and complications, if any.

Methods

A retrospective analysis of 621 fractures in 361 patients managed by ORIF over a four year period was carried out.

Result

The average age of patients was 24.3 years with a male to female ratio of 21.2:1. Panfacial fractures comprised 4.7%, frontal bone fractures 8.9%, orbital fractures 0.7%, naso-orbito-ethmoid complex (NOE) fractures 0.7%, zygomatic complex fractures 23.5%, fracture maxilla 11.5% and mandibular fractures 52.2% of all facial fractures. All the cases were successfully managed by ORIF under general anaesthesia (GA). Complications were noticed in 6.8% of cases in the form of reactive implants in 3.6%, deranged occlusion in 1% and infection at operated site in 1% cases which were managed satisfactorily.

Conclusion

The findings of this study reveal sharp annual increase in the number of cases of maxillofacial trauma. Road traffic accidents (RTA) were the commonest cause and the age group most affected was between 20-25 years. ORIF of these fractures was chosen for its obvious advantages of direct anatomical reduction, early return to function and minimal complications.Key Words: Road traffic accidents (RTA), Inter maxillary fixation (IMF), Open reduction and internal fixation (ORIF)     

Extracorporeal irradiated tumor bone: A reconstruction option in diaphyseal Ewing��s sarcomas

Background:

Limb salvage in extremity tumors is now established as an oncologically safe option without compromising long-term survival. En bloc resection followed by extracorporeal radiation and reimplantation is a biological reconstruction option in diaphyseal Ewing’s sarcomas. We analyzed the results of 12 cases of diaphyseal Ewing’s sarcomas treated using this modality.

Materials and Methods:

Between March 2006 and March 2008, 12 patients with Ewing’s sarcoma underwent enbloc resection and reconstruction, with reimplantation of the sterilized tumor bone, after extracorporeal irradiation. There were eight males and four females, with a mean age of 14 years (range 2 to 22 years). The femur was the most common bone involved (n=8) followed by the tibia and the humerus (two cases each). All these patients were non-metastatic at presentation and received chemotherapy as per the existing hospital protocol. The mean length of the bone resected was 20 cm (range 11 to 25 cm). The specimen was irradiated with 50 Gy prior to reimplantation and stabilized with the host bone, using suitable internal fixation. Standard biplanar radiographs were assessed for evidence of union on the follow-up visits. The functional status was assessed using the Musculoskeletal Tumor Society Scoring system at the time of the last follow up. The mean follow up duration was 29 months (range 12 to 57 months).

Results:

Two patients (17%) had early infection with graft removal, hence are excluded from any analysis of union, however they are included when analysing complications such as infection. Rest 10 cases were analyzed for bony union at the osteotomy sites. Sixteen (84%) of the 19 osteotomy sites united primarily, without any intervention. Implant failure and non-union was seen at three diaphyseal osteotomy sites. The average time for union of all osteotomy sites was 7.2 months (range 3 to 13 months).The average time for union of the metaphyseal osteotomy sites was 5.9 months (range 3 to 12 months) and of diaphyseal osteotomy sites was 8.3 months (range 4 to 13 months). The mean Musculoskeletal Tumor Society Score was 27 (range 19 to 30) with a mean of 27. Nine of the ten patients with lower limb involvement were independent ambulators without additional aids. At the time of the last review, six patients were free of disease and six patients had died from the disease. There were two recurrences around the operative site. Both were associated with disseminated disease and in both the recurrences were in the soft tissue, away from the irradiated graft.

Conclusion:

Extracorporeal irradiation is a useful, convenient technique for limb salvage in diaphyseal Ewing’s sarcomas when there is reasonable residual bone stock. It is oncologically safe and has good functional results. A radiation dose of 50 Gy for sterilizing the bone ensures adequate tumor kill, while minimizing the deleterious effects on the biomechanical and biological properties of the bone. The use of appropriate implants for adequate internal fixation and supplementary bone grafting at the index surgery may help reduce the need for subsequent additional interventions to achieve union. The limitations of this procedure are that it is not applicable in tumor bones that are structurally weak and in bones with pathological fractures.     

A clinical evaluation of midface advancement using intraoral distractors in management of bone stock deficiencies

Background

Cleft lip and palate patients present large osseous defects of the alveolus and midface hypoplasia. Traditional orthognathic surgery has limitations of relapse and limited age group. Distraction osteogenesis (DO) as a modality for midface advancement is relatively new. Modular internal distractor (MID) offers the advantage of patient compliance and minimal discomfort. The purpose of this study was to evaluate the versatility of intraoral distractors in midface advancement.

Method

Nineteen patients with midface bone stock deficiency were selected for maxillary advancement. At the first surgery under general anaesthesia, after the osteotomy (Le Fort I/II), MID system was used. After distraction, evaluation was done for ease of the procedure, stability, and complications. Lateral cephalograms were evaluated at three stages: T1, pre-distraction; T2, post-distraction; and T3, one year post-distraction.

Results

Significant changes showed 13.3 mm mean midface advancement bone formation at the pterygomaxillary region. The results were stable even at one year follow-up.

Conclusion

Maxillary position improved in relation to the cranial base. This study showed that the MID was versatile in midface advancement in stability and patient compliance with minimal complications.     

Aggressive Approach in a Case of Cancer Cervix with Uremia

Carcinoma of cervix is the most common cancer in developing countries. Majority of them present in locally advanced stages. A 36-year-old lady presented with bleeding and white discharge per vagina since four months, vomiting and reduced urine output since two weeks. Patient had an exophytic cervical growth. Investigation revealed elevated serum creatinine. Patient received single fraction radiation and underwent percutaneous nephrostomy. At one month follow-up, serum creatinine returned to almost normal level. Patient underwent bilateral ante grade stenting and completed concurrent chemoradiotherapy. In selected subsets of patients, aggressive management offered longer palliation and good quality of life.     

Psychometric evaluation of the myasthenia gravis composite using Rasch analysis

Introduction: The MG Composite (MGC) is a validated outcome measure of the clinical manifestations of myasthenia gravis. Methods: We performed Rasch analyses of the MGC to investigate additional properties, including its unidimensionality and the appropriateness of the weights assigned to the response categories for the MGC items. Results: The fit statistics indicated that the 10 items belong together and can be summated for a total score. There was an overall absence of item order distortion between response categories. The Rasch model's expected category response values were compatible with item weights previously assigned. Conclusions: Our analysis suggests that: (1) the score can be summated to estimate an overall disease severity score; (2) the response options of the 10 items are not significantly distorted; and (3) the assigned weights of the response options are appropriate. Muscle Nerve 45: 820–825, 2012