Orthopaedic Protraction of the Maxilla with Miniplates: Treatment of Midface Deficiency

Class III malocclusion is a consequence of maxillary deficiency and/or mandibular prognathism, resulting in an anterior crossbite and a concave profile. Early class III malocclusion treatment with reverse pull headgear generally results in maxillary skeletal protraction but is frequently also accompanied by unfavourable dentoalveolar effects. Titanium miniplates used as temporary anchorage device might permit equivalent favourable skeletal changes without unwanted dentoalveolar effects. We report two cases having class III malocclusion with maxillary deficiency treated by using titanium miniplates. Cephalometric tracings were done pre and post treatment to determine the anatomic changes during the course of treatment.     

Detection of Bacterial Flora in Orofacial Space Infections and Their Antibiotic Sensitivity Profile

Introduction

Most odontogenic infections arise as a sequel of pulp necrosis caused by caries, trauma, periodontitis, etc. They range from periapical abscesses to superficial and deep infections in neck. Some resolve with little consequence and some lead to severe infections of head and neck region. The purpose of this study was to identify microbial flora present in orofacial space infection of odontogenic origin and thereby provide better perspective in management of odontogenic infection.

Materials and Methods

Twenty-six patients with space infection of odontogenic origin were selected irrespective of their age and gender. Pus samples were collected and processed in the microbiology laboratory for the growth of anaerobic and aerobic bacteria and antibiotic sensitivity profile.

Results

Demographic profile of the patients showed that male patients were more commonly involved and most patients fell in to the third and fourth decade of age groups. Most common site of involvement was submandibular space. Alpha hemolytic streptococci were the frequent aerobic bacterial isolate and among anaerobes, anaerobic streptococci followed by bacteroids were the major pathogens. Clindamycin, Gentamycin, Linezolid, Imipenam were the most effective antibiotics. 20 % of the aerobes were resistant to penicillin.

Conclusion

Streptococcus species are still the commonest pathogen in orofacial infections of odontogenic origin. Administration of amoxicillin clavulanic acid combination and metronidazole followed by surgical drainage of abscess and extraction of infected teeth, yielded satisfactory resolution of infection.     

A Prospective Study on Management of Mandibular Angle Fracture

Purpose

To evaluate the results of management of mandibular angle fracture by open reduction and internal fixation using single non compression miniplate via transbuccal, intraoral or extraoral approaches.

Patients and Methods

In this prospective study, 30 patients were randomly selected regardless of age, sex requiring open reduction and internal fixation of non comminuted angle fracture with/or without other associated fractures of the mandible. All the patients were operated under general anaesthesia following routine haematological, biochemical, general physical examination and routine radiographic examination. Patients were randomly distributed into 3 groups namely: (1) intraoral, (2) transbuccal, and (3) extraoral groups depending on the surgical approach used for open reduction and internal fixation of fracture of the angle of mandible. In the intraoral group (12 patients), angle fracture was approached through the intraoral vestibular incision similar to sagittal split incision. In the transbuccal group (8 patients), angle fracture was approached through the intraoral vestibular incision and transbuccal stab incision for screw fixation via trochar. In the extraoral group (10 patients), angle fracture was approached through the Risdon’s submandibular incision. In all the patients, fractures were reduced with upper and lower Erich’s arch bar fixation as means for IMF intraoperatively. In all the patients, fracture of the angle of the mandible was fixed with single non compression 2.5 mm, 4 holed with gap stainless steel miniplate and 6/8 mm monocortical screws. All patients were followed up for minimum of 6 months to maximum of 24 months.

Results

Complications were relatively minor such as paresthesia (on average 26.7 % first post-operative day which was gradually improved and on average after 1 month was 3.3 %), mild to moderate occlusal discrepancies (on average 36.7 %) which needed the post-operative intermaxillary fixation with elastics for 1–2 weeks, infection (20 % on average) was mild to moderate which was managed with antibiotic therapy and/or incision and drainage except in one case, plate removal was done under general anaesthesia (extraoral group) because of recurrent infection. Post-operative pain was mild to moderate (mean VAS score pre operative–6.17, post-operative 1 week–1.63) which was managed with analgesics. Mouth opening was recorded in all patients which was on average 20.98 mm preoperatively which improved to 40.57 mm after 1 month.

Conclusion

The use of a single non compression miniplate for fractures of the angle of the mandible is a simple, reliable technique with relatively rare major complications and few minor complications irrespective of the surgical approach used for the open reduction.     

Comparison of circummandibular wiring with resorbable bone plates in pediatric mandibular fractures

Pediatric patients present a unique challenge to maxillofacial surgeons in terms of their treatment planning as well as in their functional and nutritional needs which are different from that of adult patients. Early literature has advocated conservative closed management of pediatric fractures to prevent complications. However recent advances in maxillofacial surgery has enabled us to use biodegradable plates and screws, which overcomes the limitations of metallic plates. We present a comparison of two cases of parasymphysis fracture treated with circum-mandibular wiring and biodegradable plate fixation their outcome in terms of fracture healing and functional stability.     

The Versatility of Temporalis Myofascial Flap in Maxillo-Facial Reconstruction: A Clinical Study

Objectives  

This clinical study was conducted in the department of Oral & Maxillofacial Surgery, at our institute, to study the versatility of temporalis myofascial flap in maxillofacial reconstruction.     

A comprehensive review on antimicrobial face masks: an emerging weapon in fighting pandemics

The world has witnessed several incidents of epidemics and pandemics since the beginning of human existence. The gruesome effects of microbial threats create considerable repercussions on the healthcare systems. The continually evolving nature of causative viruses due to mutation or re-assortment sometimes makes existing medicines and vaccines inactive. As a rapid response to such outbreaks, much emphasis has been placed on personal protective equipment (PPE), especially face mask, to prevent infectious diseases from airborne pathogens. Wearing face masks in public reduce disease transmission and creates a sense of community solidarity in collectively fighting the pandemic. However, excessive use of single-use polymer-based face masks can pose a significant challenge to the environment and is increasingly evident in the ongoing COVID-19 pandemic. On the contrary, face masks with inherent antimicrobial properties can help in real-time deactivation of microorganisms enabling multiple-use and reduces secondary infections. Given the advantages, several efforts are made incorporating natural and synthetic antimicrobial agents (AMA) to produce face mask with enhanced safety, and the literature about such efforts are summarised. The review also discusses the literature concerning the current and future market potential and environmental impacts of face masks. Among the AMA tested, metal and metal-oxide based materials are more popular and relatively matured technology. However, the repeated use of such a face mask may pose a danger to the user and environment due to leaching/detachment of nanoparticles. So careful consideration is required to select AMA and their incorporation methods to reduce their leaching and environmental impacts. Also, systematic studies are required to establish short-term and long-term benefits.

Schematic representation of antimicrobial face masks with details of various antimicrobial agents and its preparation route.     

Comparative Evaluation of Drill-Free and Self-Tapping Titanium Miniscrews for Semi-Rigid Internal Fixation in Maxillofacial Trauma

IntroductionConventional semi-rigid fixation systems in maxillofacial trauma use self-tapping titanium miniscrews (STS) that require preliminary drilling of a pilot hole. Although drill-free miniscrews (DFS) accompany these systems, they have not dominated practice despite their allure of improved screw-bone contact and holding power. The COVID-19 pandemic has brought these DFS to light as they avoid aerosol production. The present study has compared DFS to STS in patients being treated with miniplate fixation for maxillofacial trauma to understand their feasibility for maxillofacial fracture fixation. MethodologyThis prospective case–control study sampled 16 patients each with zygomaticomaxillary buttress fracture and parasymphysis fracture of the mandible and grouped alternating patients as case (DFS) and control (STS). Intraoperatively duration of fixation, incidence of screw failures and fragment stability; postoperatively occlusion, neurosensory deficits, teeth vitality and infection and removal rates were evaluated at postoperative week 1, 3, 6, 12 and 24 using Cramer''s V test. A P value < 0.05 was considered significant.ResultsIn the 32 patients evaluated, DFS reduced internal fixation time at zygomaticomaxillary buttress (P = 0.001) but not at parasymphysis (P = 0.206). No significant difference in screw failures or fragment stability was observed. Stable occlusion was maintained in all groups with vital teeth and intact neurosensory function, but the summative incidence of infection was significant at week 24 when STS was used at parasymphysis (P = 0.019).DiscussionWhile DFS may facilitate ease of insertion with a single instrument pick-and-screw-in approach, avoiding thermal osteonecrosis and aerosol production, they fail to confer any other clinical advantage.     

Objective and subjective comparison of submucosal and intravenous routes of single-dose preoperative dexamethasone for mandibular third molar surgery—a prospective randomized observer-blind study

Purpose

Adjuvant corticosteroid administration through local routes has gained popularity due to ease of technique, lesser morbidity and presumed advantage of achieving therapeutic dosage at the site. To evaluate this, present study has compared submucosal route with an intravenous route control using single-dose preoperative dexamethasone. The study investigated objective facial measurements, mouth opening and compared them with subjective scores on a visual analogue scale and quality of life (QOL) recovery questionnaire.

Materials and methods

This was a prospective, randomized, open-label study with blinded end-point assessment of submucosal and intravenous routes of single preoperative dexamethasone administration, in patients undergoing mandibular third molar surgery. Patients were randomly divided into two groups and received 8 mg DX as either submucosal or intravenous injection 5 min after administration of local anaesthesia. Data was collected at 2nd and 7th post-op intervals. Statistical analysis was done keeping a P value <?0.05 as significant.

Results

Thirty patients were evaluated in the study. SM route behaved similarly to IV route in producing changes in facial measurements [P?=?0.533], mouth opening [P?=?0.533] and pain [VAS] scores [P?=?0.533] at early and late intervals. Questionnaire subscale scores were not significantly different between groups, but total mean score was significant [P?=?0.050] with a measure of variance 17.54 in group IV compared with 39.54 of group SM showing that subjectively, IV route brought better recovery.

Conclusion and clinical relevance

Submucosal route can be an effective less invasive, painless, straightforward alternative to systemic administration of corticosteroid for improving QOL recovery in mandibular third molar surgery.

     

Use of a modified epidural catheter for analgesia after iliac crest bone procurement

Background and objectives  

Autogenous bone grafting is the gold standard procedure for various maxillofacial defects which needs surgical correction and anterior iliac crest is the most common site of harvest. Immediate postoperative pain at the harvested site is a major morbidity associated with it. The aim of the study was to assess the immediate postoperative pain control at the iliac crest graft harvested site by placing an epidural catheter in the incision wound and continuously infiltrating bupivacaine 0.25% at regular intervals.