National journal of maxillofacial surgery最新文献

Acquired facial defects have been noted to cause functional and esthetic impairment and carry a social stigma. Patients frequently exhibit avoidance of social interactions and decreased quality of life. Surgical reconstruction is preferred in extensive facial defects but may be contraindicated in certain cases, in which case the defect must be rehabilitated by a prosthesis. Prosthetic rehabilitation of facial defects has been shown to significantly improve quality of life and allow the patient to resume daily activities. Silicone has become a popular material for maxillofacial prostheses, but in extensive defects, excessive weight compromises retention, and the use of an adhesive may not be effective, requiring external mechanical retention. In these cases, a lightweight material that can hold the desired contour and be easily modified for external mechanical retention is required. Polymethyl-methacrylate meets these criteria and was chosen as the material of choice to rehabilitate a case of an acquired facial defect after resection of squamous cell carcinoma of the buccal mucosa.

The study aimed to assess the outcomes of literature published between 2012 to 2022 and gather information about clinical, radiological, histopathological characteristics and treatment outcomes of unicystic ameloblastoma in infants, children, and young adults. A total of 325 publications were assessed using computer and manual approaches. A structured literature search was carried out utilizing predefined criteria. An assessment and critical appraisal were done in three distinct rounds. In total, 34 articles describing 36 cases satisfied the selection criteria and were thus included in the final review. Unicystic ameloblastoma was most commonly presented as swelling found on the mandibular posterior region exhibiting unilocular radiolucency. Maximum cases were of the mural type of histopathologic variant. According to the result of this study, conservative treatment appears to be more effective in younger age groups due to reduced reported recurrence rate.

Replacing missing ears with implant-retained prostheses, particularly when using a surgical guide, can yield highly satisfactory prosthetic outcomes. This case report describes the prosthetic rehabilitation of a 28-year-old man with severe facial burns, which resulted in significant cosmetic and psychological challenges. Bilateral implant-retained auricular prostheses were fabricated, and a surgical guide was employed to ensure predictable implant placement and accurate prosthesis positioning. This approach not only addressed the physical deformities but also alleviated the associated psychological distress. The use of osseointegrated implants for auricular prosthesis retention proved to be a predictable and effective treatment modality, enabling the patient to reintegrate into society. This case highlights the clinical significance of combining reconstructive techniques with prosthetic solutions to improve both physical appearance and self-perception, ultimately enhancing the patient's quality of life.

Management of the oral cancer, involves surgical intervention and the associated complications are quite prevalent after oral cancer surgery. This article aims to provide a comprehensive review of all the possible complications associated with surgical management of oral cancer to apprise about adequate management of such complications if they manifest. An internet based literature review was performed in PubMed, Embase and Cochrane Central Register electronic databases using keywords "oral cancer," "oral surgical procedures," "post operative complications," "intra operative complications," which resulted in 19 articles. After screening only relevant English language articles from 2000-2022 were considered. A working classification, described in our study, provides an easier understanding of the possible complications associated with surgical management of the oral cancer. It has been based depending upon their time of occurrence. A learned surgeon thus can provide adequate surgical care and minimize the occurrence of such complications that may occur even with adequate precautions. If such complications do occur, there is always a management protocol.

The sialolith is a calcified mass resulting from the crystallization of salivary solute made up of calcium phosphates such as hydroxyapatite and octacalcium phosphate with yellowish discoloration and different shapes and sizes in the range of 1-2 cm normally, while occurrence of large sialolithiasis is rare, with literature showing sizes from 3.5 cm to 7 cm noted till date. About 80% of sialolithiasis occurs in submandibular glands and 20% in parotid gland and <1% is seen with sublingual gland. For small sialolithiasis and for superficially located sialolithiasis at ductal regions, conservative management is performed. However, for larger sialolithiasis, surgical management is mandatory which includes various methods such as transoral sialolithotomy, laser techniques, and sialendoscopy-assisted techniques. Complete excision of salivary gland is recommended for large, multiple, and recurrent cases of sialolith. In the present study, we have presented the unusual-sized rare case of salivary gland stone found in submandibular salivary gland and not in ductal region which was mimicking an osteoma on OPG and discuss the review of literature. This giant sialolith was managed with extraoral submandibular approach followed by TOTO removal of the sialolith which measured about 38 g in weight and 28 mm in size. Present sialolith was the rarest till date with heavyweight of about 38 g and 28 mm in size. Even the conventional method is sufficient to excise the sialolith when other modalities are not available. Chronic sialolith is common in old male patients and shows positive correlation with chronic smoking.

Aims and objective: To evaluate lingual split technique vs buccal guttering in the extraction of lingually placed impacted mandibular third molar and to assess the clinical outcome of the two techniques in relation to pain, swelling, mouth opening, intra-operative time, dry socket, paraesthesia due to injury to the lingual and inferior alveolar nerve and hemorrhage.

Materials and methods: The present clinical study comprised of 36 lingually impacted mandibular third molars. Patients were divided into two groups, and bone covering the third molar was removed by the lingual split technique using chisel and mallet and buccal guttering approach technique using rotary instruments.

Results: The conventional buccal guttering technique took longer time with higher incidence of dry socket than the lingual split technique. Significant findings were also recorded in the lingual split technique in terms of pain, swelling, and trismus. Postoperative nerve injury was significantly higher in lingual split technique.

Conclusion: The study concluded that lingual split technique using chisel and mallet is found to be better than the buccal guttering approach technique using rotary instruments.

Intraoral reduction and fixation of mandibular angle fractures is a routine surgical procedure for oral and maxillofacial surgeons across the globe. Access is the surgeon's major challenge while treating the same via an intraoral approach. Conventional principles of fracture management comprise reduction, intermaxillary fixation, and bone fixation. Access for the fixation screws in the ramal segment with intermaxillary fixation in place has always posed a problem while operating intraorally. This may lead to misdirected loose fixation screws which may compromise the fixation. Excessive stretching of the cheek also leads to injury and increased postoperative swelling. Mild sequential modification is suggested in this standard operative protocol (SOP) to facilitate the treatment and reduce the operative time. We have developed and copyrighted an SOP for ORIF of mandibular angle fractures via an intraoral approach. This well-designed protocol can be used as a universal protocol. Utilization and practice of this SOP will help budding surgeons learn and master the operative skills for ORIF of angle fracture via an intraoral approach.

Reconstruction of the lip is crucial to regaining essential functions, including oral competency, speech articulation, and aesthetics. Reconstruction is often challenging when commissure is involved as it affects the anatomy of both the upper and lower lip as well as the size of the oral stoma. Improper commissure reconstruction results in drooling and a reduction in mouth opening. This case highlights the versatility of the simultaneous use of a bilateral nasolabial flap for the reconstruction of subtotal lower-lip defects in cases where a tumor involves one of the commissures, providing satisfactory aesthetic and functional results.

Introduction: Skin cancer of the head is the commonest cancer worldwide, frequently affecting older, medically complex patients, rendering postresection reconstruction challenging.

Methods: This is a retrospective cohort study comparing the clinical outcomes of oncologic soft tissue defect reconstruction of the head with the Integra dermal regeneration template versus local flaps. Defects reconstructed at a single center between January 1, 2022, and December 31, 2022, were included. Multivariable logistic regression determined the independent effect of demographics and surgical factors on the odds of complications.

Results: A total of 125 defects were included, 59 reconstructed with Integra and 66 with a local flap. Baseline characteristics were similar, but patients were significantly older within the Integra group (84 vs. 78 years, P = 0.022) with larger defect sizes (699 mm² vs. 454 mm², P < 0.001). Multivariable analysis showed that when accounting for confounding variables, local flap reconstruction remains associated with significantly reduced odds of complications (OR 3.54 [1.59-8.25], P = 0.002). The commonest complication was graft failure, with all cases recorded in the Integra group. Graft failure did not correlate with clinical failure, as 90% of Integra wounds were fully healed at six months.

Conclusion: Reconstruction of oncologic soft tissue defects with Integra is related to high graft failure rates, limiting its clinical effectiveness compared to local flaps. Surgical factors like subsequent epidermal grafting, fenestration, or antibiotic prophylaxis are likely to improve outcomes. The development of a standardized surgical approach based on randomized, prospective research is warranted, as Integra can enable the closure of large defects in medically complex patients, unsuitable for reconstruction by other methods.