Journal of Maxillofacial & Oral Surgery最新文献

Purpose: The aim of the study was to evaluate and compare the efficacy of extra-oral mandibular nerve block (infra-zygomatic approach/lateral approach) vs. intra-oral (Gow-Gates) mandibular nerve block in arch bar fixation for management of mandibular fractures.

Methodology: A total of 200 patients reported with maxillofacial fractures. Out of them, 50 patients who required arch bar fixation for management of mandibular fractures were divided into two groups: Group I: Extra-oral and Group II: Intra-oral mandibular nerve blocks. The intra-operative pain, time of onset of anaesthesia, volume of drug administered, depth of needle insertion, repetition of injections and postoperative complications were analysed.

Results: In Group I (Extra-oral nerve block), the time of onset of anaesthesia, volume of anaesthesia administered, needle depth, number of repetition of injections and postoperative complications were more as compared to Group II. No significant difference was observed in intra-operative pain score between two groups.

Conclusion: Intra-oral approach with Gow-Gates technique seemed to be efficient and easy to operate as compared to extra-oral approach, for arch bar fixation of mandibular fractures in an output door setting, as extra-oral approach is more technique-sensitive and may lead to certain complications which require operation theatre setting with medical attention.

Introduction: Mandibular continuity defects can cause functional and cosmetic deformities affecting a patient's quality of life. Reconstruction of such defects can be intricate even for the most seasoned maxillofacial surgeons. Reconstruction plates were the standard of care in the past, followed by a secondary reconstruction using autogenous grafts.

Materials and methods: Novel technological upgrades like customized computer-designed patient-specific implants (PSIs) have overtaken these stock reconstruction plates to enhance the aesthetics and address the individual clinical situation. Affirmation of the above plate design using biomechanical analysis can further improve the efficacy of PSIs.

Discussion: The present case report describes a novel combination of an autogenous graft and a low-cost patient-specific implant with the prosthesis design validated using finite element analysis. The authors have also reviewed the biomechanical evaluation of PSIs design and its uses in treating mandibular continuity defects.

Conclusion: Use of FEA helped to inspect the potential weakness and stress distribution through out the implant due to this there was no sign of hardware failure.

Purpose: To propose a novel technique of fixation and stabilization of the nasoendotracheal tube for maxillary osteotomies.

Method: The technique utilizes a flexible Portex north pole endotracheal tube size 6, elastic adhesive tape, a catheter mount and a head cap made of cloth in the fixation and stabilization of the nasoendotracheal tube for maxillary osteotomies.

Result: It is a simple method of fixation and stabilization of the nasoendotracheal tube, particularly for maxillary osteotomies that essentially eliminates distortion of the nasal, labial and perinasal areas and facilitates good nasolabial control during maxillary osteotomies.

Conclusion: This technique is simple, safe and versatile and may be employed for maxillary osteotomies.

Introduction: Oral squamous cell carcinoma (OSCC) is a formidable malignancy in the Indian subcontinent, characterized by high morbidity and mortality, with a dismal 5-year survival rate of 40-50%. The tumor's histopathological heterogeneity is well documented, particularly in its differentiation status, which ranges from well-differentiated lesions with prominent keratin pearls to poorly differentiated forms lacking such structures.

Objectives: Existing literature has elucidated the role of neutrophils and macrophages in the degradation of keratin pearls, the involvement of multinucleated giant cells (MNGCs) in this process remains cryptic.

Case report: This study reports a novel case of a 49-year-old male with moderately differentiated OSCC, characterized by ulcerative growth in the left buccal mucosa. Histopathological analysis revealed neoplastic cell infiltration, keratinization, and abnormal mitoses, alongside the degradation of keratin pearls by large foreign body and Langhans MNGCs. This intricate keratin pearl degradation by MNGCs in OSCC highlights tumor heterogeneity and aggressiveness, offering profound insights into surgical, radiotherapy, and chemotherapy strategies. Surgeons must meticulously consider this process as a marker of aggressive behavior, warranting precise surgical planning and a multidisciplinary approach for optimal outcomes.

Conclusion: This case emphasizes the critical role of foreign body and Langhans MNGCs in the degradation of keratin pearls within OSCC, revealing a hitherto unrecognized facet of tumor biology. This discovery holds profound implications for understanding OSCC progression, prognosis, and therapeutic responsiveness, warranting further investigation into the molecular mechanisms underpinning this process.

Objective: To evaluate the efficacy of aqua titan patch in postoperative sequelae after mandibular third molar surgery.

Material and methods: A total of 20 patients were selected and divided into two groups, Group A was evaluated by using Aqua titan patch with oral antibiotics and anti-inflammatory analgesics while Group B was only provided with antibiotics and anti-inflammatory analgesics.

Results: There were total 20 subjects, with 4 males and 16 females. Pain was evaluated after surgical removal, where significant reduction was observed on 5 and 7th postoperative day in study group with p value 0.004 and 0.013, respectively. Reduction in swelling was observed to be statistically highly significant (p values = 0.000) in study group on 5 and 7th postoperative days. Beneficial results were obtained in study group where mouth opening was statistically significant with p value 0.002 on 5th and 0.049 on 7th postoperative day. For postoperative neurosensory deficit, mean values were constant and difference was found to be statistically insignificant with p value 0.13.

Conclusion: Postoperative local application of aqua titan patch in study group provided beneficial effects in terms of reduction in pain, swelling and maximum mouth opening as compared to the control group.

Introduction: Submental intubation allows for the passage of an endotracheal tube through the anterior floor of the oral cavity. This allows for adequate surgical access to the regions of the mouth and the nasal pyramid with minimal to no hindrance in airflow to the lungs.

Aim of the study: To explore the perception of an anaesthetist regarding the submental intubation.

Materials and methods: A questionnaire‑based prospective randomized analysis was formatted and carried out in Odisha, India, between 20 Jan 2023 and 20 may 2023. A self-structured questionnaire consisting of 16 questions was distributed to the anaesthetists of the medical colleges in Odisha.

Results: Out of 97, 42 (43%) male and 45 (46%) female were familiar with the submental infiltration technique. Among the participants, 56% females and 43% males have performed and assisted in a submental intubation procedure. None of them encountered any complications or adverse events related to submental intubation (p = 0.0001).

Discussion: Out of all, 20% females and 19% males were very confident in performing submental intubation.

Conclusion: Submental intubation is a simple, safe, quick, and relatively harmless alternative to tracheostomy for securing the airway in selected patients with craniofacial trauma. Familiarity with the submental intubation technique will help the anaesthetists to avoid tracheostomy in selected patients with craniofacial trauma who do not require long-term mechanical ventilation. But, this procedure is technique sensitive as well.

Objectives: To evaluate the positions of the mandibular foramen (MF) and mandibular canal (MC) between different skeletal classes to highlight the implications for bilateral sagittal split osteotomy (BSSO).

Methods: A cross-sectional study was performed using cone-beam computed tomography on 90 patients classified into classes I, II and III. Linear measurements were performed on multiplanar reconstructions as follows: from the MF to the edge of the mandibular ramus (1), to the mandibular notch (2), to the ramus width (3) and to the occlusal plane (4); and from the MC to the alveolar crest (A), to the lower border of the mandible (B) and to the mandibular buccal cortical bone (C). Mandibular thickness (D), width (E) and height (F) of the MC were measured. Intra-class correlation coefficient (ICC) checked the reliability. Two-way ANOVA and Tukey's test were used to compare measurements and classes.

Results: Linear measurements 2 presented a statistically significant difference between classes I and II. There was no statistically significant difference between the classes and measurements B, C, D, E and F. Linear measurements A were shorter in class III than in class II.

Conclusions: Although most measurements suggest that the BSSO technique does not need to be modified for each skeletal class, measurements from the MF to the mandibular notch in class II and from the MC to the alveolar crest on distal of the second molars in class III could help surgeons to recognize critical regions.

Introduction: Coronoid process of mandible is seldom fractured during maxillofacial trauma. Majority of the cases of coronoid fracture are treated conservatively, but some lead to complications which are often overlooked. At present, the literature on coronoid fractures is inadequate for meta-analysis. Also, there exists no standardized classification in the literature. Hence, the purpose of this study was to analyze the incidence and establish a novel 'tripartite' classification.

Material and methods: In this study carried out at level 1 trauma center, all patients with coronoid fracture with or without associated maxillofacial fractures were included. Relevant data were noted from Hospital records and CT scans (computer tomographic scans). These cases were classified according to 'tripartite' classification and treated. Data feed was given to IBM® SPSS® statistics (version 21) for analysis.

Results: Among 33 coronoid fracture patients, majority (57.57% cases) were from age group of 21-40 years with 82.85% cases attributed to road traffic accidents. 11.43% cases were bilateral, and the rest unilateral cases revealed right-side predilection.

Conclusion: Novel tripartite classification allows us to easily categorize and visualize the coronoid fractures. Horizontal types 1 to 3 and vertical types 4 to 6 are in increasing order of incidence, which makes it easy for communication, treatment approach and record maintenance.

Background: Oral carcinoma cuniculatum (CC) is a rare variant of squamous cell carcinoma. It exhibits a locally aggressive behaviour, and its histopathology poses a diagnostic challenge, as it can be mistaken for other conditions. We present five cases of oral CC treated at our institution and conduct a comprehensive review of the current literature.

Case series: Five patients (two women and three men) were treated in our institution with a final diagnosis of oral CC. Ages ranged from 9 to 85 years at the time of diagnosis. Four patients had mandibular involvement requiring mandibulectomy and reconstruction using an osseous free flap. The diagnosis of oral CC was straightforward in the most recent cases. However, for the first two cases, the diagnosis of oral CC was established after thorough discussions between the surgeons and the pathologist regarding the similarities with recent cases. Consequently, the pathological specimens had to be retrospectively re-evaluated to confirm these diagnoses.

Conclusions: Oral CC is a locally aggressive tumour that can present a challenge for pathologists, often leading to misdiagnosis. According to the existing literature, surgical resection with clear margins is the preferred treatment approach.

Objectives: The primary aim is to determine the accuracy of contrast-enhanced computed tomography (CT) in evaluation of depth of invasion (DOI) and detection of cervical node metastasis. We also analysed the relation between radiographic DOI (rDOI) and cervical lymph node metastasis.

Materials and methods: We have retrospectively reviewed 201 oral squamous cell carcinoma (SCC) patients. The rDOI was compared with histological DOI. Sensitivity, specificity, accuracy, and negative (NPV) and positive (PPV) predictive values were evaluated for CT scan in predicting nodal metastasis. The relation between rDOI and lymph node metastasis was analysed using ROC curve.

Results: rDOI correlated significantly with histologic DOI for oral tongue, buccal mucosa, gingiva, and mucosal lip SCC (P < 0.05) and for tumours with rDOI > 5 mm. The sensitivity, specificity, PPV, NPV and accuracy rate of CT scan were found to be 84.71%, 50.86%, 55.81%, 81.94% and 65.17%, respectively. Tumours with rDOI > 16 mm had significant (P < 0.001) chance of having neck node metastasis.

Conclusion: CT-derived DOI correlates significantly with pathological DOI although both are not similar. CT scan can predict nodal metastasis in fairly accurate manner using the four radiographic criteria used in this study. Radiographic depth of invasion can be used as predictor of cervical node metastasis.