Maxillofacial and Oral Surgery

Use of a Versatile Buccinator Myomucosal Flap in the Palatal Defect

Hyalinizing Clear Cell Carcinoma of the Maxilla Abstract Hyalinizing clear cell carcinoma (HCCC) is a rare low-grade salivary gland tumor with distinctive clear cell morphology, accounting for < 1% of all salivary gland tumors. In the majority of cases, the tumor originates typically from the minor salivary glands in the oral cavity. A total of 155 cases of HCCCs from head and neck region have been reported in the literature until 2017, of which only 16 are of maxillary origin. Due to its low incidence, there is no clear consensus on prognostic factors and optimal treatment strategies yet. In this paper, a new case of HCCC of the maxilla is presented and its clinical and histopathological features are discussed.

Comparison of two L shaped Plate on Plate Versus Single Conventional L Miniplate in Fixation of Subcondylar Mandibular Fractures Abstract Aim To compare and evaluate treatment outcome and postoperative complications in subcondylar fractures of mandible–single L shape plate versus two L shape plate–using plate on plate technique. Materials and Methods The clinical trial had a total of ten patients (ten unilateral subcondylar fracture sites), which were divided randomly into two groups of five each. Group I patients underwent open reduction and internal fixation with single L shaped miniplate and Group II ORIF was done with two L shaped miniplates by plate on plate technique. Results Both the groups showed comparable results in terms of postoperative complications. Few cases in Group I presented with minor occlusal discrepancy which was easily corrected with transitional inter-maxillary fixation(IMF) for 1 week, and none of the Group II cases required postoperative IMF, but stability in Group II was better than Group I. Conclusion The results of this trial suggested that the treatment of mandibular condylar fractures with 2 (2-D) plates placed one over the other is better suited than conventionally practiced single-plate fixation. Increased 3-dimensional stability, low morbidity and infection rates are the advantages offered by 2-plate technique of ours.

Huge Radicular Cyst of the Maxilla Treated with Complete Resection and Immediate Reconstruction by Rib Bone Graft Abstract Radicular cysts are the most common odontogenic cystic lesions that occur in jaws. They rarely become problematic and are incidentally found on routine dental radiographs. As they appear to reach a considerable size prior to medical attention due to their insidious and destructive growth characteristics during the intraosseous stage, treatment often requires extensive cystectomy and skeletal reconstruction. Here we present the case of an 18-year-old man who was sent to our department, because of a huge, bulging mass in his left cheek. Surgery consisted of complete removal of the cyst and immediate reconstruction of the midfacial buttress using an autologous rib graft in a tongue-and-groove fashion. Histopathological examination of the lesion confirmed the diagnosis of a maxillary radicular cyst. This case underscores the nature of the frequently asymptomatic and long-term evolution of maxillary radicular cysts, with their growth causing massive bone destruction for which skeletal reconstruction is required.

Lingual Hypoglossal Reflex: An Unusual Reflex of Head and Neck Abstract Introduction Oral-pharyngeal reflexes demonstrate a wide range of complexities due to their intricate synaptic pattern. Most of the reflexes are protective in nature such as preventing aspiration. These reflexes in oral cavity affect the muscles and can be evoked either in isolation or in combination in order to achieve a specific response. Certain sensory inputs induce an entire motor behavior pattern as seen in lingual hypoglossal reflex. Materials and Methods A case report depicting this reflex have been presented. To our knowledge, this is the first case documented in a living human. Along with this, cadaveric studies have been also done in fifteen specimens. Results Extralingual anastomosis between lingual nerve and hypoglossal nerve were found in six specimens. Conclusion Hereby, we present a clinical paper of this unusual phenomenon which has not been documented in the literature.

Tongue Flap Reconstruction in Carcinoma of Oral Cavity: An Institutional Experience Abstract Introduction Abundant blood supply of tongue permits various flap designs and makes it a good choice for reconstructing defects following resection of oral cancer. Aim We aim to evaluate the reliability of tongue flap for small- and medium-size defects after resection of oral cancer in terms of viability, complications, and functional outcome. Methods In this retrospective analysis, patients reconstructed with lateral tongue flaps after resection of oral cavity carcinoma from May 2011 to December 2017 were included. Results Forty-two patients underwent tongue flap reconstruction during the study period. Median size of defect was 3.5 cm. Out of 42 patients, 27 had carcinoma of buccal mucosa and 8 had carcinoma of lower alveolus. Mandibular resection was performed in 30 patients. Neck was addressed in all 42 patients. Supraomohyoid neck dissection was done in 12 patients, while others had comprehensive neck dissection. Average time to harvest flap was 25 min. There was no flap loss in the postoperative period. Three patients each developed flap tip necrosis and minor orocutaneous fistula that were managed conservatively. Subjective functional outcome was good to satisfactory in most patients (88%). Conclusion Lateral tongue flap is a simple reliable flap for reconstruction of small- and medium-sized defects following resection of oral cavity cancers in terms of low morbidity and satisfactory functional outcomes. It obviates the need of distant tissue transfer.

Ameloblastoma Management: “Horses for Courses” Protocol Abstract Purpose The purpose of the article is to review 45 cases of ameloblastoma treated in a tertiary care centre depending on the extent of the pathology, in terms of recurrence and morbidity of the patients. Materials and method This was a retrospective study of patients who underwent treatment for ameloblastoma between 2009 and 2018 at Vydehi Institute of Dental Sciences, Bangalore. During the first phase of 4 years, the focus of the treatment was on avoiding any recurrence, and therefore, resection followed by reconstruction with reconstruction plates was the only modality used in ten patients. However, from 2014, it was decided to treat each patient based on the extent of the lesion and decide on either conservative management in the form of enucleation followed by peripheral ostectomy and chemical cauterisation or resection with safe margins and reconstruction with reconstruction plates. Results The study sample consisted of 45 patients, and the ages ranged from 12 to 65 years with an average of 36. There were 30 males and 15 females. In the first phase of treatment protocol adopted, ten patients underwent resection. In the later period, 18 patients were treated by conservative methods and 16 patients were treated by radical management. There were only three recurrences over a period of 3-year follow-up in the group treated conservatively. Conclusion Considering the benign nature of the tumour and the morbidity after resection, patients, most of whom are in the younger age group, can still be subjected to conservative treatment provided they are followed up for a long period thus assuring them of a better quality of life.

The Difficult Route to Glottis in Cleft Patients Simplified Abstract Introduction Cleft lip with or without palate is one of the most common craniofacial anomalies worldwide. Airway problems in children with cleft lip and palate were well recognized since very early times. Objective The aim of this technical note is to describe a unique method of performing direct laryngoscopy in children with cleft lip and palate by using a palatal obturator to cover the alveolar and palatal defect in these patients. Methods The palatal obturator was fabricated using cold cure acrylic after making an impression of the defect using putty-type impression material. Results The use of the palatal obturator facilitated the placement of the laryngoscope's blade by providing adequate leverage to it during the process of direct laryngoscopy prior to intubating children with cleft lip and palate defect. Conclusion A discontinuous alveolar arch and palatal defect contribute to lack of effective leverage of the laryngoscope blade while attempting visualization of the glottis. This difficulty can be overcome by use of an obturator to cover the alveolar and palatal defect in order to provide adequate leverage while using a laryngoscope for visualizing the glottis.

Understanding Predictability Error in Orthognathic Surgery Abstract Introduction Orthognathic surgery aims to improve the facial aesthetics while maintaining stable jaw form and function. Lateral cephalometry provides objective data used in pre-op mock surgery to predict movement of the maxilla and mandible during orthognathic procedures. Patient and Methods A prospective cohort study was conducted on 30 adult orthognathic surgery patients. Mock jaw surgery predicted two-dimensional (horizontal and vertical) linear movement of maxilla and mandible. Operative procedures performed were bilateral sagittal split osteotomy and Le Fort I osteotomy. Seven-day pre-op cephalogram (T1) was compared to 7th day post-op cephalogram (T2) to assess hard tissue movement of point A (maxilla) and point B (mandible) using Cartesian (X–Y) plane. Results The difference between predicted values to the 7th day post-op outcome results was statistically insignificant (p value less than 0.001). Conclusion Planning in orthognathic surgery using digitized two-dimensional cephalometric tracings and mock jaw surgery produces predictable results.

Soft Tissue Injuries of the Maxillofacial Region Occurring from Motorcycle Accidents Abstract Introduction Soft tissue injuries are the most common type of injury occurring from a motorcycle accident. Not many studies have been conducted to determine the incidence and pattern of soft tissue injuries and the effectiveness of helmet to prevent them. Methods In this prospective cross-sectional study, all the patients attending three centres in North Bangalore, with facial injuries occurring from a motorcycle accident, were included. The subjects were analysed for the type of collision, helmet use, type of helmet use and incidence and pattern of extra-oral and intra-oral soft tissue injuries. Results A total number of 311 motorcyclists were included in this study for a period of 18 months (December 2015–June 2017). The most prominent age group was 21–30 years. Abrasions were the most common type of injury followed by the lacerations, contusions and communication. Injuries to the middle third and lower third of the face were significantly higher in non-helmeted and open-face-helmeted patients. Middle third injuries were most common in the full-face helmet group. Conclusion Abrasions are the most common type of soft tissue injury, and most common site was the nose, followed by the forehead, orbit and chin. Full-face helmets are more effective and protective as compared to open-face helmets. Open-face helmets offer minimal protection against facial injuries occurring from road traffic accidents.