AN INNOVATIVE APPROACH IN THE MANAGEMENT OF ALVEOLAR CLEFTS WITH BONE GRAFT HARVEST FROM MAXILLARY TUBEROSITY AND MANDIBULAR WISDOM MOLAR ODONTECTOMY SITES- A CASE REPORT

Alveolar bone grafting is a complex procedure utilized in alveolar cleft repair, however, the ideal site of bone graft material remains highly debated. In this paper, we describe the management of a 14 year old female with bilateral alveolar clefts using alternative intra-oral donor sites for bone graft harvest.

Transoral Endoscopic Localization of the Parapharyngeal Internal Carotid Artery

Objectives To define transoral endoscopic surgical landmarks for the parapharyngeal segment of the internal carotid artery (ppICA) using cadaveric dissection. Materials and Methods Ten fresh cadaveric heads were dissected to demonstrate the parapharyngeal space anatomy and course of the ppICA as seen in a transoral approach. Anatomical measurements of the distance between the ppICA and bony landmarks were recorded and analyzed. Results The stylohyoid ligament, styloglossus, and stylopharyngeus could be considered to be the safe anterior boundary of the ppICA in the transoral approach; among them, the styloid ligament was the most rigid tissue. Dissection between the stylopharyngeus muscle and superior pharyngeal constrictor muscle provides direct access to the ppICA. At the level of the skull base, the distance from the root of the styloid process to the lateral margin of the external aperture of the carotid canal on the left side and on the right side was 8.57 ± 1.97 and 8.80 ± 1.21 mm, respectively. At the level of the maxillary tuberosity, the distance from the ppICA to the maxillary tuberosity on the left side and on the right side was 31.48 ± 2.24 and 31.01 ± 2.88 mm, respectively. Conclusion The endoscopic-assisted transoral approach can facilitate exposure of the ppICA. The root of the styloid process, styloid ligament, and maxillary tuberosity are critical landmarks in the identification of the ppICA in the transoral approach.

Fracture of the maxillary tuberosity: Troubleshooting in general dental practice and a proposed fracture classification

A tuberosity fracture can prevent or delay the timely delivery of the most appropriate treatment option for a maxillary molar. This is a relatively common complication, but should not prevent treatment in general practice provided the clinician has adequately risk assessed, planned and obtained informed consent. Should a fracture occur, its initial management in general practice is encouraged. This article aims to improve patient outcomes by providing a troubleshooting guide. A fracture classification is suggested to aid assessment, recognition and management. Should referral to secondary care be required, a classification system will provide a basis for discussion and clarity on further management. CPD/Clinical Relevance: This article provides a tuberosity fracture classification to guide clinicians in the management of patients who have sustained such a fracture.

TRIGEMINO CARDIAC REFLEX IN ORAL & MAXILLOFACIAL SURGERY – A REVIEW

Trigemino cardiac reflex (TCR) which was originally called as OCCULOCARDIAC REFLEX is a physiological response due to the pressure effect on the largest cranial nerve, the trigeminal nerve. Oral and maxillofacial procedures can induce the development of this reflex. TCR is a triad of bradycardia , bradypnea and gastric motility changes due to the efferent activation of the vagal nerve in response to the pressure distribution in Trigeminal nerve. TCR may be generated as a result of procedures or conditions that increase intraocular pressure, strabismus surgery, nasal packing after rhinoplasty, the reduction of zygoma and zygomatic arch fractures, elevation of bone flap or osteotomies, reflection of a palatal flap for removal of a mesiodens, during Le Fort I downfractures, sagittal split ramus retraction, midface disimpaction, cutting maxillary tuberosity, and temporomandibular joint arthroscopy. The purpose of this paper is to discuss the pathophysiology and to review the main risk factors , treatment, prevention and management with emphasis on the role of maxillofacial surgeons and attending anesthetist. Maxillofacial surgeons should be familiar with presentations, preventive measures for the effective management of this complication.

The assessment of need for suturing following maxillary third molar extractions

Maxillary third molar extractions (MTME) are one of the most common procedures done in maxillofacial surgery. Nevertheless, there are general complications that arise with every surgery. In our study, we have aimed to understand why suturing had been done following MTME and to observe a predilection in age and gender. By attempting to do so, we may establish when suturing is required and if age and gender have a role to play. A retrospective cross-sectional study was conducted after reviewing and analysing the data from 86,000 patient records between June 2019 and March 2020. Patients with an established record of MTME were selected from the age group of (20-60) years. The females of the study population had a larger frequency for having undergone MTME (52.7%) compared to the males (47.3%) and lastly transgenders (0.1%). The highest incidence of MTME was found in the age group of (31-40) years with 30.6% followed by (20-30) and (41-50) years with 26.9% each. (51-60) years had the least MTME done (15.6%). There was a higher incidence of extracted 28’s than 18’s (52.1% > 47.9%). Sutures were placed only in 1.6% of the total cases due to tuberosity fractures that had occurred as a complication of MTME. The placement of a suture following exodontia is not always mandatory, but when a complication such as a maxillary tuberosity fracture arises, suturing must be done. It is imperative to be equipped with the knowledge on how to manage possible complications, because even simple exodontias can prove to have fatal outcomes. Thus, further studies must be done to confirm our findings and to test other geographical locations and ethnicities.

The assessment of need for suturing following maxillary third molar extractions

Maxillary third molar extractions (MTME) are one of the most common procedures done in maxillofacial surgery. Nevertheless, there are general complications that arise with every surgery. In our study, we have aimed to understand why suturing had been done following MTME and to observe a predilection in age and gender. By attempting to do so, we may establish when suturing is required and if age and gender have a role to play. A retrospective cross-sectional study was conducted after reviewing and analysing the data from 86,000 patient records between June 2019 and March 2020. Patients with an established record of MTME were selected from the age group of (20-60) years. The females of the study population had a larger frequency for having undergone MTME (52.7%) compared to the males (47.3%) and lastly transgenders (0.1%). The highest incidence of MTME was found in the age group of (31-40) years with 30.6% followed by (20-30) and (41-50) years with 26.9% each. (51-60) years had the least MTME done (15.6%). There was a higher incidence of extracted 28’s than 18’s (52.1% > 47.9%). Sutures were placed only in 1.6% of the total cases due to tuberosity fractures that had occurred as a complication of MTME. The placement of a suture following exodontia is not always mandatory, but when a complication such as a maxillary tuberosity fracture arises, suturing must be done. It is imperative to be equipped with the knowledge on how to manage possible complications, because even simple exodontias can prove to have fatal outcomes. Thus, further studies must be done to confirm our findings and to test other geographical locations and ethnicities.