Ipsilateral keratoconus associated with long-standing primary hydatid cyst of the orbit.

Abstract

Hydatid cyst is a cyclozoonotic infection of the larvae form of a platyhelminthes Echinococcus granulosus. The majority of hydatid cysts appear in the liver (65%) and lungs (25%). Kidneys and brain are other less common sites for this disease. Only 1% to 2% cases are seen in the maxillofacial region. These commonly appear as cystic lesions located in the mandible, maxillary sinus, orbit, infratemporal fossa, pterygopalatine fossa, parapharyngeal space, tongue, and parotid and submandibular salivary gland. Hydatid cysts of the orbit are rare and account for 1% of all hydatid cysts. The article presents hydatid cyst of the orbit in a 10-year-old child. Clinical features, investigations, surgical approaches, and adjuvant medical management have been emphasized. We believe that the lateral orbital route allows excellent exposure and safe removal of an intraorbital hydatid cyst located posteriorly, superiorly, and laterally without damaging the surrounding important orbital structures. Upper blepharoplasty incision results in good cosmetic outcome.

Peripheral neurectomy: minimally invasive surgical modality for trigeminal neuralgia in Indian population: a retrospective analysis of 20 cases

Abstract

OBJECTIVE:

To evaluate the efficacy of peripheral neurectomy in 20 cases of trigeminal neuralgia as minimally invasive surgical treatment modality.

MATERIALS AND METHODS:

Twenty (12 males and 8 females) patients with trigeminal neuralgia aged between 35 and 68 years (mean 48 years), who had undergone peripheral neurectomy, were retrospectively analyzed for relief of pain, complications, recurrence of pain, and any additional procedure required to treat recurrence, in a follow-up period of 36 months postoperatively.

RESULTS:

There was no significant intra-operative and post-operative complications. There was recurrence of pain in two patients (10 %) in 24 and 28 months post-operative follow-up respectively, whereas, rest of the 18 patients were symptom free during 36 months follow-up.

CONCLUSION:

Peripheral neurectomy is one of the minimally invasive and expeditious forms of surgical modality for the treatment of trigeminal neuralgia. This treatment option is cost effective and provides long term relief from neuralgic pain.

KEYWORDS:

Facial pain; Neurectomy; Tic douloureux; Trigeminal neuralgia

Is use of laser really essential for release of tongue-tie?

Abstract

Ankyloglossia, or tongue-tie, is a congenital condition characterized by a short, thickened, or abnormally tight lingual frenulum. This anomaly can cause a varying degree of reduced tongue mobility and has been associated with functional limitations including breastfeeding difficulties, atypical swallowing habits, speech articulation problems, mechanical problems such as inability to clean the oral cavity, and psychosocial stress. In this article, we report a 50-year-old female patient with tongue-tie having difficulty in speech and maintenance of oral hygiene due to high attachment of lingual frenum. The patient was managed by frenectomy by conventional method (scalpel and blade) under local anesthesia as an outpatient procedure without any complications. She later required speech therapy lessons for improvement of speech.

Role of cone-beam computed tomography in diagnosis and management of nasopalatine duct cyst.

Abstract

Nasopalatine duct cysts (NPDCs) are the most common nonodontogenic cyst of the jaw, with a reported prevalence of between 1% and 11.6% of all jaw cysts.1 It is believed to arise from epithelial remnants of the nasopalatine duct, the communication between the nasal cavity and anterior maxilla in the developing fetus. For huge NPDCs, total excision is difficult, and there is an increase in the possibility of postoperative complications including submucosal hematoma, wound dehiscence, wound infection, injury to tooth roots, injury to nasopalatine neurovascular bundles, paresthesia of the anterior palate, facial swelling, and oronasal fistula formation. This article discusses a case with a large NPDC, which was managed surgically without any complication. Radiological findings emphasizing the importance of cone-beam computed tomography in diagnosis and optimized treatment planning of NPDCs are discussed

Pectoralis major myocutaneous flap--still a workhorse for maxillofacial reconstruction in developing countries.

Abstract

PURPOSE:

To retrospectively evaluate the utility of the pectoralis major myocutaneous (PMMC) flap for head, face, and neck (HFN) reconstruction in the Indian population.

MATERIALS AND METHODS:

The hospital records of 496 patients in whom the PMMC flap was used (saving the deltopectoral flap) for reconstruction of HFN defects from January 1991 to December 2010 were reviewed retrospectively. All the patients were followed up for a minimum period of 6 months, and the utility of the PMMC flap was evaluated for HFN reconstruction.

RESULTS:

Of the 496 patients, complications developed in 84 patients. The complications included complete flap failure in 12, partial skin paddle loss in 24, wound infection in 12, peripheral wound dehiscence in 16, plate exposure in 12, and donor site morbidity such as infection and a decrease in function in 8.

CONCLUSIONS:

The PMMC flap or its modification was used in 496 cases of reconstruction after resection surgery for malignancy of the HFN region with minimal morbidity and 1 death. This technique is a useful alternative in places with a high incidence of HFN malignancies and microsurgical free tissue transfer is not possible or as a salvage procedure in selected large, full-thickness, oral cavity lesions. In our 19-year experience, the final functional and cosmetic results were satisfactory with this sturdy flap.

Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Efficacy of single dose azithromycin as prophylactic antibiotic in surgical removal of mandibular third molars: a clinical study.

Abstract

OBJECTIVE:

To evaluate the efficacy of single dose Azithromycin as prophylactic antibiotic in surgical removal of mandibular third molar.

MATERIALS AND METHODS:

The study was carried out as an open clinical trial on fifty (23 males & 27 females) patients chosen from the ones referred to our Oral & Maxillofacial Surgery Department for surgical removal of mandibular third molar (SRMTM). Pre-surgical evaluation of pain, swelling, lymphadenopathy, fever and purulent discharge from the surgical site were made. All patients were administered oral Azithromycin 500mg, 1 hour prior to the procedure. The patients were followed up clinically for a minimum period of 10 days post operatively. Evaluation for pyrexia, purulent discharge from surgical site, persistent pain &/or swelling & lymphadenopathy was done on 1st, 3rd, 7th and 10th postoperative day to determine SSI (surgical site infection). All patients received same set of post-operative medications (Tab. Diclofenac sodium (50mg) TID, Tab. Ranitidine 150 mg BID for 5 days) and set of instructions.

RESULTS:

Surgical site infection was seen in only one patient (2%) out of the total fifty patients included in the study when oral Azithromycin was administered one hour prior to surgical removal of mandibular third molar.

CONCLUSION:

Our study suggests that, giving antibiotics pre-operatively 1 hour before the SRMTM is beneficial to reduce/avoid SSI. The surgeon must consider all potential factors that may contribute to the post-operative complication and decide whether the benefits of antibiotic therapy outweigh its risks.

KEYWORDS:

Azithromycin; Impacted mandibular third molar; Prophylactic antibiotic; Surgical site infectio

J Maxillofac Oral Surg. 2014 Jun;13(2):189-94. doi: 10.1007/s12663-013-0495-6. Epub 2013 Apr 6. Is post-operative antibiotic therapy justified for surgical removal of mandibular third molar? A comparative study.

Abstract

Surgical removal of impacted mandibular third molar (SRIMTM) is the most common procedure performed in oral and maxillofacial surgery. In the literature, many complications associated with lower third molar removal are described such as pain, swelling, trismus, infection, inflammation, and nerve damage. Antibiotics are routinely used either pre-operatively or post-operatively to reduce the chances of surgical site infection (SSI). However routine use of antibiotics for SRIMTM is still controversial. For antibiotics to be effective in reducing post-operative infective complications, the time of administration is very important. Adequate serum concentration of antibiotic must be achieved prior to the procedure. In a developing country like India, antibiotics are routinely prescribed post-operatively. The current study is designed to evaluate the efficacy of post-operative prophylactic antibiotic in SRIMTM.

KEYWORDS:

Impacted mandibular third molar; Post-operative prophylactic antibiotic; Surgical site infection