Clinical outcome following conservative treatment of 58 mandibular ameloblastoma patients: a retrospective study

The aim of this study was to retrospectively analyze the surgical outcome of the patients with mandibular ameloblastoma (MA) with intact inferior cortex and the lingual cortex of the mandible, treated with conservative management in the form of enucleation with peripheral ostectomy, mechanical curettage, chemical cauterization, dredging, and marsupialization. The patients were included with the diagnosis of MA between the age group of 14 to 60 years with their computed tomography (CT) scans showing intact inferior cortex and the lingual cortex of the mandibular walls. Out of 96 cases of ameloblastoma, 58 (61%) were in mandible and 38 (39%) cases in maxilla. We analyzed these 58 patients retrospectively which were operated conservatively between January 2009 and December 2018. The treatment protocol for all the solid variants and the unicystic variants with intact buccal, inferior, and the lingual cortex was enucleation with peripheral ostectomy followed by mechanical curettage, chemical cauterization, and subsequent dredging. This was performed in 90% (n = 52) cases, whereas the treatment protocol for unicystic variants with perforated buccal cortex and intact inferior and lingual cortex was marsupialization followed by the enucleation with peripheral ostectomy, mechanical curettage, chemical cauterization, and subsequent dredging which was performed in 10% (n = 6) cases. Chi square test was applied to the effectiveness of conservative management as outcome variable. The new bone formation along with bony trabeculae was found in 96.6% (n = 56) of the cases. Recurrence was noted in 3.44% (n = 2) of the cases. A p value was 0.001, thus suggesting statistically highly significant result. On the basis of present study, though we can conclude that the MA with the intact inferior and the lingual cortex can be managed effectively with conservative treatment with long term regular follow up, still we would caution that the reader must use their best clinical judgement based on latest available data. For some patients, returning to clinic frequently and undergoing multiple minor procedures may not be suitable to be considered the best, whereas resection and reconstruction may be deemed more appropriate.

Zygomaticomaxillary Osteomyelitis due to COVID-19 Associated Mucormycosis (CAM): A Case Series of 10 Patients

Aim

To highlight the incidence of osteomyelitis due to CAM and to elucidate the mode of spread of infection from maxilla to zygomatic bone, to highlight how that is distinct from other cases of zygomatic osteomyelitis due to other etiologies.

Methods

A standard protocol of treatment of the cases of CAM with zygomatic involvement based on our own outcomes was furnished. All 10 patients were treated with dual antifungal therapy and aggressive surgical resection via extraoral approach, in conjunction with functional endoscopic sinus surgery (FESS).

Results

Ten out of 116 patients of CAM reporting to our institute presented with zygomatic bone involvement with an incidence rate averaging at 8.6%, whereas in previous literature osteomyelitis of zygomatic bone was extremely rare with an incidence pattern of just 1.42%.

Conclusions

The treatment protocol followed by the authors gave good outcomes to all patients treated, with no mortalities.

Anti-fungal therapy: An overview for maxillofacial surgeons in post-covid-19 fungal infections

India is well known as the diabetes "capital" of the world but now it is also becoming the mucormycosis "capital" of the world. Indian Council of Medical Research has formed an "Evidence-Based Advisory in The Time of COVID-19 on Screening, Diagnosis, and Management of Mucormycosis." As per this advisory, an oral and maxillofacial surgeon forms an integral part of the team dedicated to fight this epidemic of mucormycosis. Also, there are other fungal infections such as aspergillosis which are getting reported in these patients affecting the paranasal sinuses and the jaws. Aggressive surgical debridement and a thorough knowledge of anti-fungal therapy are must in treating these fungal infections. The aim of this article is to give an overview on the available anti-fungal therapy required to manage the ever-increasing rise in fungal infections faced by maxillofacial surgeons in post-COVID-19 patients.

Utility of tooth as an autogenous graft material in the defects of alveolar cleft - A novel case report

Reconstruction of the alveolar cleft is very important for providing both aesthetic as well as functional benefits to the patients with cleft lip and palate. The autogenous iliac crest is the most widely used bone graft in SABG procedures. There are very few published studies in the literature where tooth as an autogenous graft is used in dentoalveolar defects. Through the medium of this article, we present a novel idea of the tooth as a graft in a 20-year-old male patient with bilateral cleft alveolus. Grafting of the bilateral cleft alveolus was done by using an autogenous graft from the teeth which were indicated for extraction. The patient was monitored at 1-week, 1-month, and 6-month intervals postoperatively. On the Bergland scale, the bone graft of Type I was seen on the right side as the interdental bone level was normal and Type II was seen on the left side as the interdental bone level was greater than three-quarters of normal height. The result of this report proves that autogenous tooth graft is equally effective as compared to the other options available today. The postoperative complications are also minimal with no donor site morbidity.

Use of oral screen for preventing soft tissue injuries associated with use of arch bars: a prospective randomized clinical study

PURPOSE

The purpose of the present study was to access the efficacy of oral screen in protection of arch bar-induced soft tissue injury after achieving maxillomandibular fixation (MMF).

MATERIALS AND METHODS

This study is a randomized clinical trial. The study sample was derived from the population of patients who required MMF and reported from January 2017 to December 2017. A total of 60 patients in whom application of an Erich arch bar was indicated for MMF were selected for the study. The patients were divided into two groups. In group I, only MMF was done; however, in group II, oral screen was used after MMF. The patients were assessed for soft tissue injury, pain, and maintenance of oral hygiene. All parameters were compared statistically using the chi-square test and Student's t test.

RESULTS

The soft tissue injury in group I (73.33%) was greater than that in group II (3.33%). The pain was worse in group I than in group II. The mean value of plaque index in group II is 1.20 and in group I is 2.89. It signifies that plaque deposition was more in group I.

CONCLUSION

Soft tissue injury and pain were less, as well as oral hygiene maintenance is better in patients who used oral screen after the placement of Erich arch bars.