Rajiv M. Borle

Reconstruction of full-thickness defects of the head and neck is a challenge. In this clinical study, we assessed the role of the bilobed/bipaddled pectoralis major myocutaneous flap (PMMF) for the reconstruction of large full-thickness defects of the cheek, after resection of oral cancer. After resection of oral cancer, 62 cases of through-and-through defects of the oral cavity were reconstructed using folded/bipaddled/bilobed PMMF flap. All were males and presented with locally advanced oral squamous cell carcinoma (SCC), which involved the buccal mucosa and gingivo buccal sulcus (n = 53) and gingivo buccal sulcus + lip (n = 9). All the flaps survived, and no patient developed a major complication. The most common complication in the current series was wound dehiscence. In 8 % of cases, wound dehiscence was found at the donor site; in 6.45 % of cases, dehiscence was present at the recipient site; and in 4.83 % of cases, dehiscence was present at the neck. All the wounds healed secondarily with regular dressings. The bilobed/bipaddled PMMF is a straightforward and reliable flap that provides an effective mechanism to reconstruct full-thickness cheek defects while avoiding the complexity of microvascular free flaps. The bilobed/bipaddled PMMF has become our preferred reconstruction option for large full-thickness defects after resection of oral carcinoma.

Airway management in patient with restricted mouth opening is a great challenge, owing to the difficulty in laryngoscopy and visualisation of the vocal cords during the procedure of intubation. The term retrograde intubation refers to a technique in which a guide wire is passed into the trachea and then into the mouth or nose. A tracheal tube is then passed down over the guide until it enters the trachea.

Mandibular fractures are relatively less frequent in children when compared to adults. Pediatric patients present a unique challenge to maxillofacial surgeons in terms of their treatment planning and in their functional needs. We currently describe our experience with lateral compression open cap splint with circummandibular wiring as a treatment modality which involves fewer risks in treating pediatric symphysis/parasymphysis/body mandibular fractures. A retrospective analysis of pediatric patients with mandibular symphysis/parasymphysis/body fractures operated from January 2007 to January 2012 was performed. Clinical photographs and orthopantomogram assessment at the time of presentation, after treatment, and at 6 months postoperatively were evaluated. All the 10 patients were followed up until the period of 6 months, and none of them had any major complications. Postoperatively, there was satisfactory healing and union of fracture fragments in all the patients. Only one patient developed infection at submental region. The 6-month follow-up showed good occlusion, without interference in teeth eruption and no signs of temporomandibular joint problems. Lateral compression open cap splints for treatment of pediatric mandibular symphysis/parasymphysis/body fractures are reliable treatment modalities with regard to occlusion-guided fracture reduction.

Oral submucous fibrosis is a chronic, debilitating disease characterized by gradually increasing fibrosis of oral cavity and pharynx, mainly the buccal mucosa, resulting in trismus. Various flaps have been used to reconstruct the surgical defects following excision of fibrous bands. It is inevitable to prevent these flaps from trauma by occlusion. The main objective of the authors is to introduce a technical innovation used to protect the flaps in the post-operative period. Here, we propose an easy and economical method to protect the flaps.

The present study was planned to assess the efficacy, utility and complications of transmylohoid intubation in facial polytrauma patients, by setting and design: prospective study. This study was conducted between May 2008 and May 2011 and 35 patients of facial polytrauma were included irrespective of sex, caste and religion. All the selected 35 patients were male and the age of patients ranged between 15 to 45 years (mean age 31 years). All the patients were intubated with transmylohoid, orotracheal intubation using an armoured endotracheal tube (ETT). Average time to perform transmylohoid intubation was 15.51 + 1.85 min (mean + standarad deviation). Average time for drawing the ETT transmylohoid from the submental incision was 49.7 + 24.8 s. Mean duration for which the ETT was kept indwelling was 0.37 + 1.03 days. Accidental extubation of ETT was noted in two patients. Minor post operative complications like swelling in the submental area (2 patient), dehiscence of the submental incision (2 patient) and minor infection at the site of submental incision (3 patients) were noticed, which were found to be statistically insignificant. The transmylohoid intubation allowed simultaneous reduction and fixation of all the facial fractures and intraoperative control of dental occlusion without interference from the tube during the surgery without interfering in the maintenance of the anesthesia and air way.

Background: Lateral cephalometric standards of normal Central Indian adults having class I occlusion and acceptable facial profile were studied using the Burstone and Legan comprehensive cephalometric analyses that are specific for orthognathic surgery. Aim: To study normal dentofacial patterns of adult population belonging to Central India. Materials and Methods: Cephalometric radiographs of 76 Central Indian adults (38 males and 38 females) having class I occlusion with acceptable facial profile were analyzed, and the mean values of their hard and soft tissue measurements were compared with those of Caucasian adults as reported in the literature. Results: The Central Indian males demonstratedgreater anterior cranial base length and ramal length and a reduced chin depth. The inclination of the upper and lower incisors was also greater. The females demonstrated greater posterior cranial base length, increased upper anterior and posterior facial heights, and an increased maxillary length. Both mandibular body and ramal lengths were increased and there was greater mandibular protrusion and a reduced chin depth. The lower incisors were found to be proclinated. Conclusion: This study reveals that some of the cephalometric parameters in the Central Indian population are significantly different than that of the Caucasian population, especially in the females.