A comparative study of the outcomes of mandibular fractures treated with and without per and post operativemaxillo-mandibular fixation.

Background: Mandible being prominent and mobile gets fractured commonly. Fracture healing is important for restoring chewing abilities andaesthetic appearance. The fracture healing in mandibles is painful and maintaining reduction is difficult due to the action of various the musclesattached to mandible. There are few reports about fixing mandible fracture with intraoperative manual maintenance of occlusion without applyingtraditional arch bars and MMF.Aims: to study the outcome following rigid fixation of mandibular fractures without per operative or postoperativemaxillo- mandibular fixation and immediate mobilisation.Materials and methods: This is a prospective study conducted in theDepartment of Plastic and Reconstructive Surgery in a Government tertiary care centre over a duration of 18 months in 30 patients with anteriormandibular fractures in which each 15 patients belonging to Group I and Group 2 received ORIF with MMF.Results: Mean time of fixation inGroup 1 (ORIF without MMF) was 22.27 minutes whereas in Group 2 (ORIF with MMF) it was 38 minutes which is statistically significant.There was statistically no significant difference in occlusal disturbances in both groups compared in the study. There was no significantdifference after fixation with or without MMF in stability of fracture segment.There was no statistically significant difference between bothgroups in terms of neurosensory deficits and masticatory efficiency. Patients of both groups were kept on soft diet for a period of 1 month. Mouthopening in patients in both the groups showed a gradual recovery till 1 month after which it stabilized. There was gradual decrease in pain inpatients of both groups.Conclusion: Maxillomandibulary fixation reduces the operative time and aids in early mobilisation and better intake ofdiet. Mandible fractures can be managed by Open reduction and internal fixation with intra operative manual maintenance of occlusion andsatisfactory results can be obtained

Management of Panfacial Fractures- A Clinical Study at Tertiary Care Centre- Osmania General Hospital

Introduction: Panfacial fractures commonly occur due to road traffic accidents in developing countries like India. Submental intubation can be an effective technique for upper airway management in few panfacial trauma patients associated with fracture of skull base or displaced nasal fracture and it offers an effective alternative to short term tracheostomy.Aims:To study different patterns of Panfacial fractures, their management and complications and to study the pattern and distribution of fractures at different sites of the maxillofacial skeleton.Materials and methods: This study is a prospective clinical study conducted in department of plastic surgery for a period of 2 years. Panfacial fractures divided as fracture involving the upper, middle, and lower face. The patients were followed at 2 weekly interval for the first 3 visits, followed by monthly interval up to a maximum of 6months.Results: Mandible is the most common in the mid face fractures in facial fractures. In the mandible, parasymphysis was the most common fractured site constituting 43.33% of patient population. 27 patients(90%) were treated by open reduction and internal fixation and 3 patients (10%) were treated by closed reduction arch bar/eyelets and inter maxillary fixation .Out of 30 patients studied, 1 patient had zygomatic arch prominence,1 patient had wound infection, In two patients, malocclusion was identified in the in post operative period, and was managed by reapplication of IMF in the operation theatre.Conclusion: Treatment to be focused on re-establishing proper occlusal, vertical and horizontal dimensions in the facial frame, as well as restoration of orbital, oral volumes. The high frequency of panfacial fractures due to RTA in our country

A clinical study of various methods of reconstruction of scalp defects and its outcomes

Introduction: The scalp, as the body's superior boundary, is often subjected to environmental insults. Since the scalp is seldom covered by clothing, it is more vulnerable to burns and other wounds that can result in extensive disfigurement and scarring. The scale, depth, and position of scalp defects all influence decision-making in their repair. The existence of the defect is another important factor in determining management. Aim : To study the various scalp defects in terms of their clinical presentation, Management and their outcome and reconstruction of scalp defects with local flap and split thickness skin grafts. Materials and methods: This prospective interventional research was performed in the Department of Plastic and Reconstructive Surgery over the course of 18 months,. Patients with 0-70 years of age with electrical burns, trauma , benign tumors and congenital abnormality associated with loss of scalp tissue.Results: In this sample, 12 (60%) patients had a defect size varying from 9 to 100 cm2, 02 (10%) patients had a defect size of less than 9 cm2, and 6 (30%) patients had a defect size of more than 100 cm2. In our sample, the majority of patients presented within 24 hours, 15% presented within one week, and 15% presented after three months. Transposition flap with ssg was performed in the maximum number of patients (50%) in ten patients, rotation flap in three (15%), ssg in five (25%) patients, and primary closure in three (15%) patients. Conclusion: Good knowledge of the anatomy, the individual patient, and the resurfacing choices that are available is the beginning, but the surgeon's success needs creativity to add all these elements together to give a satisfactory result for the patient