Shreyas Orvakonde

Abstract

Mandibular condylar fractures account for a sizeable segment amongst facial fractures. Previously most of these fractures were managed conservatively with periods of Intermaxillary fixation(IMF). Shortcomings of such an approach such as prolonged pain, Tmj dysfunction and delayed return to function has shifted the discourse to open reduction and internal fixation of the fractured mandibular condyle.ORIF is the universally accepted and mainstay of intervention. Numerous extra oral approaches have been employed with various modifications. The retromandibular transparotid approach is a relatively simple and direct approach to the posterior mandible, enabling the surgeon to deal with sub condylar and condylar neck fractures with relative ease. This approach is a safe approach and does not result in permanent palsy of any of the branches of the facial nerve. Aims: To analyse facial nerve function after ORIF of mandibular sub condylar fractures through the retromandibular transparotid approach. Materials and Methods: 25 patients reporting with unilateral condylar fractures, sub condylar (16) and neck fracture (9) (Ellis classification)consenting for the study were taken up. All patients were followed up for 8 months. Post-operative nerve function was evaluated at 24 hours after surgery, 1,4,12 weeks and at the end of 8 months. Results: 4(16%) patients presented with weakness of the facial nerve. Buccal branch (3) and zygomatic branch (1). In all cases the weakness was temporary and no permanent deficit was noted. Keywords: Mandibular condylar fracture, Facial nerve, ORIF, Retromandibular, Transparotid.

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Abstract

Numerous approaches have been described to access the fractured condyle. Unrestricted wide optical window to the fracture site and the safety of the facial nerve dictate the type of approach required. Aims: To evaluate the pre auricular transmassetric anterior parotid approach in 20 unilateral condylar fractures. Results: All the twenty cases evaluated showed adequate mouth opening, no signs of facial nerve palsy and sialocele. The transmassetric anterior parotid approach is a safe approach which can be used in the surgical management of condylar fractures and is of special value in obtaining excellent exposure in the cases of medially displaced condylar neck fractures. Keywords: Condylar fractures, Open reduction internal fixation, Preauricular, Transmassetric anterior parotid.

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Abstract

The surgical correction of the cleft lip is a challenging one and obtaining consistently good esthetic outcomes sometimes can be elusive. Primary correction of cleft lip often results in secondary deformities requiring re intervention. Chemoimmobilsation with Botulinum Toxin A post-secondary cheiloplasty can help obtain favourable esthetic results. Aims: To evaluate the esthetic value of Botulinum Toxin A injection in secondary cleft lip surgeries and to assess the role of Botulinum toxin A in secondary cleft lip scars. Materials and Methods: 30 systemically healthy unilateral cleft lip patients reporting for secondary cheiloplasty procedure were taken up for the study. 10-12 units of Botulinum Toxin A was injected along pre-determined points on the lip. Objective (Photographic evaluation) and subjective (Patient questionnaire method) evaluation was carried out after one year post injection of Botulinum Toxin A. Results: Photographic evaluation revealed that the outcomes were mostly excellent or good. Subjective evaluation conducted showed that majority of patients were either happy or very happy with the esthetic results. Keywords: Botulinum Toxin A, cheiloplasty scars, esthetic evaluation, secondary cheiloplasty, secondary cleft lip, subjective evaluation, unilateral cleft lip.

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Abstract

In the surgical correction of the cleft lip, the surgeon faces numerous challenges which make the task of obtaining appreciable esthetic results an arduous one. A multitude of problems can present to the surgeon after the surgical repair of cleft lip, such as hypertrophic scar, peaking and notching. In such a scenario Botulinum Toxin A can help achieve improved esthetic results. Botulinum toxin type A is a powerful neurotoxin which is produced by the anaerobic organism Clostridium Botulinum and when injected into a muscle causes interference with the neurotransmitter mechanism producing selective, transient paralysis of the muscle, which in turn reduces scar contracture. Aims: To evaluate the esthetic outcome of Botulinum Toxin A injection in cleft lip surgeries and to evaluate the role of Botulinum toxin A in unilateral cleft lip scars. Materials and Methods: 30 healthy unilateral cleft lip patients reporting for cleft procedure were taken up for the study. 6-8 units of Botulinum Toxin A was injected (after test dose) along pre-determined points. Both objective (Photographic evaluation) and subjective (Patient questionnaire method) evaluation was carried out after 1 year. Results: Photographic evaluation revealed that majority of the patients had either excellent or good esthetic outcomes. Scar characteristics were evaluated and most patients were happy or very happy with the surgical results. Keywords: Botulinum Toxin A, Esthetic evaluation, Primary cheiloplasty, Subjective evaluation, Unilateral cleft lip

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