Successful Surgery Management of Giant Periorbital Malignant Schwannoma in a Low-Income Setting Abstract Schwannoma can arise from any cranial, peripheral or autonomic nerve, except the olfactory and optic. About 25–45% of extracranial schwannomas lie in the head and neck. Data on malignant schwannoma from low-income settings are inconsistent. We reported a case of giant periorbital malignant schwannoma successfully treated in a low-income setting. The strength of our case is given not only by the rarity and the size of the disease but also for highlighting the weakness of health system in low-resource settings. It is mandatory to strengthen the health system with particular attention to physical, psychologic and social aspects and to promote comprehensive programs including all these aspects.

Temporomandibular Joint Synovial Chondromatosis Posing as Diagnostic Dilemma: A Case Report

Extraction in Patients on Oral Anticoagulant Therapy With and without Stopping the Drug: A Comparative Study Abstract Aim and Objective The aim of this study was to compare postoperative hemorrhagic complications after dental extractions in two groups of patients receiving oral anticoagulants with one group receiving oral anticoagulant without interruption and another group stopping the drug 3 days prior to extraction. Materials and Methods A control group consisted of 30 patients who had stopped the oral anticoagulant 3 days before undergoing dental extractions, resulting in a reduction in the average preoperative international normalized ratio (INR) from 2.8 to 1.6. The study group of 30 patients received the anticoagulant drug without any alteration before extractions and had an average preoperative INR of 2.7. All extractions were done under local anesthesia on an outpatient basis, and local measures consisting of gelfoam and sutures were used in all cases to control postoperative bleeding from extraction sockets. Results None of the patients had any immediate postoperative bleeding, and only one patient from the control group and two patients from the study group had mild delayed hemorrhage which was easily managed with local measures. Conclusion There is no need to alter the dosage of oral anticoagulants prior to dental extractions provided the INR is within the therapeutic range of 2.0–4.0, extractions are done in least traumatic manner and local measures are used to control postoperative hemorrhage, thereby reducing the risk of thromboembolic episodes in these patients.

Are Bondable Buttons a Better Option than Intermaxillary Fixation Screws for Achieving Maxillomandibular Fixation? A Prospective Randomized Clinical Study Abstract Aim The aim of this study was to identify a better option in achieving maxillomandibular fixation (MMF) comparing bondable buttons and Maxillomandibular Fixation screws in achieving Maxillomandibular Fixation. Patients and Methods In this randomized clinical trial, study sample was derived from the population of patients who reported with minimally displaced mandibular fractures and who required Maxillomandibular Fixation. The patients were divided into two groups. In Group I (n = 20), Maxillomandibular Fixation was done with Maxillomandibular Fixation screws; on the other hand, in Group II (n = 20), bondable buttons were used. In both the groups the patients were analyzed for the time duration required in minutes for securing and removal of Maxillomandibular Fixation, plaque accumulation and postoperative stability. Plaque accumulation was evaluated using TURESKY–GILMORE–GLICKMAN modification of the Quigley-Hein plaque index. The complications encountered during and after the surgery were also analyzed. Results The plaque accumulation and time required for placement and removal in group I were more as compared to group II. In Group I, there were more complications as compared to Group II such as tooth root damage, screw loosening, screw breakage and infection. Conclusion Bondable buttons are a better choice for achieving Maxillomandibular Fixation in comparison with Maxillomandibular Fixation screws for the treatment of minimally displaced mandibular fractures. Further studies with a bigger sample size must be carried out.

Pedicled Supraclavicular Flap for Neck Defect Reconstruction in Poland Syndrome Abstract Introduction The most accepted pathogenesis for Poland syndrome is the subclavian artery supply disruption sequence during embryonic growth. The result is associated with a constellation of abnormalities of structures supplied by the subclavian artery. We present a case of a neck defect reconstructed with a fasciocutaneous supraclavicular flap in a patient with Poland syndrome with the absence of a pectoralis major muscle. To the best of our knowledge, this is the first report of the use of the supraclavicular flap in patients with Poland syndrome. Methods An 80-year-old patient with a 14-mm-Breslow-thickness melanoma had undergone a 3-cm-wide local excision of the scar on his right neck and reconstruction with a pedicled supraclavicular flap despite him having Poland syndrome on the same side. Results The flap was well perfused, and the patient was discharged at postoperative day 5. Complete healing of the flap was observed without any flap loss. Conclusion The supraclavicular fasciocutaneous flap is a versatile and useful pedicled flap reconstruction for head and neck defects. It is possible in patients with Poland syndrome as shown, and the pedicle should be checked with preoperative Doppler and an exploratory incision before completely raising it.

Novel Technique to Increase the PMMC Flap Pedicle Length by Coplanar Rotation Along the Pedicle Axis Abstract Pectoralis major myocutaneous flap (PMMC) continues to be a prime tool in the armamentarium for the reconstruction of head and neck malignancies even though free flaps have proved their versatility in functional and cosmetic outcomes. It still holds significance in both primary reconstruction and salvage procedures in head and neck malignancies. Inadequate infrastructure and resources make PMMC a preferred choice in many high-volume centres of developing countries. However, the length of the PMMC flap becomes a limiting factor for the distance that flap can be transferred when extensive reconstructions are being planned (Kudva et al. in J Maxillofac Oral Surg 14:481–483, 2015). We propose a modification in the conventional technique that maximises the length of the pedicle in orofacial reconstruction. Our technique allows the rotation of skin paddle along the longitudinal axis of the pedicle at the distal end along the same plane. This technique provides an easily reproducible and reliable technique that enables the surgeon to enhance the reach of the skin paddle and flexibility considerably.

Surgical Treatment of Recurrent Lower Eyelid Sebaceous Gland Carcinoma and Reconstruction with Pedicled Nasolabial and Non-vascularised Buccal Mucosal Flaps Abstract Introduction Sebaceous gland carcinoma of the eyelid is an uncommon but highly malignant tumour. Post-tumour excisional defect reconstruction must aim in restoration of function and aesthetics. Prompt diagnosis and adequate treatment is of paramount for successful outcome of disease. Case Report A 61-year-old female patient underwent surgery for sebaceous gland carcinoma of right lower eyelid 3 years back and reported to us with recurrence. On examination, an exophytic mass was seen over right conjunctiva adjacent to the eyelid margin. With the objective of restoring form and aesthetics, immediate reconstruction was carried out using superiorly pedicled nasolabial flap to cover the lower eyelid defect and non-vascularised buccal mucosal flap for bulbar and palpebral conjunctival reconstruction. Conclusion The tumour is notorious to cause local recurrence and metastases; hence, an early and accurate diagnosis, surgical and adjunctive chemoradiation and regular periodic follow-ups are of utmost importance for the successful management of sebaceous gland carcinoma of eyelids.

Simple Vestibuloplasty Using a Tube in Combination with Cortical Bone Screws Around Dental Implant Abstract Introduction We developed a novel, reliable and easy method that retains stability of the repositioned flap and vestibular expansion. Method The conventionally elevated mucosal flap is secured to the desired depth of the vestibule by the pressure created by the polyvinyl chloride 6Fr suction catheter which is fixed to the alveolar bone with cortical bone screws passing through the inner lumen of the tube. The keratinized free flap is placed on the periosteum conventionally, and horizontal mattress suturing is performed for immobilization, with the suture running through the inner lumen of the tube transversally. Conclusion This simple method gives us great benefit on the vestibuloplasty.

Novel Use of a Disposable Syringe Barrel as a Mouth Prop in Emergency Maxillofacial Trauma Cases to Access Intraoral Soft Tissue Injuries Abstract Oral and maxillofacial surgeons are often called in emergency situations during odd hours to manage facial trauma cases. While addressing these patients, many a times the surgeon might require to keep the patients mouth open for long time while accessing intraoral injuries. This can become difficult for a surgeon if in case regular dental mouth props/mouth gags are not available at a particular surgical setup. The author here describes a technique of using a standard disposable syringe as a mouth prop in emergency cases to access and repair any intraoral injury in absentia of a regular mouth prop/mouth gag.

Twin Alar Rims: A Rare Type of Alar Rim Deformity and Its Correction Using “SAIL” Technique Abstract The beauty and golden proportions of a face are largely determined by the shape and size of the nose one inherits. When the subunits of the nasal structure are considered, the width and structure of Ala and Alar rims determine to a large extent the beauty of the nose itself. Various classifications exist to evaluate the alar rim deformities that are inherited as well as iatrogenic, but occurrence of twin alar rims as a deformity has rarely been reported. This article reports the deformities of drooping tip, hanging columella, and asymmetry of alar rims along with twin alar rims. All the problems were addressed with an open rhinoplasty approach and combining the alar incision with the sail technique to achieve the correction of twin alar rim.