42 Annual Congress of AOMSI Nagpur 16–18 Nov 2017

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 DOI 10.1007/s12663-017-1052-5

ABSTRACTS

Ó The Association of Oral and Maxillofacial Surgeons of India 2017

Scientiﬁc Oral Paper References/Bibliography Manisali M et al, Retromandibular approach to the mandibular Section: Cranio Maxillofacial Trauma condyle: a clinical and cadaveric study. International Journal of Oral and Maxillofacial Surgery 32(3) June 2003, 253–56.

ABS0015 Open Treatment of Mandibular Sub Condylar ABS0023 Fractures via the Retromandibular Approach A Comparative Evaluation Between Conventional Titanium Miniplate & Customised Titanium CRB Dr Imran Khan Omega Miniplate for the Management of Anterior Mandibular Fractures Faculty of Dentistry, Jamia Millia Islamia, New Delhi-110025 Dr. Chandrashekhar R. Bande Abstract Background/Introduction Swargiya Dadasaheb Kalmegh Dental College & Hospital, Injuries to the mandible often result in mandibular condylar fractures. Wanadongri, Nagpur Various approaches have been advocated for accessing the mandibular condyle. Objectives Abstract The aim of this paper is to evaluate the results of retromandibular Background/Introduction approach in management of condylar fractures of the mandible. The mandible is the second most common bone involved in facial Methods fractures. The weakest areas of mandible which are prone to fracture From January 2014 to January 2017 (Three years) Total number of 38 are the condylar neck, angle and the parasymphysis region. The goal patients with mandibular condylar fracture were open treated, of treating mandibular fractures is to obtain the pre-morbid anatom- Retromandibular approach was used in 31 patients, Preauricular ical form, proper function and appreciable aesthetics. This aim must approach was used in 03 patients & extended submandibular approach be accomplished by means that will produce the least disability, was used in 04 patients. All the cases were evaluated for intraoper- smallest risk and shortest recovery period for the patient. In today’s ative and post operative complications like haemorrhage, Injury to the scenario the patients demand for early return of normal function and facial nerve, infection, signs of salivary fistula, discrepancy in lifestyle, likely favouring treatment by open reduction and internal occlusion and function of the temporomandibular joint. fixation (ORIF) for treating fractures than conservative treatment Results modalities like closed reduction and intermaxillary fixation (IMF). In None of the patient suffered from any major intraoperative or post- developing counties like India, cost and economic viability are also operative complications and all patients had good functional and important treatment considerations. aesthetical results. This study was aimed to compare the efficacy and surgical out- Conclusions come of customised titanium CRB omega miniplate with the Retromandibular approach was found to be most convenient in conventional titanium miniplates in the management of parasymph- managing mandibular condylar fractures with open treatment & ysis fractures of mandible, with or without involving mental nerve on almost insignificant surgical scar. the basis of clinical and radiographic evaluation.

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Objectives Methods This study was aimed to compare the efficacy and surgical outcome of A 17 years old female reported to our department with complaint of customised titanium CRB omega miniplate with the conventional pain in left ear region and difficulty to open mouth since 40 days. titanium miniplate in the treatment of anterior mandibular fracture Patient sustained injury to chin region due to RTA (road traffic with or without involving mental nerve on the basis of clinical and accident) and was managed for conservatively with IMF for 04 weeks radiographic evaluation. at some other centre. On clinical examination patient had deviation of Methods mandible to left on mouth opening, trismus and posterior open bite on A total number of 252 patients with anterior Mandibular fracture were left side. Radiographic examination revealed patient as a case of selected for the study and divided randomly into two groups, Group A malunited condylar fracture left side. Patient was managed with 126 patients and Group B 126 Patients. The Group A patients EVRO and extracorporeal fixation of left condylar fracture using underwent open reduction and internal fixation using conventional miniplates under general anesthesia. titanium miniplates and Group B patients underwent the same using Results customised titanium CRB omega miniplate. The surgeries were car- Patient showed marked improvement in esthetics and function post- ried out by the same operating surgeon. Duration of surgery was operatively. Facial height was restored with satisfactory occlusion, no measured for every case from the placement of incision to the closure deviation of mandible on mouth opening and good rehabilitation of of defect. Subsequent postoperative follow up for occlusion, postop- TMJ. Patient’s follow up was done at 1 month, 03 months and 06 erative complications like paraesthesia, infection, hardware failure months. Six months follow up radiographic examination showed were assessed. Radiological healing was evaluated for all patients at condylar head remodeling with well united osteotomized segments. 1st, 3rd and 6th months post operatively. Conclusions Results EVRO and extracorporeal fixation is a viable treatment option in A major difference in results of surgery is seen between both the malunited condylar fracture where access to the malunited proximal groups with less duration of surgery and less postoperative compli- segment is very difficult. cations like paraesthesia, infection, hardware failure along with good radiological bone healing seen in customised omega CRB miniplate References/Bibliography (Group B) patients. 1.1. Ellis E III, Walker RV. Treatment of malocclusion and TMJ Conclusions dysfunction secondary to condylar fractures. Craniomaxillofac It led us to the conclusion that customised titanium CRB omega Trauma Reconstr. 2009; 2:1–18. miniplate is effective option in treatment for anterior mandibular fracture. References/Bibliography ABS0034 1. Agrawal M., Meena B., Gupta D. K., Tiwari A. D., Jakhar S. K. A prospective randomized clinical trial comparing 3D and Co Relationship of Midface Fractures and Ophthalmic standard miniplates in treatment of mandibular symphysis and Injuries: A Clinical Study parasymphysis fractures. J. Maxillofac. Oral Surg. 2014; 13(2): 79–83. Dr Bobby John, Dr Sobitha G 2. Booth PW, Schendel SA, Housamen J-E, Maxillofacial Surgery (2007), vol. 1, 2nd edn Churchill Livingstone, London, UK, Govt Dental College Kottayam, Kerala pp 74–76. Abstract Background/Introduction Trauma to face, particularly above the level of mouth, require a ABS0031 careful examination to assess ophthalmic and orbital injuries. Inap- Management of Malunited Condylar Fractures Using propriate diagnosis and inadequate care for these injuries can result in Extraoral Vertical Ramus Osteotomy: Report blindness with social and medico legal implications. The early and Review detection of vision threatening injuries and timely referral to an ophthalmologist is needed to reduce the incidence of vision loss in midface trauma. By the study we can assess the prevalence of oph- Maj (Dr.) Shanender Singh Sambyal, Maj Gen (Dr.) NK Sahoo, Lt thalmic and orbital injuries in midface fractures and how often a Col (Dr.) N Mohan Rangan surgical intervention is required in the correction of these injuries. The co-relationship between various midface fractures and oph- Command Military Dental Centre, Lucknow thalmic injuries is assessed in this study. Objectives Abstract To assess the proportion of ophthalmic injuries in midface fractures. Background/Introduction To classify ophthalmic injuries in mid face fractures based on the Malunited condylar fractures due to delayed/unsuccessful treatment severity. can lead to decreased ramus height, malocclusion and deranged Methods function of Temporomandibular joint (TMJ). Here we present our The study assessed 401 patients with midface fractures. The various experience of a case of malunited condylar fracture managed suc- mid face fractures assessed included Lefort I, Lefort II, Lefort III, cessfully using extraoral vertical ramus osteotomy (EVRO). zygomatic complex and nasoethmoid fractures. Each patient was Objectives assessed and the mild, moderate and severe ophthalmic injuries To present a viable option for the treatment of malunited condylar recorded. Thorough clinical examination with various test specific for fractures. injuries was used for assessment. A comprehensive ophthalmological examination was done by an ophthalmologist to assess the various ophthalmic injuries.

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Results fractures and 11 patients had isolated mandible fractures, 4 patients The results showed that zygomatic complex fracture was mostly presented with panfacial trauma. About 37 patients were observed related with ophthalmic injuries. The most frequent mild ophthalmic with significant bradycardia which resolved with the cessation of injury in the study was periorbital odema (99.8%) followed by stimulus, however 1 patients developed asystole which needed ecchymosis (96.5%), subconjunctival haemorrhage (98.5%), chemo- administration of atropine. sis (38.2%) etc. The main moderate ophthalmic injury in the study Conclusions was Infraorbital dysesthesia (95%), followed by enophthalmos TCR is a physiologic response which may mimic a closed cranial (54.5%), traumatic optic neuropathy (16.7%), antimangaloid slant injury or a cardiac dysarrythmia in a post traumatic patient. Though (32.6%), traumatic telecanthus (12.7%) etc. Diplopia (15.7%) and the reflex resolves without complications however whenever surgery hypoglobus (12.7%) was the most common severe ophthalmic inju- is planned in maxillofacial region and if TCR is anticipated, contin- ries. Loss of vision reported in the study was 1.5% only. Incidence of uous and closed ECG monitoring is important. The reflex cannot be retrobulbar haemorrhage was only 0.5%. neglected in maxillofacial injuries. Conclusions Based on the study it can be concluded that all mid face fractures need References/Bibliography a comprehensive ophthalmological evaluation to rule out vision 1. Lu¨bbers HT, Zweifel D, Gra¨tz KW, Kruse A (2010) Classifica- threatening injuries. As per the study the occurrence of vision tion of potential risk factors for trigeminocardiac reflex in threatening injuries are low. Early surgical intervention was needed in craniomaxillofacial surgery. J Oral Maxillofac Surg the correction of enophthalmos, hypoglobus, diplopia, antimangloid 68(6):1317–1321. slant, traumatic telecanthus etc. Zygomatic complex fracture was the main mid face fracture associate with highest incidence of ophthalmic injuries. References/Bibliography ABS0038 Shantha Amrith, Seang Mei Saw, Thiam Chye Lim, Timothy Kam A Retrospective Evaluation of Efficacy Yiu Lee. Ophthalmic involvement in cranio-facial trauma. Journal of of Sphenozygomatic Suture Fixation for Restoration Cranio –Maxillofacial Surgery 2000; 28:140–147. of Orbital Volume Al-Qurainy IA, Stassen LF, Dutton GN, Moos KF, el-Attar A. The characteristics of midfacial fractures and the association with ocular Lt Col (Dr.) Rohit Sharma injury: a prospective study. British Journal of Oral and Maxillofacial Surgery 1991; 29:291–301. 11 CDU, C/O 56 APO

Abstract ABS0035 Background/Introduction Lateral displacement of high energy fracture zygomaticomaxillary Trigeminal Cardiac Reflex in Faciomaxillary Trauma complex (ZMC) can cause significant increase in orbital volume Patients leading to enophthalmos. Objectives Altaf H Malik The objective of this study was to evaluate the efficacy of sphenozygomatic (SZ) suture fixation for restoration of orbital volume after elevation of the temporalis in cases of fracture ZMC where the Govt Dental College Srinagar fixation of zygomatic arch (ZA) was deemed necessary through latero-posterior approach. Abstract Methods Background/Introduction 43 operated cases of fracture ZMC using 4-point fixation were divi- Trigemino cardiac reflex (TCR) is a sudden physiological response ded into two groups. Group I (n = 24) had undergone reduction and due to the pressure effect or stretching of the largest cranial nerve, the fixation of SZ suture as fourth point of fixation by elevating tempo- trigeminal nerve. TCR is a triad of bradycardia, bradypnea and gastric ralis muscle using hemicoronal approach. Group II (n =19) had motility changes due to the efferent activation of the vagal nerve in undergone reduction and fixation of Infraorbital (IO) rim as fourth response to the pressure distribution in V5. TCR is seen in most of point of fixation using preseptal transconjunctival approach. Both the faciomaxillary procedures in maxilla or mandible. It is important to groups were analyzed separately and compared for restoring the have knowledge of this sudden physiological response in maxillofa- increased orbital volume on CT. cial surgery. The paper highlights the importance of this reflex during Results management of facial fractures. Difference in the pre-surgical orbital volume of both the groups was Objectives found to be statistically insignificant [p=.678]. In group I, the average The study intends to evaluate the effect of the reflex in maxilla-facial bony orbital volume significantly reduced by 3.6 cc from 25.5 cc to fracture patients and its subsequent implications. 21.9 cc [p = .000] post-surgically. In group II, the average bony Methods orbital volume reduced by 1.5 cc from 25.6 cc to 24.1 cc post-sur- A total of 46 patients were included in the study who visited the gically. There was a significant difference in the reduction of the Department of Oral and Maxillofacial Surgery Govt. Dental College increased orbital volume among the 2 groups (Group I: 3.6 cc, group Srinagar from Oct 2016 to July 2017 for the treatment of maxillo- II: 1.5 cc). Orbital volume reduction was more and statistically sig- facial fractures. Only ASA 1 patients were included in the study. The nificant [p= .000] in group I. patients were evaluated for the fracture after proper investigations. Conclusions Results SZ suture fixation is reliable in reducing fractures ZMC and restoring The study showed male predominance with more susceptibility in 18 the increased orbital volume where the fixation of zygomatic arch to 32 year age group. About 31 patients presented with maxillary (ZA) was deemed necessary through latero-posterior approach. 123 S4 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

References/Bibliography present day high speed transport modalities in a medical college of Western part of Rajasthan comprising of 4 major districts. Sharma R, Muralidharan CG, Roy ID, Jain NK, Patrikar S. Objectives Radiological evaluation of sphenozygomatic suture fixation for To compare and present the changing trends in epidemiology pre- restoration of orbital volume: A retrospective study. J Craniomaxillo- sentation and management of maxillofacial trauma in present era in a fac Surg 2016; 44(12): 1903–08. developing state of India within given resources. Methods Data were obtained from the Operation register in MDM Hospital Jodhpur associated with Medical College, which included all major ABS0054 trauma patients undergoing Surgery for facial trauma under general Binocular Blindness Following Maxillofacial Trauma… anaesthesia in Jodhpur. Data collected included demographic and A Report of Two Mechanisms injury details, and operative procedures carried out. In this study we analyze etiology and pattern of MF trauma. Results Dr. Usha Giridhar MDS, Dr. Varun Muthuraman, MDS 478 patients included in the study consisting of 93.7% male and 06.3% female, and the male-to-female ratio was 4.8:1. Mean age was Best Dental Science College 40.3 ± 17.2 years with a range of 18 to 97. 77.4% of the patients were between the ages of 18–39 years and predominantly male. Above 60 Abstract years of age, referrals were mostly woman. The most common cause Background/Introduction of injuries were road traffic accidents 80% violence 15%, followed by Loss of vision after a, Maxillofacial injury is a rare complication, the falls The primary cause of injuries were RTA between ages 20 and 49 incidence being 0.32% and 9% (Ansari). Ocular injuries can be a and falls after 60. In earlier times most common fractures were result of injury to the globe or indirect cause. The globe is protected reported of mandible which gradually increased to panfacial traumas from direct injury due to the prominence of the facial bones and some cases reused fall even under lefort classification given by natural reflexes. The optic canal is also protected because of the Marciani et al. history revealed travel by bicycle resulted in fracture presence of dense bony ring. The presence of injuries to certain dentoalvolus or mandible some times ZMC, slowly as economy regions of the Maxillofacial region that appear innocent can result in developed with 150 cc motorcycle and suvs complicated fractures irreversible injury to the eye. These indications should alert the started occurring. 9% of the patients had brain injury and only frontal examiner as to the probability of an impending danger of losing the fractures is significantly associated. Male gender has statistically vision in the eye. A case with contrasting injuries that produced stronger association for suffering male (p \ 0, 05). No statistically binocular injuries is presented. significant data were revealed between alcohol consumption and Objectives presence of fracture. Case report. Conclusions Methods The need for preventive strategies to be reinforced has been high- Case report. lighted as high speed transport-related injuries remain high especially Results in the younger age groups. Case report. References/Bibliography Conclusions A relatively trivial nature of injury to critical areas of the max facial 8. Gratten E, Hoobs JA. Mechanism of injury to the face in road region can produce irreversible damages. traffic accidents. In: Rome NL, Williams J, editors. Maxillofacial injury. London: Churchill-Livingstone; 1985:37–74. References/Bibliography 1. Blindness after Facial Fractures A 19 year retrospective study. Ansari et al. JOMS 2005. 2. Blindness following severe mid facial trauma Johannes et al. ABS0058 JCMS 2012. Comparison of Subciliary and Subtarsal Incisions as Surgical Approach to Infraorbital Rim Fracture

ABS0056 Dr. Pravin Chouhan, MDS (OMFS); Dr. Varsha Manekar, MDS Emerging Trends in Maxillofacial Trauma: A Medical (Asso. Prof., OMFS) College Experience Govt. Dental College & Hosp., Nagpur

Dr Chandrashekhar Chattopadhyay, Assistant Professor Abstract Background/Introduction Dr S N Medical College Jodhpur Orbito-zygomatic fractures represent one of the frequent conditions encountered today. Transcutaneous approaches includes subciliary, Abstract subtarsal and infraorbital incisions. The study is planned to see the Background/Introduction accessibility, functional and aesthetic aspects of subciliary and sub- Trauma has been identiﬁed as a major public health problem both in tarsal incisions for approaching the infraorbital rim fractures. India and globally. The incidence and epidemiological causes of Objectives maxillofacial (MF) trauma varies more widely. The objective of this 1. Assess the intraoperative ease of surgical access and exposure study is to point out maxillofacial trauma patients’ emerging trends achieved. 2. Compare the aesthetic outcome of the incision at inter- and trauma patterns with changing era from slow moving vehicles to vals of 15 days, 1 month and 3 months after surgery. 3. Assess

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S5 postoperative complications such as scleral show, ectropion, lid Conclusions edema. Styloid fractures may be found co-existing with mandibular fractures. Methods It is mandatory to treat these fractures either conservatively or sur- A randomized, prospective, comparative, clinical study was done on gically on the basis of severity of clinical features. Hence, careful 20 patients having infraorbital rim fractures with or without other radiological assessment of styloid region is essential in mandibular facial fractures. Patients divided into Group A (Subciliary incision) & fractures. This classification would be helpful in future to manage Group B (Subtarsal). The patients were evaluated intra-operatively these cases. and postoperatively for various parameters at the 15 day, 1 month & 3rd month. References/Bibliography Results Blythe JN, Mathews NS, Connor S. Eagle’s syndrome after fracture of The exposure was adequate in 7 patients (70%) of Group A and in all elongated styloid process. Br J Oral Maxillofac Surg 2009;47: 233-5. 10 patients (100%) of Group B. In group A at 3 months, the scar was barely visible in 2 patients (20%) and in 5 patients (50%) in group B. At 3 months, scleral show was present in 50 % of group A patients and 10% in group B. Ectropion persisted in only 1 patient (10%) in group A and none of the patient in group B at 3 months. 1 patient ABS00175 (10%) in group B was showing persistence of lid edema. Retrospective Analysis of 100 Mandibular Fractures: Conclusions An Institutional Experience When scar and edema is concerned, subciliary incision has better outcome and when ectropion and scleral show is concerned, subtarsal Dr. Ramdas Balakrishna, Dr. Bhuvaneshwari S, Dr. Sudarshan, Dr. incision has less complications. Veena Gc, Dr. Suhas Prabhakar References/Bibliography KLE Society’s Institute of Dental Sciences Ridgway EB, Chen C, Colakoglu S, et al. The incidence of lower eyelid malposition after facial fracture repair: a retrospective study Abstract and metaanalysis comparing subtarsal, subciliary, and Zygoma Reconstruction 199 transconjunctival incisions. Plast Reconstr Surg Background/Introduction 2009;124:1578–86. Of all the maxillofacial bones; mandible is the second most common bone affected in maxillofacial trauma. With its higher incidence in the present modern world; evaluation of the etiology, pattern and distribution of such fractures is quintessential in understanding its mechanism and management. ABS00150 Objectives Stylo-Mandibular Complex Fracture: A Protocol To evaluate the age, gender distribution, site distribution, etiology and to Recognise and Proposal of New Classification common patterns of mandibular fractures. with Critical Review of Literature Methods Systematic retrospective review of records of 58 patients with 100 mandibular fractures treated in a single institution. Nanda Kishore Results Of the 58 patients; 49 males and 9 female patients belong to the age Donepudi; Bapuji Dental College and Hospital group of 4–62 years (average 31.57 yr). Among the various etiologies i.e., assault, road traffic accident (RTA), self-fall, work place injury Abstract and sports-related injury; RTA accounts for 37.93% and self-fall for Background/Introduction 36.02% of cases. Of the 100 fractures analyzed, 36% are unilateral The incidence of either isolated Styloid process fracture or in com- fractures and 64% are bilateral. Side affected among these are left (54 bination with mandibular fractures is rare. Fractures may occur with %), right (43 %) and symphysis or midline (3%). The site distribution or without an obvious relation to trauma. Since there are a number of is as follows:- Symphysis – 3; Parasymphysis – 42; Body- 7; Angle – symptoms on presentation and the overlapping with adjacent ana- 26; Subcondylar – 22. The most common fracture pattern is the tomic areas, cases of symptomatic styloid process may be ipsilateral parasymphysis with contralateral angle (16 cases). Open misdiagnosed and mistreated. Styloid fractures may cause symptoms reduction and internal fixation was the predominant modality of that are vague and inconsistent as seen in the case of Eagle’s syn- treatment. Complications were observed in 25.86 % of patients. drome. In the review of literature, majority of the patient’s were Conclusions treated conservatively, while few demonstrated the necessity of sur- Surveys play a vital role in better understanding the biomechanics of gical intervention. There is a definitive need for protocol to recognize the mandible fractures. Furthermore, analysis of the treatment and classify styloid fractures based on which treatment may be modalities used and their respective outcomes are of paramount planned. This presentation focuses on proposal of its classification importance in guiding the surgeons to evaluate their efficacy. with critical literature review. References/Bibliography Objectives 1. To explore the biomechanics resulting in styloid fracture and Cheng CS, Ching YC, Sulaiman WAW, Rahman SA. Five-Year rationalize the need for its either conservative or surgical management Analysis of Mandible Fracture and its Associated Factors. IOSR 2. To propose a standard classification of stylomandibular complex Journal of Dental and Medical Sciences, Volume 16, Issue 3 Ver. II fracture based on which treatment can be planned. (March. 2017), P 118–124. Methods SB KSN, Kamath RAD, Lakshmi SS, Deepthi V, Prabhakar S. Not applicable. Mandibular trauma in Central Karnataka, India – An outcome of 483 Results cases at a regional maxillofacial surgical unit. Journal of Oral and Not applicable. Maxillofacial Surgery, Medicine and Pathology, 27, 2015, P 308–317. 123 S6 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

ABS00190 Background/Introduction Maxillofacial Injury Caused by Bear Mauling: Case Rapid growth in the Gulf region has fueled an explosive pace of construction and a rise in risks of occupational injury. The con- Series struction workers are usually highered from developing countries, these workers usually do not have enough experience of latest Pranali Nimonkar machineries and work over time without complete training and safety measures. Govt Medical College, Nagpur Objectives The aim of this study was to discuss the peculiarity of the multidis- Abstract ciplinary approach in treatment of five victims of an industrial Background/Introduction accidents where patients were brought to Emergency department with Animal bites has a special place in traumatology owing to its high Foreign bodies (FB) retained in intra craniomaxillo facial region. The complication rate when compared with similar soft tissue wound Objective of the study is to find out the possible etiology, time, level otherwise caused during trauma. Bear attacks are very rare constituting of education and safety measures used during industrial accidents. only 0.1 % of all animal attacks in India. However, among other animal Methods attacks bear mauling is inflicted on face most commonly. Major concern A retrospective study is carried out at Al-Noor Specialist Hospital is prevention of postoperative infection in such cases owing to the fact Makkah, after approval from ethical clearance committee. Five that Bite wounds are contaminated with variety of pathogens and are patients who were surgically treated for removal of intra cran- further soiled with mud, grass which is forced during the struggle in the iomaxillo facial FB. They include two most commonly encountered course of attack. Hence management of bites require both systemic and types of these injuries: cutting disc, nail gun and one rare caused by local consideration. Excellent blood supply of face poses it to low risk of machine bolt of huge crane. In all the patients’ CT scan was done pre post treatment infection but it can result in facial disfigurement with operatively to see proximity of FB and vital structure. FBs were distressing physical and psychological consequence. removed successfully under general anaesthesia. All patients received Objectives antibiotics post operatively. To present a case series of maxillofacial injuries caused by bear Results mauling and to propose a rationalized treatment approach for man- All patients were male, and received in hospital in emergency after agement of bear mauling attacks. regular working hours. In all cases FB was removed successfully with Methods no death reported. One of the patient developed brain deficit, uni- Routine blood investigations, diagnostic imaging were performed. lateral loss of vision, two developed facial nerve palsy and scar. Swab cultures from the wound were sent. General condition was Conclusions assessed and necessary management was done. Post-trauma anti Immigrant workers’ exposure to unhealthy and unsafe working con- tetanus prophylaxis, post exposure prophylaxis and broad spectrum ditions, and their corresponding susceptibility to workplace injuries antibiotics were administered to all the cases. Thorough debridement and illnesses. of wound and primary closure was done in first surgery. Rehabilita- References/Bibliography tion was planned for one of the case with hard tissue loss. Open reduction and rigid internal fixation was done for another case. 1. Rathod JM Danger and Dignity: Immigrant Day Laborers and Results Occupational Risk, Seton Hall Law Rev. 2016;46(3):813–82. Acceptable aesthetic out come and control of infection with func- 2. Tucker P et al. Work time control, sleep & accident risk: A tional rehabilitation was achieved. prospective cohort study Chronobiol Int. 2016 Apr 15:1–11. Conclusions Maxillofacial reconstruction should aim at functional rehabilitation and esthetic camouflage. Management of such injuries regularly require multidisciplinary approach and several secondary interven- ABS00257 tions to treat the secondary defects. Etiology and Incidence of Maxillofacial Trauma in High References/Bibliography Altitude: A Two Year Experience at 9100 Feet 1. Patil SB, Mody NB, Kale SM, Ingole SD. A review of 48 patients after bear attacks in Central India: Demographics, management and Dr (Lt Col) Yuvraj Issar, Dr (Maj) Bhargava D outcomes. Indian Journal of Plastic Surgery. 2015;48(1):60–65. 2. Shah AA, Mir BA, Ahmad I, Latoo S, Ali A, Shah BA. Pattern of Army Dental Corps CMDC (SC) Pune bear maul maxillofacial injuries in Kashmir. Natl J Maxillofac Surg 2010;1:96–101. Abstract Background/Introduction The management of Cranio-Maxillofacial trauma may be somewhat ABS00238 similar in Maxillofacial centers around the world, however the eti- Removal of Complex Type Penetrating Cranio Maxillo ologies vary vastly as we work in different parts of the world. Very Facial Foreign Bodies Caused by Industrial Accidents: little scientific literature is available for remote high altitude areas. Case Series Our share our experience of operating in such region. Objectives To evaluate the features of the population victim of facial trauma as to Dr. Sajid Ahmed Sanadi, Dr. Jamil Ma Shargavi gender, age, occupation, origin, type of fracture and its cause, at an isolated multi-speciality hospital at an altitude of 91000 feet above Al-Noor Specialist Hospital Makkah, KSA sea level.

Abstract 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S7

Methods Results A Retrospective study at an altitude of 9100 feet above sea level. From survey, it was concluded that most of the trainees were capable Patients who were treated for Oral and Maxillofacial injury from Jun of managing maxillofacial injuries with normal physiology. Most of 2015 to Jul 2017 (25 months). Data regarding incidence, age and sex them referred the patients/intervened when condition was critical. distribution, causes, types and site of injury, treatment modalities and Trainees had difficulty in managing of airway, bleeding and shock. trauma associated complications were collected and analysed. Maintenance of records were not standard. Results Conclusions A total of 59 patients were studied. There was a higher incidence of Need to strengthen certain areas of training for maxillofacial surgeons facial trauma on men (85.5%), and with an average age of 28 years. such as management of ABC, better understanding of anatomy and Regarding occupation, the trauma was occurred to Construction physiology of body and concept of maintaining accurate medico legal workers/Saw mill workers/ professional woodcutters (22.5%) second records. were Policemen /Soldiers (16.6%) and students (15.5%). Mandible was the most commonly fractured (35.2%), followed by zygoma References/Bibliography (19.7%) and by the nasal bones (15.4%), most patients presented a Advance trauma life support course manual, atlas of operative single facial fracture (85%). Among the causes, Road Traffic acci- maxillofacial trauma surgery. dents (34.6%), accidental falls (28.3%), Animal Assaults (12.7%) and aggressions (10.4%) were the most common. Head/neck (50.29%) and limb injuries (27.2%) were the most prevalent associated injuries. Conclusions Road Traffic Accidents closely followed by fall from height and ABS00273 Animal assault are the main causes of facial trauma in isolated high Is Delta Plate a Better Option than Single Miniplate altitude region of the Indian peninsula. Whereas, construction workers for Management of Condylar Fracture of Mandible? are the most common segment of society suffering facial trauma in sharp contrast to most parts of the world. 1. Dr Archana D. Deshpande, Assistant Professor, 2. Dr Prashant K. References/Bibliography Pandilwar, Professor, 3. Dr Abhay Datarkar, Professor & HOD

1. Brook M and Wood N. Aetiology and incidence of facial 1. Govt. Dental College, Nagpur; 2. Govt. Dental College, fractures in adults Int Journal Oral Surg. 1983; 12:293–298. Aurangabad; 3. Govt. Dental College, Nagpur 2. Boffano P, Kommers SC, Karagozoglu KH, et al. Aetiology of maxillofacial fractures: a review of published studies during the last 30 years. Br J Oral Maxillofac Surg. 2014; 52:901–906. Abstract Background/Introduction Management of mandibular condylar fracture is one of the most controversial topic in maxillofacial surgery. Single miniplate is generally used for open reduction and internal fixation with some ABS00261 disadvantages while two miniplates, though having good results are Are Maxillofacial Surgeons in India Trained to Manage difficult to place 1. Hence there was need to explore the use of Life Threatening Injuries in Emergency Department suitable device. Delta plate was evaluated for stable osteosynthesis. Objectives To compare the efficacy of Delta Plate versus Conventional Single Dr Kunwar Satish, Reader miniplate in the fixation of condylar fracture of mandible. Methods Teerthankar Mahaveer Dental College and Research Centre, 20 adult patients with displaced unilateral subcondylar fracture were Moradabad, UP selected for RCT. Patients were randomly equally divided into two groups and fractures were reduced with delta plate and single 4-hole Abstract miniplate respectively. Materials used 1. 3-Dimensional titanium Background/Introduction Delta Plate. 2. Single 4 hole titanium miniplate. Following parameters With increase in number of trauma cases, health service sector is were evaluated after 1 week, 1 month and 6 months respectively. 1. coming up with more number of trauma centres across the country. Maximum Inter Incisal Distance, 2. Mandibular Deviation, 3. Head and neck injuries constitute 50 % of 12 millions wounds treated Occlusion, 4. Need for Inter Maxillary Fixation, 5. Post operative in emergency room. Management of fresh trauma cases in general complications 6. Radiological evaluation The statistical analysis was require quick assessment, performing life saving procedures and exact performed using SPSS 18.0 (SPSS Inc.) software and the statistical documentation with little scope for flaws. significance was evaluated at 5% level. Objectives Results 1. To asses the level of training for maxillofacial postgraduates in Sn Parameters Used Delta Plate Single 4 Hole p-value for (Mean- management of trauma patients 2. To recommend improvement in the Value) Maniplate difference in (MeanValue) two Groups 1 Inter level of training of maxillofacial surgeons of India in management of Incisal Distance 39.3mm 35.6mm 0.3131 (NS) 2 Mandibular Devia- life threatening conditions. tion 1.0mm 2.6mm 0.0071 (S) 3. Normal Occlusion 90% 30% 0.0048 Methods (S) (Immediate Post Operative) 4. Inter maxillary 10% 70% 0.0225 1. Set of questions were given to post graduate trainee to respond 2. (S) Fixation Required 5 Displacement of Condyle in Coronal Direc- Questions were based on hours of duty in emergency, management tion in degrees 5.95 9.7 0.0125 (S) 6 Loss of Ramus Height 0.7mm protocol followed at their centre, record maintenance of such cases, 1.7mm 0.0294 (S) 7 Complications (Plate bending, screw 0% 30% any special training to handle life threatening conditions, response 0.2104 (NS) loosening, etc). were analysed. Conclusions Open reduction and internal fixation of mandibular condylar fracture with Delta condylar plate is found to provide Stable osteosynthesis,

123 S8 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 internal stability, optimal leverage with minimal thickness of plate 2. Ellis E 3rd. A study of 2 bone plating methods for fractures of the and is suitable for the treatment of mandibular condylar fractures 2. mandibular symphysis/body. J Oral Maxillofac Surg. 2011 Jul;69(7):1978–87. References/Bibliography 1. Gu¨nter Lauer, A New 3-Dimensional Plate for Transora Endo- scopic-Assisted Osteosynthesis of Condylar Neck Fractures. J Oral Maxillofac Surg 2007;65:964–971. ABS00298 2. Dominik Haim, Biomechanical Study of the Delta Plate and the Efﬁcacy of 3 Dimensional Plate in Maxillofacial TriLock Delta Condyle Trauma Plate. J Oral Maxillofac Surg Trauma 2011; 69:2619–2625.

Dr. Deepa BV

ABS00276 JSS Dental College and Hospital, Mysuru A CBCT Analysis of Buccal Bone Thickness in Maxilla and Mandible and Its Clinical Significance Abstract Background/Introduction in Monocortical Screws Placement Maxillofacial trauma is a cause of alarming concern due to the increasing road traffic accidents, violence and sports injury. The Kartik Shyam Tank, Ramdas Balakrishna, G C Veena, Rahul treatment options in the management of maxillofacial injuries are Maheshwari, S Bhuvaneshwari numerous and not without controversies. The management of trauma evolved from the supportive bandage to splints and has changed from Consultant Oral and Maxillofacial Surgeon, Nagpur; Professor and close to open reduction and direct fixation using bone plates and Head of the Department, Oral and Maxillofacial Surgery; K.L.E screws. Michelet et al began experimenting with mono-cortical non Society’s Institute of Dental Sciences, Bangalore; K.L.E Society’s compression miniplates. He described the treatment of fractures using Institute of Dental Sciences, Bangalore; Consultant Oral and small, easily bendable, non compression miniplates, anchored with Maxillofacial Surgeon, Dibrugarh; K.L.E Society’s Institute of Dental mono-cortical screws. Champy et al. showed that the superior Sciences, Bangalore mandibular border was subjected to tension and splaying, and the inferior border was subjected to compression plates placed along the ideal line of osteosynthesis were thought to provide optimal fixation Abstract and stability. As these plates were small and the screws mono-corti- Background/Introduction cal, it simplified surgery and reduce surgical morbidity. However they The placement of monocortical screws may carry the risk of damage fail to surpass the predictability of rigid fixation using compression to the tooth roots and important anatomical structures during treat- and reconstruction plates. Farmand et al in 1992 developed the con- ment of fractures. cept 3D miniplates. Their shape is based on the principle of the Objectives quadrangle and geometrically stable configuration for support. 1. To determine the buccal bone thickness in maxillary and Objectives mandibular arches through CBCT. 2. To predict the safest length of The primary objective is to identify papers reporting the results with monocortical screw that can be placed without damage to roots of the treatment of Maxillofacial fractures with the aim of comparing the teeth or important structures like mandibular nerve. different techniques using different miniplates designs (3D). Methods Methods 100 samples including 50 maxillae and 50 mandibles were assessed The study was done by referring and reviewing the various publica- using CBCT. The measurement of buccal bone thickness was done tions on the related topic from 2000 to 2017. from canine to second molar; from outer buccal cortex to inferior Results alveolar nerve canal (IANC) and from the outer buccal cortex to floor The biomechanical and technical constraints of the conventional rigid of the maxillary sinus/nasal floor. internal fixation devices have prompted the use 3D miniplates as a Results viable treatment modality. In mandible the buccal cortical bone thickness increased from canine Conclusions to second molar at the level of the apex. In maxilla the mean buccal The purpose of this paper is to highlight the versatility of 3D mini- cortical bone thickness at the level of apex was highest in the region plate in the management of maxillofacial trauma. of second molar (5.22 ± 1.54 mm) and least in the region of first premolar (1.96 ± 0.97 mm). At the level of floor of the maxillary References/Bibliography sinus the mean buccal cortical bone thickness was highest in the region of first premolar (4.13 ± 2.04 mm) and least in the region of 1. G. Mittal, R.R. Dubbudu, K.M. Cariappa. Three dimensional second molar (2.66 ± 1.09 mm). Titanium Miniplates in Oral and Maxillofacial Surgery: A Conclusions Prospective clinical Trial. J. Maxillofac. Oral Surg. (Apr-Jun This study showed that if longer length of screws are to be used for 2012)11(2):152–159. better stability they need to be directed such that damage to the tooth 2. Shreyas H Gupteshruti Chaddava et al. Evaluation of Efficacy of roots or important anatomical structures is avoided. 3 dimensional stainless steel miniplates in the treatment of fractures of the mandible: A prospective Study. Journal of References/Bibliography Orthopaedic Case Reports 2016 Nov-Dec:6(5):35–40. 1. Al-Jandan BA, Al-Sulaiman AA, Marei HF, Syed FA, Almana M. Thickness of buccal bone in the mandible and its clinical significance in mono-cortical screws placement. A CBCT analysis. Int J Oral Maxillofac Surg. 2013 Jan;42(1):77–81.

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ABS00324 Intraoral & extraoral internal fixation technique in these fractures Management of Zygomatico-Maxillary Complex have their own advantages and disadvantages which often puts the surgeon into a dilemma. Fracture Using Two Point Versus Three Point Fixation: Objectives A Prospective Study In the light of these factors, the aim of this study was to compare treatment outcomes between extraoral and intraoral fixation for Dr Mayur Janardan Gawande management of mandibular angle fractures. Methods A prospective randomized comparative study was conducted to Abstract compare open reduction and internal fixation of mandibular angle Background/Introduction fractures via intraoral approach according to Champy’s ideal line of Zygomatico-Maxillary complex functions as the principle buttress of osteosynthesis (group A) versus extraoral approach with application the face and is the cornerstone to an individual’s aesthetic appearance. of an inferior border plate (group B). In both groups 2mm, 4 hole with Zygomatic complex fractures are one of the frequently occurring gap miniplates and 2x10 mm screws were used. Clinical and radio- maxillofacial injuries owing to its position and facial contour. graphic assessment was done preoperatively, immediately Assaults, road traffic accidents and falls are the common causes postoperative & 1st week, 6th week, 3rd month and 4th month. leading to fracture of the zygomatic bone. Displacement of the Intraoperative assessment was done in terms of Surgical approach, fractured fragments leads to aesthetic and functional disturbances. Surgical complications, hardware complications & Operative time. Objectives Postoperatively treatment scoring system (V Uglesic 1993) was used To evaluate: Post operative Stability Duration of surgery Facial to assess the complications, occlusion, chewing and appearance of the Aesthetic Neurological Assessment Radiographic Assessment Asso- scar. Data were evaluated by t-test and Chi square/fisher exact test; P ciated complications. \ 0.05 was considered statistically significant. Methods Results 10 patients of Zygomatico-Maxillary complex fracture reported to the There was no significant difference between the two groups with Department of Oral and Maxillofacial Surgery were randomly divided regard to complication rates. Functional outcome was better in group equally into two groups. In group A, 5 patients were treated by ORIF B. The intraoperative time was shorter in group B. using three point fixation by mini-plates and in group B, 5 patients Conclusions were treated by ORIF using two point fixation by mini plates. They Both approaches (intraoral or extraoral) for fractured mandibular were evaluated for their complications during and after surgery with angle provide adequate stability and similar treatment outcomes. their advantages and disadvantages. However, extraoral approach was considered to be easier for severely Results displaced and unfavourable fractures. Still, surgeon should consider We found that post-operative complication like decreased malar the best approach for treatment based on severity of displacement, height and vertical dystopia. location of fracture, ability to visualize & reduce the fracture. Conclusions Based on this study, ORIF using three point fixation by miniplates is References/Bibliography the best available method for the treatment of zygomatico-Maxillary complex fracture. 1. Uglesic V., Virag M., Aljinovic N., Macan D. ‘‘ Evaluation of mandibular fracture treatment ’’. J Cranio Maxillofacial Surg. 21: References/Bibliography 251–257, 1993. 2. Ellis E., Lee W. Treatment of mandibular angle fractures using Prachur Kumar, Suhas Godhi, Amit Bihari Lall, C. S. Ram; one non compression miniplates. J Oral Maxillofac Surg. 54: Evaluation of Neurosensory Changes in the Infraorbital Nerve 864–871, 1996. following Zygomatic Fractures; J. Maxillofac. Oral Surg.; (Oct-Dec 2012); 11(4):394–399. Edward Ellis, and Winai Kittidumkerng, Analysis of Treatment for Isolated Zygomaticomaxillary Complex Fractures; American Associ- ation of Oral and Maxillofacial Surgeons;1996;54;386–400. ABS00389 Intraoral Fixation Over External Oblique Ridge Compared to Lateral Cortical Plate Fixation ABS00369 in the Treatment of Mandibular Angle Fractures: A Comparative Evaluation of Efficacy of Intraoral & A Prospective Clinical Study Extraoral Internal Fixation Technique in Mandibular Angle Fracture Dr Shweta Gupta

Abstract Presenting Author – Dr. Dilpreet Trilochansingh Rajkhokar, Background/Introduction Lecturer. Co-Author-Dr. Pravin Lambade, Consultant Since the initial description by Michelet et al. and research by Champy et al. the placement of a single, four-hole, monocortical, Department of Oral & Maxillofacial Surgery, Government Dental osteosynthesis plate has been considered an acceptable method of College, Raipur, Chhattisgarh, India; Oral & Maxillofacial Surgeon, ﬁxation for a fracture of the mandibular angle. The aim of this study is Nagpur, Maharashtra to compare the treatment outcome of ﬁxation of mandibular angle fracture through intraoral and transbuccal approaches. Abstract Objectives Background/Introduction Objectives of this study are assessment and comparison of these two Treatment of mandibular angle fractures is plagued with highest surgical approaches. The patients are evaluated for operative time, postsurgical complication rate amongst mandibular fractures.

123 S10 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 difficulty in access to surgical site, postoperative occlusion, fracture vestibular and a retromandibular approach were used to address displacement, infection rate, complications, postoperative neurosen- bilateral condylar and parasymphysis fractures. In the third case, a sory disturbances and quality of external scar. preauricular and intraoral approach were advocated. Methods Results Patients were randomised to having their angle fractures treated with In all the cases, good anatomical reduction was achieved and occlu- a ridge plate placed intraorally or transbucally. The patients were sion was stable. Facial nerve weakness was found to be negligible in evaluated preoperatively, intra-operatively for various parameters and the first case and totally absent in the other two cases. Discussion: post-operatively at 1st week, 1 month & 3rd month. Fixation of the condylar segment first would prevent lateral flaring of Results the gonial angle, which is a common occurrence at the time of Of the 40 angle fractures, there was a highly significant difference in application of Intermaxillary fixation on a free floating dentate seg- infection and complication rate in intraoral approach. Transbuccal ment. In addition the vertical height of the ramus can be restored plates were far less likely to need removal for infection than intraoral easily. ridge plates. There is no significant difference in post-operative Conclusions occlusal outcome & post operative fracture displacement. The inci- The condyle first approach in the surgical management of double/ dence of facial nerve palsy was zero in case of both the groups and the triple mandibular fractures, is a reliable and efficient technique and scar was inconspicuous in all patients treated via transbuccal can be a valuable alternative to the conventional technique. approach. Conclusions References/Bibliography Thus it can be concluded that if mandibular fractures are being treated 1. Giovanni DO, Vincenzo A, Salvatore D, Giorgio I: Surgical according to the principles of Champy et al a monocortical sequence of reduction in double mandibular fractures treatment. osteosynthesis plate placed against the lateral cortex or the buccal side Ann. Ital. Chir 85:207–213, 2014. of the mandible by a transbuccal approach would be better as it gives 2. Mauro PA, Knut ER, Matthias F, Kawe N, Hans Karcher: The promising results in terms of function and esthetics and associated mandibular symphysis as a starting point for the occlusal-level with fewer complications. reconstruction of panfacial fractures with bicondylar fractures References/Bibliography and interruption of the maxillary and mandibular arches: Report of two cases. Journal of Cranio-Maxillo-Facial Surgery 42:e51– 1. Ellis III E, Walker LR. Treatment of mandibular angle fractures e56, 2014. using one noncompression miniplate. J Oral Maxillofac Surg 1996;54: 864–72.

ABS00423 Frontal Bone Fracture Management; Our Experience ABS00416 in Last Four Years in a Single Hospital Surgical Management of Double/Triple Mandibular Fractures Involving the Condylar Segment: Our Dr Om Prakash MDS DNB FIBOMS Lecturer Perspective Dept of Oral & Maxillofacial Surgery and Oral Implantology Dental Dr. Sunil S Nayak. Co Author: Dr. Abhay T Kamath, Professor Institute RIMS, Ranchi (Ex-Consultant Maxillofacial Surgeon, and Head Bhagawan Mahaveer Medica Superspecialty Hospital, Ranchi)

Department of Oral and Maxillofacial Surgery Manipal College of Abstract Dental Sciences, Manipal, Karnataka State, India, Phone: Background/Introduction 9845308590, Email: [email protected]; Department of Oral Frontal bone fractures are relatively uncommon and can be associated and Maxillofacial Surgery, Manipal College of Dental Sciences, with significant morbidity. the frontal sinus is protected by thick Manipal, Karnataka State, India cortical bone and is more resistant to fracture than any other facial bone. The surgical management of frontal bone fracture has been Abstract always a challenge and controversial because of associated anatomy, Background/Introduction involvement of different speciality and other associated injuries. This Surgical management of double/triple mandibular fractures is a paper a retrospective study, deals with our experience of frontal sinus unique challenge. Our experience in the management and sequencing fractures and its management to overview the fracture pattern, patient of double/triple mandibular fractures involving the condyle is characteristics, surgical approaches, short term complications asso- described. ciated with the cases managed in a single super specialty centre in Objectives Ranchi in last four years. To analyse and evaluate the different techniques and sequencing Objectives employed in the surgical management of double/triple mandibular To review our cases retrospectively to overview the fracture pattern, fractures involving a condylar fracture. patient characteristics, surgical approaches, short term complications Methods associated with frontal bone fractures in last four years in the single A series of 3 surgical cases operated in our unit are considered. hospital and to share our experiences. Deviating from the normal sequence of reducing and fixing the Methods dentate segment first, we addressed the condylar segment first. In the A retrospective study was designed with a set proforma to record first case, a combination of the preauricular and retromandibular details like age, mode of injury, neurological status, other associated approach were advocated to manage a medially displaced condylar injuries, mode of treatment and post operative complications in the segment. The accessibility was further facilitated by using Hegar patient who were surgically treated for frontal bone fractures in last uterine dilators. In the second case, a periangular approach, a 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S11 four years in the mentioned hospital. The data was tabulated and approach has the advantage of being immediately over the fracture, compared. allowing direct access for reduction and fixation. Results Objectives Total 35 patients with frontal bone fracture were included in this Evaluation of outcome of Retromandibular approach in the manage- study. The age of patient varied from 7 years to 60 years, with road ment of condylar fractures of mandible. traffic accident as the only cause of injury. Either old laceration or Methods coronal incision was used to reach to the surgical site. Titanium mesh Trauma patients operated in Department of Oral & Maxillofacial or multiple plates made up of titanium were used for stabilization of Surgery, V.S.P.M’S DCRC from June 2013 to June 2016 who fractured segments. In only one patient there was exposure of titanium underwent open reduction and internal fixation of fractured mesh through the laceration as early post operative complications, mandibular unilateral/bilateral condyles through Retromandibular which was managed successfully with aggressive debridement, approach were selected for the study. Patients of condylar fracture dressing and use of both topical and systemic antibiotics. In another treated by other approaches than retromandibular approach and with incident of complication, four months after surgical correction preoperative facial paralysis were excluded. The data collected were reported with painless swelling, which was managed conservatively age, gender, mechanism of injury, anatomic location, concomitant with medication. (Statistical results will be submitted before the facial fractures, follow-up time and complications. conference if required). Results Conclusions 26 patients, 31 condyles (19 males, 7 females); age-19 to 55 years, Deformity in frontal bone region is very prominently visible and is mean-(39.3 ± 4.1) met the inclusion criteria. The mean follow-up primarily noticed, so it requires the attention of surgeon for early time for all patients was at least 6 months. 3 cases (9.68%) of tem- management of any defect in the region. Frontal bone is important porary facial nerve paralysis, 1 cases (3.2%) of infection, 1 case of and unique because of frontal sinus, fronto nasal duct and peculiar salivary fistula, 1 case of deranged occlusion and 1 case of chin activity of frontal recess. Displaced frontal bone fractures should be deviation were observed. There were no cases of sialocele. managed surgically for better out come. Coronal incision is the best Conclusions incision for exposure and minimal visible scar. It is not always Retromandibular approach provides an excellent and safe approach mandatory to remove sinus mucosa unless it is disturbed because of for the management of mandibular subcondylar fractures and com- trauma. Local use of antibiotics has always prevented incidence of plications associated with this approach are rare. post operative infections. Team work and involvement of different specialists in planning of surgery always helps in better outcome and References/Bibliography minimization of complications. 1. Ellis III E, McFadden D, Simon P, Throckmorton G: Surgical References/Bibliography complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg 58: 950, 2000. 1. Arthur A. Gonty, DDS, * Robert D. Marciani, DMDf and 2. Bouchard C, Perreault MH. Postoperative complications associ- Dominick C. Adornato, DMDf; Management of Frontal Sinus ated with the retromandibular approach: A retrospective analysis Fractures: A Review of 33 Cases; J Oral Maxillofac Surg of 118 subcondylar fractures. Journal of Oral and Maxillofacial 57:372–379, 1999. Surgery. 2014 Feb 28;72(2):370–5. 2. Rodriguez ED, Stanwix MG, Nam AJ, St Hilaire H, Simmons OP, Christy MR, Grant MP, Manson PN.; Twenty-six-year experience treating frontal sinus fractures: a novel algorithm based on anatomical fracture pattern and failure of conventional ABS00437 techniques. Plast Reconstr Surg. 2008 Dec;122(6):1850–66. Clinical Outcome of Pediatric Maxillofacial Fracture Management

ABS00433 Dr. Supreet Gill, Dr. Kannan Balaraman Evaluation of Retromandibular Approach in the Management of Condylar Fractures Abstract Background/Introduction of the Mandible The growing patient with facial injuries presents the clinician with a series of complex and thought-provoking circumstances. while Dr Kshitij Bang MDS OMFS Assistant Professor determining the optimal treatment strategy for a pediatric fracture, planning must factor in the patient’s age, anatomy, stage of dental Dept of OMFS VSPM DCRC Nagpur development and fracture site. Careful consideration must be given to the possibility of long term growth disturbances secondary to various Abstract fracture patterns and types of treatment. Objectives Background/Introduction The aim of this study was to retrospectively evaluate the treatment Management of condylar fractures is a controversial topic among oral methods and outcome of pediatric fractures. and maxillofacial surgeons. Some favour open reduction and rigid Methods ﬁxation of condylar fractures, while some prefer conservative man- The study included a total of 24 patients up to 16 years of age who agement. However, an increasing number of articles report better reported to Department of Maxillofacial surgery, Ganga hospital results for surgically treated condylar fractures in terms of occlusion, Coimbatore form 2015 to 2017. The etiology of trauma, treatment bone morphology and articular function. Condylar and subcondylar methods used and postoperative complications were noted. Patients fractures can be exposed through different approaches. The more with dentoalveolar fractures and those managed non surgically were commonly used extraoral approaches comprise the sub-mandibular, excluded from the study. The treatment methods included retromandibular and preauricular methods. The retromandibular

123 S12 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 circummandibular wiring or open reduction internal fixation end of 2nd week postoperatively, all patients had satisfactory depending on the type and nature of injury. occlusion in group A, however, in group B, 3 patients (20.0%) still Results showed deranged occlusion. At the end of 6th and 12th week The age range of patients was 5–16 years. The most common cause of postoperatively, all patients had satisfactory occlusion in both the injury was road traffic accidents followed by playground injuries. The groups. most prevalent site of fracture was mandible particularly parasymphysis and condyle which were 14 out of 24 patients. There were 4 References/Bibliography midface fractures, 2 panfacial fractures, 2 nasal complex fractures, 1 Biomechanical study of the delta plate and trilock delta condyle orbit and 1 frontal bone fracture. Pediatric fractures comprised 3–4% trauma plate (JOMS 2011). of maxillofacial injuries encountered at out center over a period of two and a half years. Out of 24 patients, 11 patients were treated with closed approach and remaining treated with open approach. Conclusions Pediatric trauma requiring surgical intervention though is less in ABS00621 incidence, however the treatment has to be tailored depending on Epidemiology and Assessment of Maxillofacial Trauma individual scenario. The main objective of treatment should be early in a Tertiary Health Care Centre: A 5 Years rehabilitation and restoration of normal form and function. Retrospective Study References/Bibliography NJ Budhraja, SR Shenoi, P Ingole, A Garg, VS Kolte, KO Bang Management of pediatric mandible fractures. Erik M et al, Otolaryn- gologic Clinics of North America. Abstract Background/Introduction The epidemiology of facial injuries varies in different countries and geographic areas [1,2]. ABS00476 Objectives A Comparative Study of 3-D Delta Plate and Double This study aimed to identify the cumulative incidence, causes Miniplate in Osteosynthesis of Sub Condylar Fracture and pattern of maxillofacial trauma amongst the patients reported in a tertiary health care centre from January 2012 to December 2016. Dr. Neelam Shakya Methods Hospital records of 302 patients were reviewed retrospectively after Govt. College of Dentistry Indore obtaining clearance from the institutional ethics committee. Data collected included patient’s name, sex, age, etiology, history of Abstract alcohol consumption, interval of reporting after trauma, primary care Background/Introduction administered, radiological investigations, pattern of facial fractures Condylar fractures account for 25–45% of mandibular fractures and and interval between date of admission and surgery. deserve a special consideration apart from rest of the mandible due to Results their anatomical differences and healing potential. The debate con- There were records of total 302 patients of trauma reported in the tinues over how to best manage subcondylar fractures and the tertiary health care centre in the defined period. The incidence of question of which fractures should be treated surgically has yet to be facial fractures was more in males (88.7%), with highest number in answered. age group of 21–25 years. Road traffic accidents were the most Objectives frequent cause of facial fractures (94%). A majority of patients To compare the efficacy of 2mm 3-D titanium delta-shaped plate with were brought directly from the site to our emergency room i.e. 2mm conventional titanium miniplate. To evaluate the stability of 60.6% of cases whereas 90.7% of patients reported within 1 to 5 Delta plating system over conventional miniplate. To evaluate post- days after trauma. Plane radiography was found to be adequate in operative occlusion and mouth opening, incidence of complications only 22.18% of cases; whereas in about 44.7% of cases computed like infection, pain, hardware failure and paresthesia. tomography was the only imaging modality of choice. Mandible Methods was found to be the most common facial bone to get fractured A total of 30 patients who required open reduction of a subcondylar followed by zygomatic complex and maxilla. In mandible, fracture of mandible were selected for the study. The patients were parasymphysis (36%) was the most frequently involved site. The randomly divided into two groups of 15 each. Group I comprised of period between admission and surgery was 1 to 5 days in 87.4% patients treated with titanium delta shaped plate and Group II were cases. treated with two non compression miniplate. The patients were Conclusions assessed for malocclusion, lateral deviation on opening, infection, This study is in consonance with the global literature that motor plate removal, facial nerve function in both the groups. vehicle accidents are the most common cause of facial fractures. The Results results of the study indicate the necessity for strict enforcement of Postoperatively at 72 hours, occlusion was deranged in 2 patients road safety rules and regulations to check the growing cause of (13.3%) in group A and 4 patients (26.7%) in group B. At the end of trauma in central India. 2nd week postoperatively, all patients had satisfactory occlusion in group A, however, in group B, 3 patients (20.0%) still showed References/Bibliography deranged occlusion. At the end of 6th and 12th week postoperatively, 1. Rezaei M, Jamshidi S, Jalilian T, Falahi N. Epidemiology of all patients had satisfactory occlusion in both the groups. maxillofacial trauma in a university hospital of Kermanshah, Conclusions Iran. Journal of Oral and Maxillofacial Surgery, Medicine, and Postoperatively at 72 hours, occlusion was deranged in 2 patients Pathology. 2016;17. (13.3%) in group A and 4 patients (26.7%) in group B. At the

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ABS00637 ABS00696 Malunited Maxillofacial Fractures: Protocol in Their A Comparative Evaluation Between One Point Versus Management Two Point Fixation for Zygomaticomaxillary Complex Fractures Umashankara K.V, Kirthikumar Rai Dr. Vrinda Kolte (Professor and Guide), Dr. S Khandaitkar, Dr. S R Bapuji Dental College and Hospital Shenoi, Dr. A Garg, Dr. K Bang, Dr. P Ingole, Dr. N Budhraja

Abstract VSPM’s Dental College and Research Centre, Nagpur Background/Introduction Injuries to the face, head and neck are relatively common and yet, in Abstract the overall trauma literature, very little attention has been paid to Background/Introduction malunited fracture cases of maxillofacial region. Fractures of max- The zygomaticomaxillary complex consists of 4 pillars attached by 4 illofacial region have been treated by a number of methods, including suture lines. It includes the frontozygomatic suture, part of the orbital closed reduction, external pin fixation, internal wire fixation and more floor lateral to the infraorbital fissure, buttress region and zygomatic recently, open reduction and internal stable fixation using plates and/ arch. Aim of a treatment should be adequate reduction and or screws. In last few years maxillofacial surgery emerged out as stable fixation to provide esthetic and functional stability. Various major field in modern era of surgical practice. But due to lack of literatures are present regarding protocols of reduction and fixation of awareness and specialist expertise availability in most of the areas of ZMC fractures. The aim of the study was to compare between one our country such injuries may go undiagnosed or most of the times point versus two point fixation for zygomaticomaxillary complex wrongly diagnosed and treated as well. Malunited fractures have fractures. always been a big challenge to the surgeon. As such there is no Objectives treatment protocol available in the literature which can guide us to To compare between one point versus two point fixation for zygo- build a definitive line of treatment in managing these fractures. maticomaxillary complex fractures in terms of stability, esthetics and However we can follow certain basic principles for management of functional outcome. post traumatic skeletal deformity. Most important of all in Methods approaching such cases is to have a proper history and requirement of This retrospective study from 2015 to 2017 June included 30 patients, the patient. The one which is most concerned to the patient should be who needed to undergo open reduction and internal fixation for on top priority. Occlusion is a point on which no compromise is zygomaticomaxillary complex fracture and were divided into two acceptable. Minimally invasive procedures and relatively simple groups A and B, depending upon the points of fixation. In one point; measures can sometimes yield a marked improvement in net result. fixation was done on zygomatic buttress region while in two points So a calculated approach should be taken while operating such cases. fixation plating was done on FZ suture and zygomatic buttress region. Treat each case as a new case and set criteria of your own depending Results upon the patient situation and its requirement. This paper is all about In undisplaced and minimally displaced fractures, adequate stability, presenting such few cases of malunion treated in our unit and discuss good esthetics, and functional outcomes were achieved in group A the challenges and complications encountered during their while in displaced fractures these parameters were more satisfied in management. group B. Objectives Conclusions Not applicable. One point fixation is a treatment of choice for minimally displaced Methods fractures with good esthetic and functional outcome however dis- Not applicable. placed and unstable should be fixed at two points to get better esthetic Results and functional stability. Not applicable. Conclusions References/Bibliography Not applicable. Kim ST, Go DH, Jung JH, Cha HE, Woo JH, Kang IG. Comparison of References/Bibliography 1-point fixation with 2-point fixation in treating tripod fractures of the zygoma. Journal of Oral and Maxillofacial Surgery. 2011 Nov Sung-Suk Lee, Su-Gwan Kim, Seong-Yong Moon, Ji-Su Oh, Jae- 30;69(11):2848–52. Seek You. The treatment of malocclusion after open reduction of maxillofacial fracture: a report of three cases. J Korean Assoc Oral Maxillofac Surg 2014;40:91–95. ABS00724 Role of Drug Abuse and Alcohol in Maxillofacial Trauma

Kavita Raghotham

Department of Oral & Maxillofacial Surgery, Geetanjali Medical College & Hospital, Udaipur

Abstract Background/Introduction

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Excessive consumption of alcohol and Opium abuse results in studied the incidence of slot misalignment, screw driver slippage, and impaired judgement and plays a major role in Road traffic accidents difficulty in screw fastening using these systems. and interpersonal violence. This study describes the experience of Methods alcohol and patients with Opium abuse-related Maxillofacial trauma. After patient selection, the sites of fracture fixation were divided into Objectives 2 groups, sites were allotted to respective groups by lottery method of Aim of the study was to investigate the impact of alcohol and Opium sample selection and were matched for fracture site. Groups con- abuse in facial trauma. taining 68 and 69 Sites where cross recess screws and monoslotted Methods screws were used to secure the miniplate into place respectively. A Retrospective database of patients presenting to Oral and Maxillofa- standardized data sheet was formulated and relevant clinical findings cial Surgery unit at the Geetanjali Medical College & Hospital during of time were noted in seconds. a 13 month period was reviewed. Variables recorded were type of Results fracture, mode of injury, location of fracture, treatment received and Time taken for loading the screw, time for fastening the screw and days of hospitalisation. total time taken were presented as Mean ± Standard Deviation (SD). Results and were studied by performing independent t-test. Slot misalign- Over 480 patients were evaluated. 55% of the patients were under the ment, difficulty in fastening and slippage on fastening were compared influence off alcohol. 40% of the patients admitted to drinking alcohol across different dimension of screw by performing Pearson’s chi on a daily basis and were not sure of the quantity. 12% admitted to square test. Time taken for loading, fastening and total time required Opium dependence. Around 70% of the maxillofacial trauma was for consecutive batches (after every 17 screws) of 17 screws each was attributed to Road Traffic Accidents, 10% to interpersonal violence compared by one-way ANOVA test. Findings were significant (p \ and 8% to falls. Around 60% of the patients reported were Motorbike 0.005) for the 1.5 mm X 4 mm and 2 mm X 10 mm cross slotted riders or pillions without the use of helmets. Mandible and zygoma monocortical screws only. were reported at 35% and 37% respectively. Lefort 1 and Lefort 2 Conclusions fractures were reported at 10%. 50% of the patients presented with The Cross slotted screw design has a significant mechanical advan- soft tissue lacerations. Mean age was 26 years. tage in the extremes of sizes used for internal fixation in common Conclusions Cranio - Maxillofacial Trauma, but the aforementioned distinction Alcohol and Opium abuse contributed to the majority of Road traffic fails to hold up in other commonly used categories of screw sizes accident and interpersonal violence leading to Maxillofacial trauma of possibly negating its mechanical advantages. varying degree. Hence, calls for a need to address the public, especially the young on the harmful effects of alcohol and drug abuse. References/Bibliography Also, raises a concern about unsafe driving practices in the country 1. Colton C, Orson J. Screws – Form and function. AO Trauma. and a need to push for education. 2. Chen L. Effects of Different Screw Head Designs on Screw Head References/Bibliography Slippage [Master’s Thesis]. China. 2014. [cited on – 2015 Sept, 7]. Available from: http://pc01.lib.ntust.edu.tw/ETD-db/ 1. Alcohol abusive use increases facial trauma? Med Oral Patol Oral ETD-search-c/view_etd?URN=etd-0722114-103038. Cir Bucal. 2016 Sep 1;21(5):e547–53.

ABS00762 ABS00756 The Pattern of the Maxillofacial Fractures in North Monoslotted Screws: Are They Still Relevant? Bengal: A Retrospective Study

Dr. S. R. Shenoi, Dr. Vrinda Kolte, Dr. Kshitij Bang, Dr. Pranav Dr. Sumit Agarwal Ingole, Dr. Chinmay Rao The Specialist’s Dental & Maxillofacial Centre Siliguri VSPM Dental College and Research Centre Abstract Abstract Background/Introduction Background/Introduction The incidence and etiology of maxillofacial fractures vary widely Bone plates and screws have today become the mainstay in the between different geographical areas. Understanding the cause and management of fractures in the maxillofacial region. The screw head pattern of these injuries can assist in establishing clinical and research allows for the attachment of the screwdriver and to arrest forward priorities for more effective treatment and prevention of maxillofacial motion. Monocortical screws for use in internal fixation are com- injuries. The study aimed to evaluate the etiology and pattern of monly available with a single slot and a cruciate slot, the later said to maxillofacial fractures in trauma patients hospitalized in North Ben- provide a measure of redundancy. Despite this the monoslotted gal in India. screws are in widespread use in the Indian Subcontinent. The authors Objectives have endeavoured to verify the touted advantage of the cross slotted The present study was planned to investigate the etiology of max- monocortical screws as against the monoslotted screws in rampant use illofacial injuries and to analyze the pattern of maxillofacial factures today. as well as the various factors influencing their distribution. Objectives Methods To evaluate the cross recess monocortical screws as against the A retrospective analysis of all maxillofacial fracture patients admit- monoslotted monocortical screws in miniplate fixation in terms of; the ted/referred to the Department of Oral and Maxillofacial Surgery was time required to load the screw on to the screw holder, the time performed during a period from June 2015 to September 2017. required to fasten the screw into place, and the total time required to Recorded data included age, sex, cause of trauma, and the pattern of fasten the screw from loading to fastening. Further, the authors also maxillofacial fractures/injuries.

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Results Conclusions 425 patients sustaining maxillofacial injury were referred to the Our retrospective case study shows that Delta plate & TCP miniplate department of maxillofacial surgery out of which 210 patients fixation technique showed almost equally highest stability. underwent treatment. The most commonly fractured facial bone was the zygomaticomaxillary complex followed by mandible. Most frac- References/Bibliography tures occurred in the second-fourth decade of life with male Three-dimensional assessment of unilateral subcondylar fracture predominance. Main etiology was road traffic accidents. Motor using computed tomography after open reduction. Indian Journal of vehicle collisions constituted the highest incidence as a cause of Plastic Surgery May-August 2014 Vol 47 Issue 2. traumatic maxillofacial injuries followed by fall from height, assault and sport related injuries in young population. Conclusions In most other epidemiologic studies of maxillofacial fractures, MVA was the main cause of injury; and midface the most common site of ABS00832 fracture. However, the vagueness and imprecision in the classification Orbital Floor Reconstruction Titanium Mesh Versus and nomenclature of maxillofacial fractures has led to confusing Autogenous Bone Graft: Clinical Study results that are difficult to compare. References/Bibliography Dr. Shashwat Magarkar Assistant Professor, Dr. Ketaki Joglekar, Dr. Vyankatesh Sahu, Dr. Kavita Sahu Naveen Shankar A, Naveen Shankar V, Hedge N, et al. The pattern of the maxillofacial fractures: A multicentre retrospective study. J Cran- Government Dental College and Hospital, Nagpur; Email: iomaxillofac Surg. 2012; 40 (8): 675–679. [email protected], 9975635634, 115, Reshimbagh The pattern of maxillofacial fractures in central India A Unicentric Godavari Nagpur-440009 retrospective study Dr. Rajanikanth K, Dr. R.M. Borle, Dr. Nitin Bhola, Dr. Shivam Volume 13, Issue 1 Ver. X. (Feb. 2014), PP 28–31 IOSR-JDMS. Abstract Background/Introduction The complexity of anatomy of the orbit makes the treatment of traumatic orbital injuries a formidable challenge to the maxillofacial surgeons. The list of substances called on to reconstruct the orbits ABS00775 original anatomy encompasses- autogenous, synthetic, allograft, Evaluation of Various Fixation Methods xenograft, or a combination, which successfully achieves its purpose. in the Management of Subcondylar Fractures Objectives of Mandible To study and evaluate the effectiveness of autogenous bone graft and of titanium mesh (alloplastic material) for repairing traumatic orbital floor defects and compare these results in terms of level of Dr D Sathya Kumar Prof & Head improvement in function as well as aesthetics at a rural hospital setup. Methods Dept of OMFS, Narayana Dental College, Nellore A prospective - orbital floor fractures of 10 patients were analyzed. The patients were divided into 2 groups: (1) those in which orbital Abstract floor fractures were treated with titanium mesh and (2) patients in Background/Introduction which orbital floor fractures treated with titanium mesh. Patients Fractures of mandibular condyle account for 20–30% of all were clinically evaluated for the presence of enophthalmos, mandibular fractures. The treatment of subcondylar fractures remains diplopia and restriction of the ocular muscles and change in ocular one of the most controversial topics in maxillofacial surgery. Though level. closed reduction has been the preferred treatment, but owing to Results demerits like poor patient compliance to IMF, possibility of internal It was observed that diplopia as well as the restriction in the derangement, ankylosis etc & the development of better fixation extraocular movements was completely corrected at the end of 6th devices, refinement of surgical approach technique makes ORIF as postoperative month in all the patients in which TM was used for gold standard treatment method for subcondylar fractures. reconstruction, also enophthalmos and hypoglobus were inadequately Objectives corrected in only one patient in which TM was used. 5 cases in which The aim of the study was to evaluate the Clinical & Radiological ABG was used for reconstruction of orbital floor, diplopia as well as outcome of patients with mandibular subcondylar fractures treated the restriction in the extraocular movements were persistent in one with six different types of fixation techniques. case, while there was inadequate correction of the enophthalmos and Methods hypoglobus in two cases after 6 months. This retrospective clinical case record study includes 78 patients with Conclusions unilateral subcondyle fractures treated over a period of 7 years Orbital floor defects can be reconstructed using titanium mesh with (March 2010 to June 2017) by Open reduction & Internal fixation good functional as well as aesthetic results as compared to autogenous with Six different types of fixation techniques. bone graft by avoiding donor site morbidity, reduced operating time Results and eliminating the risk of resorption. The results of our retrospective study suggest that in all cases initial anatomic reduction was good in all six fixation techniques. Stability of different fixation techniques is in the decreasing order of Delta plate Trapezoidal plate 4 hole plate?2 hole plate Double 2 hole plate Single 4 hole plate Single 2 hole plate.

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ABS00834 ABS00835 Evaluation of Craniofacial & Cervical Injuries in Two Comparative Study of Combination of Drill Free Wheeler Road Trafﬁc Accident (RTA) Victims, With Screws (DFS) Versus Self Tapping Screws or Without Wearing a Helmet for Osteosynthesis of Fractures

Dr Vyankatesh Sahu, Asst Prof, Co Author: Dr Kavita Vyankatesh Dr Kavita Vyankatesh Sahu (Gupta), Co Author: Dr Vyankatesh Sahu Sahu (Gupta), Dr Shashwat Magarkar Asst Prof, Dr Ketaki Joglekar Asst Prof, Dr Shashwat Magarkar Asst Prof, Dr Ketaki Joglekar

Government Dental College & Hospital, Nagpur Department of Oral Max Care Multispeciality Clinic Sahu’s Dental Clinic, Nagpur, India; & Maxillofacial Surgery; Max Care Multispeciality Clinic Sahu’s Government Dental College & Hospital, Nagpur Department of Oral Dental Clinic, Nagpur, India; Government Dental College & & Maxillofacial Surgery; Government Dental College & Hospital, Hospital, Nagpur Department of Oral & Maxillofacial Surgery; Nagpur Department of Oral & Maxillofacial Surgery; Smilekraft Smilekraft Maxillofacial Surgery and Dental Hospital, Nagpur, India Maxillofacial surgery and Dental Hospital, Nagpur, India

Abstract Abstract Background/Introduction Background/Introduction India has one of the highest RTA rates in the world, nearly 80,000 get In general, osteosynthesis screws were inserted into bone after drilling killed and 3,40,000 are injured every year in about 3,00,000 accidents. a pilot hole. Although the application of self tapping & DFS is vir- There is an accident every minute and death every 8 min in India. tually universal in craniomaxillary surgery, the inevitable time Motorcycle is considered the most dangerous of all motorized vehicle consuming procedure of drilling a pilot hole in self tapping has some due to its nature and design e.g. absence of outer body, airbags and potential disadvantages. DFS have specially formed tips and cutting seat belt to reduce impact in the event of a collision. Many of these flutes, which act like a cork-screw & can be inserted into bone injuries can be severe and some can be prevented or reduced in without predrilling. Therefore, a prospective study was performed to severity by wearing a helmet. investigate the efficiency of DFS in clinical use in maxillofacial Objectives traumatology. To describe the pattern, incidence and characteristics of maxillofacial Objectives and other concomitant injuries in two wheeler accident cases and To evaluate the efficacy, advantages & disadvantages, ease of fixa- explore potential factors related to the type of Helmet and pattern of tion, stability & functional load bearing capacity, complications etc Facial, cervical, head and other injuries. provided by mini & micro DFS in maxillofacial trauma. Methods Methods A prospective and observational study was conducted in which a total 2O Healthy individuals were selected having maxillofacial fractures. of 200 patients was screened within a period of 20 months who had a 10 patients were selected as Group A and Group B respectively. two wheeler RTA and survived at the time of examination and fol- Patients were treated with open reduction & internal fixation. Mini- lowing sequence of events was performed: Through Case History plates with DFS screws and self tapping screws of 1.5/2mm used in recording, Clinical Examination and Radiographic Evaluation was fracture of maxilla or mandible respectively. Patient were kept on done. regular follow up, 1st postoperative week, followed by weekly visits Results & thereafter monthly visits. Patient were evaluated for post operative Mandibular fractures were the most commonly encountered fractures discomfort, pain, numbness, palpable screws & periodic radiographs followed by maxillary & nasal fractures and ZMC fractures. 60% were performed. patient sustained dental injuries. It was statistically seen that not Results wearing a helmet had direct association with upper and middle facial It was concluded that DFS is more effective in terms of time taken for third injuries, deranged occlusion, fracture of mandible and other fixation, less stripping of the bone threads, less damage to nerves, facial bones. Direct association existed between failure to wear a tooth roots or tooth germs, less thermal necrosis to the bone and helmet and head injuries, concluding helmet is protective against head avoidance of drill bit breakage as predrilling is not required. It is also injury. Helmet is not protective against cervical injury and an asso- useful if there is sudden loss of electricity and lastly less armamen- ciation exists between wearing a full type of helmet and cervical tarium as the motor handpiece system is not required. The only injury. drawback of the DFS is that it is difficult to use it in communited Conclusions fractures. Hence, two wheeler RTA’s are a source of a large number of max- Conclusions illofacial injuries and wearing a helmet significantly decreases the It was concluded that DFS is more effective in terms of time taken for severity and extent of maxillofacial and head injuries. fixation, less stripping of the bone threads, less damage to nerves, tooth roots or tooth germs, less thermal necrosis to the bone and avoidance of drill bit breakage as predrilling is not required. It is also useful if there is sudden loss of electricity and lastly less armamentarium as the motor handpiece system is not required. The only drawback of the DFS is that it is difficult to use it in communited fractures.

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Oral Presentation ABS00540 Clinical Audit of 111 Procedures in 75 Patients Section: Craniofacial Anomalies in a Craniofacial Centre

Dr. Arjun Krishnadas, Dr. Pramod Subash, Dr. Suhas Udayakumaran ABS007 Amrita Institute of Medical Sciences, Kochi Maximising the Effectiveness of Temporalis Flap for Facial Augmentation in Progressive Hemifacial Abstract Atrophy. A Simple Technique Background/Introduction Craniofacial Surgery has evolved over the years and with the advent of recent techniques and technology it has progressed exponentially. Lt Col S Sudeep With the increasing numbers of Craniofacial deformities, it is the responsibility of a Craniofacial Unit to collect, analyze and audit MDC Kirkee (West) Estate patient data, outcome of which in turn can be utilized to set standards and quality of care. Abstract Objectives Background/Introduction To retrospectively analyze standard procedures, their outcome and Progressive Hemifacial Atrophy or Parry-Romberg’s syndrome is an morbidity following surgical management of craniofacial deformities uncommon degenerative condition of unknown aetiology and is in 75 patients during July 2014 and August 2017. characterized by insidious unilateral facial atrophy. Treatment is Methods challenging and is aimed primarily at aesthetic correction and 111 procedures in 75 patients were classified as Simple (n = 28, achieving long term stable results is difficult as, there is progressive Single Suture Non Syndromic Craniosynostosis) Complex (n = 46, regression of augmented soft tissue. Multi-suture synostosis and Syndromic Craniosynostosis) Craniofa- Objectives cial Conditions. Duration of the Procedure, Intra-operative blood loss, To describe a novel technique for positioning temporalis muscle flap Intra and Post operative Blood transfusion, Post operative pyrexia, in augmentation of facial tissues in mild to moderate Hemifacial Duration of antibiotic administered, Hospital stay, Morbidity and Atrophy for improving the aesthetic outcome. Mortality were assessed. Methods Results Three cases of Hemifacial atrophy of mild to moderate severity based There was no mortality or any significant morbidity in our series. The on clinical and MRI evaluation were taken up for augmentation of average procedure time for a simple condition was 5.8 hours and 9.2 atrophied facial tissues using temporalis flap and porous polyethylene hours for complex. Blood loss was higher in the complex (513 ml) implants. A transcutaneous tethering technique was utilized for compared to simple group (115ml). 96% and 44% patients received positioning the temporalis flap. Following surgery patients were Intra-op and Post-op transfusion respectively. Post-operative pyrexia evaluated clinically for the aesthetic outcome at intervals of 6 months was seen in 42.6% of the patients. Patients received antibiotics for an for a period of at least 1 year. average of 3.5 days, post-operative pyrexia and presence of distractors Results determining the longer duration of administration. Hospital stay was No severe postsurgical complications occurred in any patient. The relatively the same for both. mean follow-up was 20 months. There has been no loss of the pro- Conclusions jection achieved and the facial contour was comparable to the Clinical audit is necessary to understand and analyze the issues unaffected side one year after the procedure at the end of one year. encountered and helps us to improvise on the technique and care Conclusions delivered to the patients. In this preliminary study, the transcutaneous tethering technique for positioning temporalis muscle flap in augmentation of facial tissues in References/Bibliography mild to moderate Hemifacial Atrophy yielded stable aesthetic results 1. Kirkpatrick et al.: Paediatric transcranial surgery: a review of 114 and excellent facial symmetry at the end of one year post-operative. consecutive procedures. British Journal of Plastic Surgery (2002) However, long-term follow-up is necessary. 55, 561–564. References/Bibliography 1. Goldhammer Y, Kronenberg J, Tadmor R, Braham J, Leventon ABS00831 G. Progressive hemifacial atrophy (Parry-Romberg’s disease), A Questionnaire Survey on Implications of Navigators principally involving bone. J Laryngol Otol. 1981;95:643–7. 2. Pensler JM, Murphy GF, Mulliken JB. Clinical and ultrastructural in Correction of Craniofacial Anomalies studies of Romberg’s hemifacial atrophy. Plast Reconstr Surg. 1990 May;85(5):669–74. Dr. Shweta S. Sonwane (Kamble) Associate Professor, Dr. Abhay Datarkar Professor & Head, Dr. Siddharth S. Sonwane Associate Professor

GDCH Nagpur; Mansarovar Dental College Bhopal

Abstract Background/Introduction Navigation surgery is simple localization tool used in operation the- atre, implication of navigators in surgery facilitate in localization and

123 S18 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 orientation of targeted anatomical area with more safer, less invasive Section: Cleft Lip and Palate procedures. Objectives This questionnaire survey was conducted to evaluate the use of advanced technologies (navigators) in correcting craniofacial defor- ABS0041 mity and to evaluate the final outcome by means of with and without Primary Bilateral Cleft Lip Repair Using Pfeifer’s navigators. Technique: A Study of 129 Cases Methods The questionnaire study was designed and conducted among the young and experienced oral surgeons, ENT surgeons and plastic Dr. R.V. Kishore Kumar, Professor, Dr. Sivanagendra Reddy, surgeons. Sum of 75 surgeons were included and equally divided in to Director three groups containing 25 surgeons in each. An appropriate typed questionnaire (as per WHO questionnaire format) was given and Narayana Dental College, Nellore, Andhra Pradesh; Durga collected back for evaluation. To minimize errors the question Hospitals, Visakhapatnam, Andhrapradesh numbers were altered and questionnaire was given to similar participants. Both first and second answers were compared. Abstract Results Background/Introduction Majority of oral and maxillofacial surgeons and plastic surgeons were Primary Repair of bilateral cleft lip depends on sound knowledge of found to be operating without navigators among the total sample. anatomy, identification of landmarks, clinical variation of presenta- However, most often and most of the ENT surgeons were using the tion, surgical expertise of the operator etc. Here with we are navigators in routine surgical procedures. Inter group comparison was presenting a series of 129 cases done in our study. done with kruskal walli test, and there was significant difference was Objectives between ENT surgeons and oral surgeons and plastic surgeons Evaluation of pfeifers technique in primary bilateral cleft lip repair. (p=0.144). Within oral surgeons and plastic surgeon the kruskal walli Methods test showed no significant difference. The study was carried out in patients attending Narayana Dental Conclusions college, Nellore and Durga Hospitals, Visakapatnam, Andhrapradesh Implication of navigators in surgery is most reliable and accurate were considered for study. All cases were done using pfeifer’s tech- method in reconstruction of craniofacial deformities. However, it is nique. Pfeifer in 1970, described a technique which involves changing always depending upon experience, knowledge, and skills of the the lip skin Incision to a wavy line, thus making it less conspicuous. surgeons to reproduce results accurately with or without use of nav- Pfeifer designed this incision using the concept of ‘‘morphological igators. Hence, implication of navigation system is technique order’’. The basis of this is that a skin incision between two points can sensitive, time consuming and cost-effective method. be lengthened if both points are joined in a curved or wavelike manner and not in straight line. References/Bibliography Results 1. Yu, H., Shen, S. G., Wang, X., Zhang, L. & Zhang, S. The The results were evaluated and found to be good in terms of white roll indication and application of computer-assisted navigation in oral match, vermilion match, Cupids bow, nasal architecture etc; clinically and maxillofacial surgery-Shanghai’s experience based on 104 and statistically. cases. J Craniomaxillofac Surg 41, 770–774 (2013). Conclusions 2. Chen, X. et al. A surgical navigation system for oral and Though the technique is not new, but the literature available for the maxillofacial surgery and its application in the treatment of old Pfeifer‘s technique is less either in books or internet. The technique is zygomatic fractures. Int J Med Robot 7, 42–50 (2011). easy to learn and teach. Good results were observed clinically and 3. Zhang, S., Gui, H., Lin, Y., Shen, G. & Xu, B. Navigation-guided statistically. correction of midfacial post-traumatic deformities (Shanghai References/Bibliography experience with 40 cases). J Oral Maxillofac Surg 70, 1426–1433 (2012). Closure of cleft lips with wave line incisions according to Pfeifer 4. Yu, H., Shen, G., Wang, X. & Zhang, S. Navigation-guided Michael Bergermann, Hamm (Germany) and Cordula Tilkorn, reduction and orbital floor reconstruction in the treatment of Wellington (New Zealand). zygomaticorbital-maxillary complex fractures. J Oral Maxillofac Surg 68, 28–34 (2010). 5. Yu, H. B., Li, B., Zhang, L., Shen, S. G. & Wang, X. D. Computer-assisted surgical planning and intraoperative nav- ABS0045 igation in the treatment of condylar osteochondroma. Int J Oral A Correlation of Incidence of Preoperative URTI Maxillofac Surg (2014). 6. Cai, M. et al. Navigation-assisted mandibular body distraction and Surgical Outcomes in Patients with Cleft Lip osteogenesis: a preliminary study in goats. J Oral Maxillofac Surg and Palate 72, (168), e161–167 (2014). 7. Collyer, J. Stereotactic navigation in oral and maxillofacial Dr. VR Chandra Babu Pamidi, Dr. RM Borle surgery. Br J Oral Maxillofac Surg 48, 79–83 (2010). 8. Kaduk, W. M., Podmelle, F. & Louis, P. J. Surgical navigation in reconstruction. Oral Maxillofac Surg Clin North Am 25, 313–333 GSL Dental College (2013). 9. Sun, Y., Luebbers, H. T., Agbaje, J. O., Lambrichts, I. & Politis, Abstract C. The accuracy of image-guided navigation for maxillary Background/Introduction positioning in bimaxillary surgery. J Craniofac Surg 25, The SMILE TRAIN guidelines suggests that patients are taken up for 1095–1099 (2014). surgery only in the absence of RTI but don’t specify URTI or LRTI. Since there is no evidence to postpone endotracheal intubation and

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S19 surgeries in presence of URTI alone, this study benefits in interest of Conclusions patients and academicians. Presurgical Naso-alveolar molding can be a useful adjunctive treat- Objectives ment modality for management of cleft lip and palate patients. This 1. To study the association of perioperative and intraoperative res- technique being a cost effective is more beneficial in reducing the piratory complications in cleft lip and palate. number of future surgeries required like secondary rhinoplasties and Methods alvelolar bone grafting in the management of cleft lip and palate A randomised clinical trial included 150 patients with cleft lip and patients. palate and common cold questionnaire under standard protocol. Diagnosis of URTI was done based on clinical, radiological, nasal References/Bibliography swab findings. 1. Alzain I, Batwa W, Cash A, Murshid ZA. Presurgical cleft lip and Results palate orthopedics: an overview. Clin Cosmet Investig Dent. Out of 150, 58 patients were positive for URTI preoperatively out of 2017;9:53–59. which 36 patients experienced URTI postoperatively. 2. Shetty V, Agrawal RK, Sailer HF. Long-term effect of presur- Conclusions gical nasoalveolar molding on growth of maxillary arch in The incidence of URTI was more in cleft palate than cleft lip patients. unilateral cleft lip and palate: randomized controlled trial. Int J The significant association was found in regards to incidence of URTI Oral Maxillofac Surg. 2017;46(8):977–987. preoperative and postoperative patients. References/Bibliography 1. Dr. Kothur P.F. Surgical repair of cleft lip and palate in children ABS00258 with URTI, Indian J anaesthesia, 2006:50(1);58–59. 2. Allen R. Tait et al. Interoperative respiratory complications in Anthropometric Evaluation of Unilateral and Bilateral patients with upper respiratory tract infection. Can J Anaesthesia Cleft Lip Repair 1987;34:300–303. Dr. Anil Kumar Desai, MDS Professor

Maxillofacial Surgery, Department of Cranio-Facial Surgery and ABS00154 Research Centre, S.D.M. College of Dental Science and Hospital, Presurgical Naso-Alveolar Molding in Cleft Lip Dharwad and Palate Patients: A Critical Review Abstract Background/Introduction Dr. Nagaveni N. B. Professor Cleft lip and palate may be symmetrical or asymmetrical due to complex aspects like the size, shape and growth of the segments. To Department of Pedodontics, College of Dental Sciences, Davangere - improve functional and aesthetic results an accurate evaluation and 577004, Karnataka, India quality assessment of surgical outcomes is required. Exact and detailed anthropometric measurements are necessary to detect short- Abstract comings and to focus further efforts on improving these. Background/Introduction Objectives The management of infants with cleft lip and palate is a challenging Aim of the study is to assess basic quantitative data of lips and nose task and has revolutionized dramatically in recent years. The quest preoperatively and postoperatively by anthropometric methods from over the concern for final nasal form lead to the introduction of new cleft lip and palate patients and to compare the data with normal treatment approach called pre-surgical naso-alveolar molding. individuals. Objectives Methods To evaluate and assess the current scientific evidence pertains to the Prospective study on patients with cleft lip palate between February efficiency and usefulness of Presurgical Naso-alveolar molding in 2014 to September 2016 with age range of 6 months to 3 years was cleft lip and cleft palate patients and to describe the changing para- carried out. Anthropometric measurements were taken preoperatively digms in the management of patients with cleft lip and palate using & postoperatively at 1& 2 years. the same. Results Methods Total of 60 patients were included out of this, 30 were unilateral cleft A comprehensive scientific literature search was carried out using patients and remaining 30 were normal individuals of same age group. electronic databases (PubMed and EMBASE) which focus on the In the results mean value of Vertical lip length, Nasal Tip Projection, current concept of Presurgical Nasoalveolar molding and those Bialar width and Nostril Width Cleft side in study group preopera- which critically analyze its long term effects in the treatment of tively was 5.43mm, 4.80mm, 28.87mm and 13.67mm respectively, cleft lip, palate and nasal deformity. The search was carried out while in control group values were 8.27mm, 7.70mm, 23.37mm and 7 using the different terminologies like presurgical nasoalveolar mm respectively. On postoperative two years the values of VLL, NTP molding, nasal molding and infant orthopaedics and documented improved to 8.83mm, 9.63mm and were similar to the control group, articles over a period of 25 years were selected for the critical while BAW and NWC which was more preoperatively, decreased at 2 review. yrs to 27.13mm and 10.10mm. Results Conclusions It is evident from the critical review that Presurgical Naso-alveolar Anthropometric measurements can provide valuable information in molding appears to be more effective and useful in management of assessment of facial disharmonies which helps us in planning surgical cleft lip and palate patients. reconstruction.

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ABS00292 ABS00431 Congenital Cardiac Anomalies Associated with Cleft Analysis of Unilateral Cleft Lip Repair Using Modified Lip and Palate and Its Impact on Treatment Planning Rotation Advancement Technique: A Retrospective Analysis Dr Gautam Rao 1. Dr. Karan Mehta, Assistant Surgeon 2. Dr. Nisheet Agni, Director Subbaiah Institute of Dental Sciences and Hospital, Shimoga Mumbai Cleft Centre, Navneet Hi-Tech Hospital, Dahisar, Mumbai Abstract Background/Introduction Abstract Cleft lip and palate are the most commonly seen forms of craniofacial Background/Introduction anomalies. Oral clefts are common birth defects occurring rather in Most common technique for unilateral cleft lip repair is the Millard’s isolated or in association with other malformations in approximately rotation advancement technique and its modifications. Mohler’s 1.3 to 1.7 per 1000 live births. Congenital heart diseases occurs in 5.5 modification has an advantage of lip lengthening using columella. to 8.6 per live births, which is approximately six times greater than Objectives the incidence of cleft lip and palate. Congenital heart diseases (CHDs) To analyze the surgical outcomes of Modified (Mohler’s) Rotation have been reported in 1.3 to 27% of the patients with oral clefts. Advancement technique for Unilateral Cleft lip repair. This is a ret- Although many studies have shown strong association between con- rospective analysis of unfavorable outcomes after unilateral cleft lip genital cardiovascular malformations and cleft lip and/or palate, the repair performed by single surgeon over a period of two years. nature of cardiovascular malformations has not been described in Methods detail in these subjects, nor has the impact of these cardiovascular Thirty three patients who have undergone primary unilateral cleft lip malformations in management of these cleft patients been mentioned. repair using Mohler’s Modification of Millard’s Rotation Advance- Objectives ment technique since September 2015 were included in the study. The To study the prevalence, type of congenital heart diseases in cleft lip cleft nose was not addressed during the primary surgery. Skin closure and/or palate patients and to know the impact of these congenital was done using 5-0 Vicryl rapid suture. Surgical results were ana- heart diseases on treatment planning. lyzed over a period of 6 months to 2 years. Unfavorable results were Methods studied. A total of 1381 non-syndromic cleft lip and palate patients reporting Results to SDM Craniofacial center, Dharwad were included in the study. The Out of 33 patients, Vermillion notching was seen in 2 patients who data was collected from clinical examination of the patients, evalu- had a mild injury during the first week postsurgery. Thick scar with ating the chest radiograph, and 2D Echocardiographs. Based on this contracture was seen in 4 patients who had not followed the massage information’s total incidence of congenital heart diseases and its protocol. White roll mismatch was seen in 3 patients and inadequate impact on treatment planning was evaluated. rotation was seen in 1 patient. Two patients were lost to follow-up. Results Conclusions There were 32 (2.32%) cleft lip and palate patients with congenital Good, predictable results can be achieved using Mohler’s technique. heart diseases (CHDs). The defects in the septa, valves and vascu- Scar contracture seen in early postoperative period settles over 6 lature was 1.07%, 0.79% and 0.79% respectively. In 2 patients months with diligent massage of the scar. Postsurgery massage of the surgery was delayed by 6 to 9 months. Subacute bacterial endocarditis scar is necessary to avoid scar contracture. (SABE) prophylaxis was administered in 7 patients. Cardiac surgery was advised prior to cleft surgery in 3 patients. There were no References/Bibliography intraoperative and postoperative complications in these patients. 1. Narayanan P V, Adenwalla HS. Unfavourable results in the repair Conclusions of the cleft lip. Indian J Plast Surg. 2013;46(2):171–82. The results emphasize the association between clefting and CHD. The collected data suggests that there should be careful examination of children with cleft lip and palate for signs of heart disease. This could significantly reduce the morbidity/ mortality of cleft surgery making it safer and predictable. ABS00460 Anterior Maxillary Distraction Using a Tooth Borne References/Bibliography Palatal Distractor Tailored for Cleft Maxillary The impact of cardiovascular malformations on the assessment and Hypoplasia: A Review of 30 Cases surgical management of infants with cleft lip and/or palate. Harry BL et al, Cleft Palate J 2013; 50(3): 323–329. 4. Dr Dipesh Rao, Dr Pritham Shetty, Dr Krishnamurthy Bonanthaya

Bhagwan Mahaveer Jain Hospital, Bangalore

Abstract Background/Introduction The stigmata of cleft Maxillary hypoplasia has been well documented. The treatment options ranging from orthodontic camouﬂage, Growth modulation, Orthognathic surgery and Distraction have provided the answer for the deformity for many years.

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Objectives Further research is needed concerning the incidence, including inter- In recent times the role of anterior Maxillary Distraction (AMD) has population differences, and type of additional congenital malforma- gained popularity for its ease of procedure and cost effectiveness. We tions in cleft cases. conducted a study to understand the effectiveness of this procedure in the 30 patients that we treated over the last 5 years. References/Bibliography Methods Balagir RS, Mitra SS. Congenital cleft lip and cleft palate anomalies: Thirty consecutive patients undergoing AMD for Cleft Maxillary a dermatoglyphic study. J Postgrad Med. 1986;32:18–23. Hypoplasia were included in the study. Patients having a secondary Orthognathic/Distraction procedure for the Maxillary or those patients with simultaneous need for mandibular procedure were excluded from the study sample. Results ABS00501 The results showed an improved facial profile, increased arch length Speech Outcome After Maxillary Advancement in Cleft and no effect on speech outcome. Patients Conclusions A relatively easy technique which is tailored for the cleft Maxillary Sony G Pullan, Pramod Subash, Arjun Krishnadas Hypoplasia. The soft palate maintains its position and the increased arch length provides for dental rehabilitation in cleft patients where the occurrence of Hypoplastic teeth/missing teeth is higher. Department of Craniofacial Surgery, Amrita Institute of Medical Sciences, Kochi References/Bibliography Abstract 1. Gunaseelan R1, Cheung LK, Krishnaswamy R, Veerabahu M Anterior maxillary distraction by tooth-borne palatal distractor J Background/Introduction Oral Maxillofac Surg. 2007 May;65(5):1044–9. Outcome assessment is important to analyze results of techniques as well to modify/improve standard of care. Effect of maxillary advancement procedures on speech in cleft patients is poorly studied and documented in literature. Objectives ABS00497 To assess speech outcome in patients who underwent maxillary Dermatoglyphic Patterns in Cleft Lip and Palate: Is advancement surgery. 1. Subjective – with questionnaire 2. Objective There a Correlation? • Perceptual speech assessment • Videoflouroscopy • Nasoendoscopy. Methods Dr. Alok Bhatnagar, Reader For subjective assessment, 22 patients who underwent Maxillary advancement and their parents were asked about post operative Faculty of Dental Sciences, SGT University, Gurugram, Haryana speech status. Objective assessment was done by analyzing pre and post surgery Videoflouroscopy, nasoendoscopy and perceptual speech Abstract assessment records of 7 patients who underwent maxillary osteotomy Background/Introduction alone or along with mandibular setback (after a minimum period of 3 Dermatoglyphics is the study of dermal ridge configurations on the months). Speech was recorded both pre surgery and post surgery and fingers, palms and soles. The word ‘‘Dermatoglyphics’’ has Greek it was analyzed by 2 speech pathologists for lisping, intelligibility, roots derma = skin and glyphic = carvings. The term was coined by hyper-nasality and distortion. In all cases except one, the magnitude Harold Cummins & Midlo in 1926. Dermal Patterns are fully of movement was greater than 8mm (Mean – 10.8mm). developed at birth, and once formed remain consistent throughout Results life. Dermatoglyphics is considered a window of congenital abnor- In subjective analysis most of the patients and parents reported that malities and is a sensitive indicator of intrauterine abnormalities and there was no significant change in the speech (no change-11, is known to be one of the best available, inexpensive, easy to master improved-7, worsened-4). Even though Velopharyngeal gap increased and reproducible diagnostic tools in genetic disorders. in resting position and as well as during speech in most patients, Objectives distortion of sounds and hypernasality improved in most of cases, Observe any positive correlation of the different dermatoglyphic where as lisping and intelligibility didn’t show significant patterns in cleft lip and/ or palate cases. improvement. Methods Conclusions Sample of the study chosen from the OPD of the Nav-Muskan Clinic: In our series of cases speech did not worsen as expected with the A Cleft Care Initiative by SGT University reporting with non syn- magnitude of movement rather remained unchanged or even showed dromic primary or secondary cleft lip/ palate. Bilateral finger prints improvement in articulation and hypernasality. obtained on executive bond paper by guiding the hand to inked stamp pad and pressing firmly on the paper placed on a smooth surface. The References/Bibliography obtained fingerprints were then classified into arches, loops or whorls The effects of Left 1 osteotomy with maxillary movement on with the help of magnifying glass (2X). articulation, resonance and velopharyngeal function. Cleft palate Results journal. July 1989, vol 26. no 3. Statistically significant differences have been observed that suggest genetic aetiology for congenital cleft lip and palate malformations and likelihood of the manifestation of chromosomal aberrations. Conclusions

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ABS00515 ABS00521 Efficacy of NAM and Nasal Conformers in Comparison ‘‘Rapide’’: Not so Rapid for Better Cosmesis in Cleft with Open Rhinoplasty to Achieve Nasal Symmetry Lip! in Unilateral Cleft Lip Dr Anil K. Sheorain, Professor Dr. Aafreen Aftab Faculty of Dental Sciences, SGT University, Gurugram Hke’s S.N. Dental College and Research, Gilbarga Abstract Abstract Background/Introduction Background/Introduction The type of suture material used in surgery has been a long-standing Most of the primary cleft lip repair techniques do not address the debate among surgeons. In this study we compared rapidly absorbable nasal deformity; result in poor nasal outcomes leading to gross nasal suture material (Vicryl Rapide/Irradiated Polygalactin 910) with non- asymmetry. Several techniques and maneuvers which are employed to absorbable suture material (Nylon or Polyamide) in patients with non- minimize this have varying degree of success. syndromic congenital unilateral cleft lip. Objectives Objectives To assess the efficacy of various modalities employed to establish To compare the appearance and course of scar, wound infection and nasal symmetry in unilateral cleft lip. patient’s perception between two groups. Methods Methods 100 patients with complete unilateral cleft lip/palate were operated for Twenty patients of Unilateral Cleft Lip, in the age group of 3–18 primary cheiloplasty with modified Millard’s rotation advancement months were randomly allocated to two groups with 10 patients each. technique, for all the 5 groups. Subjects were divided into 5 groups of Skin suturing was done with 6-0 Polyamide and 6-0 Irradiated 20 each. Group 1 subjects operated employing modified Millard’s Polygalactin in the respective groups. Patients were evaluated at 1 technique alone. In group 2, subjects underwent NAM therapy fol- week, 1 month, 3 months, 6 months and 1 year postoperatively by the lowed by lip repair. Group 3 subjects underwent lip repair followed observer and patient’s parent. by placement of a nasal conformers for 12 months postoperative. Results Group 4 patients were treated using NAM therapy followed by lip According to Observer, the difference between two groups was sig- repair and placement of conformers. Group 5 underwent lip repair nificant regarding pigmentation and height of scar at 3 months, 6 with primary rhinoplasty. All patients were evaluated after minimum months and 1 year with P\0.05; the values being higher in irradiated period of 12 months post operatively, except those using conformers Polygalactin 910 group. were evaluated 12 months after discontinuing the same. Parameters Conclusions like Alar inclination angle, Nostril apex overhang, Nostril height and We conclude that the Vicryl Rapide showed poorer cosmetic out- diameter, Columellar length and deviation angle were evaluated on comes regarding height and pigmentation of scar as compared to 1:1 standard photograph. nylon sutures. Results References/Bibliography All parameters were statistically significant in group 4 and group 5 compared to the other groups. Parell GJ, Becker GD. Comparison of absorbable with non – Conclusions absorbable sutures in closure of facial skin wounds. Arch Facial Maneuvers like NAM and placement of nasal conformers have a Plast Surg 2003;488–90. significant influence in establishing nasal symmetry. However, open tip rhinoplasty establishes better nasal symmetry. References/Bibliography ABS00564 1. Chang C.S, Por YC, Liou EJ-W, Chang C-J, Chwen PK-T, Comparison of Nasal Results Following Nasal Hook Noordhoff MS (2010) Long-term comparison of four techniques for obtaining nasal symmetry in unilateral complete cleft lip with Lip Taping to PNAM patients: a single surgeon’s experience. Plast Reconstr Surg 126:1276–1284. Dr Radha Prabhu, Dr Renu Parmar, Dr Krishnamurthy Bonanthaya 2. Nakajima T., Yoshimura Y., Augmentation of the nasal splint for retaining the corrected contour of the cleft lip nose. Plastic Abstract Reconstructive Surgery vol 85 no 2. Background/Introduction The nose is the most prominent structure on the face. Cleft nose carry the cleft stigma in the society with immense impact on the child in its growing years. The presurgical correction of the same to bring post operative results closest to normal is one of the aims of PNAM and the Nasal hook with lip taping. Objectives The purpose of this study was to compare the Nasal parameter results following application of Nasal hook with lip taping to PNAM. Methods 90 unilateral cleft lip and palate patients who underwent treatment at Bhagwan Mahaveer Jain Hospital, smile train cleft center, Bangalore between September 1, 2012, and September 1, 2015 were evaluated. Out of the 90 subjects shortlisted, 30 patients had nasal hooks and lip

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S23 taping another 30 patients had PNAM as part of their presurgical using ImageJ software of 1 month follow up of the lip area. Using preparation and 30 others served as control. The nasal base width, these points, the anthropometric measurements of the lip were made. nasal dome height and columella angle were the three parameters These linear measurements give an indication of the horizontal and assessed. vertical lip length, the vertical vermilion length as well as the width of Results the Cupid’s bow and nostril floor. Based on the image parameters like The results of Nasal hook with lip taping are comparable to those of quality of scar, presence or absence of wound dehiscence, vertical and PNAM. horizontal length achieved, Cupids bow width, Vermillion length, Conclusions nasal floor achieved were assessed. The parameters are used to work The findings of this study will be presented at the meeting suggesting out a ‘‘ Cleft Lip Component Symmetry Index’’ that could be used to a definite role for Nasal hook with lip taping in presurgical nasal compare objectively the various components of the lip and nose and molding. the scar is assessed using ‘‘ stone brook scar evaluation scale ‘‘. Results References/Bibliography As the study is an ongoing one, results are awaited. 1. Comparative study of Nasoalveolar moulding methods: Nasal Conclusions elevator plus Dynacleft versus NAM Grayson in patients with No Definitive conclusion can be made at present as it is an ongoing complete unilateral cleft lip and palate. Monasterio L et al; The study, but the study will surely help in knowing the surgical outcome cleft palate-craniofacial Journal 50(5) 548–554: September 2013. using tennison –randall technique in our center. 2. The Nasal alar elevator: A new device that may reduce the need References/Bibliography for primary operation of the nose in patients with cleft lip. Abdiu A et al; Scandinavian Journal of Plastic reconstructive surgery 1. Sabitha S, Veerabahu M, Vikraman B: Esthetic evaluation of Hand surgery, 2009; 43: 71–74. treated unilateral cleft lip using phothographs and image analysis software: A retrospective study; J Maxillofac Oral Surg; 2011 10(3). 2. Olusanya A, Akadiri A: Developing a visual rating chart for the ABS00568 esthetic outcome of unilateral cleft lip and palate repair; Ann Maxillofac Surg; 2015 5(1). Analysis of Quality of Cleft Lip Repair Using Tennison Randall Technique: A Retrospective Study

Dr T Devika Das, Dr Sankalp Chaudhari, Dr Amit Mahajan; K.M ABS00729 Shah Dental College, Vadodara Comparative Evaluation of Outcomes of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) Abstract Background/Introduction with Cancellous Bone Grafts in Cases of Alveolar Cleft Cleft lip and Cleft palate accounts to 65% of all head and neck anomalies. Numerous methods have been described for repair of the 1. Dr. Abhilasha Yadav Ex Associate Prof, 2. Dr. R. M. Borle cleft lip deformity. Since then, the two most popular types of repairs Professor, 3. Dr. Suhas Jajoo Professor have been the Tennison and Millard techniques with many modifications. Various authors have deliberated on the importance of 1. New State Bank Colony, Nagpur Road, Wardha- 442001 Mob- assessment of cleft lip management. Incidentally, most of the existing 9890002523 Email- [email protected], Dept of OMFS Sharad and popular ‘‘ Ascher McDade system’’ gives a non-descriptive Pawar Dental College Sawangi (M) Wardha; 2. Dept of OMFS qualitative assessment like very poor, poor etc. This is subjective and Sharad Pawar Dental College Sawangi (M) Wardha; 3. Dept of extremely variable between individual assessors. A more relevant General Surgery Jawaharlal Nehru Medical College Sawangi rating scale should be based on realistic weighing of residual ana- (M) Wardha tomic deformity and the scoring should immediately communicate the type of structural deficit present and hint on the type and extent of Abstract further surgical correction that might be required. In this paper we Background/Introduction evaluated the surgical outcome of unilateral cleft lip repair using A cleft is a congenital abnormal space or a gap in the upper lip, image analyse software. alveolus, or palate. Any disturbance during the embryonic formation, Objectives development and growth of oro-facial region will result in the for- 1. To evaluate post operative quality of scar 2. To evaluate post mation of oro-facial clefts. The oro-facial clefts are congenital operative wound dehiscence 3. To evaluate vertical lip length deformities, which manifests at birth. Facial aesthetics, speech, achieved 4. To evaluate horizontal lip length achieved 5. To evaluate mastication, deglutition can be impaired because of oro-facial clefts Cupid’s bow width achieved 6. To evaluate vermilion length achieved with a significant impact on the psychosocial aspect of the patients 7. To evaluate nasal floor width achieved. life during his/her life. Methods Objectives Retrospective data from January 2006 to January 2017 who have The objective of this study was to determine the efficacy of alveolar undergone cleft lip repair using tennison –randall method were col- bone grafting with autologous iliac cancellous bone incorporation lected from department of Oral and Maxillofacial Surgery for this with platelet-rich plasma (PRP) and platelet-rich fibrin and evaluate study. All patients operated by a same operating surgeon for unilateral its osteoregeneration. cleft lip who have complete records were chosen. Malnourished Methods patients, patients with systemic and intra operative complications Total 75 patients of cleft alveolus out of which 25 alveolar clefts in 25 were excluded from the study. 1 month follow-up photographs were patients with grafted autogenous bone and PRP (PRP group), 25 clefts included in the study. The photographs, by Farkas’ cleft-related in 25 patients with grafted autogenous bone alone (Control group) and anthropometric lip landmarks were marked on the enlarged images 25 alveolar clefts in 25 patients with grafted autogenous bone and 123 S24 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

PRF (PRF group) were enrolled for the present study. PRP and PRF Early identification of the problems and early intervention for the were extracted from autogenous blood using a plasma centrifuge same is indicated in the children with this type of conditions. system. Age range was 7–20 yrs. Quantitative evaluation of regenerated bone was made and compared with controls. References/Bibliography Results 1. Beriaghi S, Myers SL, Jensen SA, Kaimal S, Chan CM, et al. The average of the volume ratio of regenerated bone was higher in Cleft lip and palate: association with other congenital malfor- cases with PRF followed by PRP when compared to the control mations. J Clin Pediatric Dent 2009; 33: 207–210. group. 2. P.S. Sekhon, M. Ethunandan, A.F. Markus, Gopal Krishnan, C. Conclusions BhaskerRao, Congenital Anomalies Associated With Cleft Lip PRF is a safe and cost-effective source for growth factors and is easy and Palate-An Analysis of 1623 Consecutive Patients. Cleft to extract. It could enhance the osteogenesis of alveolar bone grafting Palate–Craniofacial Journal 2011; 48:371–78. in cleft lip and palate patients and may be useful for subsequent orthodontic therapy. References/Bibliography ABS00770 1. Boyne PJ, Sands NR. Secondary bone grafting of residual alveolar and palatal clefts. J Oral Surg 1972; 30:87–92. Rhinoplasty: An Approach to the Nasal Skeleton 2. Lee C, Nishihara K, Okawachi T, Iwashita Y, Majima HJ and Through the Open Access Nakamura N. A quantitative radiological assessment of outcomes of autogenous bone graft combined with platelet-rich plasma in Dr V Sathyabama the alveolar cleft. Int J Oral Maxillofac Surg. 2009 Feb;38(2):117–25. doi:10.1016/j.ijom.2008.11.019. Epub 2009 Ragas Dental College 2/102, East Coast Road, Uthandi Jan 14. Abstract Background/Introduction Cleft patients undergo a series of surgical procedures early on to EPS00736 correct their cleft lip followed by the palate and deal with its reper- Incidence of Congenital Cardiac Anomalies in Patients cussions stage by stage. with Cleft Lip and Palate: Its Implications in Surgical Objectives Management To correct the nasal asymmetry and provide a functional nasal apertures. Methods Dr Akash Kasatwar Assess the extent of the deformity. Insinuate a normal anatomy with an open access approach. The bony base with the correction of the Sharad Pawar Dental College & Hospital, Wardha anterior nasal spine to the septal correction followed by the soft tissue correction of the alar components. Auricular cartilage procured for Abstract augmentation. Background/Introduction Results Cleft lip and palate is one of the most common congenital craniofacial Septal deviation formats the core of the asymmetry. Provides an deformities seen in children. Various congenital anomalies are acceptable facial profile in the society. Henceforth the timing of the reported in the literature to be associated with cleft lip and palate. procedure needs to be assessed to eliminate retardation of growth Cardiac anomalies are one of the most common congenital disorders versus the social stigma. associated in cleft lip and palate patients. It includes patent ductus Conclusions arteriosus, ventricular septal defect, atrial septal defect, transposition Open access approach gives a complete access to the nasal archi- of greater vessels, tetralogy of fallot etc. Incidence of congenital tecture. However the timing of performing this procedure needs to be cardiac anomalies is reported to be higher in general population. audited and assayed as to whether the procedure can be performed According to ESC/ESA guidelines for non-cardiac surgeries, patients early in life once the maxillary arch expansion has been achieved with with stable cardiac disease can undergo low and intermediate risk the closure of the fistula. Secondary Rhinoplasty may be performed surgeries which include cleft lip and palate surgeries. later in life after the cessation of growth. Objectives References/Bibliography To study the incidence of congenital cardiac anomalies in cleft lip and palate patients. Objectives: To study different types of congenital 1. Unique approach to Cleft lip secondary deformity in Cleft Lip cardiac anomalies /defects in patients with cleft lip and palate and its Rhinoplasty in Facial Plastic surgery: - P W Hellings, G Hens J implications in surgical management. Schoeners M Jorrisen B-ENT 2010 6 97–101. Methods 2. Cleft Lip Rhinoplasty - A Review Ashok Jonnalagadda*, Sreeja This is a retrospective study carried out for a period of one year. In Jami, Kusuma Latha Pydi Drs. Sudha & Nageswera Rao this study medical records of 200 patients were evaluated and ana- Siddhartha Institute of Dental Sciences, Gannavaram, Andhra lyzed for presence of congenital cardiac anomalies. Pradesh. Results Out of 200 patients, 30 patients (15%) were associated with congenital cardiac anomalies (CCA) with the male to female ratio of 1:1. Associated congenital cardiac anomalies were most frequently seen in unilateral cleft palate patients (21.05%) The most common cardiac anomaly was Ventricular septal defect (36.6%). Conclusions

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Section: Orthognathic Surgery Objectives To devise a specific treatment plan and to modify the conventional surgical techniques to achieve desirable results in these patients. Methods ABS001 Diagnosis was made using clinical and radiographic data. patient’s Is There Linearity Among Soft and Hard Tissue desires and needs were obtained and surgical plan was framed Change Following Orthognathic Surgery? according to it. surgical methods will be eloborated in the presentation. Results Tanmoy Nath, Ramdas Balakrishna Desirable results were achieved. Patients were satisfied. postoperative stability was good. Abstract Conclusions Background/Introduction This paper will bring awareness to the general dentists and people of Today treatment planning for orthognathic surgeries has shifted from other dental specialties on how to identify and manage skeletal facial acetate paper tracings to sophisticated 3D imaging softwares, which deformities. are based upon ratios of soft to hard tissue changes. These ratios are mostly dependent upon linear ratios based upon published literature. References/Bibliography Objectives 1. Trauner R, Obwegeser H. The surgical correction of mandibular The aim of this study is to evaluate the linearity soft tissue changes prognathism and retrognathia with consideration of genioplasty. with skeletal movements by orthognathic surgery. I. Surgical procedures to correct mandibular prognathism and Methods reshaping of the chin. Oral Surg Oral Med Oral Pathol. 1957; Lateral cephalograms of 24 patients were taken preoperatively at least 10(7):677–689. 1 week before (T1) and, postoperatively (T2) 2 months after the surgery and tracings were done. The maxillary group (Group I) consisted of patients undergoing isolated maxillary orthognathic surgeries. The mandibular group (Group II) consisted of patients undergoing isolated mandibular orthognathic surgeries. Five pairs of ABS0022 soft and hard tissue landmarks were studied preoperatively and Challenging Orthognathic Surgeries: An Experience postoperatively. Results Dr. Chandresh Jaiswara Both groups showed that relationships between the soft and hard tissues were linear, except for the Sn-ANS pair that showed a nonlinear relationship. Ls-U1E pair of landmark in maxillary group Faculty of Dental Sciences. IMS BHU Varanasi showed a ratio of 0.85:1, Pg’-Pg pair of landmark in the mandibular group, showed a ratio of 1.19:1, which were closest to 1:1 in their Abstract respective group. Background/Introduction Conclusions The word orthognathic comes from the Greek word orqos, meaning to When isolated mandibular orthognathic surgeries are performed, the straighten, and gnaqos, meaning jaw. Orthognathic surgery thus mandibular pairs of soft and hard tissue landmarks show evidence of means to straighten a jaw but actually Orthognathic surgery is the linear relationship. When isolated maxillary orthognathic surgical repositioning of basal bone in the maxillo-mandibular deformities. Its procedures are performed, all maxillary and mandibular pairs of soft results are both esthetic and functional. For adults, improved aes- and hard tissue landmarks showed linear relationship except Sn-ANS. thetics results is becoming increasingly important in these procedures This supports the use of nonlinear ratios for predicting maxillary to the point where some patients seek only an esthetic and not a landmarks in simulation softwares. functional one. To achieve their aesthetic purpose, it is becoming progressively more necessary for oral surgeons and orthodontist to collaborate effectively in a well-coordinated effort. Objectives ABS0014 This study is done to evaluate facial changes after orthognathic Management of Patients with Skeletal Facial surgery. Deformities Mismanaged by Other Dental Specialists Methods group of patients undergoing otrhognathic surgery were assessed for presurgical and post surgical changes. 1. Dr. Nisharudeen, Consultant, 2. Dr. N. Venkadasalapathi, Head Results The perfect planning and surgical technique selection is vital factors Hannah Joseph Hospital, Madurai; Department of for orthognathic surgery. Craniomaxillofacial Surgery, Hannah Joseph Hospital, Madurai Conclusions Esthetic considerations form the most important aspect of contem- Abstract plated orthognathic surgery. Background/Introduction References/Bibliography Patients with skeletal facial deformities in peripheral areas mostly seek dental correction from general dentists or from quakes practicing Bell WH. Modern practice in orthognathic and reconstructive surgery. in the villages who use their limited knowledge try to manage these Philadelphia: WB Saunders Company, 1992. patients with dental bridges and othodontic camouflage worsening the situation.

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ABS0060 Objectives Extended Lateral Sliding Advancement Genioplasty: The aim of the present study was to see the effect of orthognathic surgery (OS) 1. on oral health related quality of life (OHRQOL) in A Predictable and Versatile Corrective Procedure patient’s with jaw deformities and 2. To identify any improvements in for Facial Asymmetry and Retrognathia Correction the patient’s psychological and social behaviour. Methods Dr. Hitesh S. Dewan M.D.S., DNB, Professor This was a prospective, clinical, observational study. The patient’s reported to our outpatient department with facial deformities between Dec 2014 to June 2017 were included in the study. The 32 Dept. of Oral & Maxillofacial Surgery, Faculty of Dental Science, subjects reported in whom OS were performed (16 Bilateral sag- Dharmsinh Desai University, Nadiad, Gujarat gital split osteotomy, 14 le_fort 1 osteotomy, 5 anterior maxillary osteotomy, 3 genioplasty). All patients treated under General Abstract anaesthesia after obtaining the written informed consent. The study Background/Introduction was approved by our ethical committee. The oral health was Facial Asymmetry associated with retrognathia is a common defor- assessed by using Japanese version of oral health impact profile mity especially after unilateral ankylosis release although it may be (OHIP). Pre and post operative experience of the patient’s were present in other developmental non syndromic conditions also. Ple- analysed. thora of surgical options exist including ramus osteotomies, Results distraction osteogenesis and onlay grafts. These are tedious technique The OS had a positive impact on OHRQOL. The OHIP which was 62 sensitive procedures which are demanding to the clinician, patient or per operatively comes to 30 after surgery. The psychological and both. Extended lateral sliding advancement genioplasty is a com- social behaviour of the patient’s improved after surgery. paratively simple and predictable technique to achieve optimum Conclusions esthetic correction. The determination of OHRQOL in patient’s with jaw deformities Objectives seems to be very useful in 1. Understanding the patient’s problems. 2. Achieving facial symmetry without disturbing existing occlusal status Providing appropriate treatment and 3. Assessing the extent of thereby increasing patient compliance alleviating the need for changes in term of patient well-being. extensive distraction procedures. Methods References/Bibliography Extended lateral sliding advancement genioplasty performed via intraoral approach and fixation with one miniplate and one chin plate 1. Kim SJ et al. Evaluation on psychosocial status of orthognathic performed in ten patients from 2014–16. surgery patients. OOOO 2009;108:828–32 2. Yamazaki M et al. Results Japanese version of oral health impact profile (OHIP-J). J Oral Optimal esthetic results were achieved in majority of patients. As Rehabil 2007;34:159–68. occlusion was untouched post operative masticatory efficiency was unaltered. Only complication in two cases was temoporary mental nerve paresthesia which resolved in a couple of months. Conclusions ABS00399 Two plate rigid fixation in this procedure ensures maximum stability Augmentation Genioplasty [ 15mm Using Sandwich of the osteotomized chin and no bone grafts are required. Occlusal Bone Grafting: 7 Years Follow Up of Series of Cases - stability is an added bonus for patients seeking quick and predicat- able esthetic correction for asymmetry. Our Experience References/Bibliography Dr. Samprati J Badjate MDS. Associate Professor Extended lateral sliding genioplasty for correction of facial asymmetry. Varghese Mani et al, asian journal of oral & maxillofacial Department of Oral and Maxillofacial Surgery, VSPM-DCRC, surgery, 2004;16:84–90. Digdoh Hills, Nagpur

Abstract Background/Introduction ABS00102 Severely receded chin cannot be treated satisfactorily with sliding Are Orthognathic Surgeries has any Impact on Oral genioplasty because of the limitation of advancement upto 8mm– 10mm. To over come this we have treated 10 patients of severely Health Related Quality of Life in Patient’s with Jaw receded chin requiring advancement more than 15mm, by Advance- Deformities? A Clinical, Prospective and Observational ment genioplasty and increasing vertical height at the same time and Study by rigid fixation and sandwiching free iliac crest bone graft. Objectives Patient requiring advancement genioplasty [ 15mm were treated and Dr Anshul Rai follow up was done for 7 years. Methods All India Institute of Medical Sciences Bhopal, MP After routine sliding genioplasty osteotomised segment was advanced by [ 15mm as described by the clinical condition and free iliac crest Abstract block bone graft were sandwiched in between the osteotomised seg- Background/Introduction ment and secured with bone plates and screws. The facial deformities has a significant effects on individual identi- Results fication. They may be acquired or congenial. They have direct impact All the patient treated by this technique were found to have satis- on patient’s quality of life, there psychological and social behaviour. factory cosmetic result. 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S27

Conclusions ABS00327 The level of satisfaction was significantly high for all the patients. Is Anterior Maxillary Distraction an Alternative The current findings strongly suggest that this is a reliable procedure for achieving harmony of the lower face. In addition, it permits a to Rigid External Distraction in Cleft Maxillary simplification of facial reconstruction and rejuvenation. Hypoplasia? References/Bibliography Dr. Jaeson M. Painatt, Dr. Ravi Veeraraghavan, Dr. Pramod Subash, 1. Sliding Osteotomy Genioplasty for Facial Aesthetic Balance: 10 Dr. Sherry Peter Years of Experience. Aesthetic Plastic Surgery. August 2007. 31:384–391. Amrita Institute of Medical Sciences, Amrita University 2. Bedoucha V, Boutin F, Frapier L. Impact of genioplasty during puberty on the upper airways. Int Orthod. 2015 Dec. 13(4):421–35. Abstract Background/Introduction Section: Distraction Osteogenesis Orthognathic surgery and distraction osteogenesis are the most favored surgical treatment modalities for cleft maxillary hypoplasia. Distraction has various benefits over orthognathic surgery such as ABS00107 evading bone grafting and donor site morbidity and its concurrent A Retrospective Study to Evaluate Cephalometric expansion of soft tissue envelope. Maxillary distraction with Rigid External Distraction (RED) device has proved to be effective in Changes in Triad TMJ Ankylosis Patients Who treating cleft maxillary hypoplasia. However, there are a few disad- Underwent Prearthroplastic Mandibular Distraction vantages such as an expensive halo frame and patient discomfort Osteogenesis whereas Anterior Maxillary Distraction (AMD) with a tooth borne appliance is more patient compliant. On review of literature, there are no reports comparing the airway and only a report comparing the Neha Aggarwal; Neelam Andrade; Paul Mathai profile changes of cleft patients on RED and AMD. Objectives Nair Hospital Dental College To compare the profile changes, airway and stability of patients who underwent RED and AMD in adult patients with cleft maxillary Abstract hypoplasia. Background/Introduction Methods In the last two decades, mandibular distraction osteogenesis (MDO) Three lateral cephalometric radiographs were taken: predistraction became a popular modality in managing the hypoplastic mandible (T1), postdistraction (T2) and 1 year after distractor removal (T3). followed by the release of TMJ Ankylosis. Through this study we aim to The treatment changes (T1 vs. T2) and the stability (T2 vs. T3) were evaluate cephalometric changes pre and post distraction in Ankylosis analysed for patients who underwent both RED and AMD. The lateral patients. cephalograms were digitally analyzed with the help of a software Objectives named Dolphin. i. To evaluate the result of the distraction vector by measuring the Results changes in the position of the mandible. ii. To compare differences in Seven adult patients with CLP who underwent both RED and AMD the lower anterior facial height before and after distraction iii. To each were retrospectively analyzed. The convexity of the facial pro- compare differences in SNB angle, occlusal plane angle and plane file had improved significantly in both techniques. The RED patients angle of the distraction vector before and after distraction. had an increased total facial height than AMD patients. The upper Methods airway had significantly improved in RED patients whereas in AMD This study was a retrospective observational study. The study comprised patients, the airway was almost constant. Both the techniques had a of a minimum of 30 patients of TMJ Ankylosis who underwent certain amount of relapse. mandibular distraction Osteogenesis for correction of sleep apnoea and Conclusions micrognathia. Cephalometric records of the patients were digitalized with The clinician should have an understanding of the related hard and the help of image scanner (Epson Perfection V800 Photo Color Image soft tissues as well as airway changes which may assist them when Scanner) and the digitalized images were fed into the Nemotec Studio’s planning for maxillary advancement for CLP patients with DO. In our Nemoceph 2D Software. The dental and skeletal observations from the series of cases, some AMD patients required another osteotomy study were recorded, tabulated and subjected to statistical analysis. procedure as compared to the RED patients. However, each case is Results different and case selection for a particular technique is important. Pre and Post distraction hard tissue and soft tissue changes showed sta- References/Bibliography tistically significant values (p value \0.05). All patients showed a satisfactory change in profile and an increase in lower anterior facial height. S. Richardson et al, Tooth-Borne Anterior Maxillary Distraction for Conclusions Cleft Maxillary Hypoplasia: Our Experience With 147 Patients, J Oral Through this study, we conclude that pre arthroplastic mandibular Maxillofac Surg 74:2504.e1-2504.e14, 2016. distraction allows satisfactory correction of micrognathia in TMJ Painatt JM, Veeraraghavan R, Puthalath U, Peter S, Rao LP, ankylosis patients, thus proving to be a good treatment modality with Kuriakose M. Pro le changes and stability following distraction excellent stability and less relapse. osteogenesis with rigid external distraction in adult cleft lip and palate References/Bibliography deformities. Contemp Clin Dent 2017;8:236-43. 4. Sadakah AA, Elgazzar RF, Abdelhady AI. Intraoral distraction osteogenesis for the correction of facial deformities following temporomandibular joint ankylosis: a modified technique. Int J Oral Maxillofac Surg. 2006;35(5):399–406.

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ABS00363 present literature analysing the histological quality of the consoli- Bilateral Biplanar Distraction Osteogenesis Post TMJ dating regenerate in humans, this study was conducted to evaluate and compare the histological and histomorphometric interpretation of Ankylosis Release for Correction of Facial Deformity distracted mandibular callus after 8 and 12 weeks of consolidation. Objectives Dr. Sonal Anchlia, Dr. Siddharth Vyas, Dr. Vipul Nagavadiya, Dr. To evaluate and compare the histological and histomorphometric Ramyata Dayatar interpretation of distracted mandibular callus after 8 and 12 weeks of consolidation. Government Dental College and Hospital, Civil Hospital Campus, Methods Ahmadabad Twenty (20) patients of mandibular corpus deficiency were operated for corpus lengthening by Distraction Osteogenesis (DO). The cases Abstract were randomly divided into two equal groups. In group A, distractor Background/Introduction device was removed after 8 weeks and in group B after 12 weeks. At Biplanar distraction is used to lengthen a severely hypoplastic ramus the time of distractor removal, scraping was obtained from the callus as well as corpus of the mandible. It simultaneously corrects for histological evaluation and histomorphometric interpretation. Obstructive Sleep Apnoea and prevents the most common compli- Results cation of uniplanar distraction - anterior open bite. We could not find statistically significant variation between the two Objectives groups suggesting that 8 weeks consolidation is optimum as cited by To evaluate correction of facial asymmetry using bilateral biplanar various authors. Our results concurred with previous animal studies distraction osteogenesis post TMJ ankylosis release. validating decreased consolidation of bone and increased remodelling Methods with change in trabecular orientation and mass after 8 weeks. 10 cases post ankylosis were selected with: - advancement required Conclusions more than 10mm. - severe corpus and ramal deficiency. - with/ The distractor can be safely removed in mandible corpus distraction without severe OSA Two osteotomy cuts were made bilaterally, in the after 8 weeks of consolidation. body and ramus region, distractors placed and activated. References/Bibliography Results The total distraction was compared clinically, cephalometrically after 1. Cope JB, Samchukov ML. Mineralization dynamics of regenerate callous moulding, then after distractor removal and finally 6 months bone during mandibular osteodistraction. Int J Oral Maxillofac after removal. The body average was 17, 16, 15 and 14.5 mm. The Surg. 2001;30(3):234–42. ramus average was 15, 13.5, 12 and 11 mm. Average follow up: 1.5 2. Hong P, Boyd D, Beyea SD, Bezuhly M. Enhancement of bone years Average post op AHI score: \ 5 Patient satisfaction score was consolidation in mandibular distraction osteogenesis: a contem- 100%, no compliance issues. No Complications like major relapse, porary review of experimental studies involving adjuvant loss of vector or reankylosis. Posterior open bite was noted in 3 therapies. J Plast Reconstr Aesthet Surg. 2013;66(7):883–95. patients, corrected significantly by callous moulding. Schanz Pin infection was noted in 2 patients, treated conservatively. Conclusions Bilateral biplanar distraction proves to be extremely efficient in cor- ABS00710 recting facial asymmetry in terms of mandibular ramal as well as Evaluation of Transport Distraction Osteogenesis body deficiency. Most importantly, the use of two osteotomy cuts in this study has negated the popular belief that in biplanar distraction: - in Maxillofacial Region there occurs loss of vector control. - ramal stump goes upwards till the ‘‘cranial stop’’. Dr Naresh Kumar (Professor), Dr Neeraj Kr Dhiman (Asst Prof), Dr Ajit Vishwakarma (JR 3) References/Bibliography Ortakoglu et al: Distraction osteogenesis in a severe mandibular Faculty of Dental Sciences IMS BHU Varanasi deficiency. Head and face medicine 2007; 3–7. Abstract Background/Introduction Transport distraction osteogenesis is the technology to restore bony ABS00484 continuity through the use of in situ bone in an attempt to create an Histomorphometry of Distracted Callus anatomically similar regenerate that is better than bone grafting or vascularised free tissue transfer. In this method, a bone segment is osteotomized adjacent to the defect and then distracted slowly across Maj Amit Bhandari, Maj Gen NK Sahoo, Brig ID Roy, Lt Col Rohit the defect so that new bone forms continuously in the gap, eventually Sharma leading to reconstruction of the bone defect. Costantino et al. were the first to report bifocal distraction (TDO) of the mandible by using an 4CDU; AFMC Pune external custom made distraction device to regenerate a segmental defect of 40-mm. Since then there have been rapid advancements in Abstract the field of TDO, which has now become an important tool for the Background/Introduction reconstruction of composite defects. Zhang and Zhang have described Bone deficiency in the craniofacial skeleton has posed a challenge to 3–12 cm defects to be optimal for considering TDO in maxillofacial craniomaxillofacial surgeons for many decades. The possibility of region. Most mandibular defects are composite defects that involve a bone lengthening by means of distraction osteogenesis was suggested combination of osseous and soft tissue deficiency. These defects are many years ago by Codivilla and later clinically and biologically often congenital, a results of trauma, infection, or resection of benign established by Ilizarov. With very few documented studies in the and malignant tumours. The attraction of applying the distraction

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S29 technique for mandibular reconstruction is its lack of donor site morbidity and its ability to increase the overlying soft tissues by Section: Facial Aesthetic Surgery inducing histogenesis. Objectives To evaluate the role of Transport Distraction Osteogenesis (TDO) in ABS00279 restoration of osseous continuity, alveolar height, arch form, width and acceptable facial form after resection of maxillofacial bony Management of Mandibular Asymmetry Due to Hemi- tumor. Mandibular Hyperplasia-(Report of Cases and Review Methods of Literature) The study was conducted on those patients who require reconstruction of mandibular defects that result following surgery for pathology. A Dr. Thiruneelakandan Sambanthan, Associate Professor extraoral custom made bone transport distractor with reconstruction plate was used to transport the two segments created on each side of the mandible (trifocal distraction), and intraoral device used in bifocal Department of OMFS, Rajah Muthiah Dental College and Hospital, distraction. A. anaesthesia: According to cases- GA/LA B-approaches Annamalai University (for mandibular body and ramus) submandibular and intraoral incision transport disc of about 14 to 18 mm osteotomised on mandibular Abstract stump. (Special attention paid to avoid lacerating the soft tissue Background/Introduction attaching to lingual side of transport disc) distraction device fixed to Facial Asymmetry is predominantly associated with under or over transport disc & remaining mandible (basal bone) with transport growth of condyle and other growth disturbances which might affect segment in close contact with basal bone. extraoral incision sutured in the mandible [primary or secondary]. layers. Activation: 1. After a latency period of 7 days (avg 3–4 days) Objectives depending upon the patient age. 2. Distraction rate-0.5mm twice/day. Addressing the dilemmas faced by the maxillofacial surgeon in 3. Consolidation period-approx 16 weeks or decided by degree of restoring the aesthetics. calcification in distraction gap on panoramic radiograph. Methods Results Analyzing the different treatment procedures with respect to the All the patients irrespective of whether extra-oral or intra oral device clinical presentation. was placed had minimal difficulty in the immediate post operative Results phase. The advantage of using bone transport for reconstruction of Satisfactory facial symmetry can be attained by addressing the par- mandibular continuity defects is that the neo mandible has the same ticular affected region in the mandible namely the condyle, gonium shape as original mandible with same quality of bone. Additionally all and body of the mandible. local soft tissue viz. gingiva, buccal and lingual sulci are recreated. Conclusions With this technique there can be a paradigm change from recon- Specific surgeries in par with the complaints of the patient makes the structive to regenerative surgery. difference in the surgical outcome{facial aesthetics}. Conclusions References/Bibliography The functional and aesthetic reconstruction of the mandible after resection continues to be a formidable problem in maxillofacial sur- Int. J. Oral Maxillofac Surg 1995;24;134–41. gery. Grafts, flaps, and synthetic materials have been used to J Oral Maxillofac Surg 2009;67;2201–9. reconstruct the mandible. Unfortunately, grafts and flaps result in added morbidity, and may be of limited availability. Transport Dis- traction Osteogenesis has been proposed as an alternate method of mandibular reconstruction, through which mandibular defects could ABS00409 be replaced by new bone grown from the remaining mandible. Hair Restoration Using Follicular Unit Extraction References/Bibliography (FUE) Technique. A Maxillofacial Surgeon’s 1. R. S. Neelakandan, Darpan Bhargava. Transport Distraction Perspective Osteogenesis for Maxillomandibular Reconstruction: Current Concepts and Applications J. Maxillofac. Oral Surg. (July–Sept Kiran Savant (Private Practitioner, Bangalore), Rakshit 2012) 11(3):291–299. Khandeparker, Omkar Shetye, Praveen S Kumar, Saurabh Kamat 2. Double-step transport distraction osteogenesis in the reconstruction of unilateral large mandibular defects after tumour resection Goa Dental College and Hospital, Goa using internal distraction devices BY J. Chen-Int. J. Oral Maxillofac. Surg. 2012. Abstract Background/Introduction Alopecia of the maxillofacial region be it the scalp hair, eyebrows, moustache, side locks or beard can occur due to various reasons. Reconstruction of these areas not only animates the face and adds confidence but also breaks the cycle of self pity giving a feeling of completeness and camouflaging the existing alopecia. Hair restoration has come a long way from the days of punch hair transplant to Fol- licular Unit Transplantation (FUT) to the most recent FUE technique. Although numerous articles have been published on FUE for scalp restoration, it’s efficacy for various situations in the maxillofacial regions is yet to be evaluated.

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Objectives cases were cleft nasal deformities and 2 patients were treated for To evaluate the efficacy of FUE technique for treating Alopecia of the cosmetic reasons In our study we have used iliac crest and alloplastic maxillofacial region secondary to different causation. porous poly ethylene material (Biopore). Methods Results A total of 242 patients with Alopecia of the maxillofacial regions The efficacy of the material were analysed both intra operatively and secondary to either androgenetic, autoimmune, post traumatic, post post operatively in terms of contour, shape, stability and graft burns or post surgical causes were treated using FUE technique with acceptance. All the patients were followed for a period of six months 0.9 mm motorised punches. In patients needing multiple sittings, 8 to and results were made. The 10 patients were divided into Group I who 10 months period was allowed between the sittings. Patients were received autogenous iliac grafts for nasal augmentation and Group II followed for at least 1 year and the level of patient satisfaction was who received alloplastic Biopore grafts. graded using a 5 point scale with 1 been not at all satisfied and 5 been Conclusions completely satisfied. Any complications, if present were also noted. Based on our study we conclude that Biopore alloplastic nasal implant Results has shown to be superior compared to autogenous iliac grafting as it Among the 242 patients, 224 were underwent scalp transplantation, 3 avoids problems related to donor site morbidity, graft size and underwent beard, 12 underwent moustache and 3 underwent mous- biocompatibility. tache transplantation. Hair growth was observed in all cases between 2 to 6 months post surgery. Although initially not an uniform result to References/Bibliography begin with, complete result was observed at 10 to 12 months. Most 1. Julie Karnes, Porous High-density polyethylene implants (med- patients (n=190) were completely satisfied, 34 were very satisfied, 10 por) for Nasal dorsum Augmentation, Aesthetic Surgery Journal- were quite satisfied while 8 were barely satisfied with the surgical January/February 2000. outcome. No major complications were noted. The scars in the donor 2. Michael J. Brenner, Grafting in Rhinoplasty Review Article, area were visually imperceptible after 7–10 days. Facial Plastic Surgery Clinics of North America, Volume 17, Conclusions Issue 1, February 2009, Pages 91–113. From the maxillofacial perspective, Alopecia of the maxillofacial regions can be effectively managed using FUE technique of hair restoration. The technique offers the advantages of been a minimally invasive procedure which is not only scarless but also naturally pain free in the post operative period. ABS00727 Microtia Reconstruction with Porous High Density References/Bibliography Polyethylene Ear Implant: A Prospective Evaluation Dua A, Dua K. Follicular unit extraction hair transplant. J Cutan Aesthet Surg 2010; 3: 76–81. Dr. Shiva Mani- Senior Lecturer Rajput R. Post burns hair restoration of eyebrow, eyelash, moustache, beard and scalp areas. Indian J BUrns 2015; 23: 26–31. Department of Oral and Maxillofacial Surgery at Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India

Abstract ABS00533 Background/Introduction Efficacy of Autogenous Grafts Versus Alloplastic Grafts Microtia is a condition characterized by deficient external ear with/ in Nasal Augmentation Procedures: A Comparative without associated internal ear malformations, rehabilitation of which Study is always a challenge to surgeon. Autologous costal cartilage, Porous High Density Polyethylene (PHDPE), Titanium dowel based ear reconstruction are the common modalities of microtia rehabilitation. Siddharth Dhanaraj, M.V. Sainath, Kamal Kannadasan Objectives To evaluate the versatile role of PHDPE implants and document any SRM University, Chennai, India post-operative complications when used for auricular reconstruction. Methods Abstract A prospective study comprising of 7 non-syndromic patients with Background/Introduction unilateral grade III microtia was conducted. Parameters evaluated An esthetically balanced eye, ear, nose and mouth is always appre- were duration of surgery; pain score (using Visual Analog Scale ciated. The dilemma when arises about introducing foreign or [VAS]), drain collection and duration for which it was in situ, wound autologous materials for augmenting columella, dorsum and bridge dehiscence upto 2 weeks postoperatively. Other long term parameters the septal cartilage, the autologous materials proved the best. In our evaluated were implant exposure, mobility, deviation, infection at study we have used iliac crest and alloplastic porous poly ethylene surgical site, need and number of secondary surgeries and compli- material (Biopore) and compared three characters like stability, cations at Temporo Parietal Fascia (TPF) fascia harvest site. acceptance, shape and contours of the graft. Results Objectives Wound dehiscence due to TPF ischemic necrosis was seen in 1 out of The purpose of this study is to compare the efficacy of autogenous 7 patients necessitating removal of implant leading to exclusion of the (Iliac crest) and alloplastic (Porous Polyethylene - Biopore) in case from the study. Post operatively, significant reduction in VAS rhinoplasty. scores was seen from day 1 to day 5 for all patients. In the remaining Methods 6 cases, complications encountered were late infection, implant This study was done at SRM Dental College, Ramapuram in exposure and hypertrophic scar with alopecia in one case each. department of Oral and Maxillofacial Surgery on 10 patients with Conclusions deformed nose. Their age ranging from 18 to 25 years (mean=21.5 PHDPE ear implant with all its inherent advantages, being completely years). In our study 6 males and 4 females were taken in which 8 inert and biocompatible has a promising future and proves to be a 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S31 good alternative for conventional autologous costal cartilage in ABS00833 auricular reconstruction. Sculpting the Face with Biopore References/Bibliography Dr. Ketaki Joglekar, Dr. Shashwat Magarkar, Dr. Kavita Sahu, Dr. 1. Romo T, Presti PM, Yalamanchili HR. Medpor Alternative for Vyankatesh Sahu Microtia Repair. Facial Plast Surg Clin North Am 2006; 14:129–36. Email: [email protected], Contact details: 9975635634, Postal Address: 115, Reshimbagh Godavari Nagpur-440009

ABS00824 Abstract Background/Introduction Computer Assisted Surgical Planning in Cranio- Facial skeletal augmentation is an important clinical procedure for Maxillofacial Surgery surgeons performing cosmetic and reconstructive facial surgery. High- density porous polyethylene (BioporeTM) has gained wide acceptance Dr. Usha Asnani as an implant for facial skeletal augmentation in the last decade. Objectives To study the versatility of high density porous polyethylene for the Mahatma Gandhi Mission’s Dental College and Hospital, Kamothe, correction of various maxillofacial defects and deformities. To eval- Navi Mumbai uate the post-operative esthetic outcome and complications following its use. Abstract Methods Background/Introduction All the patients of traumatic/congenital/iatrogenic maxillofacial In cranio-maxillofacial surgery, surgeons are often faced with the defects and deformities were included. Patients were evaluated pre reconstruction of massively destroyed or radically resected tissue, operatively on the basis of clinical examination (Site and size of the structures. Corrections of malunited fractures up to the complete re- defect/deformity), radiographs, CT scan and at intervals of 7 days, 1, modeling of facial regions in cases of complex congenital malfor- 3, 6, and 12 months post-operatively for Aesthetics, Symmetry, mations are common tasks of maxillofacial and reconstructive Allergic reactions, Infection, Exposure and other complications. Pain, surgeons. With regard to the individual anatomy and physiology, such numbness, satisfaction with treatment proceedings, and outcome were procedures have to be planned and executed thoroughly in order to evaluated by the patient on a four-point scale. The remaining criteria achieve the best functional as well as an optimal aesthetic rehabili- were evaluated by the treating doctor on a four-point scale. tation. The application of the CAD/CAM technology, together with Results the emerging 3D images based virtual surgical planning (VSP) High Density Porous Polyethylene implants - Biopore TM – have technology; to cranio-maxillofacial reconstruction has been gaining worked well in at least 13 patients out of 15 who underwent implant attention to reconstructive surgeons. surgery. Only the patient, in whom Orbital Sheet and Plumper were Conclusions used, showed an unsatisfactory outcome of the implant surgery. Computer-assisted modeling, planning and simulation approach Conclusions allows for pre-operative assessment of different therapeutic strategies High density porous polyethylene implant is a versatile material for on the basis of three-dimensional patient models and improve the the reconstruction of maxillofacial defects and deformities. It also predictability of planning and outcome while improving efficiency gives good esthetics and is biocompatible. preoperatively as well as intraoperatively. References/Bibliography Section: Maxillofacial Implant C.P. Kasaven et al.: Accuracy of both virtual and printed 3-dimensional models for volumetric measurement of alveolar clefts before grafting with alveolar bone compared with a validated algorithm: a preliminary investigation British Journal of Oral and Maxillofacial ABS00218 Surgery xxx (2016). Maxillary Sinus Floor Elevation Using Osteotome With Y. Y. Wang, H. Q. Zhang, S. Fan, D. M. Zhang, Z. Q. Huang, W. L. Chen, J. T. Ye, J. S. Li: Mandibular reconstruction with the Immediate Placement of Implant in Atrophic Maxilla vascularized fibula flap: comparison of virtual planning surgery and Without Graft Material: A Clinical Study conventional surgery. Int. J. Oral Maxillofac. Surg. 2016. Stefan Zachow, Hans-Christian Hege, Peter Deuflhard Computer- Dr. Shibaliik Mukherjee, Dr. Zodin Liana Assisted Planning in Cranio-Maxillofacial Surgery Journal of Com- puting and Information Technology - CIT 14, 2006, 1, 53–64. The Oxford Dental College

Abstract Background/Introduction Implant restorations in the posterior maxilla pose signiﬁcant challenges to the clinician because of the location of maxillary sinus and softness of the alveolar bone in this area. Minimally invasive sinus augmentation is an effective solution for this problem. Objectives The aim of this study was to investigate amount of sinus lift achieved by the cheapest and less time consuming procedure osteotome

123 S32 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 mediated maxillary indirect sinus lift technique with simultaneously Results implant placement without using grafting material. The patients in study group had lesser postoperative pain, swelling Methods and required lesser analgesic consumption as compared to the patients The study was conducted on 16 patients males and females. Indirect in control group with statistically significant difference. Less oper- sinus lift was done with osteotome of gradual diameters and 8–10 mm ating time was also statistically significant for study group. There was long implants placed simultaneously. Preoperative & postoperative no implant failure reported in any group and the difference between bone height and sinus lift respectively was measured in OPG using the peri-implant bone losses in both the groups after 6 months post- caliper. 4 months later endosinus bone gain was recorded in OPG. loading was statistically insignificant. Results Conclusions All implants achieved primary stability and were successfully loaded 4 Both techniques were successful for implant placement, but single months after healing. The mean sinus lift was 3.19 mm. Highest sinus drill required less surgical time and the postoperative morbidity was lift achieved was 4.8 mm in 1 of the patient. In all the patients the minimal. implants were completely embedded in the newly formed bone and the sinus floor had been relocated apical to its previous demarcation. References/Bibliography Conclusions Guazzi P, Grandi T, Grandi G. Implant site preparation using a single The findings from these 16 cases suggest that the osteotome sinus bur versus multiple drilling steps: 4-month post-loading results of a floor procedure without grafting material, and immediate implant multicenter randomised controlled trial. Eur J Oral Implantol. 2015 placement, can be applied in situations for which previously only Autumn; 8(3):283–90. direct sinus lift by lateral approach and indirect sinus lift with other Bettach R, Taschieri S, Boukhris G, Del Fabbro M. Implant survival methods except osteotome were applied. More patient and longer after preparation of the implant site using a single bur: a case series. follow-up are warranted to investigate how reliable this technique can Clin Implant Dent Relat Res. 2015 Feb;17(1):13–21. be when applied to atrophic maxilla. References/Bibliography Toffler M. Osteotome mediated sinus floor elevation: Int J Oral ABS00376 Maxillofac Implants 2004; 19:266–73. Nedir R, Nurdin N, Szmukler-Moncler S, Bischof M. Osteotome Role of Custom Fabricated Titanium Implants sinus floor elevation technique without grafting material and imme- in Maxillofacial Reconstruction: Experience of 2 Cases diate implant placement in atrophic posterior maxilla. J Oral Maxillofac Surg 2009; 67:1098–103. 1) Dr. Raghav Agrawal, Senior Resident, 2) Dr. Biju Pappachan Professor

Govt. Medical College, Rajnandgaon; Govt. Dental College Raipur ABS00311 Single Drill Versus Multiple Sequential Drills in Dental Abstract Implant Site Preparation: A Randomized Controlled Background/Introduction Trial Craniofacial defects also have complex anatomical shapes that is hard to achieve intraoperatively by carving harvested bone from the donor site. Use of auto grafts is limited by the availability of suitable donor Anuj Jain, Anshul Rai site especially for large defects, additional expensive surgeries, tissue harvesting problems, donor site morbidity with an additional patient All India Institute of Medical Sciences, Bhopal discomfort, chances of infection at both the recipient and donor sites, increased surgical time, resorption of the graft requiring secondary Abstract surgeries and the need for additionally skilled surgical team, which Background/Introduction has led to the search of alloplastic material that would be suit- Dental Implants have become an increasingly opted treatment modality able without the inherent problems. for the rehabilitation of edentulousness. The placement of dental Objectives implant requires preparation of recipient site using multiple sequential To access the role of custom fabricated titanium implants in drills resulting in various complications like post-operative pain, improving precise adaptation to the region of implantation, reducing swelling, peri-implant crestal bone loss and sometimes implants failure. surgical times, leading to lesser chances for infection, faster recovery Objectives and better cosmesis in craniofacial surgery. This prospective trial was performed to compare the clinical out- Methods comes between the use of single drill and conventional multiple A case of frontal bone defect caused after primary healing of gun shot sequential drills for implant site preparation. injury was reconstructed through hemicoronal ﬂap using CFTI. In Methods another case defect in the malar region after improper reduction of Fifty patients reporting to our institute requiring dental implant zygoma and zygomatic arch fracture was reconstructed via hemi- rehabilitation and having residual bone with height of minimum 10 coronal approach using CFTI. mm and width of minimum 5 mm were enrolled in the study. These Results patients were randomly allotted to either of the two groups, Study CAD/CAM systems have enabled us the ability to design and man- group (single drill group) or control group (multiple sequential drills). ufacture custom implants at an acceptable cost in a reasonable time. After three months these implants were loaded with a metal ceramic CFTI have an advantage of preventing donor site morbidity and crown. The parameters studied and statistically analyzed were oper- giving predictable results in maxillofacial reconstruction. ation time, postoperative pain, swelling, analgesic consumption and Conclusions peri-implant bone loss. Follow up period was up to 6 months from CFTI if becomes economical and easily accessible to maxillofacial implant loading. surgeons we can deﬁnitely avoid donor site surgeries with better 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S33 aesthetic and stable outcome. A team effort is mandatory for better ABS00560 outcome. The Socket Shield Technique: Bilaspur Experience References/Bibliography Sandeep Prakash, Ketaki Kinikar, Prakash Khare, Bhupendra 1. Jayanthi Parthasarathy 3D modeling, custom implants and its Kashyap future perspectives in craniofacial surgery Ann Maxillofac Surg. 2014 Jan-Jun; 4(1): 9–18. doi:10.4103/2231-0746.133065. Chhattisgarh Institute of Medical Sciences, Bilaspur

Abstract ABS00490 Background/Introduction Anterior esthetic implant placement requires exact three dimensional Immediate Vs Delayed Placement of Implants placement of implant fixture so that the hard n soft tissues maintain Following Split Crest Procedure to Augment Narrow their position. Extraction of a tooth invariably leads to loss of hard Alveolar Ridges: A Pilot Study tissue dimensions. There have been numerous methods for the maintenance of facial bone, ranging from immediate implant placement to socket preservation with GBR, but these have not been very 1. Dr. Himanshu Chauhan, MDS Senior Lecturer Co-Authors: 2. Dr. predictable. In-lieu of surgical procedures to prevent collapse of hard Shubha Lakshmi, MDS Professor, 3. Dr Puneet Wadhwani Professor tissue, the socket-shield technique offers a promising solution. Objectives Dept of Oral & Maxillofacial Surgery Saraswati Dental College, To analyse the efficacy of socket shield technique in preventing loss Lucknow (UP); Dept of Oral & Maxillofacial Surgery College of of facial bone and gingivae after immediate implant placement. Dental Sciences, Davangere (Karnataka); Dept of Oral & Methods Maxillofacial Surgery Saraswati Dental College, Lucknow (UP) Seven patients were selected for the study requiring immediate replacement of eight teeth. Six implants were placed in anterior Abstract region and two in premolar region using socket shield technique. Background/Introduction Results Narrow ridges pose a serious challenge for successful placement of In the eight cases where the socket shield technique was carried out, the endosseous implants. Alveolar ridge widening procedures is indicated results of the cases were followed up till 1 year post-treatment. Except for in cases of crest thickness of = 4.0mm. the one shield, the rest seven shields showed very encouraging results. Objectives Conclusions Evaluate and compare between immediate and delayed implant It is to be concluded that this technique is a highly promising addition to placement using split crest procedure to augment atrophic narrow aesthetic implant dentistry, further reaffirming the hypothesis that the alveolar ridges. retention of a prepared tooth root section as a socket-shield prevents the Methods recession of tissues buccofacial to an immediately placed implant. Ten patients were randomly divided into two groups of five (Imme- diate) and (Delayed). Implants were placed simultaneously following References/Bibliography split crest procedure in immediate technique and after 3–4 weeks of rst histological, clinical, and volumetrical observations after separa- healing in delayed technique, Loading was done at the end of 6 tion of the buccal tooth segment – a pilot study. Clin Implant Dent months and patients were called for periodic follow ups. Both the Relat Res 2015; 17: 71–82 Hurzeler MB, Zuhr O, Schupbach P, techniques were evaluated for amount of augmentation achieved and Rebele SF, Emmanouilidis N, Fickl S. implant success and survival rates. The socket-shield technique: a proof of principle report. J Clin Results Periodontol 2010; 37: 855–62. Baümer D1, Zuhr O, Rebele S, Statistically significant (p = 0.000) difference was observed for Schneider D, Schupbach P, Hu¨rzeler M. The socket-shield technique. implant stability at intra-op, 4 months between the two groups, There was no statistically significant difference in the amount of augmentation achieved between the two groups. 100 % success and survival ABS00566 rate was achieved using both the techniques. High positive correlation (R = 0.845) was noted between the amount of augmentation achieved Design and Development of Silicon Based Cartilage and the length of edentulous span. Like Ear, Nose, Eye, Orbital Implants for Craniofacial Conclusions Reconstruction We observed that both the techniques were comparable on the basis of augmentation achieved and implant success and survival rates, Dr. Biswajit Kumar Biswas whereas implant stability was significantly higher in delayed technique group. Although Periotest values of all the implants were within range of good stability range we felt the need to use bone grafts in two Avinash Dental Laboratory and Research Institute Pvt. Ltd, Kolkata, case of immediate technique group. West Bengal, India

References/Bibliography Abstract 1. Enislidis G, Wittwer G, Ewers R. Preliminary report on a staged Background/Introduction ridge splitting technique for implant placement in the mandible: a In twenty ﬁrst century, composite materials gained a lot of interest not technical note. Int J Oral Maxillofac Implants. 2006 May- only in material sciences but also it showed a wide range of use in Jun;21(3):445–9. medical sciences. Composite materials or simply composites are those 2. IE Zakhary et al. Oral Surg Oral Med Oral Pathol Oral Radiol materials made from two or more constituent materials with signiﬁ- 114 (5 Suppl), S179–S189. 2012 May 12. cantly different physical or chemical properties. The property of new composite may include stronger, lighter and/or less expensive when

123 S34 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 compared to traditional materials. Composite materials are used clinically just after placement and 3 months later at the abutment widely in dentistry for a long time. surgery. Bone healing and marginal bone changes were evaluated Objectives radiographically and clinical parameters evaluated were pocket depth, In the present study, we are trying to develop silicon based cartilage local infection, altered sensation, soft tissue dehiscence, pus dis- like bio-active implantable composite bio-materials to reconstruct the charge, implant mobility and patient’s satisfaction. loss facial tissue with minimum morbidity. The ideal outcome Results expected of an artificial implantable material is bio-integration. It The results revealed that there was a significant difference in pocket should not induce any deleterious /harmful effects or reaction such as depth and crestal bone loss in both groups. Mean pocket depth in chronic inflammatory response or formation of unusual tissues bar- immediate group was 3.285 mm and in delayed group mean pocket rier. Hence, it is of paramount importance to find outbiomaterials in depth was 3.523mm at 1 year respectively. There were minimal such a way, so that the graft materials or an implant produces such an crestal bone loss in immediate group as compared to delayed implant environment, where body tissue reacts favorably tissue in-growths group at 1 year follow up. Also there were reduced complication like towards the implanted materials. Biologically active materials are the local infection, altered sensation, soft tissue dehiscence, pus discharge choice today instead of biologically inert material. in immediate implant placement group. And resulted in patient’s Methods satisfaction. Different bio-materials are added to the silicon in different permu- Conclusions tation and combination process and finally characterization for the We conclude that the immediate dental implant placement is signif- new composites done. icantly superior over the delayed implant placement. Results Results are highly satisfactory in terms of bio-compatibility with References/Bibliography animal trails. Immediate Versus Delayed Loading of Dental Implants Placed in Conclusions Fresh Extraction Sockets in the Maxillary Esthetic Zone: A Clinical There is an absolute need of cartilage like biomaterials which are not Comparative Study. available at present in the world market, in the field of reconstructive surgery. We have understood the bio-physics of the implant problem and try to find out the alternative means to solve these problems. Hope these new material can shows new hope in the field of cartilaginous alloplastic bio -materials. ABS00650 Ridge Preservation Techniques in the Anterior References/Bibliography Aesthetic Zone for Implant Placement 1. Physicians at Massachusetts General Hospital in Charlestown, using magnetic resonance imaging, found that a significant Dr. Sheetal Kelkar amount of free silicone had migrated from an implant (not noticeably ruptured) into the liver and spleen of a woman. YMT Dental College and Hospital (Magnetic Resonance Medicine 36:3 [September 1996], 498–501. Researchers also found that silicone in the liver could be detected Abstract in the first three to four years after a woman received her implant. (Magnetic Resonance Medicine 33:1[January 1995], 8–17.). Background/Introduction Extraction of a tooth sets in progress a number of changes that lead to loss bone and soft tissue support. The bone width loss in the highly aesthetic zone of the premaxilla is primarily from the facial region because the labial plate is very thin compared with the palatal plate ABS00603 and facial undercuts are often found over the roots of the teeth. Hence Clinical Outcome of Immediate Verses Delayed Dental this region often requires both hard tissue and soft tissue restoration Implants: A Prospective Study before placement of an implant. However it is advantageous to preserve the dimension of the post-extraction ridge instead of reconstructing it thereafter, thus maintaining its ideal vertical and Dr. Rushit Patel, Narsinhbahai Patel horizontal dimensions and decreasing patient morbidity. Objectives Dental College and Hospital Visnagar, Gujarat, India The aim of this study is to discuss and evaluate various techniques of ridge preservation of the aesthetic anterior region. Abstract Methods Background/Introduction Various techniques of ridge preservation including the socket seal The implant surgical protocol proposed by Bran mark et al involves (grafting), soft tissue grafting, socket shield technique, root submer- open flap access, stepwise osteotomy of the bony ridge, and implant gence technique etc. are discussed and evaluated. placement followed by good primary closure. Results Objectives The preservation of ridge after extraction helped in optimal placement To compare the radiographic marginal bone loss, pocket depth and of implant and avoiding the complicated grafting procedures at the along with that clinical outcome associated with immediate and time of implant placement. delayed implants, and success rates two years after the placement of Conclusions implants. Ridge preservation procedures are effective in limiting horizontal and Methods vertical ridge alterations in post extraction sites. Also the maturation Total 62 Dental implants were placed in 42 patients, they were ran- and mineralization of the newly formed bone in the extraction socket domly selected to the Immediate or Delayed group. In that 30 were is accelerated or improved by ridge preservation. This facilitates the immediate implants and 32 were delayed implants. The width and placement of an implant in a correct 3-dimensional position opti- depth of marginal bone defects around the implants were measured mizing its aesthetic and functional outcome.

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References/Bibliography tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:e56–e60. 1. Brandom L, Malmstrom H, Jawed F etc. Ridge Preservation Lundgren S, Cricchio G, Palma VC, et al. Sinus membrane elevation Techniques in the Anterior Esthetic Zone. Implant. Dent. 2015; and simultaneous insertion of dental implants: A new surgical 24(6): 699–712. technique in maxillary sinus ﬂoor augmentation. Periodontol 2000. 2. Darby I, Chen S, Buser D. Int J Oral Maxillofac Implants. 2009; 2008; 47:193–205. 24: 260–71.

ABS00797 ABS00676 A Systematic Evaluation of Membranes Used in Guided Use of PRF as the Sole Grafting Material After Sinus Bone Regeneration Procedures in Oral Implantology Membrane Elevation and Immediate Implant Placement in the Posterior Maxillary Region Dr. Nitin Verma

Dr Sachin Rasal, Senior Resident, Dr Anshul Rai, Assistant Professor Government Dental College and Hospital Amritsar

All India Institute of Medical Sciences, Bhopal Abstract Background/Introduction Abstract Membranes have been used extensively in advance cases of oral Background/Introduction implantology. Most commercially available resorbable membranes Conventionally, autogenous bone graft was considered the gold standard used are made of collagen which is cross linked barrier. Whereas non in the maxillary sinus floor grafting procedures. However, following resorbable membranes are made up of Titanium PTFE. Since they research and advances in the field of implant dentistry, many substitutes dont get dissolved with saliva or blood, they have high predictability were devised. These included synthetic graft materials which avoided the in bone reveneration. common complications associated with autogenous graft materials. Objectives Later, certain growth factors were discovered which enhanced and To evaluate resorbable and non resorbable membranes in terms of accelerated the bone formation process and was initially used only in membrane exposure, graft resorption, height gained or reduced, aes- conjunction with graft materials. However, later many studies were thetic results and patient satisfaction. conducted to decisively prove that growth factors alone were required for Methods the bone forming process irrespective of the use of graft materials. The study was done on 10 patients who required bone augmentation Objectives with Immediate and or delayed implant placement using resorbable vs To assess the increase in alveolar bone height after sinus membrane non resorbable membrane. elevation & implant placement without bone graft and use of PRF. To Results assess the implant survival in the posterior maxilla with the direct It was found that in terms of Membrane exposure, less grafy technique of sinus membrane elevation procedure and implant resorption bone height gained was remarkably more with non placement without bone graft and use of PRF. resorbable. But patient satisfaction was same in both groups. Methods Conclusions 10 sinus elevations with simultaneous implantation were performed Non resorbable is definitely more predictable with bone regeneration on 10 patients with Choukroun’s PRF as the sole filling biomaterial. in implant dentistry with unavoidable problems of 2nd surgery and For each patient, a presurgical exam and a 1, 4 and 6-month post- costly availability. surgical radiologic exam were performed with a panoramic x-ray and three-dimensional CBCT to evaluate the sub-sinus residual bone References/Bibliography height and the final bone gain around the implants. Long-term outcome of implants placed with guided bone regeneration Results (GBR) using resorbable and non-resorbable membranes after 12–14 In this study, 21 implants from different systems with different screw years. designs were placed. All implants were inserted in residual bone height between 1.5 and 6 mm (mean ± SD: 2.9 ± 0.9 mm). The final bone gain was always very significant (between 7 and 13 mm [mean ± SD: 10.1 ± 0.9 mm]). No implant was lost. After radiologic ABS00842 analyses, the position of the final sinus floor was always in the con- The Bone Formation at the Maxillary Sinus Floor tinuation of the end of the implant. Following Simultaneous Intra Alveolar Elevation Conclusions of the Mucosal Lining and Implant Installation Without From a radiologic point of view at 6 months after surgery, the use of PRF as the sole filling material during a simultaneous sinus lift and Graft Material: Prospective Clinical Evaluation implantation stabilized a high volume of natural regenerated bone in the subsinus cavity up to the tip of the implants. Choukroun’s PRF is a Dr Mrs Varsha S Manekar, MDS & PhD Scholar Associate Professor simple and inexpensive biomaterial, and its systematic use during a sinus lift seems a relevant option, particularly for the protection of the Oral & Maxillofacial Surgery, GDCH, Nagpur Schneiderian membrane. References/Bibliography Abstract Background/Introduction Choukroun J, Diss A, Simonpieri A, et al. Platelet-rich fibrin (PRF): A In the posterior maxillary quadrant, insertion of implants of desired second generation platelet concentrate. Part IV: Clinical effects on length and diameter is often limited by the dimensional alterations of

123 S36 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 the residual ridge as well as the pneumatization of the maxillary sinus occurring after tooth loss. Intra alveolar sinus floor elevation repre- Section: Oral Precancer and Cancer sents a surgical option to vertically enhance the available bone in the posterior maxillary quadrant through an access created in the edentulous bone crest. Restoration of this condition has for last two ABS0085 decades been successfully treated with various sinus augmentation techniques and installation of dental implants. The use of graft To Evaluate Factors Involved in Delayed Presentation material is anticipated to be necessary. However recent studies have of Oral Cancerous Lesion in Rural Areas demonstrated that the mere lifting of the sinus mucosal lining and simultaneous placement of implants results in bone formation. This Dr. Harish Saluja Reader study is conducted to evaluate the intra alveolar sinus lift and simultaneous implant placement without graft. PICO-problem is Dept of OMFS, RDC, LONI-413736 reduced subantral bone in the posterior maxilla, in patients (Popula- tion) indicated for implant supported prosthesis, intervention is intra alveolar hydrolic sinus lift; expected outcome is increase in subantral Abstract bone resulting in use of adequate length of implant indicated and Background/Introduction success of implant. In India the incidence of oral cancer is very high. The tumor size has Objectives been classified according to their sizes from T1 to T4. At our institute Primary objective is to evaluate bone formation at the maxillary sinus more than 70% of the cases encountered are of T3, T4 size. Many of floor (subantral bone) following simultaneous intra alveolar elevation the times tumor reported to us become nonoperable. There are evi- of the mucosal lining and implant installation without graft material dences that early detection of oral cancer in its early stages has a great Secondary objectives are –1. primary stability of implant at the time positive influence on the prognosis of the disease, treatment results of first stage surgery 2. success of implant. and it may also improve significantly the person’s quality of life Methods (Allison et al. 1998; Baykul et al. 2010). Tumor size influences Study design is prospective clinical study. The dependant variable is therapy and prognosis of oral cancer. Patients with oral cancer often sub antral bone height and independent variable is sinus lift proce- present late to the doctor making treatment difficult, expensive and dure. A prospective study is carried out in patients with inclusion sometimes unsuccessful. There is huge difference between staging at criteria of subantral bone 4mm–7mm with adequate alveolar width which patient reports to rural and urban centers. So we decided to find and indicated for implant prosthesis. A sample size of 15 patients out the reasons behind such delayed presentation of oral cancer underwent implant placement simultaneously with sinus lift proce- patients. dure. The sinus lift procedure is intra alveolar with sequential drilling. Objectives The sinus lining is lifted with hydrolic pressure. The implant is placed The aim of the study was to find out the % of tumor size reporting to in the osteotomy directly without any graft placement. The cover our rural institute and reasons behind reporting of patient at such a screw is placed and sutured. The healing period for osseointegration is late stage. 6 months. Then the implant is loaded with prosthesis and brought into Methods function. The post-operative x-rays shows the tenting of the sinus Study included 300 oral cancer patients and tumor size was noted. A membrane above the end of implant. The follow up x-rays and CBCT questionnaire was prepared to find out the reason behind such late shows bone formation here. presentation. Time lapse was also noted between first presentation of Results any sign/symptom or first notification by the patient till patient There is mean increase of 3mm, with range of 3–6mm, subantral reported to our department. bone. All the implants were successful according to criteria of Buser Results et al. The sinus lining remained intact in all cases and the primary Self negligence, reluctant attitude towards health and negative atti- stability ranging from 20 to 30 nm was achieved. The CBCT imaging tude of relatives towards cancer patient was big reason for late shows that sparse bone is formed above the implant although good reporting. Even misguidance/inability to diagnose lesion by local quality bone is seen around the implant in tented sinus floor. In cases doctors was another big reasons for late referral to onco centers. of more than one implants there is continuous increase in bone Conclusions formation. Awareness is required in rural areas for issues related to health. Even Conclusions health professionals of rural areas require training to screen out sus- The bone formation at the maxillary sinus floor following simulta- pected cancerous lesions. neous intra alveolar elevation of the mucosal lining and implant References/Bibliography installation without graft material is a successful technique. It is less invasive and more acceptable to the patients. Kademani D, Bell RB, Bagheri S, et al.: Prognostic factors in intraoral squamous cell carcinoma: the influence of histologic grade. J Oral References/Bibliography Maxillofac Surg 2005; 63: 1599–1605. 1. He LL, Chang X, Liu Y. Sinus floor elevation using osteotome technique without grafting materials: a 2-year retrospective study. Clin. Oral Impl. Res. 24 (Suppl. A100), 2013, 63–67 doi: 10.1111/j.1600-0501.2011.02376.x. 2. Seyed Amir Danesh-Sani, Petre M Loomer, Stephen S Wallace; A comprehensive clinical review of the maxillary sinus floor elevation: anatomy, technique, biomaterials and complications.

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ABS00124 Methods Predictability of Depth of Tumor Invasion, Tumor Series of five cases done with one year follow up. Results Budding & Worst Pattern of Invasion as Risk Factor Modified nasolabial biwinged flap is advantageous than conventional for Nodal Metastasis one MIcrostomia is minimal Reach of flap from retromolar region to commisure is adequate. Dr Vijaykumar J Girhe Conclusions Modified biwinged naso labial flap is comfortable than conventional flap in advanced cases. DR HSRSM Dengan College Hingoli References/Bibliography Abstract Background/Introduction Extended nasolabial flap in the management of oral sub mucous Oral squamous cell carcinoma is characterized by highly variable fibrosis -BJOMS 2009 382–385 RM Borle, PV Nimonkar, R. Rajan. prognosis even in early stage disease. Nodal metastasis is amongst most important prognostic factor. Objectives To verify the predictability of depth of tumor invasion, tumor budding ABS00221 & worst pattern of invasion as risk factor for nodal metastasis. Surgical Margin in Oral Cancer: How Close can We Methods Get? Depth of tumor invasion, Tumor budding & worst pattern of invasion were studied in 20 cases of T1/T2 N0M0. Oral squamous cell carcinoma managed in our hospital were reviewed histologically. Dr Praveen Satish Kumar, Dr Omkar Shetye, Dr Rakshit Results Khandeparkar Tumour budding and depth of invasion were associated with poor prognosis in patients with early oral squamous cell carcinoma. The Goa Dental College and Hospital, Goa, India worst pattern of tumour invasion was also found to be an independent prognostic factor. Abstract Conclusions Background/Introduction Depth of tumor invasion, Tumor budding & worst pattern of invasion The ideal width of the surgical margin for oral cancer has always been are reliable risk factors for nodal metastasis in early oral squamous an issue of debate. Microscopic tumor at the inked resection margin cell carcinoma. increases the chance of local recurrence by a factor of 2. The most References/Bibliography widely accepted definition of a close margin is tumor within 5 mm of the inked resection margin. This an arbitrary designation and when 1. Ganly I, Patel S, Shah J. Early stage squamous cell cancer of the recurrence rates are specifically cited for close margins, they are oral tongue—clinicopathologic features affecting outcome. generally less than the rate observed for patients with tumor at the Cancer 2012;118: 101–111. inked resection margin. Patients with clear but close margins are often 2. Ho CM, Lam KH, Wei WI, Lau SK, Lam LK. Occult lymph node considered from a clinical standpoint to have positive or inadequate metastasis in small oral tongue cancers. Head Neck margins. The precise definition of the clear or adequate surgical 1992;14:359–363. margin is an important prognostic consideration with clinical impli- 3. Kellermann MG, Sobral LM, da Silva SD, et al. Myofibroblasts cations in the selection of patients for adjunctive treatment. in the stroma of oral squamous cell carcinoma are associated with Objectives poor prognosis. Histopathology 2007;51:849–853. The aim of this review is to evaluate the definition of close margin in head and neck squamous cell carcinoma and its possible prognostic significance. Methods ABS00205 A scopus /PubMed search was done to retrieve articles discussing adequate surgical margin in HNSCC. A double cross-check was Bi Winged Nasolabial Flap: A Modified Reconstruction performed on citations and full-text articles. Approach for Submucous Fibrosis Results This systematic evaluation of surgical margins suggests that an ade- Dr. R. Murugan MDS Fiboms quate resection in oral cancer should provide a margin of greater than 3 mm on permanent pathology section. Conclusions Rajah Muthiah Dental College and Hospital Pathology reports should designate the distance in millimeters of tumor from the inked mucosal and deep resection margin to facilitate Abstract ongoing evaluation. Intraoperative assessment of margin status needs Background/Introduction to be refocused to examine the proximity of tumor to, as well as Surgical management of submucous fibrosis includes various flaps involvement, of the deep surgical margin. and grafts. Amongst all nasolabial flap is the most accepted and gold standard reconstructive option till followed. But conventional naso- References/Bibliography labial flap has its own merits and limitations in advanced cases. So we have done a series of cases with bi winged flap in our centre. What is the adequate margin of surgical resection in oral cancer? Objectives doi.org/10.1016/j.tripleo.2008.11.013. To give adequate access of flap till commisure after releasing circum oral bands to prevent post Operative microstomia.

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ABS00282 ABS00398 Evaluate the Efﬁcacy of an Absorbable Bilayer Does Adjuvant Therapies Improve Outcomes in pT1-3 Collagen Membrane in Cases of Oral Submucous Oral Cavity Cancer with Tumor-Free Margins Fibrosis and Perineural Invasion?

Dr Pragya Harsh Ex Resident, 2 Dr Dk Gupta Ex-HOD, 3 Dr Dr. Ashish Sharma Ashutosh Harsh Assistant Professor General Dentistry Kothiwal Dental College and Research Centre, Moradabad Dr SN Medical College; Government Dental College Jaipur; Dr SN Medical College Jodhpur Abstract Background/Introduction Abstract The criteria for administration of adjuvant therapies in oral cavity Background/Introduction squamous cell carcinoma (OSCC) remain controversial, and it is Oral Submucous fibrosis (OSMF) is a chronic, complex, irreversible, unclear whether patients with pT1-3N0 disease benefit from adjuvant highly potent pre-cancerous condition that affects the entire oral chemo-radiation or radiation in the presence of free margins and cavity which predominantly affects the people of southeast Asia. It perineural invasion. characterized mainly by two symptoms, burning sensation in the Objectives mouth while eating spicy food in early stages of the disease and The goal of this report was to determine whether the groups would trismus in the late stages of the disease. Numerous non-surgical and benefit from adjuvant radiation or chemoradiation therapy in terms of surgical methods have been employed for treatment of this disease. In 5-year local control rate and overall survival rate. our cases we use an absorbable bilayer collagen membrane. After Methods fibrotomy for replacement. We retrospectively reviewed our case records from January 2006 to Objectives May 2017. In all, 180 cases of pT1-3N0 OSCC patients had tumor- The aim of our study, to assess the efficacy and usefulness of a free margins, of whom 24 had perineural invasion. Postoperative commercially available absorbable bilayer collagen membrane in adjuvant RT and postoperative concomitant chemo-radiation therapy surgical management of Oral submucous fibrosis. were used for patients. Local control and overall survival rates were Methods plotted by Kaplan-Meier analysis for the three groups that is only Xenogenous collagen membrane supplied by EUCARE pharmaceu- surgery, surgery with RT and surgery with concomitant chemo- ticals private limited; Chennai will use for the study. Procedure would radiation. include resection of fibrous bands, intra operative forced mouth Results opening, followed by covering the raw mucosal defect with a com- The results revealed that local control and survival were insignificant mercially available absorbable bilayer collagen membrane. Collagen among the three groups and the addition of adjuvant radiotherapy and membrane will thoroughly washed in sterile saline solution and will chemotherapy did not significantly alter the 5-year local control rate (p cut by scissors in slight excess of the wound size and sutured to the \0.05) or the overall survival rate (p \ 0.05) in patients with per- edges of the wound by the use of vicryl sutures. They will be inural spread. instructed to quit the habit completely. Patients will be required to Conclusions continue with postoperative physiotherapy along with nutritional Altogether, these data seem to indicate that radical surgical resection supplements. alone should be considered a sufficient treatment for OSCC patients Results with pT1-3N0 disease, even in the presence of perineural invasion. The collagen membrane used to cover the buccal defects after fibrotic bands release had excellent results in total thirty cases we have gain References/Bibliography good results take less suturing time so less operating time, good 1. Ballantyne AJ, McCarten AB, Ibanez ML. The extension of interincisal opening, good postoperative healing, less post pain, less cancer of the head and neck through peripheral nerves. Am J Surg Contracture. Patient have preoperative interincisal distance of 0–15 1963;106: 651–667. mm and post operative interincisal distance of 25–35 mm. 2. Batsakis JG. Nerves and neurotropic carcinomas. Ann Otol Conclusions Rhinol Laryngol 1985;94:426–427. We concluded that the advantages of using bilayer collagen membrane to cover the defect of oral mucosa are easily availability, simplicity of procedure, good tolerance of membrane by oral tissue, no need to perform a second operation for obtaining a graft or detachment of the pedicle, no morbidities as associated with various ABS00466 other grafts and no problems associated with donor site healing. Impact of Depth of Invasion, Perineural Invasion and Lymph Node Involvement on Disease Free Survival References/Bibliography in Head and Neck Cancer Patients 1. Comparative Clinical Evaluation of Buccal Fat Pad and Collagen in Surgical Management of Oral Submucous Fibrosis. Nataraj S, Dr Mayank N Patil Guruprasad Y, Shetty JN. Archives of Dental Sciences 2011; 2: 1 15–22. 2. The Efficacy of Collagen Membrane as a Biodegradable Wound HCG Manavata Cancer Centre, Nashik Dressing Material for Surgical Defects of Oral Mucosa: A Prospective Study. Rastogi S, Modi M, Sathian B. J Oral Abstract Maxillofacial Surg 2009;67:1600–160. Background/Introduction Head and neck cancers are the most common type of cancers worldwide. Cervical lymph node metastasis is one the known

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S39 prognostic factor which lowers the survival rate by 50%. Recent data Many studies have reported iatrogenic SAN injury are seen in suggest that Depth of invasion is better predictive parameter than 60–80% of patients who undergo RND, 1.68% in patients who tumor thickness and is a significant predictor of nodal metastasis. undergo MRND and in 30 % of patients who undergo SND which Objectives includes the cervical lymph node level II–IV. We present a study of 1) to determine the role of depth of invasion in predicting disease free evaluation of SAN of patients who had underwent exclusively survival 2) to evaluate the role of nodal staging on disease free sur- selective neck dissection for squamous cell carcinoma involving head vival 3) to check the impact of nodal positivity on disease free and neck region over a period of 5 years prospectively. survival. Objectives Methods The Aim of the study is to describe the function of spinal accessory It is a retrospective study which was conducted in HCG Mnavata nerve (SAN) postoperatively after performing neck dissection due to Cancer Centre, Nashik. In this study we included 100 patients who oral cancer and also to describe the modalities of trauma to the SAN had undergone surgery for Head and neck cancers. The depth of while doing different type of neck dissection. invasion and pathologic nodal status was noted and its effect on Methods disease free survival was monitored. This study was done Between 2012–2017, Patients reported (male - Results 305 female - 245) with mean age of 54 years with a range of 39–69 It was found that patients with primary tumor having depth of inva- years receiving all SND performed by a single surgeon who belongs sion more than 5mm and positive lymph node had disease free to the department of Head & Neck Oncology services, Karpaga survival ranging from 4–6months. Vinayaga Institute of Medical & Dental Sciences, Kanchipuram dis- Conclusions trict, Tamilnadu were studied. None of the patients had metabolic It is concluded from the study that the patient with depth of invasion disorders, muscle disease, concomitant rheumatological disorders, more than 5mm and positive lymph node have greater chance of with no history of previous trauma and no history of any surgery recurrence. related to the neck. We identified the SAN in all SND done patients by dissecting the sternocleidomastoid muscle and retracting it pos- References/Bibliography teriorly to identify the entry point of SAN nerve at the junction of 1. Head and Neck Cancers—Major Changes in the American Joint upper third and middle third of posterior border of sternocleidomas- Committee on Cancer Eighth Edition Cancer Staging Manual. toid muscle. Identified SAN were retracted with use of vessel loop to William M. Lydiatt CA Cancer J Clin 2017;67:122–137. prevent it from injury during surgery. It was then meticulous dis- 2. The Indian scenario of head and neck oncology – Challenging the section were carried out to clear level IIa and IIb group of lymph dogmas Vidisha Tuljapurkar, South Asian Journal of Cancer nodes. All patients shoulder function was assessed pre operatively and July-September 2016 Volume 5 Issue 3. post operatively by the arm abduction test. Based on the abduction of arm resulting in a value from 1 (abduction \ 90 degree) to value 5 (abduction [180 degree). Results Arm Abduction test after performing neck dissection were carried for ABS00479 all the patients in the frequency of I week, III week, I month, III Post Operative Assessment of Spinal Accessary Nerve month & VI Post-operatively (Includes after radiation therapy). Based Function of Patients Undergoing Neck Dissection on the abduction of arm resulting in a value from 1 (abduction \ 90 for Oral Cancer: A Prospective Study degree) to value 5 (abduction[180 degree) the results were tabulated as follows: Totally 550 patients, in which 426 patients were satisfied the study up to the follow up of 6th month post -operatively, Dr. Vinod Krishna, K, Dr. Mathan Mohan, Dr. B. Bala Guhan, Dr. remaining patients were not able to follow up to the institution due to G. R. Karthikeyan various reason. Conclusions Oral Cancer Foundation, Head & Neck Services, Karpaga Vinayaga Shoulder dysfunction after neck dissection gives a consideration Inst. of Medical & Dental Sciences, Madhurantakam, Tamil Nadu - about the spinal accessory nerve (SAN) while performing neck dis- 603 319 section in Sub level IIB. Even we preserve the SAN clinically (intra operatively), we suggest that prevention of SAN from thermal injury Abstract during dissection from cautery, careful retraction of Sternocleido- Background/Introduction mastoid muscle, shoulder exercise physiotherapy even after radiation The eleventh cranial nerve, otherwise termed as spinal accessory therapy must be educated for the patients post operatively to maintain nerve (SAN) which innervates the trapezius and sternocleidomastoid the function of the shoulders. muscle. Trapezius muscle acts as a stabilizer for scapula and makes it References/Bibliography to rotate, elevate and also to retract. Head and neck cancer tops at the sixth level of all cancer in the worldwide. One of the prognostic factor 1. Shoulder complaints after nerve sparing neck dissections, van of squamous carcinoma mainly depend on the involvement of the Wilgen CP1, Dijkstra PU, van der Laan BF, Plukker JT, level of cervical lymph nodes. For many years addressing the cervical Roodenburg JL., Int J Oral Maxillofac Surg. 2004 group of lymph nodes surgically by radical neck dissection (RND) Apr;33(3):253–7. was a golden standard technique for head and neck squamous cell 2. Shoulder disability after different selective neck dissections carcinoma which sacrifices SAN, sternocleidomastoid and internal (levels II–IV versus levels II–V): a comparative study. Cappiello jugular vein. Sacrificing SAN leads to denervation and atrophy of the J, Piazza C, Giudice M, De Maria G, Nicolai P. Laryngoscope. trapezius muscle with onset of shoulder disability showing limited 2005 Feb; 115(2):259–63. range of motion, pain, muscle weakness and drooping. In order to reduce these functional morbidities modified radical neck dissection (MRND), selective neck dissection (SND) were preferred recently.

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ABS00512 further sub grouped into =70years and [70years groups. The asso- Treatment Algorithm in Oral Submucous Fibrosis ciation of these groups with various factors like co-morbidities, type of reconstruction, tumour factors –peri-neural invasion, extra-capsular Based on OSMF Scoring Index: A Prospective Study spread and adjuvant therapy was assessed. Uni and multi-variate analysis of factors affecting overall survival (OS) and disease free Dr Pawan Dawane; Assistant Professor survival (DFS) was done. Results RRK Dental College & Hospital, Akola Male to female ratio was 2:1. Median follow was 48 months. There was no difference in association of Clinico-pathological factors, Abstract reconstruction choice, adjuvant therapy completion, OS and DFS Background/Introduction between the =70 and [70 years sub-group (p[0.005). The OS of the Oral submucous fibrosis is poorly understood and unsatisfactorily entire cohort was 46.1months while DFS was 37.5months. On mul- treated disease with obscure etiology. tivariate analysis, tumour thickness, adjuvant received, extracapsular Objectives spread, nodal involvement were found to be significantly affecting We have classified the disease in different groups according to the both OS &DFS (p\0.005). Of the patients advised adjuvant therapy, OSMF scoring Index and treated them according to the stage of 93.6% of them could complete it. disease. Conclusions Methods There is no difference in tumor biology, association with different 93 patients of oral submucous fibrosis and classified them into three clinico-pathological factors and survival in patients=70 and[70years groups based on OSMF scoring Index and given specific treatment for of age. Majority of patients could complete the adjuvant therapy each group. Group A (n=31) patients treated with medicines, Group B advised to them thus indicating no requirement of de-escalating (n=31) treated with intra lesional injections and Group C (n=31) treatment in them in view of the age. treated with surgical therapy and followed them up for 2 years References/Bibliography regularly. Results 1. Kowalski LP, Alcantara PS, Magrin J et al. A case-control study Almost all patients got symptomatic relief from the disease. Patient’s on complications and survival in elderly patients undergoing interincisal mouth opening increased significantly. All patients can major head and neck surgery. Am J Surg 1994;168:485–490. take regular diet. Progressive malignant transformation can be diag- 2. Huisman MG, et al., Delivering tailored surgery to older cancer nosed earlier to avoid future morbidity and mortality. patients: Preoperative geriatric assessment domains and screen- Conclusions ing tools e A systematic review of systematic reviews, Eur J Surg Oral submucous fibrosis (OSMF) scoring index is reliable method to Oncol (2016), http://dx.doi.org/10.1016/j.ejso.2016.06.003. decide the severity of disease and progress. Based on this scoring and grouping, we can give definite prompt treatment to the patients with satisfactory results. References/Bibliography ABS00607 Use of Buccal Fat Pad for Treatment of Oral 1. Pindborg JJ, Sirsat SM (1966) Oral submucous fibrosis. Oral Surg Submucous Fibrosis Oral Med Oral Pathol Oral Radiol Endod 22:764–779.

Col MK Rath ABS00586 AFDC, New Delhi Treatment Outcome of Geriatric Patients with Oral Squamous Cell Carcinoma (OSCC): Rationale Abstract in Indian Scenario Background/Introduction The buccal fat pad (BFP) is a supple and lobulated mass, easily accessible and mobilized. It is a well accepted graft for defects after Prashant Chopda, Akshat Malik, Aseem Mishra, Pankaj Chaturvedi, incision of fibrotic bands in the surgical management of oral sub- Prathamesh Pai mucous fibrosis (OSMF). Objectives Dept. of Head & Neck Oncology, Tata Memorial Centre (TMC), The aim of this study was to clinically evaluate the application of Mumbai pedicled BFP in the surgical management of stage III and IV OSMF. Methods Abstract Twenty-eight cases of clinically and histologically diagnosed cases Background/Introduction of OSMF were divided into 2 groups: group I (n=15) and group II Geriatric patients ([65 years) constitute a significant number of oral (n=13), corresponding to clinical stage III and stage IV, respec- cancer patients. They are a special group of patients who have unique tively. All the patients underwent incision of fibrotic bands and issues like multiple co-morbidities, poor performance status or poor coverage of the buccal defect with a pedicled BFP flap. Both social support. groups were analyzed separately for mouth opening (interincisal Objectives distance in millimeters) preoperatively and 1 year postoperatively, There is a need to separately evaluate the tumour characteristics, time taken for epithelialization of BFP, time taken for establish- behaviour and outcomes in these patients. ment of normal contour, and changes in symptoms (painful Methods ulcerations, burning sensation, and intolerance to spices) 1 year This was a retrospective analysis of prospectively collected data of after grafting. 140 geriatric OSCC patients operated from 2012 to 2013. They were

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Results aesthetic outcome as the scar is hidden in the hairline. No serious The mean preoperative mouth opening was 19.6 mm (SD, 2.43) in adverse outcomes were observed in any patients. group I and 12.92 mm (SD, 1.21) in group II. The mean postoperative Conclusions mouth opening after 1 year was 35 mm in group I (SD, 1.96) and In a resource poor setting where Robotic surgery system is not 31.76 mm in group II (SD, 1.97). The time taken for epithelialization available, endoscope assisted retro-auricular neck dissection gives us of BFP was 4 weeks in group I and 5 weeks in group II. The mean good cosmetic outcomes without compromising oncological safety in time taken for establishment of normal contour after grafting was early oral cavity cancers. 12.25 weeks (SD, 1.42) in group I and 15.07 weeks (SD, 1.26) in group II. In 2 cases in group II, there was remission of painful References/Bibliography ulcerations, burning sensation, and intolerance to spices. 1. Robotic-assisted selective and modiﬁed radical neck dissection in Conclusions head and neck cancer patients; Nikolaus Mo¨ckelmann et al.; BFP is reliable for the treatment of OSMF. International journal of Surgery, January 2016, Volume 25, Pages References/Bibliography 24–30. 2. Approaches of robot-assisted neck dissection for head and neck Rohit Sharma, G. K. Thapliyal, Ramen Sinha, P. Suresh Menon, J cancer: a review; Shanghui Zhou, Chen ping Zhang, Daqing Li; Oral Maxillofac Surg 70:228–232, 2012. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiol- ogy, Volume 121, Issue 4, April 2016, Pages 353–359.

ABS00633 Study of Retro Auricular Endoscope Assisted Selective ABS00640 Neck Dissection for Early Oral Cavity Cancers Primary Intra-Osseous Squamous Cell Carcinoma in Mandible: Tumor Size [ 4cm Significantly Reduces 1) Dr Sagar Shridhar Vaishampayan, Consultant Maxillofacial & Loco-Regional Control and Survival Oral Cancer Surgeon, 2) Dr Prashant V Pawar, Consultant Head Neck & Skull Base Surgeon Dr Sandhya Gokavarapu. MDS, Consultant Head and Neck Oncologist, YiMing Chen, Resident 1) Apollo Hospital, Navi Mumbai; 2) Fortis Hospital, Mumbai KIMS Hospitals Hyderabad; Shanghai Ninth People Hospital Abstract Background/Introduction Abstract Conventional operation for oral cavity squamous cell carcinoma Background/Introduction includes resection of primary tumour and neck dissection. This in Primary intra-osseous squamous cell carcinoma (PIOSCC) is the most cases results in a grossly visible scar leading to stigma of a subgroup of oral cancer that is by default staged as stage IV by UICC visible scar with fibrotic band formation. Recently numerous surgical or AJCC because of bony involvement irrespective of size, since; this approaches have been developed in conjunction with a Robot in order is a special rare scenario; staging is ambiguous and needs scrutiny. to avoid these complications. The Robot is an expensive equipment The clinical and pathological features of are not well understood since and not affordable for resource poor settings. We therefore explored the literature is sparse with few clinical papers that either reported a the efficacy of a Retro auricular Endoscope assisted selective neck small series or a single case report. We analyzed the cases of PIOSCC dissection in early oral cavity squamous cell carcinoma. The aim of from a single institute database of a tertiary referral hospital to find our study was to observe surgical outcomes of Retro auricular the prognostic factors. Endoscope assisted selective neck dissection. Objectives Objectives To find the prognostic factors of primary intra-osseous Squamous cell Conventional operation for oral cavity squamous cell carcinoma carcinoma. includes resection of primary tumour and neck dissection. This in Methods most cases results in a grossly visible scar leading to stigma of a A retrospective study for primary intra-osseous squamous cell car- visible scar with fibrotic band formation. Recently numerous surgical cinoma patients treated in a head and neck department of tertiary approaches have been developed in conjunction with a Robot in order hospital from 2010 to 2015 was executed. The clinical, radiological, to avoid these complications. The Robot is an expensive equipment pathological, treatment information was collected. Statistical analysis and not affordable for resource poor settings. We therefore explored was performed for the data collected. the efficacy of a Retro auricular Endoscope assisted selective neck Results dissection in early oral cavity squamous cell carcinoma. The aim of There were a total number of 36 patients treated in the given time our study was to observe surgical outcomes of Retro auricular period, among which 34 had followed up, the minimum period of Endoscope assisted selective neck dissection. follow up was 12.00 months. 28 patients received postoperative Methods radiotherapy. 9 patients died by the end of the study period. We From August 2016 to July 2017, 21 patients of early oral cavity observed significantly lower loco-regional control and survival among cancer (c T1/T2 N0) were enrolled into this observational study. Total patients with tumors[4cm (p\0.01) in size, 100% of patients with =4 duration of surgery was recorded. Patients were then observed for tumor size were alive while 30.7% of patients with[4cm were alive, other factors such as intra-operative and postoperative complications the result was consistent in multivariate analysis, further; patients & pathological factors especially the lymph node yield. with positive lymph node had lower survival (P\0.01). Results Conclusions Mean total operative time of endoscopic assisted technique was 130 Neck metastasis and tumor size [ 4cm significantly reduces loco- minutes. Patients with retro auricular neck dissection have better regional control and survival in PIOSCC. tumor staging for this entity need evaluation. 123 S42 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

References/Bibliography ABS00685 1. To EH, Brown JS, Avery BS, et al. Primary intraosseous Predictable Results in OSMF with the Use of Nasolabial carcinoma of the jaws. Three new cases and a review of the Flap literature.[J]. British Journal of Oral & Maxillofacial Surgery, 1991, 29(1):19–25. Dr. Shweta Bhatnagar, Associate Professor 2. Cavalcante AS, Carvalho YR, Cabral LA. Tender mandibular swelling of short duration.[J]. Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics, 2002, 93(93):167–170. Bundelkhand Medical College, Sagar, MP

Abstract Background/Introduction ABS00660 Oral submucous fibrosis is a precancerous and potentially malignant condition characterized by juxtaepithelial fibrosis of the oral cavity. Management of the N1 Neck in Buccal Carcinoma: The condition is multifactorial in origin with a high incidence in A Continual Conundrum people who chew arecanut (1). Objectives The objective of this study was to evaluate the role of nasolabial flap Dr Deepika Kenkere Professor & HOD, Co-Author: Dr Azeem in the surgical treatment of OSMF. The nasolabial island flap is a full Mohiyuddin S M Professor & HOD thickness flap which is not native to the oral cavity. Hence, the chances of developing OSMF in nasolabial flap is very less (2). Department of Dentistry Sri Devaraj Urs Medical College Tamaka, Methods Kolar 563101 Karnataka, India Email id: Five patients with mouth opening of less than 15 mm were included in [email protected], Mobile Number: 98455 46746, Landline this study. The fibrotomy done along with the inset of nasolabial Number: 080 22216703/080 22211042; Department of island flap. The malposed third molars were removed. The patients Otorhinolaryngology, Head & Neck Surgery Sri Devaraj Urs Medical were evaluated for six months postoperatively. College Tamaka, Kolar 563101 Karnataka India Results In all five patients adequate mouth opening of 30–35 mm was Abstract maintained. There was no incidence of flap necrosis or flap loss. All Background/Introduction patients had acceptable aesthetics. Buccal mucosa is the most common site for malignancy in South East Conclusions Asia, accounting for 40% of the oral cancers. A majority of these (80%) As the nasolabial flap is not native to oral cavity and therefore there are at Stage III or IV at the time of presentation. The anatomy and are less chances of it to get involved by disease subsequently. physiology of the muscle predispose to an early invasion and cervical metastasis of buccal carcinoma. Cervical metastasis is the single most References/Bibliography important prognostic factor. Studies have quoted that of all the buccal 1. G. Arakeri, P. A Brennan. Oral submucous fibrosis: An overview mucosa cases, 55% present with cervical lymphadenopathy but the of the aetiology, pathogenesis, classification and principles of incidence of clinical false positivity is as high as 45%, whereas that of management. British journal of oral and maxillofacial surgery. false negativity is only 3%. 1 It is described that 49% have occult 51:587,2013. metastasis in cervical lymph nodes in patients presenting with buccal 2. Shah and Tauro. Clinical and histological basis for the use of carcinoma, Level I being the most common site for nodal metastasis nasolabial tissues in the surgical management of OSMF. J Oral (100%), followed by Level II (32%), Level III (16%) and Level IV Maxillofacial Surgeon 73:2251.e1, 2015. (8%). 2 In view of the above reports, deciding on the type of neck dissection that should be performed for a N? neck is a longstanding topic of debate. Various neck dissections have been advocated taking into consideration the natural progression of the disease, the T and N ABS00718 status and adverse tumor and nodal factors. This presentation is a lit- Oral Trauma as a Risk Factor in Oral Cancer erature review of the different types of neck dissection that have been performed for carcinoma of the buccal mucosa, and an attempt is made Dr Srishti Deshpande, 1st MDS to arrive at a rational approach in the management of a N? neck. Objectives Department of Oral and Maxillofacial Surgery, KLE VK Institute of Objectives. Dental Sciences, Belgaum, Karnataka Methods Methods. Results Abstract Results. Background/Introduction Conclusions Oral cancer is among the commonly seen cancers in the world. It leads Conclusions. to about 145,000 deaths annually. These cancers are associated with the use of tobacco, betel nut, areca nut, smoking and alcohol consumption. References/Bibliography In addition to these, long standing irritation has been postulated as a risk factor as well. Chronic irritation may result from poor oral hygiene, 1. Pradhan SA. Surgery for Cancer of the Buccal Mucosa. Seminars poor dentition, missing teeth and ill fitting dentures. However, the role in Surgical Oncology 1989; 5:318–321. of these conditions in developing oral cancer has been debatable. 2. Harald Essig, Riaz Warraich, Gulraiz Zulfiqar et al. Assessment Objectives of cervical lymph node metastasis for therapeutic decision- We therefore decided to conduct a review of literature to evaluate the making in squamous cell carcinoma of buccal mucosa: a role of chronic irritation resulting in these conditions in causing oral prospective clinical analysis. World J Surg Oncol 2012;10:253. cancer.

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Methods ABS00783 A systematic search of the databases MEDLINE, PubMed, Cochrane Postoperative Oral Health-Related Quality of Life Database of Systematic Reviews, Web of Science was done. Relevant articles were identified. The search terms used were ‘‘dental trauma,’’ (OHRQoL) in Oral Cancer Patients ‘‘mucosal trauma,’’ ‘‘oral cancer,’’ ‘‘squamous cell carcinoma,’’ ‘‘risk at Karpagavinayaga Institute of Dental Sciences, factor,’’ ‘‘potentially malignant lesion,’’ ‘‘dental factor,’’ ‘‘mechanical Tamilnadu: A Cross-Sectional Study irritation,’’ ‘‘dental irritation,’’ and ‘‘cancer.’’ These were searched as text word and as subject headings individually as well as in different 1. Dr. G.R. Karthikeyan, Reader, 2. Dr. A. Mathanmohan, 3. Dr. combinations. The reference lists of relevant articles were also sear- B. Balaguhan, Professor, 4. Dr. Meera Tinakaran, Professor & HOD ched for appropriate studies. No language restrictions were used in either the search or study selection. This search yielded 788 articles. Articles were excluded from the review if they failed to describe the Department of Oral and Maxillo Facial Surgery, Karpaga Vinayaga factors of interest for the study. Among these articles, only 22 articles Institute of Dental Sciences, Tamilnadu described chronic mucosal trauma as risk factors for oral cancers and were considered in this review. Abstract Results Background/Introduction From the literature we came across, several studies showed an asso- Treating oral cancer produces important changes in the oral cavity ciation of ill fitting or defective dentures with the development of oral which impairs normal functions such as speech, swallowing, chewing, cancer. Some studies further went on to stress that poor oral hygiene and salivation. The patient’s QOL can also be significantly impaired can be a strong factor associated with oral cancer. by these functions. Hence, there is need to evaluate final outcome Conclusions following the different combination of treatment modalities available Thus, from this review, we can conclude that chronic mucosal irri- to make better therapeutic treatment decisions. tation resulting from ill fitting dentures, poor oral hygiene etc can be Objectives factors associated with development of oral cancer. No association To assess Oral health related quality of life (OHRQoL) in 120 patients has been proven, however, between duration of denture use and with oral cancer who had undergone single or multi-modality treatments. cancer formation. No definitive relation has been seen between bro- Methods ken/ sharp teeth, dental implants, nature of dental materials and oral Participants were grouped based on the treatment they had undergone cancer formation. into Group I - Surgery alone, Group II - Surgery and Radiotherapy, Group III- Surgery, chemotherapy and radiotherapy and assessed for References/Bibliography OHRQoL using the shorter version of Oral health impact profile-14 Franco EL, Kowalski LP, Oliveira BV, Curado MP, Pereira RN, Silva (OHIP-14) questionnaire. ME, et al. Risk factors for oral cancer in Brazil: A case-control study. Results Among the 120 participants, Upper lower class and lower class people were around 81.6 %. Buccal mucosa (58.9%) was found to be the most frequent site. Among the clinical staging, Stage II (33.33%) oral cancer was more prevalent. Among the Three groups the Functional ABS00723 limitation domain was significantly different. Should We Treat Oral Cancer Patients With OSMF Conclusions and Without OSMF With Same Protocol? Oral cancer patients who had been undergone surgical treatment in the earlier stage alone had better Quality of life when compared to the other combined treatment modalities. Dr Gaurav Singh, Associate Professor References/Bibliography Super Specialty Cancer Institute, Lucknow 1. Barrios R, Tsakos G, Garcıá-Medina B, Martıńez-Lara I, Bravo M. Oral health-related quality of life and malnutrition in patients Abstract treated for oral cancer. Support Care Cancer 2014;22:2927–33. 2. Background/Introduction 2. Varshitha A. Prevalence of oral cancer in India. J Pharm Sci Res In Indian subcontinent arecanut chewing is more prevalent leading to 2015;7:845–8. OSMF and subsequently oral cancer. Objectives To evaluate and compare neck metastasis in Oral Cancer patients with OSMF and without OSMF. Methods ABS00786 A total of 102 patients were taken with oral cancer with or without Salivary Duct Carcinoma: Report of Two Cases OSMF. All patients were undergone surgery and histopathologic reports were evaluated and compared. V Deepak, Gr Karthikeyan, B Balaguhan, A Mathanmohan Results Significantly low neck metastasis was found in OSMF group. Abstract Conclusions Background/Introduction Further evaluation is needed to establish newer protocol for oral Salivary duct carcinoma (SDC) is an aggressive rare malignant cancer patients with OSMF. tumour with a propensity for invasive growth, resulting in early References/Bibliography regional and distant metastases. SCD accounts for 1% to 3% of all malignant salivary gland tumours. A few cases been reported in lit- J Oral Pathol Med. 2017 Jul;46(6):448–453. doi:10.1111/jop.12553. erature resulting in limited data about its biologic and Epub 2017 Feb 28. immunohistochemical characteristics.

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Objectives Audiometry and Impedance Audiometry, and correlated with various The authors report two cases of SDC presented to their department stages of OSMF. one with the extraoral swelling confined to the parotid gland and other Results with intra oral swelling confined to the posterior part of left side of the Hearing impairment and ETD was found to be statistically significant palate. in OSMF patients as compared to normal patients. Severity of Methods Hearing Impairment was found more in advanced stage of fibrosis i.e. SDC of Parotid gland was operated with aggressive resection, Clinical Stage III & Functional stage C. Mild to Moderate type of Selective Neck Dissection along with Split Skin Grafting as the Hearing loss was seen more in Stage IIIC. ETD was also predomi- tumour had cutaneous involvement. Other SDC was operated with nantly present in Stage IIIC OSMF patients. Correlation of age with primary tumour resection along with left maxillectomy and Selective various clinical & functional stages was found to be positive. Cor- Neck Dissection Both SDC’s received postoperative radiotherapy. relation of different clinical & functional stages of OSMF with Results Hearing Loss after Pure Tone Audiometry, ETD after Impedance Aggressive resection with adequate marginal clearance, neck dis- Audiometry was found to be positive. section and postoperative radiotherapy ensured patient disease free Conclusions without any loco-regional metastases. From the present study it is evident that that with advancing stages of Conclusions OSMF conductive hearing impairment increases as well as ETD. SDC is a rare and aggressive salivary gland malignancy for which treatment is surgical resection and neck dissection, with adjuvant References/Bibliography radiation therapy reserved for the more advanced forms. Post-opera- Gupta SC, Singh M, Khanna S, Jain S. Oral submocous fibrosis with tive radiation therapy is mandatory in advanced cases of SDC, its possible effect on Eustachian tube functions: a tympanometric whereas chemoradiotherapy is generally reserved for metastatic forms study. Ind J Otolaryngol Head Neck Surg. 2004;56:183–5. of the tumor. The prognosis may be improved in tumors measuring Shah M, Katarkar A, Shah P, Alam N, Modh D. Tympanometric \2 cm, however, the five-year recurrence-free survival rate remains study of Eustachian tube function in oral submucous fibrosis. Indian J at 30%. Otol. 2011;17:80–2. References/Bibliography Intraoral salivary duct carcinoma: A case report and a brief review. Acharya S, Padmini S, Koneru A, Krishnapillai R. J Oral Maxillofac ABS00806 Pathol. 2014 Sep;18(Suppl 1):S121-7 Salivary duct carcinoma of the parotid gland: A case report and review of the literature. Effect of Clinical, Demographic and Pathological Xie S, Yang H, Bredell M, Shen S, Yang H, Jin L, Zhang S. Oncol Factors on Disease Free Survival Rate of Patients Lett. 2015 Jan;9(1):371–374. Epub 2014 Oct 31. Having Oral Squamous Cell Carcinoma with Oral Submucous Fibrosis: A Retrospective Study

Dr. Prachet N Dakshinkar ABS00805 Does Advancing Stages of OSMF Affect Degree Datta Meghe Institute of Medical Sciences, Wardha of Hearing Impairment and Eustachian Tube Function? Abstract Dr. Apoorva Mishra, Dr. Rajanikanth, Dr. Rajiv Borle, Dr. Nitin Background/Introduction Bhola, Dr. Anendd Jadhav, Dr. Bhushan Mundada More than 90% of all oral cancers are squamous cell carcinoma (SCC). One of the most important risk factors for oral SCC is the use Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), of tobacco (in all forms) or betel quid which also serves as a causative Wardha factor for oral submucous ﬁbrosis (OSMF). There has been increased incidence of concomitant association of OSCC & OSMF in recent times. Abstract Objectives Background/Introduction The aim of this study was to evaluate the effect of individual variables Literature is available regarding the involvement of muscles of soft on disease free survival in patients having OSCC along with OSMF. palate in OSMF [2–4], and literature for associated ETD and hearing Methods impairment is deplete [6–8]. However there are no studies available A retrospective observational study was carried out in which records on assessing the degree of hearing impairment, presence of ETD and of patients were retrieved from 2011 to 2014. A total of 78 patients its correlation with clinical stages of OSMF, and its association with having OSCC with OSMF were taken up for the study. Patient‘s increase or decrease in the severity of the disease. We hypothesize present clinical information was obtained through telephone call. that with increasing severity of the disease, hearing impairment and Patients were evaluated on demographic, clinical and pathological ETD increases. fronts and its effect on disease free survival was studied. Objectives Results Assessment of degree of hearing impairment and Eustachian tube Overall disease free survival was found to be 84.62%. Patients with dysfunction (ETD) along with its correlation with various stages of negative margins had substantially low recurrence as compared to Oral Submucous Fibrosis (OSMF). those who had positive surgical margins. In regards to the present Methods study recurrence was present in 12 cases, which was found to be the Present study was conducted on 102 individuals including 51 OSMF sole factor having profound impact on survival. Rest all variables had patients (102 ears) and 51 healthy controls (102 ears). All were no signiﬁcant impact on disease free survival. evaluated for hearing impairment and ET function by Pure Tone

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Conclusions ABS00823 Good survival rate can be obtained with primary surgical treatment. Noninvasive Early Diagnosis of Oral Mucosal Pre operative assessment of factors such as stage of lesion, cervical lymph node metastasis, extra capsular spread, staging of OSCC, Precancerous and Cancerous Lesions Using grading of OSMF play a crucial role in predicting recurrence post- Fluorescence Spectroscopy operatively. Thus to improve survival rate, recurrence has to be minimized which in turn is controlled by above factors. Pranav Ingole*, P. Chaturvedi, D Nair, S Nair, S Dutta References/Bibliography *V.S.P.M Dental College & Research Centre, Nagpur Head & Neck Seyed Hosiin Tabatabaei, Mahmood Tafti, Ali Hossini. Evaluation of Surgical Oncology, Tata Memorial Hospital, Mumbai, India clinical, demographic, pathological and molecular factors with survival rate of patients with Oral squamous cell carcinoma in Yazd Abstract city during 1998–2008. Background/Introduction Camisasca DR, Silami MA, Honorato J et al. Oral squamous cell Squamous cell carcinoma of the oral cavity is usually preceded by carcinoma clinicopathological features in patients with and without changes in the oral mucosa in the form of leukoplakia, erythroplakia, recurrence. ORL J Otorhinolaryngol Relat Spec.2011:73:170–176. submucosal fibrosis etc. These lesions carry risks of varying degree for malignant transformation. We report the results of a clinical in vivo study to evaluate the potential of fluorescence spectroscopy for differential diagnosis of oral mucosal malignant and potentially ABS00815 malignant lesions. Efficacy of Botox in Reducing Silocele: A Sequel of Oral Objectives Squamous Cell Carcinoma Surgery Non-invasive screening of these lesions may help in early detection of malignancy. We report here the results of an in vivo clinical study showing clinical applicability of fluorescence spectroscopy for dis- Dr Bhushan Mundada, Dr Nitin Bhola, Dr Rajiv Borle, Dr Anendd criminating potentially malignant lesions from the healthy squamous Jadhav tissues of human oral cavity. Methods Abstract The in vivo study was conducted at the Tata Memorial Hospital Background/Introduction (TMH), Mumbai. A compact and portable spectroscopic system was Salivary fistulas are a well-known sequel of parotidectomy, and used. The system utilizes a sealed-off, high-pressure nitrogen laser, as successful treatment with botulinum toxin has been demonstrated in the excitation source for inducing tissue fluorescence. Light delivery individual cases. to and collection from tissue is achieved with a fiber-optic probe Objectives consisting of seven 400 micron core diameter fibers. The fluorescence Squamous cell carcinoma of buccal mucosa and gingivobuccal sulcus emission collected by the fiber-optic probe. The in vivo fluorescence is an aggressive form of oral carcinoma with a high recurrence rate. spectra were recorded in the 375–700 nm spectral range. Injury to the parotid duct is often unavoidable when surgically Results treating mentioned sites because of the intimate anatomic relation Figure 1 shows the mean fluorescence spectra for OSMF (n=83), LP among the buccal mucosa, Stensen duct, and parotid gland. It is often (n=90), and normal squamous (n=283) tissues. The most prominent of difficult to achieve negative margins and preserve the integrity of the these are seen in the wavelength region below 500nm particularly in parotid duct. Sialocele formation is a frequent and untoward com- the 390nm and 460nm spectral bands. The 390nm spectral band is the plication owing to extravasation of saliva into the surgical defect, most intense in OSMF tissues while the intensity of the 460nm band which delays healing, creates fistulas, and produces painful facial is the highest in the spectra from normal squamous tissues. A prob- swelling. Currently, no consensus exists regarding the management of ability based multivariate statistical diagnostic algorithm was a parotid sialocele. Multiple investigators have described different developed to analyze the oral tissue fluorescence spectra. Fluores- modalities of treatment. cence spectroscopy was able to distinguish potentially malignant from Methods normal oral tissues with a predictive accuracy of [90% with respect With approval from the institutional ethical committee, 15 cases of to histology as the gold standard. oral squamous cell carcinoma warranting injury to parotid duct, gland Conclusions or parotidectomy (tail of parotid) as a part of treatment included in The results of this pilot study demonstrate the potential of fluores- study. Botox injected at the time surgery in parotid gland at four cence spectroscopy in distinguishing potentially malignant lesions anatomical sites (anterior, posterior, superior and inferior) and from the normal mucosa of the oral cavity in a clinical setting. observed for any sign of silocele for period of 1 month. Results References/Bibliography There was significant reduction in salivary flow in all cases. No 1. De Veld DC, Witjes MJ, Sterenborg HJ, Roodenburg JL. The significant side effect seen with use of botox. status of in vivo autofluorescence spectroscopy and imaging for Conclusions oral oncology. Oral Oncol 2005;41:356–64. In summary, botulinum toxin injections into the parotid tissue at the 2. Majumder SK, Gupta A, Gupta S, Ghosh N, Gupta PK. Multi- time of surgery appear to be an effective preventive treatment for class classification algorithm for optical diagnosis of oral cancer. salivary fistulas following surgeries in head and neck region. J Photochem Photobiol B 2006;85:109–17. 3. Majumder SK, Gupta A, Gupta S. Non-linear multi-class pattern recognition for laser-induced fluorescence diagnosis of oral cavity cancer. Photo/Electrochemistry and Photobiology in the Environment, Energy and Fuel. In: Kaneco SB, Katsumata V, Katsumata H, editors. Research Signpost, 2009. p. 95–114.

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4. Majumder SK, Gebhart S, Johnson MD, Thompson R, Lin WC, Mahadevan-Jansen A. A probability-based spectroscopic diag- Section: Reconstruction nostic algorithm for simultaneous discrimination of brain tumor and tumor margins from normal brain tissue. Appl Spectrosc 2007;61:548–57. ABS0011 Use of Superficial Temporal Fascia Flap for Treatment of Post Radiation Trismus: An Innovation ABS00826 Oral Squamous Cell Carcinoma Metastasis Dr Tushar Deshmukh, Dr Rohit Sharma to Submandibular Gland: It’s Removal - Armed Forces A Questionable Necessity Abstract Dr Anendd Jadhav, Dr Nitin Bhola and Dr Rajiv Borle Background/Introduction Post radiation trismus severely reduces the quality of life. Radiation Department of Oral and Maxillofacial Surgery Sharad Pawar Dental causes fibrosis of muscles of mastication resulting in severe restriction College and Hospital, Datta Meghe Institute of Medical Sciences, of mouth opening. Sawangi (M), Wardha Maharashtra 442002, [email protected], Objectives Contact No: 9766599911, 9623399911, and 7767811911 To check new modality in reconstruction. Methods Abstract Use of superficial temporal fascia to cover the defect. Background/Introduction Results The submandibular gland is routinely removed during neck dissection Following the release of fibrosis secondary to radiation, superficial involving level IB. Its removal however reduces basal salivary temporal fascia (STF) was used to cover the defect with excellent secretion resulting in increased symptoms of subjective xerostomia. results and no recurrence after a year of follow up. Objectives Conclusions The present study was deliberated to assess whether submandibular Superficial temporal fascia (STF) can be used to cover the defect with gland preservation is a viable option in oral squamous cell carcinoma excellent results and no recurrence after a year of follow up. (OSCC). References/Bibliography Methods This was a prospective study conducted between Sept 2014 and June Borle RM, Borle SR. Management of oral submucous fibrosis: a 2017. A consecutive 153 histologically established OSCC treated conservative approach. J Oral Maxillofac Surg 1991; 49: 788–91. primarily by surgery with a curative intent were included in the study. The fibrofatty tissue surrounding the SMG was divided into 6 parts depending upon its location with the submandibular gland. These, along with SMG were separately sent for histopathological analysis. ABS00129 Metastasis pattern in level IB was noted. Results Comparative Evaluation Between Use of Different 1.30% (2/153) glands showed involvement by the tumour, 10.45% Pedicled Grafts and Prosthesis Vs Maxillofacial (16/153) gland showed chronic sialadenitic changes. The two Obturators After Unilateral Maxillectomy involved gland showed extra capsular spread from level IB nodes. Evidence of metastasis was not seen in any of the glands. Dr. Syed Ansar Ahmad Conclusions Metastatic involvement of SMG is extremely rare. SMG can safely be spared during neck dissection in OSCC. Patients with OSCC will Jamia Millia Islamia, New Delhi benefit from preservation of ipsilateral SMG. Abstract References/Bibliography Background/Introduction Panda NK, Patro SK, Bakshi J, Verma RK, Das A, Chatterjee D. If any pathology occurs in facial skeleton, pathology has to be Metastasis to submandibular glands in oral cavity cancers: Can we removed and defect reconstructed. For unilateral maxillectomy cases preserve the gland safely? Auris Nasus Larynx. 2015 debate is between use of surgical reconstruction or prosthetic Aug;42(4):322–5. rehabilitation. Chen TC, Lou PJ, Ko JY, Yang TL, Lo WC, Hu YL, Wang CP. Objectives Feasibility of preservation of the submandibular gland during neck To utilise the pedicled flaps for reconstruction of the defects fol- dissection in patients with early-stage oral cancer. Ann Surg Oncol. lowing unilateral maxillectomy and to compare, corroborate and 2011 Feb;18(2):497–504. analyse with similar defects where maxillofacial obturators have been used. Methods Patients treated by pedicled grafts were taken and were compared by patients treated by maxillofacial obturators after unilateral maxillectomy. Results were taken on different parameters. Results Most of the patient with pedicled grafts had satisfying results.

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Conclusions ABS00156 Aesthetically and functionally most of the pedicled ﬂaps were better Pectoralis Major Myocutaneous Flap: A Boon except in those patients where periodic check up of the site is required. for Maxillofacial Reconstruction

References/Bibliography Geetha N.T, Sunil S. Byadgi, Kirthikumar Rai A. Ali, M.J. Fardy, D.W. Palton. Maxillextomy to reconstruct or obturate? Results of a Uk survey of oral and maxillofacial surgery. Bapuji Dental College and Hospital, Davangere, Karnataka British Journal of Oral and Maxillofacial Surgery 1995, volume 33, 207–210. Abstract Background/Introduction Head and neck cancer is the sixth most common cancer worldwide. Oral and oropharyngeal carcinoma are the third most common in ABS00139 males and fourth most common in females in developing countries. Soft Tissue Coverage in the Aged Patient: Challenges Surgery remains the mainstay for treating these cancers. So reconstructing major ablative defects following their resection remains a and Pitfalls: A Report of Two Cases challenge for surgeons as it requires both restoration of form and function. Soft tissue defects mostly demand both skin cover and oral Major Rahul P Menon lining. The use of free flaps has become the state of the art for reconstruction of oral and maxillofacial defects in the present era. But Command Military Dental Centre (SWC) free flap transfer cannot be used for all patients at every institute since it requires special techniques and equipments as in the case of microsurgery. So locoregional flaps play a crucial role in many of the Abstract oncological cases. Conventional flap like pectoralis major remains Background/Introduction versatile and reliable flap for primary and secondary reconstruction. Soft tissue coverage, whether intraoral or extraoral has always been a Many qualities of this flap such as its proximity to the head and neck challenge. This becomes even more apparent in advanced age. region, the reliability of its pedicle and short learning curve, have Objectives contributed to the widespread use of this flap and its overall good This paper aims to highlight the challenges faced by the surgeon in success rates. Complication rates in this flap vary from 13% to 65%. the coverage of such defects by reporting two cases in male patients, This flap is now popularized in developing countries with limited both aged above the 5th decade of life. Objective: To highlight some medical resources. It seems that the role of PMMC in head and neck of the pitfalls and technique sensitivity of the two flaps used to cover reconstruction has shifted from a ‘‘workhorse flap’’ to a ‘‘salvage the defects and the ensuing complications that were age, surgical flap’’ in the era of free flaps. Furthermore, technique modifications of technique and post op care related. flap harvesting not only ensure its reliability but also decreases the Methods donor site functional impairment. In this paper we would like to share Case 1: A 58 year old man reported with extensive alveolar tissue loss our experience in using this flap as both a workhorse as well as a in the parasymphysis region secondary to panfacial trauma. He was salvage flap mainly emphasizing on the different harvesting tech- taken up for secondary closure of the defect using an anteriorly based niques and complications. buccinator myomucosal flap to cover the defect. Case 2: A 69 year old Objectives man reported with an ulcer of 3x3.5cm diameter as a complication of Not applicable. neglectful post op follow up and treatment of a submandibular space Methods infection. The defect was repaired using a platysma and skin paddle Not applicable. flap. Results Results Not applicable. Case 1: Initial 2 week follow up was promising but it deteriorated Conclusions after sectioning of the pedicle leading to only 90% recovery in cov- Not applicable. erage. Case 2: This however failed in 3 weeks due to a cutaneous salivary fistula but regained about 80% of the defect coverage. References/Bibliography Conclusions Although both flaps seemed to yield promising results at the begin- 1. Ashutosh Gupta, Gunjan Agrawal, Santanu Tiwari, Kshitij ning, the end results were less than ideal and this paper hopes to Verma, Rajesh Agrawal, Vivek Choudhary. Pectoralis major highlight some of the complications of the technique, surgery and post myocutaneous flap in head and neck reconstruction: an interest- op care. ing experience from central India regional cancer center. Int J Res Med Sci. 2015;11:3065–3068. References/Bibliography 1. Amin Rahpeymaa and Saeedeh khajehahmadib. Inferiorly based buccinator myomucosal island flap in oral and pharyngeal reconstruction. Four techniques to increase its application. International Journal of Surgery Case Reports 14 (2015) 58–62.

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ABS00193 Methods Lip Reconstruction: Why? When? & How? Cases of midface reconstruction following tumour ablation over eighteen months were reviewed. RPT models were used in 7 of those A Comprehensive Review of Various Techniques cases. The adequacy of reconstruction was assessed with subjective and objective means. The assessment was done separately for Dr. Anuj S. Dadhich (i) anatomic structure - Flap/graft bulk, fistula, vestibular depth, orbital rim), (ii) facial aesthetics (zygomatic prominence, lip support, Dept of Maxillofacial & Reconstructive Surgery, Rural Dental scleral show, scar resolution, dystopia/enophthalmos) and (iii) func- College, Loni, Maharashtra tion (speech (hypernasality), swallowing and dental rehabilitation). Results Abstract Of the seven cases, only three involved orbital floor/rim resection. In Background/Introduction all patients except one, the position of the alveolus was deemed The lips have important functional and aesthetic role in daily living, correct and was amenable for dental rehabilitation. 3 of these patients they are focal point of lower face and make an important aesthetic unit. underwent implant-based dental restoration. The orbital floor was The role of lips in aesthetic balance, speech, facial expression and reconstructed, where required by a titanium mesh, and was supported deglutination can not be replicated by any other tissue substitute. The by a fibular strut in one patient. The zygomatic prominence was a primary goal of reconstruction is restoration of function and aesthetics. factor only in two patients, and the RPT models seem to have made Objectives little impact on it. The objective of the study is to evaluate different techniques of lip Conclusions reconstruction & to evaluate the advantages and disadvantages of RPT models are good cost-effective aids to help placement of the each & provide guidelines to surgeons about application of these alveolus and orbital floor. Their use in achieving the optimal contour techniques in various clinical scenarios. of zygoma and orbital rim could not be established. Methods References/Bibliography Patients who underwent lip reconstruction in dept. of Maxillofacial and reconstructive surgery, RDC Loni were included in the study. All 1. Maxillary reconstruction: current concepts and controversies. patients were evaluated for oral continence, lip mobility, amount of S Iyer and K Thankappan. Indian J Plast Surg. 2014 Jan-Apr; mouth opening, symmetry of lips. 47(1): 8–19. Results 2. Rapid prototyping-assisted maxillofacial reconstruction. Q Peng, There is no single technique which can be used for reconstruction of Z Tang, O Liu and Z Peng. Ann Med. 2015; 47(3):186–208. all defects of lips. Different techniques have there own indications, pros and cons and these should be critically evaluated before surgery. Conclusions The best surgical outcome in lip reconstruction can be achieved by re ABS00278 positioning of the remaining lip element and mobilisation adjacent Natural Bio Ceramics-Changing Perspective soft tissue. Reconstruction of very large defects often require free flap but that provides only static support of lip and does not restore the in the Reconstruction of Maxillofacial Skeleton: Our dynamic function. Experience References/Bibliography 1- Vivekanand Kattimani, Reader & Research Scholar, 2- Krishna Lip reconstruction: Donald Baumann, Geoffrey Robb, Seminars in Prasad L, Prof and Head, Dean, 3- Dr. Girija E K- Asst. Prof. plastic surgery, 2008 Nov; Vol 22(4):269–280. 1. Dept. Oral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences, Guntur, India, [email protected]. Mb- ABS00271 09492473628; 2. Dept. Oral and Maxillofacial Surgery, and Dean, Role of Rapid Prototyping (RPT) Models in Midface SIBAR Institute of dental sciences, Guntur; 3. Department of Physics, Reconstruction Periyar University, Salem 636 011, Tamil Nadu, Salem, India Abstract Dr. Ravi Veeraraghavan, Dr. Krishnakumar T Background/Introduction Bioceramics is an advancing front in the reconstruction of defects of Abstract maxillofacial skeleton. Advancing technology for production of Background/Introduction synthetic graft materials made the surgeon to dream for artificial bone The reconstruction of midface following ablative surgery is a chal- regeneration. Various bone graft substitute materials are used to lenging task. The objectives of reconstruction are to separate oral and enhance the bone regeneration.[1] In recent past Egg shell derived nasal cavities, to provide support to the eye, to aid in dental reha- Hydroxyapatite (EHA) is introduced as synthetic bone graft substi- bilitation and to recraft the lost aesthesis. This has been attempted tute;[2] which has changed the face of regenerative science. with bone grafts, alloplastic materials, pedicled flaps and free flaps. Objectives RPT models have been used for quite some time for mandibular To assess bone regeneration using EHA in cystic and/or apicectomy reconstruction. Their use in midface reconstruction has not been defects of mandible and maxilla using digital radiographs/CBCT. detailed well. The potential advantage it offers is in proper posi- Methods tioning of (i) alveolus (so as to aid in dental rehabilitation), (ii) orbital Twenty patients of either gender requiring grafting after cystectomy floor and rim and (iii) zygomatic prominence. and/or apicectomy were enrolled in the study protocol-CTRI/2014/12/ Objectives 005340. The defects were grafted with EHA. The patients were fol- To assess the effectiveness of rapid prototyping models as an aid to lowed up over a period of 24 weeks post surgically with intervals of maxillary reconstruction using free flaps. 4,8,12 weeks to assess the amount of osseous fill using digital 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S49 radiographs and CBCT. Statistical analysis was carried out using References/Bibliography Mann–Whitney U–test, Wilcoxon matched pairs test. Results 1. Ross DA, Chow JY, Shin J, Restifo R, Joe JK, Sasaki CT, Ariyal Significant changes were observed in the formation of bone and S (2005) arterial coupling for microvascular free tissue transfer in merging of material and surgical site margin at 1st week to 1st month head and neck reconstruction. Arch Otolaryngol head neck in all the patients (age range 15–50 years). Bone formation was seen surgery 131:891. in grafted sites by the end of 8 weeks with significant P value and 2. Douglas AR, Ariyan S, Restifo R (2003) use of the operating trabecular pattern was seen by the end of 12 weeks with uneventful microscope and loupes for Head and Neck free Micro-Vascular wound healing. tissue transfer. Arch Otolaryngol Head and Neck Surgery 5:129. Conclusions EHA showed enhancement of bone formation and was complete by the end of 12 weeks. The study showed necessity of the grafting for early bone formation. EHA is cost effective and production is go ABS00446 green way with no disease transfer risks. So Natural bio ceramics will Bone-Anchored Titanium Implants for Auricular play an important role in the reduction of cost involved for grafting. Rehabilitation: Case Report References/Bibliography Deepak Agrawal 1. Kattimani VS, Chakravarthi PS, Prasad LK. Biograft Block Hydroxyapatite: A Ray of Hope in the Reconstruction of Maxillofacial Defects. J Craniofac Surg. 2016 Jan;27(1):247–52. Govt. College of Dentistry, Indore 2. Kattimani V, Lingamaneni KP, Chakravarthi PS, Kumar TS, Siddharthan A. Eggshell-Derived Hydroxyapatite: A New Era in Abstract Bone Regeneration. J Craniofac Surg. 2016 Jan;27(1):112–7. Background/Introduction Osseointegrated implants have acquired an important role in the prosthetic rehabilitation of patients with craniofacial defects. Objectives ABS00395 This paper presents a clinical case and discusses indications and advantages of the osseointegrated implant technique for retention of Various Methods of Micro-Vascular Anastomosis: auricular prostheses. A Prospective Study on Conventional Suturing Methods with Fibrin Glue, Couplers, Lasers and Staplers Two endo-osseous root-form implant with customized bar is used to retain silicon ear prosthesis. Results Dr. R. Balaji Srikanth, MDS, Dr. Senthil Murgan, MDS Prostheses made of silicone are state-of-the-art. The clinical parameters evaluated showed good postoperative healing, healthy peri- Sri Venkateshwara Dental College, Chennai; SRM Dental College, implant tissue, good hygiene and no loss of implants. Chennai Conclusions The surgical technique for rehabilitation using implant-retained Abstract auricular prostheses seems to be simple. It is associated with low rates Background/Introduction of adverse skin reactions and long-term complications. Microvascular anastomosis remains a technically sensitive and critical determinant of success in free tissue transfer. microvascular References/Bibliography anastomosis coupling device is an elegant friction fit ring pin device Bone-anchored titanium implants for auricular rehabilitation: case becoming more wide used techniques than other techniques. report and review of literature. Gumieiro EH1, Dib LL, Jahn RS, Objectives Santos Junior JF, Nannmark U, Granstro¨m G, AbrahaõM. To evaluate the Successful outcome of free flap surgery predominantly depends upon proper anastomosis of blood vessels by using various techniques. Methods Despite the tremendous advancements in the field of anastomosis, the ABS00498 conventional way of suturing the blood vessels is still in practice. Rehabilitation & Reconstruction However, the other methods like coupling and stapling the vessels are of Hemimandibulectomy Defect Using Free Fibula gaining popularity in recent years. On the other hand application of Endosseous Implants diode lasers in performing anastomosis by the way of welding the vessels is the most recent method. paper based on various method of anastomosis in 125 patients in 12 years of time. Abhishek Akare, Abhay Datarkar Results Total 125 patients performed in to various techniques, 25 patients Govt Dental College Nagpur coupler 25 patients stapler, 25 patients laser, 25 patients suturing, 25 patients fibrin glue application. success rate is better in couplers than Abstract any other techniques. thrombosis rate is less by using coupler. study Background/Introduction done in single centre and operated by the same surgeon. Mandibular reconstruction with microvascular free fibula is an ele- Conclusions gant solution to restore the anatomic arch, oral function and facial Flap survival and revision free application of the micro-vascular esthetic, vestibular groove and the fragility of the soft tissue com- coupler occurred in more than 99% of cases survival. That substantial plicated dental prosthetic stabalization. time savings with coupler device. 123 S50 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

Objectives Results To evaluate the clinical outcome and the aesthetic and functional All the 10 patients who underwent the procedure had successful graft results of implant rehabilitation of fibula free flap reconstructed incorporation. No complications were encountered and were suc- mandibles. cessfully rehabilitated with Bicortical basal Implants with immediate Methods Loading. No incidence of Implant Loosening or Failure were Five patients having pathology were constructed in this study were encountered. free fibula was harvested and immediate implants were placed, Conclusions prosthetic rehabilitation achieved after 6 month. the study was done at Our technique presented here is simple, effective, reliable, less time dept of oral and maxillofacial surgery, govt dental college and hos- consuming treatment strategy which has a short learning curve and pital Nagpur. Observation studied 1) Ossetiointegration of implants 2) hence can be carried out in tertiary care centres also. immediate implant placement 3) prosthetic rehabilitation 4) esthetic. Results References/Bibliography Ameloblastoma was the pathology and treated with immediate Iliac Crest Grafting for Mandibular Reconstruction; Kademani, reconstruction and placement of implant. a total 10 implants were Deepak et al. Atlas of the Oral and Maxillofacial Surgery Clinics of placed, an loading was done after 6 month. postoperatively. the North America, Volume 14, Issue 2, 161–170. implants were stable functionally and improvement in function and aesthetics was reported by the patients. Conclusions In our series of cases through different factors were believed to be associated with a poorer prognosis mainly because of the improperly ABS00548 formed periimplant gingival cuff. In both our patient we preserved the Rapid Prototyping Technique in Primary attached gingiva at the time of resection of the defect, this has help for Reconstruction of Segmental Mandibular Defects the proper formation of gingival cuff with the minimal periimplant complication. Dr. Manoj Kumar KP, Professor & Head References/Bibliography Dept. of Oral & Maxillofacial Surgery KMCT Dental College, 1. Brauner E, Cassoni A, Battisti A, Bartoli D, Valentini V. Kozhikode, Kerala Prosthetic rehabilitation in post-oncological patients: Report of two cases. Annali di Stomatologia. 2010;1(1):19–25. Abstract Background/Introduction Reconstruction of mandibular defects after tumor ablative surgery remains a challenge for the oral and maxillofacial surgeon, in ABS00525 achieving the best functional and aesthetic results. The widely studied From Reconstruction to Rehabilitation: A Novel Rapid Prototyping techniques include stereolithography apparatus Protocol for Segmental Mandibular Defects in Benign (SLA), selective laser sintering, three-dimensional printing, fused Pathologies with Non Vascularised Iliac Bone Graft deposition modeling, 3D plotting, solid ground curing, multiphase jet solidification, and laminated object manufacturing. 3D printing has been applied in medicine since the early 2000s, when the technology Dr. Kaushik Pai S H., Dr. Paul C Salins, Dr. Samarth R Shetty was first used to make dental implants and custom prosthetics. Stereolithography is a rapid manufacturing and prototyping technol- Mazumdar Shaw Medical Centre ogy for producing high accuracy and good surface finish. We present our experience in primary mandibular reconstruction using Rapid Abstract Prototyping technology. Background/Introduction Objectives The reconstruction of the mandible is a complex procedure because To evaluate the efficacy of Rapid prototyping technique in primary various cosmetic as well as functional challenges must be addressed, reconstruction of mandibular defects. including mastication and oral competence. The restoration of Methods mandibular bone defects depends on the diagnosis, anatomical site, Case 1 A 55 year old male was diagnosed with ameloblastoma who extent of the defect, and the patient’s age, as well as the surgeon’s underwent segmental resection of anterior mandible –Reconstruction experience. Many surgical techniques have been described to address was performed using rapid prototyping technology with SLA model. these challenges, including nonvascularized bone grafts, vascularized A virtual surgery was performed in the 3D model and a surgical guide bone grafts, distraction osteogenesis and approaches related to tissue was used to assist the resection procedure. A customized titanium engineering. The ultimate goal is restoration of both form and func- replica of the resected segment was fixed to the defect. Case 2 A 48 tion, necessitating the evaluation of appearance, mastication, year old male patient diagnosed with an extensive Keratocystic deglutition, speech, and oral competence. odontogenic tumor (KCOT) involving the mandible- Segmental Objectives resection was performed in between symphysis and sub condylar To Introduce a simple reliable and effective protocol for functional region. Rapid prototyping technology was utilised for primary reconstruction of segmental mandibular defects which enables quick reconstruction of the defect. The customized titanium replica of the rehabilitation with less morbidity. resected mandible was contoured to resemble a hollow perforated Methods crib, simulating the inner and outer cortices of mandible. The per- 10 cases of segmental mandibular defects due to benign pathology forated hollow was filled with small chips of cortico cancellous bone were reconstructed using non vascularised iliac bone grafts and from ileac crest. rehabilitated using Bicortical Basal Implants with Immediate Results Loading. This procedure has significantly reduced operating time and has provided an excellent functional and aesthetic outcome.

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Conclusions Results In our experience, the use of SLA models has significantly con- Tuberculosis of the skull should be included in the differential tributed to advanced treatment planning, decreased operating room diagnosis of scalp swellings even though it is a rare entity. time, more precise and accurate surgical procedures resulting in Conclusions improved reconstruction of form and function. A soft tissue, cystic, swelling on the scalp is associated with a variety of clinical differentials such as sebaceous cyst, lipoma, adenexal References/Bibliography tumor, solitary myeloma of the bone, secondary metastasis. Thus, a 1. Advanced Applications of Rapid Prototyping Technology in high index of suspicion is required for prompt diagnosis of this Modern Engineering Edited by Dr. M. Hoque ISBN 978-953- condition. 307-698-0. References/Bibliography 2. Cardoso CL, Munhoz EA de, Ribeiro ED, Souza Neto JB de, Sant’Ana E, Ferreira Juńior O. Application of stereolithography 1. Sridharan S, Balasubramanian D. Primary calvarial tuberculosis. in mandibular reconstruction following resection of ameloblas- Surgical Neurology Int 2017;8:126. toma: case report. Rev Clıń Pesq Odontol. 2008;4(2):101–105. 2. Abhijith et al AJNR American Journal Neuroradiology 3. Mehra P, Miner J, D’Innocenzo R, Nadershah M Use of 3-D 25:409–414, March 2004. Stereolithographic Models in Oral and Maxillofacial Surgery. J Maxillofac Oral Surg. 2011 Mar; 10(1): 6–13.

ABS00705 Lip Reconstruction with Platelet Rich Fibrin (PRF): ABS00600 A Case Report Calvarial Tuberculosis: A Rare Entity in Craniofacial Region DR. Deepak S. Singh, Observer in Head and Neck Oncology, Dr. (Mrs.) Uma Mahindra, Consultant Oral and Maxillofacial Surgeon, Dr. Sreeram. M.P. MDS (Oral and Maxillofacial Surgery) Surgical Private Practitioner; Dr. Roohi Syed, Consultant Oral Registrar, Co Authors – 1) Dr. B.S. Srinath. Ms, FRCS, FRCS Head and Maxillofacial Surgeon, Private Practitioner of the Department, 2) Dr. Praveen K.S. Dnb, Mch. 3) Dr. Vishnu Kurpad. Ms, Mch. Consultant Tata Memorial Hospital, Mumbai

Department of Surgical Oncology, Sri Shankara Cancer Hospital and Abstract Research Centre Besavangudy, Banglore – 560004 Email – Background/Introduction [email protected] Phone - ?919940489041; Surgical Healing of wound whatever may be the etiology is the main concern Oncology Sri Shankara Cancer Hospital and Research Centre for the surgeons. Growth factors release following clot formation and Besavangudy, Banglore – 560004; Department of Neuro Oncology, degranulation of platelets in the 1st stage in wound repair. Growth Sri Shankara Cancer Hospital and Research Centre, Besavangudy, factors released from platelets are biologically active products that Banglore – 560004; Department of Surgical Oncology Sri Shankara accelerates chemotaxis, cell proliferation, angiogenesis, extracellular Cancer Hospital and Research Centre, Besavangudy, Banglore – matrix deposition and reodelling. This case report describes the 560004 application of Platelet Rich Fibrin (PRF) gel in reconstruction of lip tissue loss due to trauma with minimal scarring. Abstract Objectives Background/Introduction The objective was to assess soft tissue healing and scarring. Tuberculosis is a common disease in developing countries such as Methods India, posing a major public health problem. Tuberculosis of the PRF was prepared as per Choukroun’s technique. Blood sample calvaria is a rare entity accounting for 0.2–1.3% of all cases of collected and centrifuged at 3000 RPM for 10 minutes. PRF gel was skeletal tuberculosis. Its capacity to affect every other organ, and separated from the test tube and applied on the tissue defect and atypical presentations make it an important part of the differential stabilised with sutures and dressing was given. diagnosis. Results Objectives Subsequent follow ups showed complete reconstruction of the lip, To discuss the case, review the incidence, etiology, pathogenesis, with no comparable difference between the repaired vermillion border clinical/radiological features of calvarial tuberculosis. and white line with adjacent normal area and minimal scarring and Methods aesthetic wound healing. An old aged lady who is known case of carcinoma left breast operated Conclusions 12 years back, presented with soft and ﬂuctuant swelling on her Use of PRF showed satisfactory aesthetic results, and thus have frontal scalp with 4 months duration. Swelling is painless and mea- presented as an excellent healing agent. sured about 6 x 6 cm in dimension with no evidence of pus discharge. FNAC yielded yellowish purulent exudates which was reported as References/Bibliography dermoid cyst. The CT scan of the head revealed bony erosion of the 1. Choukroun J, Diss A, Simonpieri A, Girard MO, Schoefﬂer C, inner/outer table of frontal bone of the skull. The soft tissue mass was Dohan SL, et al. Platelet Rich Fibrib (PRF): A second generation overlying the bony lesion with no intra dural extension. She under- platelet concentrate. Part IV: Clinical effects on tissue healing. went cyst excision and titanium mesh cranioplasty. Postoperative Oral Surg Oral Med Oral Pathol Oral Radiol Endod. HPE was reported as Calvarial tuberculosis. She recovered well and 2006;101:e56–60. was started on Anti tuberculous treatment. 2. Rozman P, Bolta Z. Use of platelet growth factors in treating wound and soft tissue injuries. Acta Dermatoven APA. 2007;16(4):156–165. 123 S52 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

ABS00809 option. Reconstruction is a challenge because of its unique anatomical Mandibular Reconstruction with Free Fibula Flap: structure and its functional requirement. Objectives Comparison of ‘‘Jugaad Technique’’, Virtual Surgical To device an optimum procedure for reconstruction of the RCU Planning and Conventional Surgery - An Institutional following release of TMJ ankylosis. Experience Methods In 11 patients with unilateral TMJ ankylosis (Type III- 5, Type IV - 6) CCG was used for reconstruction of the RCU. In 07 patients (Type Amit Dhawan, Ramandeep Bhullar, Vikas Kakar III-3, Type IV - 4) RCU was reconstructed by distraction osteogenesis. SGRD Dental College, Amritsar, India Results Normal range of motion and function was observed in all cases with Abstract satisfactory restoration of the ramal condylar unit. Background/Introduction Conclusions Free osteomyocutaneous fibular free flap has become one of the Long term studies with larger sample size is required to evaluate the primary options for mandibular reconstruction. Proper preoperative superiority of one modality over the other. planning is necessary to give near normal anatomical and functional form to the patient. References/Bibliography Objectives 1. Perrot DH, Umeda H, Kaban LB. Costochondral graft construc- Present study evaluated the accuracy of mandibular reconstruction tion/reconstruction of the ramus/condyle unit: long term follow with free fibula flap and assessed clinical outcomes in planning done up. Int J Oral Maxillofac Surg 1994;23:321–8. with ‘‘ jugged technique’’ (inverse denture planning), Virtual surgical planning (computer assisted) and conventional surgery (using K wire template). Methods 34 patients divided in 3 groups (I-22, II-7, III 5) were retrospectively ABS0010 evaluated for outcome measures including operative time, facial Comparative Histomorphometric Evaluation appearance, occlusal function and quality of life (QOL) assessment of Healthy and Ankylosed Mandibular Condylar scores. Group -I included 22 patients in which reconstruction was Process done conventionally, Group-II included 7 patients in which planning was done with Jugaad technique and Group III included 5 patients in which software planning was done which resulted in prefabricated Dr. NK Sahoo (Prof & HOD), Dr. Dibyajyoti Boruah (Scientist-‘D’), models and cutting guides through virtual planning. Dr. Ankur Thakral (Oral & Maxillofacial Surgeon), Dr. Rahul Kumar Results (Oral & Maxillofacial Surgeon), Dr. ID Roy (Prof) High precision with the use of cutting guides and templates were found for both the fibula and mandible, and a good fit was noted Dept of Oral & Maxillofacial Surgery, CMDC Lucknow; Dept of among the pre-bent plates, mandible and fibula segments in virtual Pathology, AFMC Pune; Corps Dental Unit, Bhopal; CMDC (NC); planning group. QOL scores were significantly improved (p\0.005) Dept of Oral & Maxillofacial Surgery, CMDC Pune in virtual planning group as compared to conventional surgery and jugged technique. Abstract Conclusions Background/Introduction The use of prefabricated cutting guides and pre bent plates makes Temporomandibular joint (TMJ) ankylosis is one of the most dis- fibula flap placement accurately, minimizes operating time, improves ruptive maladies afflicting the masticatory system. The characteristic clinical outcomes and QOL scores. Cost constraint is the only limiting feature is the formation of bony mass bridging condyle with glenoid factor. fossa. The exact pathogenesis is however not completely understood. References/Bibliography Quantitative histomorphometry is a tool that allows tissue level assessment of bone turnover and bone mineralization. YY Wang et al, IJOMS, 45, 11, 2016: 1400–1405. Objectives To investigate and compare histomorphometric features of ankylosed condylar specimen with normal condylar process. Section: TMJ Surgery Methods Group I included 17 post-traumatic unilateral TMJ ankylosis patients managed by excision of ankylosed mass and interpositional arthro- ABS008 plasty. Group II included 13 dicapitular condylar head fracture patients more than 8 weeks old and not responding to conservative Reconstruction of RCU in TMJ Ankylosis treatment managed by surgical debridement. The bony specimens of both the groups were subjected to histomorphometric examination for Indranil Deb Roy assessment of percentage of bone in trabeculae area (%BONE), osteocyte cell density (OSTCD), presence of inflammation and Command Military Dental Centre (SC) fibrosis. Results The mean %BONE, OSTCD, % inflammation, % fibrosis was 60.4%, Abstract 340.9 mm2, 52.9% and 58.8% in group I and 29.6%, 202.6 mm2, 31% Background/Introduction and 0% in group II. %BONE, OSTCD and fibrosis in cases of TMJ Management of TMJ ankylosis is a surgical challenge. Early release ankylosis were significantly higher than the controls while no sig- of the ankylosis with reconstruction of the RCU is the only treatment nificant difference was observed in presence of inflammation. 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S53

Conclusions References/Bibliography The present article emphasizes that dicapitular fracture of condylar head more than 8 weeks old and not responding to conservative Dimitroulis G: A new surgical classification for temporomandibular treatment may be considered for surgical debridement as the joint disorders. Int J Oral Maxillofac Surg 42(2): 218e222, 2013. inflammatory condition of joint space following condylar head frac- Dimitroulis G: Outcomes of temporomandibular joint arthroscopy in ture did not get resolved in majority of the patients and the persistence patients with painful but otherwise normal joints. J Craniomaxillofac of joint inflammation eventually leads to ankylosis of the joint. Surg 43(6): 940e943, 2015. References/Bibliography 1. Miyamoto H, Kurita K, Ogi N, Ishimaru JI, Goss AN. The effect ABS0086 of an intra articular bone fragment in the genesis of temporo- Viscosupplementation-The Concept in Alleviating mandibular joint ankylosis. Int J Oral Maxillofac Surg Symptoms of Temporomandibular Joint Osteoarthritis. 2000;29:290–5. 2. Dempster DW, Shane ES. Bone quantification and dynamics of A Clinical Study bone turnover by histomorphometric analysis. In: Becker KL, editor. Principles and practice of endocrinology and metabolism, Dr P G Antony, Dr Bobby John 3rd ed. Lippincott Williams and Wilkins; 2001. p. 541–48. Govt Dental College Kottayam

Abstract ABS0016 Background/Introduction Outcomes of Temporomandibular Joint (TMJ) Osteoarthritis is characterised by chronic degeneration of hard and Arthroscopic Lysis and Lavage: What is the Rate soft tissue around the joint. This result in anatomical changes in the joint and joint pain due to alterations in the central and peripheral pain of Progression to Open Surgery? processing mechanism. Osteoarthritis affect the temporomandibular joint leading to more Vishakha N. Devrukhkar complex symptoms like joint dysfunction, locking and excruciating pain due to the series of bio mechanical changes in the joint. Immune M.G.M. Dental College and Hospital, Kamothe, Navi Mumbai, India cells trigger inflammatory responses leading to the release of various mediators of inflammation. Treatment of TMJ arthritis should be directed at suppressing the active inflammatory process, preserving Abstract the function, preventing further damage to the joint and alleviating the Background/Introduction pain. This study aims to evaluate the efficiency of Hyaluronic acid Arthroscopic lysis and lavage has been shown to be effective in the injected directly into the joint to restore the function and to improve management of a variety of TMJ diseases. the joint rheology and viscoelastic properties and thereby assessing Objectives the anti inflammatory and analgesic properties of Hyaluronic acid in The purpose of this study was to evaluate the medium to long-term the treatment of TMJ osteoarthritis. outcomes of TMJ arthroscopic lysis and lavage and determine factors Objectives associated with progression to open surgery. The aim of the present study was to evaluate the efficacy of hyalur- Methods onidase injection in the treatment of temporomandibular joint Materials and methods A retrospective cohort study of a single osteoarthritis. operator series was performed over a 6-year period from 2006–2012. Methods The variables of gender, age and category (Dimitroulis classification) Patients with symptoms of unilateral temporomandibular joint were compared to evaluate factors associated with success of osteoarthritis, non-responsive to conservative measures such as arthroscopy and progression to open surgery. pharmacotherapy, splint therapy and arthrocentesis were treated with Results injections of 150 TRU of hyaluronidase. The outcome variables were Results A total of 167 patients and 216 joints underwent arthroscopy. maximum voluntary mouth opening, deviation on mouth opening, Overall 77.7% of joints had a successful result and required no further pain-visual analog scale, joint sounds (crepitations/clicking). surgery. There was no gender difference with respect to progression Results to surgery. Males underwent open surgery after a mean of 6.2 months 54 patients, including 28 females and 26 males were studied. The age from arthroscopy and Females after a mean of 15.6 months from group was 25 to 40 years. Patients received 3 injections of hyaluronic arthroscopy (p \0.005). The highest failure rate between age groups acid at 10 days interval according to their symptoms. 38 patients was in the 21–30 year age group (p\0.04). There was a statistically showed a significant reduction in symptoms after the first injection. significant rate of progression to open surgery depending on the With the third injection all patients obtained complete relief and were classification at the time of arthroscopy, with all patients with cate- symptom free during the follow up period. gory 4 and 5 disease progressing to open surgery (p\ 0.0001). Conclusions Conclusions Intra articular injection of Hyaluronic acid is a highly effective Conclusion Arthroscopic lysis and lavage of the TMJ is a reliable and treatment modality in patients with TMJ OA, non-responsive to other effective operation for patients with early stage (i.e., Categories 1, 2 conservative measures. and 3) disorders of the TMJ. Patients with more advanced joint disease (i.e. Categories 4 & 5) gain only temporary relief from TMJ References/Bibliography arthroscopy and often progress to open TMJ surgery. Clegg TE, Caborn D, Mauffrey C. Viscosupplementation with hyaluronic acid in the treatment for cartilage lesions: a review of current evidence and future directions. Eur J Orthop Surg Traumatol. 2013.

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ABS00110 ABS00113 Efﬁcacy of Dermal Fat Graft in the Management Comprehensive Management of Temporomandibular of TMJ Ankylosis Joint Ankylosis

Dr Sajjad Abdur Rahman (Presenting Author), Dr G S Hashmi (Co- Dr. Lt Col K Kamalpathey Author), Dr Kalim Ansari (Co-Author) Army Dental Centre (Research & Referral) Z A Dental College, AMU, Aligarh, UP, India Abstract Abstract Background/Introduction Background/Introduction Temporomandibular joint (TMJ) ankylosis is a morbid condition that TMJ ankylosis is a common debilitating disease affecting a large not only results in hypomobility of the joint but also cause consid- number of patients particularly affecting young growing children (1). erable facial asymmetry and obstructive sleep apnoea (OSA). Patients The most common cause leading to TMJ ankylosis has been attributed with longstanding unilateral temporomandibular joint ankylosis usu- to childhood trauma to mandible (1). The main modality of treatment ally present with restricted mouth opening, facial asymmetry and is interpositional arthroplasty. There are number of interpositional upper airway obstruction in the form of OSA. material utilized for the treatment including temporalis muscle, Objectives temporalis fascia, skin, costocondral graft, fat and even alloplastic The purpose of this article is to discuss the comprehensive manage- material etc. The main problem in the management of the disease has ment ankylosis with a holistic approach to achieve good function and been recurrence of the problem if proper post operative physiotherapy satisfactory form. is not followed by patients. Post operative physiotherapy is affected Methods by many factors especially pain at surgical site postoperatively. Five cases of unilateral ankylosis with gross facial asymmetry was Dermal fat has been successfully utilized as an interpositional mate- managed in our institution between the period Jun 2015 to Jun 2017. rial in the long run (2). Multidisciplinary approach was contemplated with surgical and Objectives orthodontic interventions. Treatment was planned in five stages with This study was planned to assess the success of dermal fat as inter- stage - 1 comprising of release of ankylosis, restore of function in positional material in maintaining adequate pain free post surgical terms of satisfactory mouth opening, follow up, prevention of mouth opening and the eventual fate of dermal fat graft at the grafted reankylosis. Stage - 2 comprised of orthodontics with fixed site. mechanotherapy for correction of malocclusion and orthodontic Methods decompensation. Stage - 3 comprised of orthognathic surgical pro- Inclusion criteria: 1. All TMJ ankylosis patients reporting to Dept of cedure with distraction osteogenesis (DO). Stage - 4 comprised of OMFS irrespective of age and sex. Exclusion criteria: 1. Patients post orthodontic treatment for callus moulding, consolidation and refusing the surgery. 2. Any medical and surgical condition con- final settling of occlusion. Stage - 5 was follow up phase and pre- traindicating the harvest of graft. 3. Pregnant patients. Method: vention of relapse. Preauricular incision for removal of ankylotic mass, creating a gap of Results at least 1.0 cm intraoperatively, achieving intraoperative mouth Release of TMJ ankylosis with osteoarthrectomy with interpostional opening of atleast 3.5cm, contralateral coronoidectomy if required, temporalis fascia was done in 4 cases and dermis fat graft in 1 case filling the gap with abdominal dermis fat. Assessing pain at 1 week respectively. Mouth opening at one year follow up showed average and 30 days postoperatively by Visual Analogue scale. mouth opening of 35 mm. Correction of canting and facial asymmetry Results with orthognathic surgery and distraction osteogenesis was done in all Total 15 patients and 18 joints were operated. 3 patient had bilateral 5 cases. Bilateral mandibular body distraction was done in 4 cases and and 12 had unilateral ankylosis. Mean age of patients was 12.6 years ramal condylar unit (RCU) DO was done in 1 case. All cases showed (6–30 yrs). Average follow up of patients is 13.2 months (6–24 satisfactory results without any complication and relapse. months). Average preoperative mouth opening was 5.1 mm Conclusions (0–17mm) and postoperative interincisal mouth opening is 3.0 cm The management of a facial asymmetry secondary to TMJ ankylosis (0–4cm). Postoperative pain after 1 week was recorded as mild and requires a combined surgical and orthodontic approach. Treatment remained below 1 after 1 month. should optimize symmetry, while minimizing morbidity and treat- Conclusions ment duration and maximizing long-term predictability. It can be interpreted from the study that because of lack of postsur- Osteoarthrectomy with interpositional material and postoperative gical pain the compliance for physiotherapy was good in majority of aggressive mouth opening exercises plays an important role in pre- patients leading to good maintenance of mouth opening. In our vention of relapse. Distraction osteogenesis is an excellent tool in opinion abdominal dermas fat is a reliable material for interposition in management of facial asymmetry and yields desired results. TMJ ankylotic surgery. References/Bibliography References/Bibliography H. Yu et al. Gap arthroplasty combined with distraction osteogenesis 1. Vinay Kumar Gupta et al. an epidemiological study of temporo- in the treatment of unilateral ankylosis of the temporomandibular mandibular joint ankylosis. Natl J Maxillofac Surg. joint and micrognathia. British Journal of Oral and Maxillofacial 2012;3(1):25–30. Surgery 47 (2009) 200–204. 2. Dimitroulis G. The interpositinal dermis-fat graft in the management of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg. 2004; 33(8):755–60.

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ABS00158 Objectives Simultaneous Mandibular Distraction and Gap 1. Correlate radiographic changes with TMJ pain/complaint. 2. Obtain specific guidelines for diagnosis & management of TMDs from the Arthroplasty for Correction of Facial Deformity scientific literature. in Temporomandibular Joint Ankylosis Methods 642 consecutive digital OPGs were analyzed for condylar changes Dr G. Harsha MDS, MOMS’RCPS (Glasg), Professor & HOD, and were correlated with patients’ complaints. A literature search was also done for specific guide lines regarding diagnosis & treatment of these changes/complaints. Department of Oral & Maxillofacial Surgery, MNR Dental College,& Results Hospital, Sangareddy, Telangana – 502294 A sizable proportion of the OPGs showed ‘‘condylar changes’’ but the % of patients who complained of TMJ problems was minimal. Uni- Abstract formity was lacking in the ‘‘scientific guidelines’’ for diagnosis & Background/Introduction management of these problems. Temperomandibular Joint Ankylosis is a debilitating disease mainly Conclusions affecting children. It is characterised by progressive restriction of Our study showed that there is no correlation between radiographic mouth opening and maxillomandibular developmental deformities. changes of the mandibular condyle and TMJ pain/complaints. It also Distraction Osteogenesis had developed as one of the surgical pro- showed that there is a woeful lack of well-conducted studies cedures for correction craniofacial deformities. The purpose of this regarding TMJ problems and most treatments were done using a study was to assess simultaneous Mandibular Distraction and Gap ‘‘blunderbuss’’ approach. Arthroplasty in correction of Facial Deformity in Temporomandibular Joint Ankylosis patients. References/Bibliography Objectives The purpose of this study was to assess simultaneous Mandibular 1. Wieckiewicz M, Boening K, Wiland P, Shiau YY, Paradowska- Distraction and Gap Arthroplasty in correction of Facial Deformity in Stolarz A. Reported concepts for the treatment modalities and Temporomandibular Joint Ankylosis patients. pain management of temporomandibular disorders. J Headache Methods Pain. 2015;16:106. This prospective randomized study included 10 unilateral TMJ 2. Acupuncture therapy in the management of the clinical outcomes Ankylosis patients associated with facial deformity and restricted for temporomandibular disorders: A PRISMA-compliant meta- mouth opening. In all 10 patients simultaneous Distraction osteoge- analysis. nesis and Gap arthroplasty were performed. Treatment outcomes were 3. Wu JY, Zhang C, Xu YP, Yu YY, Peng L, Leng WD, Niu YM, analysed in terms of mouth opening, Facial asymmetry correction. Deng MH. Medicine (Baltimore). 2017 Mar;96(9):e6064. Results Among 10 patients treated with simultaneous Distraction osteogenesis and Gap arthroplasty, 8 patients had good correction of facial esthetics and adequate mouth opening, 1 patient had reankylosis, 1 ABS00233 patient had infection and loosening of distractor. ‘‘Auricular Cartilage Fixation in Treatment of TMJ Conclusions Ankylosis’’ Case Series Simultaneous Distraction Osteogenesis and Gap arthroplasty is very effective in correcting of post ankylotic deformity and improving function and also eliminates the need for second surgery. 1. Dr Ashutosh Harsh Assistant Professor General Dentistry, 2. Dr D.K Gupta Ex-HOD, 3 Dr. Pragya Harsh Ex-Senior Resident References/Bibliography Simultaneous gap arthroplasty and intraoral distraction and secondary 1. Dr SN Medical College Jodhpur; 2. Government Dental College contouring surgery for unilateral temporomandibular joint ankylosis - Jaipur; 3. Dr SN Medical College Jodhpur Journal of Maxillofacial Plastic and Reconstructive surgery (2016)38:12. Abstract Background/Introduction Temporomandibular joint ankylosis is a condition in which there is immobility of joint, it is characterized by formation of an osseous ABS00217 fibrous or fibroosseous mass fused on the base of skull. Trauma is the most common etiology Different autogenous and alloplastic interpo- TMJ Disorders: Are We Getting it Right? sition materials have been used after the resection of the ankylotic bone to achieve desirable and long lasting results. The recurrence of Mohan Alexander disease is most distressing for both patients and surgeon. This study demonstrated that autogenous auricular cartilage fixed with condyle MAHSA University, Jalan SP2, Jenjarom, 42610, Saujana Putra, with suture is a suitable material for interpositional arthroplasty in Malaysia adults. Objectives Abstract The objective of this study is to evaluate the clinical efficacy of use of Background/Introduction autogenous auricular cartilage graft as an interposition material fixed Diagnosis as well as management of patients reporting with TMJ to condyle after arthroplasty of the TMJ ankylosis. The use of an problems is part of the maxillofacial surgeon’s repertoire. But the interposition material with less volume and proper fixation covering variety of methods for evaluating and managing TMDs that have been all the raw bone joint space prevents reunion of bone; fixation of the proposed can be quite confusing for most of us. cartilage prevents its movement and thus extrusion of interpositional graft and prevents reankylosis.

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Methods References/Bibliography All the patients will undergo gap arthroplasty followed by placement of auricular cartilage graft as interpositional material. The technique 1. Brown WA: Internal derangement of the temporomandibular of using auricular cartilage covering whole of the joint space fixed joint. Review of 214 patients following meniscectomy. Can J with non-absorbable silk 3-0 suture to the condyle was employed in Surg 23:30, 1980. all patients. 2. Holmlund A, Axelsson S: Diskectomy in treatment of disk Results derangement. A one and three year follow-up. Swed Dent J Twenty patients of temporomandibular joint ankylosis were selected. 14:213, 1990. In all patients’ treatment of tempromandibular joint ankylosis was done using auricular cartilage fixation. The pre-operative interincisal mouth opening ranged from 5 to 15 mm. The intra-operative interincisal mouth opening ranged from 25 to 45 mm. There was no ABS00427 extrusion of the auricular cartilage in follow-up period. Surgical Treatment of 14 Years Old Case of Bilateral Conclusions Use of auricular cartilage with less volume and proper fixation cov- Recurrent Ankylosis of TMJ ering the joint space, prevents reunion of bone; fixation of the auricular cartilage prevents its movement and extrusion. There was no Dr. Ravinder Solanki, Associate Professor verticle height shortening of mandible. References/Bibliography PGIDS, Rohtak, Haryana

1. Yazdani J, Ghavimi MA, Pourshahidi S, Ebrahimi H.Comparison Abstract of Clinical Efficacy of Temporalis Myofascial Flap and Dermal Background/Introduction Graft as Interpositional Material in Treatment of Temporomandibu- A patient with bilateral TMJ ankylosis was operated for two times and lar Joint Ankylosis. J Craniofac Surg.2010; 21: 1218–1220. patient developed the ankylosis for the this time providing the history 2. Kalra.G.S. (2011)8 et al did the study of temporomandibular joint of first operation 14 years back. CT evaluation confirmed the type IV ankylosis fixation technique with ultra thin silicon sheet Indian J TMJ ankylosis. Patient was planned for surgical treatment of anky- Plast Surg. 2011 Sep-Dec; 44(3): 432–438. losis first and following with orthodontic treatment and advancement of chin. Current case reports only about the surgical treatment for ankylosis and is under treatment for further procedures including orthodontic treatment. 10. ABS00367 Objectives Discectomy as the Primary Surgical Option for Painful To achieve the sufficient mouth opening for the functional move- Internal Derangement of the Temporomandibular ments of TMJ. Methods Joint: A 3 Year Clinical Follow Up Study Gap Arthroplasty. Results Dr Sandeep Mehta Satisfactory mouth opening achieved. Conclusions Military Dental Centre Old recurrent cases of TMJ Ankylosis should be managed by efficient planning along with the high patient cooperation to achieve the satisfactory results. Abstract Background/Introduction A 3 year prospective study to assess the surgical management of unilateral internal derangement of TMJ. ABS00759 Objectives The goal of this prospective study was to evaluate outcomes and Efficacy of Abdominal Dermis Fat Graft compare the pre-operative and post-operative status of the patients and Temporalis Myofascial Flap as an Interpositional who underwent unilateral temporomandibular joint discectomy Material in the Management of Temporomandibular without replacement as the primary treatment for internal derange- Joint Ankylosis: A Comparative Analysis ment after failure of nonsurgical therapy. Methods Thirteen patients with TMJ internal derangement without reduction Dr. Surendra N. Daware, Assistant Professor, Government Dental were managed with discectomy from 2014 to 2016 at Bathinda Mili- College and Hospital, Nagpur and Dr. Abhay N. Datarkar, Professor tary Dental centre. Patients were selected for surgery depending on & Hod their clinical as well as MRI TM joint findings. No patient was lost in the follow up and average follow up was carried out at least 18 months. Government Dental College and Hospital, Nagpur Results All 13 patients showed improvement in mandibular mobility, mouth Abstract opening, joint function, as well as reduction in TMJ and muscular Background/Introduction facial pain. One patient required contralateral surgery during the Temporomandibular joint (TMJ) ankylosis is characterized by the follow up period. formation of a bony or fibrous mass that replaces the normal articu- Conclusions lation, particularly hindering mouth opening, as well as anterior and Discectomy of the TMJ as a primary surgical option significantly lateral movement. The treatment for TMJ ankylosis aims at complete reduces pain and improves joint functions who show no improvement removal of ankylotic block and a more normal range of jaw motion. with prior non-surgical treatment. 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S57

Management of ankylosis occurs through surgical intervention; sev- Conclusions eral authors agree that it is necessary to use an interpositional material The success in the preventing Reankylosis after TMJ gap arthro- to prevent re-ankylosis after gap arthroplasty. The primary function of plasty is related primarily to the appropriate surgical technique with the interpositional material is to prevent the reankylosis by elimi- adequate removal of bone, early vigorous postoperative physio- nating contact between bone surfaces. Appropriate interpositional therapy, maintained for long term. Difficulty in mouth opening and material include: 1-autogenous tissue: meniscus, muscle, fascia, skin, vigorous post operative exercise are troublesome for the patient if cartilage, fat or combination of these tissues; 2: allogeneic tissues; Temporalis muscle is used as the interposition material due to cartilage and dura; 3; alloplastic: silastic materials like acrylic, pro- compression of the nerves which may subsequently reduce the plast, and silicon; 4: xenograft tissues: usually of bovine origin mouth opening. An ugly bulging in the temporal region after har- (collagen and cartilage). vesting of that side may not be neglected. However the versatility Objectives of the Temporalis Myofacial flap technique in Interpositional This paper aims at comparative evaluation of two inter positional material is not certain and failure may occur. The jaw movements materials like abdominal dermis fat graft and temporalis myofascial and physiotherapy are well tolerated and maintained by patients if flap in the management of Temporo-mandibular joint (TMJ) the gaps were filled with dermis fat grafts. The dermis fat graft ankylosis. minimizes the occurrence of excessive joint fibrosis and heterotopic Methods calcification and consequently providing improved range of motion. Total 10 cases (6 female and 4 male) of unilateral bony ankylosis Graft procurement is quick and easy with minimal morbidity and were studied for the comparative efficacy at our institute, out of which the wound and scar in the anatomical skin creases are accepted 5 were treated with abdominal dermis fat graft and 5 patients were cosmetically. The results obtained in our study are highly satis- treated with temporalis myofascial flap as an interpositional material factory and encouraging, supporting the role of dermis fat graft as after gap arthroplasty for the management of Temporo-mandibular the interposition material in TMJ Ankylosis cases especially in joint (TMJ) ankylosis. Age of the patient was ranging from 4–20 children. However, a large sample size and a longer follow-up years. Ankylotic mass removal procedure was almost same in all period are required to consolidate the findings. operated cases. For interposition purpose, Abdomen fat graft was harvested from suprapubic region whereas temporalis flap was har- References/Bibliography vested from same surgical site. 1. Temporalis Myofacial Flap in TMJ Ankylosis with Gap Arthro- Results plasty: A Case Report. Yogendra Kumar Singh et al. Annals of All patients were evaluated in postoperative period at one month, International Medical and Dental Research, Vol (3), Issue (3). three month and six month duration. Postoperative assessment was doi:10.21276/aimdr.2017.3.3.DE6. done by assessing the maximal mouth opening prior and after pro- 2. Efficacy of abdominal dermis fat graft as the interpositional cedure, complication at both donor and recipient site, and prevention material in the management of Temporomandibular joint anky- of re-ankylosis after interpositioning. Early vigorous postoperative losis in children- an original study. Dr. S. Gandhiraj et al. IOSR physiotherapy was given in all cases. Patients operated with tempo- Journal of Dental and Medical Sciences (JDMS) e-ISSN: ralis group were not tolerating postoperative exercises because of 2279-0853, p-ISSN: 2279-0861. Volume 3, Issue 6 (Jan.–Feb. contracture pain during jaw movements whereas this problem was not 2013), PP 07–11. seen in abdomen fat group. Improved range of motion was seen in abdomen fat group of patients whereas motions were limited in temporalis group. In temporalis group, depression over temporal region because of harvesting was noticed on operated side. In abdomen group, scar was well hidden in the abdomen crease. No case of reankyosis was reported in our study.

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Section: Craniofacial Research ABS00808 Assessment of Involvement of Muscles of Mastication in Long Standing Cases of OSMF. Pilot Study ABS00246 Cranioplasty: An Armed Forces Experience Dr Praful Gaikwad Dmims

Sqn Ldr Jimish Desai Abstract Background/Introduction Air Force Institute of Dental Sciences, Bengaluru Oral submucous fibrosis (OSMF or OSF) is a chronic, complex, premalignant lesion of the oral cavity, characterized by juxta-epithelial inflammatory reaction and progressive fibrosis of the Abstract submucosal tissues (the lamina propria and deeper connective tissue). Background/Introduction The pathogenesis of OSMF suggested that exposure to arecanut Cranioplasty is the surgical intervention to repair cranial defects in (Arecacatechu) containing products with or without tobacco currently both cosmetic and functional ways. The history of cranioplasty dates believed to lead to OSF in individuals with genetic immunologic or back to 7000 B.C. In 19th century, the use of bone from different nutritional predisposition to the disease. These collagen fibers are non donor sites, such as ribs or tibia, gained wide population. Although degradable and the phagocytic activity is minimized. As the disease many different materials and techniques had been described, there is progresses various cardinal features established like pain on palpation still no consensus about the best material. in the sites where submucosal fibrotic bands are developing, trismus is Objectives caused mostly by fibrosis in the dense tissue around the ptery-go- Although many different materials and techniques had been descri- mandibular raphae but it is and it is also observed that it may be bed, there is still no consensus about the best material, and ongoing because of involvement of muscles of mastication. There are fewer researches on both biologic and non biologic substitutions continue evidences supporting this hypothesis. So we planned to conduct a aiming to develop the ideal reconstruction materials. In this article, study to evaluate involvement of muscles of mastication in OSMF the principle materials and techniques of cranioplasty are reviewed. using ultrasonography and subsequent Myotomy of the involved Methods muscles to see improvement in mouth opening. Many different types of materials were used throughout the history of Objectives cranioplasty. With the evolving new biomedical technology, new To assess grading of muscle to establish regular long term follow up materials are now available to be used by the surgeons. to perform selective sequence of muscle myotomy. Results Methods An ideal cranioplasty material must have the following features: It 10 patient with long standing OSMF were selected, and sonological must fit the cranial defect and achieve complete closure Radiolucency conformation for assessing the hypertrophic changes in masticatory Resistance to infections not dilated with heat Strong to biomechanical muscles were enrolled under study. The basic protocol of releasing processes Easy to shape not expensive Ready to use. fibrous band, coronoidectomy, Followed by reconstruction with Conclusions extended Nasolabilal Flap as routine procedure and physiotherapy Most cranioplasty materials are used with little adjustments by the was decided If needed selective muscle myotomy performed in surgeon. But the basic principle must not be forgotten; to choose patient showing muscle restraining effect for mouth intraoperatively proper material for the defect. A cranioplasty material must have low to achieve standard interincisal mouth opening of 35mm. infection rates, show low heat conduction, to be non-magnetic, radi- Results olucent, tissue acceptable, durable, shapeable, and inexpensive. 4 patient require myotomy. Before achieving bone closure, clear bone borders should be obtained, Conclusions and scalp should be dissected from dura. Dural tears should be closed Selective muscle myotomy, effective method to fulfill surgical in watertight manner. Bone and cranioplasty material should touch to protocol. each other with maximum capacity. To prevent the mobility of the cranioplasty flap, the material is fixed to the bone with proper plates. References/Bibliography References/Bibliography 11. J Oral Pathol. 1985 Oct;14(9):709–17. Ultrastructural findings of muscle degeneration in oral submucous fibrosis. el-Labban 1. Sanan A, Haines SJ. Repairing holes in the head: A history of NG, Canniff JP. cranioplasty. Neurosurgery. 1997;40:588–603. 12. Ma RH, Tsai CC, Shieh TY. Increased lysyl oxidase activity in 2. Blake DP. The use of synthetics in cranioplasty: A clinical fibroblasts cultured from oral submucous fibrosis associated review. Mil Med. 1994;159:466–9. with betel nut chewingin Taiwan. J Oral Pathol Med 1995;24:407–12. 13. Khanna JN, Andrade NN. Oral submucous fibrosis: a concept in surgical management. Int J Oral Maxillofac Surg 1995; 24: 433–9. 14. Ultrasonography in maxillofacial Imaging – a review Karthik R1,*, Mohan N2, Ravikumar PT3, Saramma Mathew Fenn4, Sabitha Gokulraj5, Cicilia.

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Section: Oral Pathology: Benign increases the chances of Frey’s syndrome developing post operatively. The anterior border of the SCM which was identified is used to expose the tail of the parotid. The fascia overlying the muscle provides a safe plane to elevate the tail of the gland. Sharp dissection is ABS0012 carried out to separate the tail of the parotid gland off the SCM and Consistent and Simplified Anatomical Landmarks also the cartilaginous external auditory canal. The greater auricular for Safer Parotid Gland Surgery nerve running on the superficial surface of the SCM is identified and with Predictable Outcomes divided as close to the parotid gland as possible in an attempt to preserve the posterior branch if possible which may also serve as a potential nerve graft if required. Next, the skeletonised anterior border Kapil Tomar of SCM is retracted inferiorly to expose the PBD muscle which is then cleanly separated and visualised. The mastoid process is palpated Naval Institute of Dental Sciences (Mumbai) and the mastoid insertions of both the SCM and the PBD dissected and exposed. The facial nerve trunk (FNT) can be found exiting the Abstract stylomastoid foramen just above the attachment of the PBD to the Background/Introduction mastoid process (Fig 3). Thereafter, using bipolar cautery and sharp The facial nerve (7th cranial nerve) is intimately associated with the dissection, the cervicofacial and temporofacial divisions are exposed parotid gland and accurate understanding of its anatomy is critical for and the ‘pes anserinus’ dissected while bluntly lifting off the super- successful parotid gland surgery. Two techniques exist for identifi- ficial lobe of the parotid gland from the nerve branches (Fig 4). cation of the facial nerve, namely the antegrade and retrograde Careful hemostasis was achieved after delivering the superficial lobe. techniques. The retrograde technique involves tracing a peripheral A closed circuit suction drain was secured and layer wise closure branch proximally towards the trunk. Several anatomical landmarks done with 3-0 vicryl and subcuticular suturing of the skin with 3-0 have been listed for antegrade dissection of the facial nerve trunk and prolene. Pressure dressing was applied and patient placed on broad its branches distally. These anatomical landmarks are the cartilagi- spectrum IV antibiotics, Dexamethasone (8mg) in tapering dose and nous tragal pointer, digastric ridge, stylomastoid foramen, tympano injectable Tramadol for pain relief. mastoid suture line and mastoid process. We propose identification of Results two landmarks, the sternocleidomastoid (SCM) muscle’s mastoid Post operatively, healing was uneventful with aesthetic scar (Fig 5). insertion and the posterior belly of digastric (PBD) muscle’s mastoid No cases had surgical wound break down or hypertrophic scar post insertion to serve as easy and consistent superficial landmarks to trace op. Post operative complications included transient neurologic deficit the main trunk of the facial nerve. of the marginal mandibular nerve in 2 cases (12.5%) and of the Objectives temporal nerve in 1 case (6.25%). All 3 cases of transient nerve deficit To demonstrate the efficacy of utilising the sternocleidomastoid responded well to Tablet Methylcobalamine (1500 ugm) with taper- (SCM) and posterior belly of digastric (PBD) muscles as simple ing dose of Tablet Methyl Prednisolone (10 mg) and resolved anatomical landmarks for consistently locating the facial nerve trunk completely in 6 weeks duration. We had no complication of Frey’s (FNT) in parotidectomy surgeries with minimal neurologic deficit of syndrome or salivary fistula post operatively. the facial nerve branches post operatively. Conclusions Methods Parotidectomy is a technique sensitive surgery requiring surgical 16 patients of unilateral parotid gland disease underwent superficial finesse, understanding of surgical anatomy and attention to detail. Our parotidectomies by the same surgical team from Jan 2015 to Dec described technique using the mastoid heads of the sternocleido- 2016. 10 were male and 6 female. Institutional ethical committee mastoid and the posterior belly of digastric as anatomical landmarks clearance was taken for this study. Mean age of the patients was 42 to locate the facial nerve trunk is simpler and faster for the novice years and mean duration of presentation of symptoms was 1.2 years. surgeon to perform with a broader and safer dissection field. The All patients were subjected to MRI for purpose of imaging and a fine landmarks described are consistent, superficial, easily distinguishable needle aspiration cytology (FNAC) was carried out in all patients to and in close proximity to the facial nerve trunk, thereby allowing confirm the diagnosis prior to listing the patient for surgery. 12 easier exposure of the same. In our study, we have observed and patients were diagnosed with benign salivary gland tumors (9 pleo- demonstrated that rather than relying on anatomical landmarks such morphic adenomas, 2 basal cell adenomas and 1 Warthin’s tumor) and as the tragal pointer which is inconsistent, inaccurate and vague or 4 with chronic non specific sialadenitis of the parotid gland. Routine bony landmarks such as the tymanomastoid fissure, styloid process, investigations were ordered and pre anesthetic check up carried out. mastoid tip and stylomastoid foramen which require deeper dissection Detailed informed consent listing out all possible complications with and can cause inadvertent damage to the facial nerve trunk, the emphasis on facial nerve palsy was obtained from the patient. mastoid heads of the SCM and the PBD are relatively superficial, easy Endotracheal intubation was carried out and surgery performed under to dissect, consistent and reliable landmarks to locate the FNT with general anaesthesia. Aseptic scrubbing and draping was performed minimal post op paresis/neuropraxia. and 1;80,000 concentrated Adrenaline solution infiltrated along the References/Bibliography proposed incision line for vasoconstriction. Modified Blair’s lazy S incision was made (Fig 1) and flap raised in a sub platysmal plane in 1. Sinha UK, Ng M. Surgery of the salivary glands. Otolaryngol the cervical region and along the superficial musculo aponeurotic Clin North Am 1999;32(5):887–906. (SMAS) layer over the parotid gland to expose the glistening white 2. Scarpini M, Bonapasta SA, Ruperto M, et al. Retrograde parotid fascia/capsule (Fig 2). Sharp dissection is carried out upto the parotidectomy for pleomorphic adenoma of the parotid gland: a depth of the parotid fascia in the preauricular area and through pla- conservative and effective approach. J Craniofac Surg tysma in the cervical region. Anterior and posterior flaps are then 2009;20(3):967–9. raised along this relatively avascular plane, to expose the parotid gland anteriorly and the anterior border of the sternocleidomastoid muscle posteriorly. Great care should be taken not to raise an excessively thin flap which can cause ‘‘button-holing’’ and also

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ABS0017 Results Rare Dermoids in Maxillofacial Region The cause of the mandibular lesion can be intraosseous hemorrhage, soft tissue hemorrhage with periosteal stripping and subperiosteal hematoma formation, or a combination of these factors leading to AK Choudhary, NK Sahoo, Kapil Tomar pressure necrosis phenomenon. Conclusions Abstract The differential diagnosis of masses occurring in the jaws of children Background/Introduction is limited and since haemophilic pseudotumour is not pathognomonic The dermoid cyst is an uncommon clinicopathological lesion of in radiological findings, Haemophilic pseudotumor should be con- developmental origin. The term dermoid cyst is used to describe 3 sidered in the differential diagnosis when a mass presents with rapid cysts that are closely related histologically: dermoid cyst, epidermoid growth, even in the absence of a prior diagnosis of hemophilia as HP cyst, and teratoma. Epidermoid and dermoid cysts are benign nature, may be the initial manifestation of this disease or when a patient who which may occur anywhere in the body, but most predominantly in suffered from Haemophilia. the ovary and scrotal regions. Objectives References/Bibliography To review dermoid cyst in maxillofacial region. 1. Srinivasan K, Gadodia A. Mandibular Hemophilic Pseudotumor Methods Associated With Factor IX Deficiency: Report of Case With Operated on patients with dermoid cysts and reviewed all three Review of Literature. J Oral Maxillofac Surg. 2011;69:1683–1690. clinicopathological lesions. 2. Shi H, Wang S, Wang P, Yu Q. Haemophilic pseudotumour of Results the mandible. Dentomaxillofac Radiol. 2009;38:182–184. Postoperative healing was uneventful in all patients. Conclusions Ample understanding and vigilance about this slow growing painless mass is essential not only because of the symptoms it produces but also due to its malignant potential. When dermoid cysts occur on the ABS0052 floor of the mouth, they may enlarge to such an extent that they can Lingual Hypoglossal Nerve Reflex: An Unusual Pattern interfere with deglutition and produce respiratory obstruction. of Nerve Injury Encountered in a Series of Salivary References/Bibliography Gland Surgeries De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual Dr. Reena Rachel John, 2. Dr. Pathumai Murugadoss epidermoid cyst. J Craniofac Surg. 2002;13:308e310.

2. Vinayaka Mission’s Sankarachariyar Dental College and Hospital, Salem, Tamilnadu ABS0042 Abstract Haemophilic Pseudotumor of Mandible in a Patient Background/Introduction with Severe Haemophilia B The major salivary glands in humans have anatomic proximity to several nerves of the head and neck, hence it is natural to come across Dr (Maj) T Balasundaram, Co Author: Dr (Col) P K Chattopadhyay. nerve injuries ranging from neuropraxia to axonotmesis during sali- Dr (Maj) T Balasundaram, Graded Specialist vary gland surgeries. The most common injuries in a well executed surgery is neuropraxia, the incidence of which has been reported to be 9.3% to 64.6% for parotid surgeries and 7.7%-36% for submandibular Armed Forces Dental Clinic, Tyagraj Marg, New Delhi-110011. surgeries. The clinical features of such nerve injuries can range from Mobile No: 8826383251. Email: [email protected] mild paresthesia from afferent nerve injury, to paresis/paralysis due to efferent nerve injury, to aberrant regeneration resulting from cross Abstract innervation from two different nerves. eg:- Freys syndrome, lingual Background/Introduction hypoglossal reflex. The Haemophilic Pseudotumour (HP) is an uncommon manifestation Objectives of haemophilia that was first reported by Starker in 1918.1 Hae- To assess the variations of nerve injury in salivary gland surgeries. mophilic Pseudotumor is a rare complication seen in approximately Methods 1–2% of cases of hemophilia. 2 It most frequently affects the femur, Out of the 11 cases of salivary gland pathologies involving major and followed by the pelvis, tibia, bones of the feet, hands or wrist and minor salivary glands that reported to our department between occasionally occurring in the jaw bones. 2014–2017, seven cases were from minor salivary gland and therefore Objectives not included in this series. Of the remaining 4 major salivary gland Literature review states that Haemophilic Pseudotumor though seen surgeries we observed the effects of nerve injury in two of the cases. in Classic Haemophilia is rare in Haemophilia B. Our case report Patients were followed up over a period of 5 months. represents only the fourth case in literature wherein this tumor is Results presented in a patient of Haemophilia B. Our aim is to make clinicians Out of the 11 cases of salivary gland pathologies, nerve injuries were aware of the possibility of such pseudotumors in the jaws. seen in two major salivary gland pathology cases. One was facial Methods palsy following superficial parotidectomy for pleomorphic adenoma Our case is a 7 year old boy reporting with a spontaneous extraoral and other was exaggerated lingual hypoglossal reflex following sub- swelling from mandible that was managed with transfusion of factor lingual gland excision for chronic sialadenitis. IX along with curettage. Histopathological examination revealed it as Conclusions a case of Haemophilic Pseudotumor. Rare to common complications can be encountered on any surgeries. This series is interesting because of the occurrence of lingual 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S61 hypoglossal reflex which is only reported in feline species as per complications, diminished quality of life, and medical malpractice literature. litigation. Facial nerve monitoring is an adjunctive method available to a surgeon during parotid surgery to assist with the functional References/Bibliography preservation of the facial nerve. A diagnosed case of pleomorphic Distribution Pattern Of The Human Lingual Nerve Karen B. Zur, adenoma left parotid gland was operated for superficial parotidectomy Liancai Mu, and Ira Sanders Clinical Anatomy 17:88–92 (2004) The with the help of electric nerve simulator with no motor loss of facial Synaptic Basis Of A Bilateral Lingualhypoglossal Reflex in Cats. nerve function. Objectives To preserve the facial nerve and all its branches with no or minimal motor deficit post surgery and monitoring the facial nerve function of all its branches during surgery to enable in safe dissection. ABS0061 Methods Cemento Ossifying Fibroma of Maxilla: Rare Case Electric nerve stimulator used intraoperatively after elevation of skin Report flap and facial nerve branches identified and then the dissection carried out proximally towards the nerve trunk to identify and check the function of each of the branch during the surgery. Dr. Geeta Mishra Tripathi Associate Professor Results Safe dissection of the nerve is difficult in cases where the nerve is Dental Dept. S.S. Medical College Rewa (M.P.) involved with a tumor, which is infiltrating the gland and distorts the anatomy of the gland and the landmarks required to be identified for Abstract safe dissection of facial nerve. Continuous monitoring of the nerve Background/Introduction intra-operatively can be safe guide for dissection and identification of Ossifying fibroma is a rare, destructive, deforming, slow growing the nerve. benign fibro-osseous tumor. It is usually found in the craniofacial Conclusions bones with the mandible being the most common site. Less commonly Damage to facial nerve during parotidectomy can be devastating for the orbit, paranasal sinuses or sometimes the maxilla have been the patient and can demoralize the surgeon before attempting such involved. It is believed to be derived from the cells of the periodontal surgeries so its pertinent that use of nerve stimulator during the sur- ligament. This bone tumor consists of highly cellular, fibrous tissue gery can be a boon to beginners in attempting such complicated that contains varying amounts of calcified tissue resembling bone, surgeries. cementum, or both. They have got a female predeliction and is usually seen in the age between 35 and 40 years of age. In this report, we have References/Bibliography described a 16-year-old female with huge swelling on lt side of 1. David W. Eisele, MD, Steven J. Wang, MD, Lisa A. Orloff, MD. maxillary region with a detailed description of clinical, radiographic, Electrophysiologic facial nerve monitoring during parotidectomy. histopathologic features, and its surgical management. HEAD & NECK, Mar 2010, 399–405. Objectives 2. Stephanie Flukes, Shane S. Ling, Travis Leahy, Chady Sader. Not applicable. Intraoperative Nerve Monitoring in Otolaryngology: A Survey of Methods Clinical Practice Patterns. Int J of Otolaryn & H & N Surg, 2013, Not applicable. 2, 21–26. Results Not applicable. Conclusions Not applicable. ABS00286 References/Bibliography Use of Nerve Stimulating Device in Identification 1. Khan SA, Sharma NK, Raj V, Sethi T. Ossifying fi broma of of Facial Nerve in Treatment of Recurrent Parotid maxilla in a male child: Report of a case and review of the Tumours literature. Nat J Maxillofac Surg 2011;2:73–9. 2. MacDonald-Jankowski DS. Cemento-ossifying fi bromas in the jaws of Hong Kong Chinese. Dentomaxillofac Radiol 1) Dr. Pranay Pardeshi- Fellow & Assistant Surgeon, 2) Dr. Ashok 1998;27:298–304. Mehta- Medical Director & Senior Consultant Cancer Surgeon, 3) Dr. Rajesh Valand- Professor & Senior ENT Surgeon

1. Department of Head & Neck Cancer Surgery, Brahma Kumari’s ABS0097 Global Hospital & Research Centre, Mumbai; 2. Department of Head & Neck Cancer Surgery, Brahma Kumari’s Global Hospital & Facial Nerve Monitoring a Boon in Parotidectomy Research Centre, Mumbai; 3. Department of Head & Neck Cancer Surgery, Brahma Kumari’s Global Hospital & Research Centre, Dr Rajashekhar D Gadad Mumbai

Command Military Dental Centre (Nc) Abstract Background/Introduction Abstract Operating the parotid tumors requires great skills and experience to Background/Introduction preserve the facial nerve. This task becomes even more difﬁcult in Facial nerve injury is a feared complication of parotidectomy. Facial recurrent cases where the anatomy is disturbed due to previous nerve paralysis can cause cosmetic and functional morbidity, ocular surgery/surgeries. The nerve stimulating device provides the surgeon accuracy to identify and preserve the facial nerve during the surgery. 123 S62 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

Objectives osteoma of coronoid process, an extremely rare case of Masson’s The study aims to demonstrate the effective use of nerve stimulating Haemangioma and lastly a case of solitary Neurofibroma of mental device to identify & preserve the facial nerve in treatment of recurrent nerve. parotid tumors. Results Methods Though all these cases were appear to be complex, the treatment was 5 patients reported of recurrent pleomorphic adenoma in Department simple after diagnosis. of Head & Neck Cancer at Brahma kumari’s Global Hospital & Conclusions Research Centre from 1st July 2016 to 1st July 2017. Out of 5 patients Although these pathological conditions appear complex, the treatment 2 were males and 3 were females. The average age of patient was 29 was simple following diagnosis. Diagnosis remains a key factor for years. Prior to anesthesia facial nerve marking was done on skin with treatment of complex pathologies. nerve stimulating probe at low current. In most of the cases modified pre-auricular with extending submandibular incision was made. The References/Bibliography facial nerve identification is done with nerve stimulating device and 1. Y. K Chen, L-M Lin, C C Lin osteoma of mandibular coronoid needle by checking for twitching. process Report of a Case Int. J. Oral Maxillofac Surg Results 1998;27:222–223. The facial nerve was identified and preserved in all cases of recurrent 2. Fa´bio Andrey da Costa Arau´jo, Jimmy Charles Melo Barbalho, parotid tumors. There was no facial nerve weakness seen post- Orley Nunes de Farias Juńior, Ricardo Jose´ Holanda de operatively. Vasconcellos, Belmiro Cavalcanti do Egito Vasconcelos (2014) Conclusions Pseudo-ankylosis caused by osteoma of coronoid process. Annals The nerve stimulator device is readily available in operation theatres of Maxillofac Surg; 4: 67–69. and very often used by anesthetists for nerve blocks. The device is effective in identifying and preserving the facial nerve specially in recurrent cases where normal anatomy is distorted. References/Bibliography ABS00365 1. Treating recurrence of parotid benign pleomorphic adenomas: Odontogenic Keratocyst: A SRU Case Series Yugueros P1, Goellner JR, Petty PM, Woods JE; Ann Plast Surg. 1998 Jun;40(6):573–6. Dr Deepak C, MDS Reader, Co-Author 1: Prof. C. Ravindran MDS 2. Management and prognostic factors of recurrent pleomorphic HOD adenoma of the parotid gland: personal experience and review of the literature: Luca Oscar Redaelli de Zinis, corresponding author Oral & Maxillofacial Surgery Faculty of Dental Sciences Sri Michela Piccioni, Antonino Roberto Antonelli, and Piero Nicolai; Ramachandra University Porur, Chennai-116 Contact No: Eur Arch Otorhinolaryngol. 2008 Apr; 265(4): 447–452. 9840261543; Oral & Maxillofacial Surgery Faculty of Dental Sciences

Abstract ABS00291 Background/Introduction Uncommon Pathological Entities in Oral & Odontogenic keratocyst is a developmental cyst, it is now referred to Maxillofacial Surgery as keratocystic odontogenic tumor. It is cystic lesion originate from a dental lamina or from the primordial odontogenic epithelium that benign neoplasm characteristics and it has high recurrence rate. 1. Dr Shilpa S Bawane, 2. Dr Pushkar P Waknis Objectives To understand the nature of Odontogenic keratocyst and the treatment Dr D Y Patil Vidyapeeth, Dr D Y Patil Dental College & Hospital modalities. Pimpri Pune Methods Case Series. Abstract Results Background/Introduction Adequate follow up. Oral & Maxillofacial surgeon commonly deals with different surg- Conclusions eries ranging from cleft to orthognathic surgery. In this paper, the OKC can sometimes be treated as benign lesion, multilocular lesion author has included uncommon cases in clinical practice, their diag- have to be treated aggressively. nostic methods and management. History, detail clinical examination References/Bibliography and step by step investigation would provide the surgeon with deﬁnitive diagnosis. 1. Bhargava D, Deshpande A, Pogrel MA. Keratocystic odontogenic Objectives tumour (KCOT)–a cyst to a tumour. Oral Maxillofac Surg. 2012 Objective of this paper is to report uncommon pathological entities Jun;16(2):163–70. along with diagnostic methods and management in teaching Institute. 2. Yazdani J, Kahnamouii SS. Developmental odontogenic cysts of Methods jaws: a clinical study of 245 cases. J Dent Res Dent Clin Dent Author intends to report 4 interesting cases, all of which form a Prospects. 2009;3(2):64–6. different pathological entity. The cases include a suspected cyst which later on turn to be a carcinoma, a large swelling over the zygomatic region which on histopathologic examination was found to be a

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ABS00645 shown that allogeneic and alloplastic materials do not integrate To Evaluate the Effectiveness of Use of Carnoy’s immediately with the surrounding bone, and therefore the strength of the mandibular segment is not significantly increased in the short Solution After Enucleation in Unicystic term. Marsupialization (a conventional conservative method), where Ameloblastoma: Report of Series of 5 Cases the cystic lining is left behind has the probability of recurrence or malignant transformation. We describe three cases of very large Dr. Hirkani Ravindra Attarde. Reader mandibular cyst in which enucleation of the primary lesion was done, followed by packing of the residual osseous defect, permitting the wound to heal by secondary intention. YMT Dental College and Hospital, Kharghar, Navi Mumbai Objectives To access the feasibility of an alternative treatment modality for large Abstract cysts of mandible in achieving good functional and esthetic outcome. Background/Introduction Methods Unicystic ameloblastoma is a rare variant of ameloblastoma which After exposure of the pathology utilizing appropriate flap and creation usually occurs in younger population. They are characterised by slow of bony window, the cyst was enucleated and a strip of sterile ribbon growth and being relatively less aggressive as compared to multi- gauze impregnated with ‘Bismuth Iodine Paraffine Paste’ (one part locular ameloblastoma. Late recurrence following surgical bismuth subnitrate, two parts iodoform, one part sterile liquid paraffin management is been reported and is mainly related to its histological by weight) was lightly packed into the entire cavity from the open type, the site of origin and the initial treatment modalities (1). wound. The iodoform gauze pack was changed every 3 weeks. The Objectives iodoform dressings were discontinued once the cavities were small The aim and objective of our study is to evaluate the effectiveness of enough to be self-cleansing. use of the carnoy’s solution after enucleation in the unicystic Results ameloblastoma with special emphasis on recurrence. Satisfactory healing of the resultant osseous defect was observed Methods permitting functional and esthetic rehabilitation. We treated five patients in last 3 years who were diagnosed histo- Conclusions logically as unicystic ameloblastoma with enucleation and application Although the healing period was relatively long with our treatment of carnoy’s solution. All the patient were periodically evaluated modality, the therapeutic effect was consistently achieved and well clinically and radiologically for recurrence of lesion. tolerated, with low morbidity and low complications risks. Apart from Results that the treatment provided was economical, and comfortable to the The recurrence of lesion was not statically significant. patient. Conclusions In our observation we may conclude that unicystic ameloblastoma References/Bibliography often can be treated successfully with less aggressive surgery (2,3). However this observation needs to be confirmed by larger sample size 1. Chacko R et al: Spontaneous Bone Regeneration After Enucle- and long term follow up of cases. ation of Large Jaw Cysts. J Clin Diagno Research 9:ZC84, 2015. References/Bibliography 1. Case report-Unicystic ameloblastoma, Journal of Dental Science Services (2014) 9, 407–411. ABS00764 2. Unicystic ameloblastoma-Use of Carnoy’s solution after enucle- Neck Masses: Our Experience in the Practice of Oral ation. Int. J. Oral Maxillofac. Surg. 2004;33, 263–267. and Maxillofacial Surgery 3. Unicystic ameloblastoma of the mandible: A long term follow up. J Oral Maxillofac Surg 55;345–348, 1997. Md. Kalim Ansari, G.S. Hashmi, S.S. Ahmed

Aligarh Muslim University ABS00753 Abstract Secondary Healing After Primary Enucleation Background/Introduction and Open Packing of Large Odontogenic Cysts Being an Oral and maxillofacial surgeon we frequently deal with of Mandible: A Less Invasive Treatment Modality patients having unknown neck masses. Since Hayes Martin [1] first with Good Outcome used the technique in the 1930s, fine needle aspiration biopsy (FNAB) has become the gold standard for the histologic evaluation of a patient with a neck mass. Formulation of a differential diagnosis is essential Tabishur Rahman, Ghulam Sarwar Hashmi, Sajjad Abdur Rahman and requires that the surgeon should have sound knowledge of surgical anatomy and skills to systematically arrive at a definitive Aligarh Muslim University diagnosis and ensure that the correct treatment is provided to patients. This paper highlights some of cases of Neck masses who presented to Abstract our department and were managed successfully. Background/Introduction Objectives Treatment of very large cysts of jaws require aggressive treatment To share our experience in the management of neck masses treated at modality in the form of resection of involved bone and reconstruction our department in terms of Classification, Differential diagnosis, using auto/allo grafts. The risks involved with the use of grafts are the Different lines of investigation and management. rejection of the implants due to instability, poor blood supply, Methods increased possibility of infection and the need to open a further Five cases of neck masses who presented to our department from June operation field and resorption of the auto-transplants. Also, it has been 2016 to May 2017, were investigated using USG, CT, MRI, FNAC

123 S64 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 etc. according to their need. After making diagnosis all the cases were References/Bibliography operated under G.A. The post-operative outcome was uneventful in all cases. 1. Prasad ML, Patel S, Hoshaw-Woodard S, Escrig M, Shah JP, Results Huvos AG, et al. Prognostic factors for malignant melanoma of Five cases were operated from June 2016 to May 2017 and following the squamous mucosa of the head and neck. Am J Surg Pathol. ﬁnal diagnosis of neck masses came after histopathologic examina- 2002;26:883–92. tion; 2 cases of dermoid cyst; 2 cases of chronic submandibular sialadenitis and 1 case of lymphangioma. Conclusions History and physical examination is the corner stone in the man- ABS00590 agement of neck swelling. FNAB and CT are the choice of Biological and Technical Considerations of Dental investigation for most of the neck masses. The operating surgeon Implants in Radiated Microvascular Free Fibula should have a sound knowledge of surgical anatomy of neck to successfully manage the cases. in Malignancy Cases References/Bibliography Dr Anurag Yadav Sardar Patel Post Graduate 1. Martin HE, Ellis EB. Biopsy of needle puncture and aspiration. Ann Surg 1930; 92:160–81. Institute of Dental and Medical Sciences

Abstract Section: Oral Pathology: Malignant Background/Introduction Free fibula reconstruction of resected malignant mandible provides cosmetic results with partial functional reconstruction as fixed dental ABS009 prosthesis is still not being practiced countrywide in India although having most no of cases of oral malignancies. Lethal Primary Oral Melanoma Objectives Objective of this paper is to evaluate the biological, technical con- Maj Pramod Kumar siderations along with complications associated with the rehabilitation of patients with dental implants in radiated micro vas- Army Dental Corps cular free fibular graft in malignancy cases. Methods Abstract Implant placement was done in radiated free fibula cases after a Background/Introduction period of 18 to 24 months of radiation. loading was done after 4–5 Oral melanoma melanoma (OMM) is a rare, aggressive malignant months. Evaluation of all aspect was taken care pre, intra and post neoplasm of melanocytic origin, representing 0.2 to 8.0 percent of all operatively. Evaluation of different aspects like location of implants, melanomas. Most mucosal melanomas are painless in early stages; the placement difficulty, height factor, osseointigration and infection diagnosis is often delayed until the disease has progressed to were evaluated in all patients. advanced stage. The extent & location of OMM in oral cavity often Results leads to compromised surgical excision. High recurrence rate is Careful planning, selection of patients, age, psychological status of complicated with local and distant metastasis during its course patients, surgeons expoertise are the main factors which led to suc- resulting in poor 5 year survival rate of patient. cessful outcome of implants in such cases. Although complications Objectives like infection and failure rate is higher in such patients. The study deals with the role of histopathology and immunohisto- Conclusions chemistry in early and accurate diagnosis of Oral malignant OMM. It can be concluded that dental implant supported prosthesis can play Methods vital role in reconstructed mandible by restoring functional occlusion, Cases with histological stages I, II, III were reviewed and better nutrition, better oral health, better confidence of patients and histopathological features compared. Also immunohistochemical tests psychology. to identify antigens related to melanoma like NKI/C-3, S-100 protein, References/Bibliography gp100 (HMB-45), Mart-1, Vimentin & MiTF were conducted. Results 1. DMD Ian et al, The mandibu Osseointegrated implants and Clinical differentiation of OMM with other innocuous looking pig- functional prosthetic rehabilitation in microvascular fibula free mented & non-pigmented lesion is difficult in routine setting. Detailed flap reconstructed mandibles, The American Journal of Surgery: histopathologic examination using Hematoylin-eosin staining tech- Volume 164, Issue 6, December 1992, Pages 677–681. nique is reliable and cost effective modality in developing countries. 2. Efficacy of dental implants placed into fibula-free flaps for Other advanced immunohistochemistry techniques are costly and only orofacial reconstruction, Franz-Josef Kramer, Rupert Dempf, HMB-45 & MiTF have shown reliable and consistent results. Bernd Bremer, clinical oral implant research, Volume 16, Issue 1, Conclusions February 2005: Pages 80–88. OMM is one of the most life threating cancer known to mankind with unspecified etiology, difficult treatment and lethal course. Early and accurate diagnosis play an important role in treatment and subsequent survival of patient.

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ABS00601 ABS00757 KCOT a Conundrum of Odontogenic Pathologies: A Rare Vascular Lesion in Maxilla: A Mystery Solved A Rare Recurrence in Temporalis Muscle After Excision. ‘‘A Challenge for Maxillofacial with Malignant Transformation in to Squamous Cell Surgeons’’ Carcinoma Dr. Mounabatti Mohapatra, Prof & Head Dr Kanubaddy Sridhar Reddy, Associate Professor AIIMS Bhubanesar Dr Ankita Srivastava Senior Resident Department of Oral Maxillofacial Surgery Narayana Dental College Maxillofacial Surgery AIIMS Bhubaneswar Nellore Andhra Pradesh Abstract Abstract Background/Introduction Background/Introduction Surgery of vascular lesions in maxillofacial region is always chal- This report describes a rare case of recurrent keratocystic odontogenic lenging. For few lesions, correct diagnosis before treatment is not tumor (KCOT) in temporalis muscle with malignant transformation possible. Undertaking such cases for surgery without a definitive into squamous cell carcinoma in a 55-year-old woman, who presented diagnosis is still more challenging for a surgeon. Here to present one with a painless swelling over right temporal region following hemi- such case of slow growing, nontender, firm, swelling in right maxilla, mandiblectomy done for KCOT. Computed tomography (CT) find- whose initial diagnosis both on various imaging techniques like plain ings did not reveal any obvious temporal bone resorption and the xray, non contrast CT Scan, USG, Angiogram and Incisional biopsy provisional clinical diagnosis was a cystic lesion. The entire mass was was a vascular lesion only. As the growth was increasing in size, for excised under general anesthesia and the pathological diagnosis was the benefit of patient, surgery was undertaken and challenge was KCOT with malignant changes of cystic lining. Significantly this accepted. Subtotal maxillectomy was done with proper precautionary transformation was not evident in clinical and radiological assessment measures to prevent any haemorrhagic consequences. The resected but required meticulous histopathological examination. This is the mass was send for histopathology and then mystery was revealed. first reported case of recurrence in temporalis with malignant trans- Histopathology report was suggestive of composite haemangioen- formation into squamous cell carcinoma to the best of author’s dothelioma. Intraosseous che is a extremely rare vascular neoplasm of knowledge. Patient remained free of recurrence in postoperative head and neck region seen in younger age group. Commonly involved follow up for two years and her present status is unknown. sites are skin, long bones, striated muscles, liver and mammary Objectives glands. It is moderately malignant which might metastasize via To determine the factors for recurrence and malignant transformation haematogenous routes and treatment of choice is surgical resec- of KCOT. tion. Histopathology is the confirmative diagnostic aid for the lesion. Methods It has local recurrence rate of upto 50%. By presenting this case we A single case report from Department of Oral Maxillofacial Surgery would like to draw the attention of clinicians toward these rare Narayana Dental College was studied for its clinical radiological and challenging cases which should always be considered for differential histopathology findings with recurrent KCOT. diagnosis of intra bony lesions in maxillofacial region. Results Keywords: Haemangioendothelioma, Maxillectomy, Metastasis, This report highlights the significance of meticulous histopathological Haematogenous spread. examination of the deceptive epithelial lining of KCOT to find out Objectives any early changes in view of its potential neoplastic transformation. Objective of presenting this case in a national conference is to Conclusions appraise about such rare challenging cases which should always be The previous reports of malignant transformation of KCOT though considered for differential diagnosis of intrabony lesion in maxillo- few should prompt the clinicians for regular follow up of all patients facial region. who have been surgically treated for multiple recurrences as the Methods existence of squamous cell carcinoma is usually revealed after sur- Not Applicable. gical resection and as there no reliable tools to predict which cyst can Results transform. There is an imperative need for further research at Not Applicable. molecular level treatment for KCOT though it is novelty at present Conclusions but should influence future treatment plans as the aggressive treat- Surgery of vascular lesions in maxillofacial region is always chal- ment strategies at times have failed to impede the recurrences. lenging. For few lesions, correct diagnosis before treatment is not possible. Undertaking such cases for surgery without a definitive References/Bibliography diagnosis is still more challenging for a surgeon. 1. Tan B, Yan TS, Shermin L, Teck KC, Yoke PC, Goh C, et al. References/Bibliography (2013) Malignant transformation of keratocystic odontogenic tumor: two case reports. Am J Otolaryngol 34(4):357–61. 1. Bhat A, ChowdAPPA V. Composite Hemangioendothelioma: 2. Worrall SF. (1992) Recurrent odontogenic keratocyst within the Report of a Rare Case. Journal of clinical and diagnostic temporalis muscle. Br J Oral Maxillofac Surg. 30(1):59–62. research: JCDR. 2016 Oct;10(10):ED01. 2. Singhal a yadav RC Haemangioendothelioma maxilla. Indian Journal of Otolaryngology 1990:40(2)73–74.

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bone in the skull. It becomes essential for a surgeon to understand the Section: Oral Surgery anatomy of this bone along with understanding the placement and form of different structures passing through it. Objectives ABS0025 This paper aims at highlighting the use of CBCT in surgical procedures of mandible with the help of clinical case presentations. CBCT @Maxilla Methods 100 CBCT scans were studied. Parameters were drawn. All the dis- Dr Vimal Kalia, Principal and Head of Department tances were measured for vital structures. Results BRS Dental College, Panchkula All parameters were subjected to statistical analysis and results were formulated. CBCT is capable of providing accurate, submillimeter- Abstract resolution images in formats allowing 3D visualization of the com- Background/Introduction plexity of the maxillofacial region. All current generations of CBCT Maxillary bone can be considered the key stone of the face as all the systems provide useful diagnostic images. immobile bones are connected to it. Its pertinent for a maxillofacial Conclusions surgeon to understand this very important keystone. Anatomic con- CBCT allows us to create an accurate treatment plan and increases siderations of maxilla must be understood, including the position of our chances for surgeries that are minimally invasive, minimally the nerves, sinuses and bone undercuts. The thickness and angulation morbid and time saving and at the same time, conservative, with of bone must be studied, and the integrity of the buccal and lingual predictable prosthetic result. plates clearly determined. References/Bibliography Objectives This presentation aims to cover all the anatomical considerations of Quereshy FA, Savell TA, Palomo JM. Applications of cone beam maxilla in CBCT including their clinical applications. computed tomography in the practice of oral and maxillofacial Methods surgery. J Oral Maxillofac Surg 2008;66(4):791–6. 100 CBCT scans were studied and topographic study done. Parame- teres were drawn and measurements were made. Results All the measurements made were subjected to statistical analysis and ABS0033 distances were established for vital structures. Complex & Compound Odontoma Associated Conclusions For this purpose, Cone beam computed tomography (CBCT) is an with Impacted Teeth (Report of 4 Rare Cases) important tool in the hands of a clinician for diagnosis and preparation of any case. It provides with complete information on vital anatomy Dr Parveen Akhter Lone in the areas of consideration by producing a three-dimensional view of all of the oral structures. Scanning software allows for the fabri- Indira Gandhi Government Dental College Jammu cation of precise planning and surgical guides, which help to ensure a positive result. Communication with the patient concerning this Abstract innovative therapy reduces anxiety of an unknown procedure and Background/Introduction increases treatment acceptance. It can help the practitioner guarantee Odontomes are defined as hamartomas of odontogenic origin & are success by alleviating most common fears prior to any surgical usually considered as developmental anomalies resulting from the a intervention. growth in which both epithelial cells exhibit complete differentiation References/Bibliography of both epithelial & mesenchymal cells that give rise to both ame- loblast & odontoblast. These tumours are basically formed of enamel Adibi S, Zhang W, Servos T, Neill PN. Cone beam computed & dentine & have variable amount of pulp issue & cementum. tomography in dentistry: what dental educators and learners should According to World Health Organization (WHO) classification, know. Jof Dental Education 2012; 76(11):1437–42. odontomas can be divided into three groups. • Complex odontoma: When the calcified dental tissues are simply arranged in an irregular mass bearing no morphologic similarity to rudimentary teeth. • Compound odontoma: Composed of all odontogenic tissues in an ABS0026 orderly pattern, which result in many teeth-like structures, but without CBCT @Mandible morphologic resemblance to normal teeth. • Ameloblastic fibro- odontoma: Consists of varying amounts of calcified dental tissue and dental papilla-like tissue, the later component resembling Dr Geeta Kalra, Reader anameloblastic fibroma. The ameloblastic fibro odontoma is considered as an immature precursor of complex odontoma. We aim to BRS Dental College, Panchkula report Large complex odontoma associated with impacted permanent molar in 15 years old boy (Rare case reports) Two cases of complex Abstract odontoma associated with impacted maxillary central incisors Com- Background/Introduction pound odontoma with 9–10 teeth like structures associated with The mandible is the only bone in the entire cranium that doesn’t impacted mandibular first premolar in 24 years old female (rare case). articulate with its adjacent skull bones via sutures. When the skull is Objectives observed purely as a bony structure, there is nothing anatomically The aim of this article was to report the very rare size complex holding the rest of the skull and the mandible together. It is also the odontome & compound odontome having 9–12 no of teeth like strongest and most massive bone in the face and is the only movable structures Which are rarely reported in literature as per my knowledge.

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Methods Methods Patients were referred to our department for painless swelling, with 18 patients with prominent symptoms of chronic maxillary sinusitis in missing teeth. After clinical & radiographic examination odontomes the age group of 10–50 years were selected and an intervention study with impacted teeth were diagnosed. Three cases were done under was carried out by treating patients with Functional Endoscopic Sinus local anesthesia & one under general anesthesia. All the four cases Surgery. were done by intra oral approach. Results Results All patients were monitored post-operatively after first, third and sixth All the patients were between 15–25 years of age. Two patients were week on the basis of clinical and radiological features. The results male & 2 females. All the odontomes associated with impacted per- were statistically significant after Function Endoscopic sinus surgery. manent teeth. Conclusions Conclusions Functional Endoscopic Sinus Surgery appears to be a reliable, mini- It is suggested that any patient in adolescent age group reporting with mally invasive technique associated with less morbidity and lower delayed eruption of teeth should be evaluated properly by clinical & incidence of complications. radiographic examination of jaws. Early diagnosis & management will prevent the associated pathologies like dentigerous cyst & have References/Bibliography better prognosis & less expansive treatment. 1. Stammberger H et al: Surgical treatment of chronic recurrent References/Bibliography sinusitis–the Caldwell-Luc versus a functional endoscopic technique, HNO. 1987 Mar; 35(3): 93–105. 1. Yildirim-O¨ z, G., Tosun, G., Kiziloglu, D., Durmus, E. and Sener, 2. Unlu HH et al: An endoscopic and tomographic evaluation of Y. (2007) An Unusual Association of Odontomas with Primary patients with sinusitis after endoscopic sinus surgery and Teeth. European Journal of Dentistry, 1, 45–49. Caldwell-Luc operation: a comparative study, J Otolaryngol, 2. Singh, S., Singh, M., Singh, I. and Khandelwal, D. (2005) 1994 Jun; 23(3): 197–203. Compound Composite Odontoma Associated with an Unerupted Deciduous Incisor—A Rarity. Journal of the Indian Society of Pedodontics and Preventive Dentistry, 23, 146–150. http://dx.doi.org/10.4103/0970-4388.16889. ABS0057 Use of Platelet Rich Plasma (PRP) with Hydroxyapatite in Post Surgical Jaw Defects ABS0039 FESS: An Innovative Technique to Treat Chronic Dr. Braj Bhushan Mall, Assistant Professor Maxillary Sinusitis Department of Oral and Maxillofacial Surgery, Dental College RIMS Imphal, Manipur, India Dr. Prajwalit Prakash Kende Associate Professor & HOD Abstract Government Dental College & Hospital Mumbai Background/Introduction ‘‘Healing is defined as restoration of original integrity of tissues.’’ Abstract Healing occurs by combination of regeneration & repair which may Background/Introduction be of primary intension or secondary intension. Sequel of healing are The maxillary sinus is the largest of all other sinuses, also called as initial hemorrhage, acute inflammatory response, epithelial changes & antrum of Highmore, which actually presents as a small cavity at organization. Bone healing is accomplished by organized sequence of birth, starting its development during the third fetal month and usually bone formation. Some of the components or compounds of bone reaching its maximum development in early adult life about the matrix induces bone formation via interaction between pluripotential eighteenth year. Nearly 10% to 12% of the pathological conditions cells & morphogenetic proteins converting these cells to osteoblasts. involving the maxillary sinus are of dental origin. Prof. Messerklin- Objectives ger’s work in late 1960s and early 1970s on sinus mucosa and To evaluate the effect of Platelet-rich plasma (PRP) with hydroxya- mucocilliary transport has proved that the pathology is not principally patite (HA) in healing of post surgical osseous defects clinically and in the larger sinuses but is secondary to impaired drainage caused by radio graphically. To evaluate complications related to the grafting the disease in the ethmoidal air cells blocking their natural Ostia in procedure and natural healing of bone in osseous defects. the middle turbinate which leads to stagnation of secretions and Methods hence, persistent infection resulting in a vicious cycle causing After selection according to inclusion and exclusion criteria’s, 40 mucosal swelling that can be so gross as to appear ‘‘irreversible. Thus, patients were selected. All the patients were to undergo surgical a revised approach to maxillary sinus should be directed towards enucleation of the cystic lesion or extraction of impacted mandibular conservative principles favoring the regeneration of the normalized teeth, followed by placement of platelet rich plasma (PRP) and mucous membrane. hydroxyappatite (HA) in the surgical defect. Pre operative and post Objectives operative radiographs, ultrasonography, and color doppler were uti- The Caldwell-Luc operation or the conventional procedures, which lized as diagnostic tools. Surgery was performed. After removal of the earlier aided as an equally productive intervention for chronic max- lesion/tooth the bone defect was packed with mixture of platelet rich illary sinusitis has been recently criticized for its shortcomings and plasma (PRP) and hydroxyappatite (HA). Closure of wound was limitations. Thus, a revised approach, to maxillary sinus should be achieved by interrupted sutures using 000 black silk with 16 mm 3/8 directed towards conservative principles favoring the regeneration of reverse cutting needle. The data was analyzed statistically. the normalized mucous membrane. Hence, an in vivo study was Results undertaken to clinically assess the outcome after Functional Endo- The findings of the study suggests that plate rich plasma is a feasible scopic Sinus Surgery. method to treat post treatment jaw defects with a very high success

123 S68 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 rate and very low rate of complications such as pain, swelling and ABS0066 infection. Ultrasonographic evaluation proved to be beneﬁcial in Platelet Rich Fibrin (PRF): A Magical Healing evaluation of bone formation and calciﬁcation whereas Color Doppler evaluation helped to predict the vascularization of the affected area Biomaterial thus showing the evidence of wound healing. Conclusions Dr. Gursimrat Kaur Brar (First Author), Senior Lecturer; Dr. S. P. plate rich plasma is a feasible method to treat post treatment jaw S. Sodhi (Second Author), Head of Department defects with a very high success rate and very low rate of complications. Department of Oral and Maxillofacial Surgery Dasmesh Institute of Research and Dental Sciences, Faridkot (Punjab) References/Bibliography:

Dean H. Whitman and Ronald L. Berry. Platelet gel- An autologous Abstract alternative to fibrin glue with application in oral and maxillofacial Background/Introduction surgery. JOMS 1997; 55: 1294–1299. The use of autologous platelet concentrates represents a promising Burak Demiralp, Huseyin Gencay Keceli, Mehmet Muhtarogullarn, and innovator tool in medicine and dentistry today. Platelet Rich Ahmet Serper, Bahtiyar Demiralp and Kenan Eratalay. Treatment of Fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth periapical inflammatory lesion with the combination of platelet rich factors and cells are trapped and may be released after a certain time plasma and tricalcium phosphate-A case report. J. of Endodontics and that can serve as a resorbable membrane. Simplified processing 2004; Vol. 30(11): 796–780. technique not requiring biochemical blood handling makes it superior to Platelet Rich Plasma (PRP). Recent development is advanced PRF (A-PRF), prepared on the concept that leucocytes play a major role in the release of certain cytokines which aid in better wound healing. ABS0059 Also, the use of platelet concentrates in ‘‘liquid’’ form (i-PRF) is a Mandibular Fracture in Neonate: A Case Report new alternative to the platelet aggregate permitting incorporation of the graft forming a well agglutinated ‘‘steak for bone grafting’’. This paper presents an insight into the use of PRF and its derivatives in Dr V Gopalakrishnan, Dr N K Sahoo, Dr Indranil Deb Roy various defects. Objectives Abstract Use of Platelet Rich Fibrin (PRF) and its derivatives in various bony Background/Introduction defects. Mandibular fractures in neonate are rare. The etiological factors are Methods traumatic delivery, accidental fall, road traffic crashes and attempted Platelet Rich Fibrin (PRF) preparation was done by collecting venous infanticide. Diagnosis is difficult due to facial edema masking the blood from antecubital vein of the patient into sterile vacutainer tubes clinical features and absence of dentition. Treatment of fractures in without anticoagulant. These tubes were then placed in Choukroun’s newborn represent unique problem in terms of investigations, diag- centrifugal machine at 3000 rpm for 10 minutes, after which it settles nosis, selection of anesthesia and method of fixation. We present a into three layers. The upper layer is discarded and middle fraction is case of a one day old infant referred to us for management of collected, which is the PRF. mandibular fracture sustained due to accidental fall. During oral Results suction the neonatologist observed continuous blood stained secretion The results of Platelet Rich Fibrin (PRF) are very promising. The which raised the suspicion of trauma to oral cavity. He was diagnosed physiological time of healing of a bony defect is much reduced fol- as a case of fracture mandibular symphysis with displacement. Under lowing the use of Platelet Rich Fibrin (PRF). local anaesthesia with sedation the fracture was reduced and stabi- Conclusions lized with the acrylic splint which was secured by circum mandibular Platelet Rich Fibrin (PRF) represents a promising and innovator tool wiring. The case was followed up for 1.5 year and the healing was in medicine and dentistry today. PRF and its derivatives is a healing satisfactory. autologous biomaterial which accelerates and enhances the natural Objectives wound healing mechanisms of the body. To Treat mandibular fracture s in neonate. Methods References/Bibliography Using conservative management. 1. Gupta V, Bains V. K, Singh G.P, Mathur A, Bains R. Results Regenerative potential of Platelet Rich Fibrin in Dentistry: Only one case of neonate treated. Literature Review; Asian Journal of Oral Health & Allied Conclusions Sciences - Vol 1, Issue 1, Jan-Mar 2011. Mandibular fractures to be treated as early as possible irrespective of 2. Saluja H, Dehane V, Mahindra U. Platelet-Rich Fibrin: A second age. generation platelet concentrate and a new friend of oral and References/Bibliography maxillofacial surgeons. Annals of Maxillofacial Surgery; January - June 2011, Vol. 1, Issue 1. 1. Lustmann J, Milhem I. Mandibular fracture in infants: Review of literature and report of seven cases. J Oral Maxillofacial surgery 1994: 52: 240–245. 2. Chidzonga M M. Mandibular fracture in a neonate: report of a case. J Oral Maxillofac surg 1996: 54: 1452–1454.

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ABS0094 included Tab Diclofenac and Tab Chymoral [Trypsin and Chy- Management of Impacted Teeth: Antibiotic-Less motrypsin]. Group C included Tab Diclofenac alone. The parameters measured on the 2nd and 7th post-operative days were mouth opening, pain rating on VAS and anatomical facial measurements. Dr C A Ashoka Results There was a statistically significant [p\0.05] reduction in pain on the Mandya Institute of Medical Sciences, Mandya 2nd post-operative day in Group A. There was no difference with respect to oedema and trismus between all 3 groups. No adverse Abstract effects were noted in the 3 groups. Background/Introduction Conclusions Management of teeth impactions forms the mainstay for an oral Proteolytic enzymes may be used in combination with NSAIDs to surgeon consultation. The use of antibiotic therapy is a well estab- help add to their anti-inflammatory effect and also reduce the net dose lished partner in management of all surgical interventions. Is it still of the NSAIDs used. valid in maxillofacial region following management of wisdom teeth. References/Bibliography Objectives objective of the study was to establish the necessity of antibiotic Inchingolo F, Tatullo M, Marrelli M, Inchingolo AM, Picciariello V, prophylaxis in normal healthy individuals. Inchingolo AD, et al. Clinical trial with bromelain in third molar Methods exodontia. Eur Rev Med Pharmacol Sci. Italy; 2010 Sep;14(9):771–4. Patients included in the study were healthy patients who presented to the department of dentistry, MIMS Mandya with wisdom teeth complaints. Total of 1000 patients was included in the study. Normal healthy individual without any documented immunocompromised ABS00173 status were included in the study. Study involved removal of impacted teeth using closed and open method. Human Amniotic Membrane a Potential Dressing Results Material in Maxillofacial Region study revealed no infection in any of the patients in the post operative follow up period. Dr Ashish J Rai, A.B. Shetty Conclusions Antibiotics are not a necessity in management of impacted teeth in Institute of Maxillofacial Region healthy individuals. Host immune response is adequate in promoting and controlling surgical site healing. Abstract References/Bibliography Background/Introduction Human amniotic membrane (HAM) is known to possess distinctive 1. Jens O. Andreasen DDS et al A Systematic Review of property like pain reduction, wound protection, bacteriostatic and Prophylactic Antibiotics in the Surgical Treatment of Maxillo- anti-inflammatory. Amniotic membrane may thus be composes of a facial Fractures. J Oral Maxillofac Surg 64:1664–1668, 2006. single layer of epithelial cells that present on a basement membrane consisting of nonvascular collagenous stroma. It is also known to present HAM serves as a basement membrane that facilitates epithelial cell migration reinforcing adhesion of basal epithelial cells ABS00120 preventing epithelial apoptosis. It is also reported that HAM possess A Prospective Observer Blinded Randomised Clinical efficient wound healing property due to the growth factors and Study to Evaluate the Efficacy of Proteolytic Enzyme cytokines present. HAM application lacks a high level of clinical evidence in oral and maxillofacial surgery. Combinations in Third Molar Surgery Objectives The present case reports demonstrate the application of glycerol-pre- Dr. Paul C. Mathai, Dr. Neelam N. Andrade, Dr. Neha Aggarwal served HAM in maxillofacial surgery. The two case reports validate re- epithelisation with cervical necrotizing fasciitis. Necrotizing fasciitis is a Abstract soft tissue infection of odontogenic origin, chiefly a polymicrobial Background/Introduction infection of aerobic, anaerobic, gram positive and gram negative bacteria. The extraction of third molars is the most commonly performed surgical Methods procedure in Oral and Maxillofacial Surgery with pain, oedema and 2 cases to demonstrate the primary closure of the defect. trismus being the most common post-operative sequelae. Post-opera- Results tive NSAIDS and steroids used over a long period or in high doses are To evade the disadvantage of skin graft, glycerol-preserved HAM was associated with a multitude of side effects in certain patients. Research advocated as grafting material. The clinical success of the two cases into more natural and safer alternatives for the management of pain and provides a possible use of HAM as a new biomaterial in the field of inflammation has revealed a class of drugs called Proteolytic Enzymes. maxillofacial tissue repair. Objectives Conclusions To study the effectiveness of proteolytic enzymes in reducing post- HAM is easy to preserve, non immunogenic, economical, easily operative pain, oedema and trismus. available, easy to apply and has minimum dressing requirement after Methods application. 90 patients were randomly divided into 3 groups. Class II level B References/Bibliography mesioangular and vertical mandibular third molars were selected and a single operator was assigned to maintain uniformity of surgical Rai M, Ramaraj P N, Sharma A: Use of Amniotic Membrane as difficulty and surgical technique. Group A included Tab Diclofenac Dressing in Cervical Necrotizing Fasciitis. J Oral Maxillofac Surg and Tab Tibrolin [Trypsin, Chymotrypsin and Bromelain]. Group B 2011; 69 page 1125–1128. 123 S70 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

ABS00213 leading to neurologic complications. Hence localizing the accurate Dental Extraction and Osteoradionecrosis: Current position of IAN is always recommended. OPG is commonly employed as a pre-operative diagnostic tool for evaluation of Concepts and Review impacted third molars. However, it provides only 2 dimensional information of a 3 dimensional object. Where, CBCT provides three – Dr. Madan Mishra Reader dimensional information of the anatomical relationship between the third molar roots and adjacent vital structures. Dept of Oral & Maxillofacial Surgery Sardar Patel PG Institute of Objectives Dental & Medical Sciences, Lucknow, UP 1. To evaluate the impacted mandibular third molar using CBCT preoperatively. 2. To determine the accuracy of preoperative CBCT Abstract findings by correlating it with intra operative findings. Background/Introduction Methods Radiotherapy causes progressive fibrosis and endarteritis which ulti- A total of 50 samples with signs or symptoms of impacted mately result in hypovascular, hypocellular and hypoxic jaw bones that mandibular third molars and requiring the treatment of surgical can undergo osteoradionecrosis (ORN) on exposure to oral environ- removal of these teeth were included in the study. Third molars were ment due to trauma or tooth extraction. Most of the pre and post- evaluated preoperatively using CBCT and the parameters such as, radiation dental extractions are based on empirically designed protocols proximity of third molar to IAC, number and morphology of the rather than evidence based studies. Many clinicians routinely prescribe roots and buccal/lingual version of the tooth was assessed. Following prophylactic hyperbaric oxygen (HBO) therapy for prevention of ORN. this, surgical removal of third molar was done employing a stan- Objectives dardized procedure. The outcomes were correlated with the pre- This paper reviews the world English literature in an attempt to for- operative CBCT findings. mulate guidelines for more successful and uneventful outcomes after Results pre or post-radiation dental extractions. Out of 50 samples in 35 patients, root proximity/relation to the IAC Methods was assessed preoperatively on the CBCT scan and the same was An extensive search of world English literature was carried out on evaluated intra-operatively as the presence or absence of canal bleed Medline-Pubmed and Google Scholar using keywords osteora- following the surgical removal of the tooth. Intra-operative bleeding dionecrosis, dental extractions, radiotherapy, irradiated jaw, HBO from the IAC was observed in 6 samples. On correlating these values therapy. with pre-operative assessment of the root proximity to the IAC, it was Results found that in all these samples, the root tips were within a distance of Despite lacking in adequate methodological design, most of the =0.5 mm from the IAC. The correlation between pre-operative and existing literature suggest for meticulous history, careful case selec- intra-operative evaluation of the roots, including the number and root tion and atraumatic extraction techniques rather than relying more on morphology were 100 % accurate. Buccal/lingual version of the third HBO therapy. molar (both crown and root) with respect to the buccal and lingual Conclusions cortices was verified by the qualitative evaluation of the tooth socket Incorporation of multidisciplinary team approach and careful extraction intra-operatively. The intra-operative findings of this parameter in all selection with meticulous follow-up can lower osteoradionecrosis rates. the samples were suggestive of the pre-operative evaluation done on the CBCT. References/Bibliography: Conclusions This study showed that Cone CBCT is a very accurate tool for the 1. Nabil S, Samman N. Incidence and prevention of osteora- preoperative evaluation of impacted teeth in terms of root prox- dionecrosis after dental extraction in irradiated patients: a imity/relation, root morphology and pattern and buccolingo version systematic review. Int J Oral Maxillofac Surg 2011;40:229–43. of impacted mandibular third molar and it provides all the neces- 2. Fritz GW, Gunsolley JC, Abubaker O, Laskin DM. Efficacy of sary anatomical data that helps the surgeon in its treatment pre- and postradiation hyperbaric oxygen therapy in the preven- planning with avoidance or reduction of treatment related tion of postextraction osteoradionecrosis: a systematic review. complications. J Oral Maxillofac Surg 2010;68:2653–60. References/Bibliography 1. Jun SH, Kim CH, Ahn JH, Padwa BL, Kwon JJ. Anatomical ABS00315 differences in lower third molars visualized by 2D and 3D X-ray Preoperative Assessment of Impacted Mandibular imaging: clinical outcomes after extraction. Int. J. Oral Maxillo- facial Surg 2013;42:489–496. Third Molar Using CBCT and Its Clinical Correlation 2. Suomalainen A, Venta¨ I, Mattila M, Turtola L, Vehmas T, Intraoperatively Peltola JS. Reliability of CBCT and other radiographic methods in preoperative evaluation of lower third molars. Oral Dr Rahul Maheshwari (Consultant), Dr. Ramdas Balakrishna Surg Oral Med Oral Pathol Oral Radiol Endod (Professor & HOD), Dr. G C Veena (Professor), wd jkl Dr 2010;109:276–284. Bhuvaneshwari Srinivasan (Senior Lecturer), Dr Kartik Tank (Consultant)

K.L.E Society’s Institute of Dental Sciences, Bengaluru

Abstract Background/Introduction Removal of impacted mandibular third molar is the most common performed surgical procedure and may result in injury to the IAN,

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ABS00325 References/Bibliography A Comparative Evaluation of Transdermal Diclofenac 1. Bachalli PS et al. A comparative study of diclofenac transdermal Patch with Oral Diclofenac as an Analgesic Modality patch against oral diclofenac for pain control following removal Following Surgical Removal of Mandibular Third of mandibular impacted third molars. J Maxillofac Oral Surg Molar 2009;8(2):167–72. 2. Bhaskar H et al. Comparison of transdermal diclofenac patch with oral diclofenac as an analgesic modality following multiple Dr Neha A. Harankhedkar, Assistant Professor, Dr. Ramakrishna premolar extractions in orthodontic patients: A crossover efﬁcacy Shenoi, Professor and Head trial. Contemp Clin Dent 2010;1(3):158–63.

Dept. of OMFS, Dr. D.Y. Patil Dental College, Pimpri, Pune Add - 2, Saraswati appt., 4, Ashok Nagar, Bhosale Nagar Road, Pune - 411007 Mobile No. - 9823024992 Email - ABS00402 [email protected]/[email protected]; Dept of Preoperative Intravenous Tramadol Versus Ketorolac OMFS, V.S.P.M. Dental College, Nagpur Add - 301, Abhinav Residency, B1 Lakshmi Nagar, Nagpur - 440022 Mobile No - for Preventing Postoperative Pain After Third Molar 9822220505 Email - [email protected] Surgery

Abstract Dr. Gaurav Verma, Reader Background/Introduction Dealing with postoperative pain remains an arena for never ending Institute of Dental Sciences, Sehora, Jammu & Kashmir, India. Phone research with better formulations and modalities continuously Number- ?919736565635 E Mail- [email protected] replacing obsolete ones. Pain after third molar surgery has often been a nemesis for oral surgeons and patients alike due to the considerable Abstract degree of inflammatory response involved. Oral administration of Background/Introduction NSAIDs, however, carries a risk of first pass metabolism with sig- The aim of preemptive analgesia is to prevent postoperative pain by nificant amount of the drug being lost before it is systemically administration of various therapeutic agents prior to surgery. absorbed. Oral NSAIDs are also known to cause several adverse Preemptive analgesia concept is based on the principle of prevention effects, particularly gastrointestinal effects, which are dose depen- of peripheral and central sensitization of pain pathways by nocicep- dant. This study of a transdermally delivered drug is a way of chasing tive impulses. Pain is a predictable outcome after surgery. Preemptive a new path to achieve more effective management of post operative analgesia may prove to be a valuable tool in preventing postoperative pain after third molar surgeries with minimal occurrence of adverse pain. effects. Objectives Objectives The objective of this study was to evaluate & compare the preemptive 1. To evaluate the effect of transdermal diclofenac on pain reduction. analgesia efficacy of intravenous ketorolac and intravenous tramadol 2. To evaluate the effect of transdermal diclofenac on trismus alle- in prevention of postoperative pain after surgical extractions of viation. 3. To evaluate the effect of transdermal diclofenac on mandibular third molars. reduction in swelling. 4. To compare the findings with those of Methods Diclofenac tablets. Methods Forty patients who required surgical extraction of mandibular third molars were divided randomly into two groups. Group-I [Tramadol • Study design - Experimental study with random selection. • Sample Group (n=20)] patients were given 50 mg tramadol intravenously size – Total 60 patients divided into 2 equal groups A and B. • Group preoperatively. Group-II [Ketorolac Group (n=20)] patients were A - Tablet diclofenac sodium (50 mg) orally • Group B - Diclofenac given 30 mg ketorolac intravenously preoperatively. Surgical patch (100 mg) transdermally • Third molars removed surgically. • extractions were performed under local anesthesia. The parameters Pain, swelling and trismus were measured preoperatively and on 1st, under evaluation were postoperative pain intensity measurement, 3rd and 7th postoperative days. • Results compared. • Data analyzed mean time after which rescue analgesic was taken, total analgesic with software STATA version 13.0. consumption over 5 day recovery period, and patient’s assessment of Results the surgical procedure. • On both 3rd and 7th postoperative day, reduction in intensity of pain Results was significantly more in group B (p 1.0161 and \ 0.0001 respec- The result of the study revealed that, there was no statistically sig- tively). • On 3rd postoperative day, both the therapies resulted in nificant difference between the two groups in relation to the clinical almost equal reduction in swelling (p 0.0836). However, on 7th parameters under investigations except patient’s assessment of the postoperative day, more reduction in swelling was observed in surgical procedure. Greater percentage of patients in ketorolac group patients of group B (p\0.001). • On 3rd postoperative day, signifi- rated the procedure relatively better and less painful by giving higher cantly more increase in inter-incisal distance was observed in patients scores. of group B (p 0.0123). However, on 7th postoperative day, there was Conclusions no significant difference in values of both the groups (p 0.893). Conclusions Although both ketorolac and tramadol were equally efficacious as preemptive analgesics on statistical backgrounds but ketorolac seems Oral Diclofenac showed better pain control in the immediate post- to be more efficacious on clinical grounds. operative period when compared to the transdermal form. However, in the following postoperative days, results of both the groups were References/Bibliography comparable with negligible side effects from trandermally delivered drug. Ong KS, Tan JML, ‘‘Preoperative Intravenous Tramadol Versus Ketorolac for Preventing Postoperative Pain after Third Molar Surgery’’. Int J Oral Maxillofac Surg. 2004; 33(3):274–278.

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ABS00429 Objectives Murva: A Biotic Strand for Biological Healing Purpose of this study was to evaluate effectiveness of Intraligamental Injection technique for dental extraction in maxilla and mandible. Methods Dr Ashutosh Thorat (Consultant Oral & Maxillofacial Surgeon, The study included 100 patients (50 patients requiring extraction of Pune), Dr Pravin Lambade (Consultant Oral & Maxillofacial permanent mandibular molars bilaterally and 50 patients requiring Surgeon, Nagpur) extraction of maxillary anterior teeth bilaterally). 2% Lignocaine Hydrochloride with 1:80,000 adrenaline was standard anesthetic Abstract agent used. In mandible, one side was anesthetized via Pterygo- Background/Introduction mandibular block (PTB) and other by Intraligamental injection. The success of any surgical procedure depends upon healthy healing, Similarly in maxilla one side was anaesthetized via Infiltration while which in turn depends upon the suture material used & the method other by Intraligamental injection. Pain was recorded on VAS scale employed for the closure. Many synthetic materials have replaced the and cardiovascular changes noted in both cases before and after natural materials, which were once used for suturing in the ancient injection. times, and Murva is one of them. There are references of Murva Results (Sansevieria roxburghiana Schult. and Schult.f.) at various contexts of In mandible, 4 out of 50 patients (8%) and in maxilla, 6 out of 50 ‘‘Sushruta Samhita’’ where it has been used as a suture material. It is a patients (12%) did not have objective signs of anesthesia via xerophytic herbaceous plant occurring abundantly in the eastern Intraligamental Injection and therefore extractions were carried out coastal region of India. This study is carried out to compare the under anesthesia by conventional technique. Minimal fluctuations in efficacy of murva fiber with Silk as suture material. vital parameters viz pulse rate and blood pressure was noticed with Objectives intraligamental technique. A minimal difference in pain and dis- The objective of this study is to compare the efficacy of Murva fibers comfort on injection was noted in both cases. Duration of anesthesia with Silk as a suture material in closure of intraoral incision in third was longer with conventional PTB and infiltration technique, however molar surgeries. in terms of onset of anesthesia and volume of anesthetic agent used, Methods Intraligamental injection was superior in both cases. Fifty incisions (Wards incision) placed for the surgical removal of Conclusions mandibular third molar were sutured with Murva and fifty incisions It is recommended that use of Intraligamental injection be included as with Silk. Patients were evaluated for pain, swelling, hemostasis, a necessary skill for dental graduates in the interest of patient care. infection, wound dehiscence, local tissue irritation, and bacterial colonization. Follow-up were scheduled on postoperative 1st, 2nd, References/Bibliography 3rd, and 7th day. The periodontal ligament (PDL) injection: an alternative to inferior Results alveolar nerve block. Malamed SF. On comparing these two suture materials, in terms of post-operative pain, swelling, hemostasis, infection, wound dehiscence, local tissue irritation and bacterial colonization, the results were in favour of Murva as compared to Silk. Conclusions ABS00465 This study indicates that Murva can be effectively used as an alter- Ascendancy of Two Flap Tracery on Swelling, Pain, native suture material to Silk as it is natural, economical and Trismus, Alveolar Osteitis Following the Surgical biocompatible with an antimicrobial activity. Extraction of the Impacted Third Molar: A Prospective References/Bibliography Study Lambade P, Thorat A. Efficacy of murva (Sansevieria roxburghiana Schult. and Schult.f.) as a suture material in closure of incisions in Dr. Nandini, Reader third molar surgeries: A prospective study. Natl J Maxillofac Surg 2017;8:19–25. Sathyabama University Dental College & Hospital

Abstract Background/Introduction ABS00448 Surgical removal of lower third molar teeth is a common procedure Intraligamental Injection for Dental Extraction: and is associated with potential postoperative complications which include pain, swelling, trismus, and alveolar osteitis. To minimize A Prospective Randomised Clinical Study these complications clinicians have sought an optimal surgical approach and have investigated the use of various flap designs. The aim S. Rajurkar, M. Deshpande, R. Makwana, P. Ranadive, A. Nikunj, N. of this study is to compare the incidence and severity of postoperative Kazi, S. Ingole complications after mandibular third molar surgery using the modified triangular flap and the envelope flap. Nair Hospital Dental College, Mumbai Objectives To investigate the influence of flap tracery on postoperative pain, trismus, and swelling. Abstract Methods Background/Introduction Twenty patients were included who has bilaterally impacted The most common techniques used for dental anesthesia are Regional mandibular third molars in arandomized prospective split mouth Nerve block and Local infiltration. These are standard injection study. Two flap designs were used: a buccal envelope flap and a techniques for securing local anaesthesia prior to minor surgical modified triangular flap. Postoperative pain was recorded using a procedures on maxilla and mandible.

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S73 standardized visual analog scale. Postoperative swelling evaluated measured in 3 point measure on days 1, 2, and 7 after surgery trismus using measurements of facial markings of the patient’s cheek taken was assessed using interincisal mouth opening ability. pre-operatively and two days postoperatively. Trismus assessed with Results pre-operative & post-operative mouth opening. A total of 20 patients (10 per treatment group) were included in the Results study. The proportion of patients reporting no pain on the Visual There were no statistical differences between the flap designs in terms Analog scale was significantly higher in the group receiving dex- of severity of postoperative pain or trismus. A statistically significant amethasone and Etoricoxib compared with that in the groups difference was observed in postoperative swelling at 2 days, with the receiving Etoricoxib monotherapy Facial swelling was significantly modified triangular flap design being associated with increased less with dexamethasone and Etoricoxib. swelling. The envelope flap design was associated with a higher Conclusions incidence of alveolar osteitis. In this study, concomitant treatment with dexamethasone and Etori- Conclusions coxib provided significant relief of postsurgical pain and swelling The flap designs used in this study did not adversely affect patients in compared with monotherapy Etoricoxib. terms of postoperative pain and trismus, and although greater extraoral swelling was seen with the modified triangular flap design. References/Bibliography References/Bibliography 1. Evaluation of methylprednisolone and flurbiprofen for inhibition of the postoperative inflammatory response. Sisk AL, Bonnington 1. Primary wound healing after lower third molar surgery: evalu- Coral Surg Oral Med Oral Patho. 1985;60:137–145. ation of two different flap designs. Jakse N et al. Oral Surg Oral 2. Pain Control with dexamethasone, etoricoxib or ibuprofen Med Oral Pathol Oral Radiol Endod 2002;93:7–12. associated with arginine in impacted third molar surgery. 2. Influence of two different flap designs on incidence of pain, Alessandro Hyczy et al. Rev Gaucha., Porto Alegre, v61, n.3, swelling, trismus, and alveolar osteitis in the week following p. 335–340, jul./set., 2013. third molar surgery. D. Glenn Kirk et al. OOOE2007:104;e1–e6.

ABS00488 ABS00472 Post Extraction Bacteremia: Prospective Study Comparing the Eventuality of Dexamethasone to Evaluate the Need for Prophylactic Antibiotic Coadministered with Etoricoxib and Etoricoxib Mono- Coverage Therapy After Bi Lateral Third-Molar Extraction: A Randomized Prospective Study Aaditya S Markandey, RS Bedi, Puneet Wadhwani, Jitender Aurora, Madhumita Srivastava Dr Anu Sudha P, Reader Saraswati Dental College, Lucknow Sathyabam University Dental College & Hospital Abstract Abstract Background/Introduction Background/Introduction Bacteremia is especially common phenomenon that follows tooth Extractions of impacted mandibular third molars generally cause extraction & other dental procedure. patients discomfort, making it difficult for them to cope with their Objectives normal routines. The postoperative phase is characterized by signs To estimate the prevalence & nature of bacteremia in non pathogenic and symptoms such as pain, oedema, restricted opening of the mouth or iatrogenic extractions. and potential loss of function, due to the inflammatory response to the Methods surgery. Dexamethasone is quite widely used to minimize pain, and This split mouth study included 25 patients who were divided into 3 principally oedema, after third molar extractions. Despite this, groups – (1) group A- control group, (2) group B- receiving NS as a researchers have suggested further studies using Prostaglandin-en- mouthwash with prophylactic antibiotic coverage. (3) group C- doperoxide synthase-2 (COX-2) selective inhibitors for oral surgery. receiving chlorhexidine as a mouthwash and no antibiotic prophylaxis Etoricoxib is a COX-2 selective inhibitor anti-inflammatory drug given. Peripheral venous blood samples were collected preopera- which has been shown to be effective in treating pain, having a rapid tively, immediate, 5mins, 15mins and 30mins after extraction and response and prolonged effect. inoculated in glucose broth. These then processed for aerobic and Objectives anaerobic culture and subculture by conventional microbiological The aim of this study was to compare the effects of dexamethasone 8 techniques. mg IM and Etoricoxib 60 mg PO and monotherapy with Etoricoxib 60 Results mg PO on postoperative pain, swelling, and trismus after surgical Positive blood cultures were detected in patients after dental extrac- removal of third molars. tions. No relationship between the state of oral health, which was Methods assessed using the plaque & gingival indices. This randomized, prospective study was conducted at the Department Conclusions of Oral and Maxillofacial Surgery, Sathyabama University, Chennai. Our study concluded that routine use of chlorhexidine mouthwash Patients were randomly allocated to 1 of 2 treatment groups: con- before dental extraction is recommended to reduce the risk of bac- comitant treatment with dexamethasone 8 mg IM and Etoricoxib 60 teremia following tooth extraction. mg PO or monotherapy with Etoricoxib 60 mg PO. Overall analgesic efficacy of the drug combinations was assessed for 7 days postoperatively using Visual Analog scale (1–10). Facial swelling was

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References/Bibliography 2. Saatchi M, Khademi A, Baghaei B, Noormohammadi H. Effect of sodium bicarbonate– buffered lidocaine on the success of I. Toma’s et al, Effect of a Chlorhexidine Mouthwash on the Risk of inferior alveolar nerve block for teeth with symptomatic Postextraction Bacteremia, Infect Control Hosp Epidemiol 2007; irreversible pulpitis: a prospective, randomized double-blind 28:577–582. study. Journal of endodontics. 2015 Jan 31 41(1):33–5. II. Nicholas B. DuVall et al, The comparative efﬁcacy of 0.12% chlorhexidine and amoxicillin to reduce the incidence and magnitude of bacteremia during third molar extractions: a prospective, blind, randomized clinical trial, Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:752–763. ABS00551 Macro and Micro Challenges in Treatment of Ameloblastoma

ABS00513 Dr. Lakshmi Shetty Associate Professor Comparison of PH Buffered Local Anesthesia Containing 8.4% Sodium Bicarbonate Solution Department of Oral and Maxillofacial Surgery Dr. D.Y. Patil Dental with Standard Local Anesthesia for Infra Orbital Nerve College and Hospital Dr. D.Y. Patil Vidyapeeth Pune-18. Block Maharashtra, India. Email Address: [email protected], Phone Number: 9673006494

Dr. Sapna Vadera Abstract Background/Introduction VSPMs DCRC, Nagpur Ameloblastoma has been an challenge being a locally aggressive tumour causing the operating oral and maxillofacial surgeon in an Abstract diagnostic and surgical dilemma. Ameloblastoma over the last two Background/Introduction decades has changed its rate of presentation in the various clinical Fear-related behaviours have long been recognized as the most dif- presentation be it unicystic variant to basal cell variant form. There is ficult aspect of patient management and can be a barrier for good care. a need to systematically review with clinical evidence based approach Although short-lived, perceived pain of local anesthetic injection is for the treatment of this extensive odontogenic tumour in a macro- extreme enough to decline further surgery under local anesthesia. The scopic defect scenario and microvascular rehabilitation. use of buffered anesthetic solutions significantly reduces pain asso- Objectives ciated with infiltration without compromising onset, extent, or To determine evidence based approach for assessment of the duration of anesthesia achieved. Sodium bicarbonate is an alkaliniz- ameloblastoma 2. To evaluate the diagnostic protocols for assessment ing agent most commonly used. It increases the plasma bicarbonate of the ameloblastoma 3. To determine the synchrony between clinical ion concentration, buffers the excess hydrogen ions, and leads to the assessment to intraoperative assessment of ameloblastoma 4. To rise in pH of blood, thereby reversing clinical signs of acidosis. determine the treatment strategies for the macrodefects caused due to Objectives the extension of the lesion. To evaluate and compare the effect of buffered local anesthesia (2% Methods lignocaine, 1:2,00,000 adrenaline containing 8.4% sodium bicarbon- The evidence based approach with the assessment of all the databases ate solution) on pain on injection, onset of anesthesia & duration of of Cochrane, Pubmed, Europe Pubmed Central for systematically action with those of standard local anesthesia. reviewing the articles on the objective of evaluating the various macro Methods and micro challenges in treatment of ameloblastoma was evaluated. A prospective, double-blind, randomized study was carried out on 100 The various case scenarios at India in the reported literature was patient (50 patients in each group) Maxillary teeth were indicated for compared with world over protocols. The treatment modalities extraction under Infra orbital nerve block category. adapted for the surgical challenges encountered by the operating oral Results and maxillofacial surgeon was evaluated at various case scenarios. Buffered lignocaine produced less pain on injection compared to Results conventional solution. It also provided quicker onset of anesthesia and There is an enigmatic approach towards the clinical presentation of increased duration of action. Thus, buffered local anesthesia results in ameloblastoma. The data obtained from the various databases was better patient comfort, lessens procedural pain related anxiety, evaluated depending on parameters of clinical presentation, radio- effecting positive patient attitude towards undergoing dental and oral graphic, histopathology dilemma, intraoperative observation, surgical treatments under local anesthesia. treatment protocols, recurrence, macrodefects, microvascular reha- Conclusions bilitation, newer innovative techniques for preserving the anatomical As the use of buffered lignocaine with adrenaline could serve as a structure. The clinical case scenarios was compared with the existing boon in alleviating injection related fear and pain and also result in evidence based approach. The descriptive analysis of the above was quicker action, it could play an important role in areas of routine done to determine evidence based protocols. patient care. Conclusions The pattern of presentation histopathologically determines the surgi- References/Bibliography cal approach of the ameloblastoma. The final motive is to increase the 1. Kashyap VM, Desai R, Reddy PB, Menon S. Effect of quality of life of the patient. This was achieved with the evidence alkalinisation of lignocaine for intraoral nerve block on pain based approach. during injection, and speed of onset of anaesthesia. British References/Bibliography Journal of Oral and Maxillofacial Surgery. 2011 Dec 31 49(8):e72-5. 1. Antonoglou GN, Sandor GK. Recurrence rates of intraosseous ameloblastomas of the jaws: A systematic review of conservative

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versus aggressive treatment approaches and meta-analysis of non- ABS00662 randomized studies. J Craniomaxillofac Surg 2015;43:149–57. Evaluation of Series of Secondary Chronic Osteomylitis 2. Almeida Rde A, Andrade ES, Barbalho JC, Vajgel A, Vascon- celos BC. Recurrence rate following treatment for primary (SCO) multicystic ameloblastoma: systematic review and meta-analysis. Int J Oral Maxillofac Surg 2016;45:359–67. Dr Vandana R Gadve, Assistant Professor, Co Author Dr Varsha S Manekar, Associate Professor

Govt Dental College & Hospital, Nagpur ABS00595 Efficacy of Ozonated Water and Oil on Post Operative Abstract Sequelae Following Mandibular Third Molar Surgery: Background/Introduction Secondary chronic osteomyelitis of the jaws are common in the A Prospective Double Blind Study developing countries, where these diseases are associated with trauma, surgical procedures and previous infections, such as Dr Kishore Moturi; Professor and Head endodontic and periapical infections. This paper outlines 13 cases of secondary chronic osteomylitis of odontogenic origin, detailing their Dept of Oral and Maxillofacial Surgery; Vishnu Dental College; mode of presentation, prevalence, proper antimicrobial therapy and Bhimavaram surgical treatment. Objectives Evaluation of series of Secondary Chronic Osteomyelitis (SCO) with Abstract odontogenic etiology in terms of prevalence, etiopathogenesis, clini- Background/Introduction cal course, and Treatment. Researchers and Clinicians are always aiming to reduce post opera- Methods tive discomfort and improve the post operative healing after third 13 cases of secondary chronic osteomylitis of odontogenic origin molar surgery. Various methods are recommended and are being were evaluated according to their mode of presentation, prevalence, experimented towards attaining the same objective. Ozone therapy proper antimicrobial therapy and surgical treatment. has shown promising results in this regard. In General Surgery, Results Ozonated Virgin Olive Oil has been recommended for better wound ÒÒMean Age is 38.76yrs. ÒIdentified patterns on computed tomo- healing. Hence, the aim of this study was to evaluate the efficacy of gram- Mixed pattern- one case ÒSclerotic pattern- nil Sequestration Ozonated Water and Oil on the Post Operative Sequelae following seen with/out other bony changes- 4 cases Most microorganisms Third Molar Surgery. involved in the pathogenesis of osteomyelitis of the jaws are strict Objectives anaerobes, many of them fastidious and very difficult to cultivate 7 1. To evaluate the effect of Ozonated water and oil on post operative cases underwent culture Mucormycosis- one case, Klebicella – 2 pain, Swelling, Trismus and Healing 2. To evaluate the amount of cases No growth-4 cases •ÒLytic pattern- 4 cases With Proper post operative rescue pain medication taken by the patient following antibiotic therapy and surgical treatment (Decortication, saucerisa- third molar surgery. tion, curretage & extractions (4 Cases), Decortication, Methods sequestrectomy, extn (4 cases), Debridement of necrosed bone, extn 50 patients with bilaterally symmetrical impacted mandibular third (3 cases), Sinus opening, debridement of necrosed wall & packing (2 molars were selected. Informed consent was obtained. Sides were cases) • 12 cases shows good results where as one case with alco- randomly divided into - control and experimental group A single holism & smoking shows recurrence. operator operated both sides at an interval of three weeks Irrigation Conclusions with sterile water and plain virgin olive oil was used on the control Protocol consisting of thorough surgical debridement of infected & side and ozonated water and ozonated virgin olive oil was used on the necrotic tissue supported by proper antimicrobial therapy for 30 days experimental side Both the Operator and Patient were blinded towards can lead to predictable, good results in cases of Secondary Chronic the agent being used. Osteomyelitis (SCO) of jaws. Results The Experimental Group showed statistically significant difference on References/Bibliography Pain, Trismus and number analgesics required, though the swelling was similar on both the sides. Elerson Gaetti-Jardim Juńior; Francisco Isaak Nicolas Ciesielski; Conclusions Rice´lia Possagno; Chronic Osteomyelitis of the Maxilla and Ozonated water and oil shows a promising result on post operative Mandible: Microbiological and Clinical Aspects Int. J. Odontostomat., sequelae after third molar surgery. 4(2):197–202, 2010. References/Bibliography 1. Kazancioglu, H.O., Kurklu, E., and Ezirganli, S. Effects of ozone therapy on pain, swelling, and trismus following third molar surgery. Int J Oral Maxillofac Surg. 2014; 43: 644. 2. Sivalingam et al. Topical Ozone Therapy for Postoperative Care. J Oral Maxillofac Surg. 2017; 75: 51.e1–51.e9.

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ABS00673 ABS00752 A Prospective Randomized Double Blind Study The Safety and Effectiveness of Superﬁcial Cervical to Determine the Efﬁcacy of 2% Lignocaine with 1: Plexus Block in Oral and Maxillofacial Surgery 200,000 Epinephrine and 2% Lignocaine with 7ppm as an Alternative to General Anesthesia in Selective Dexmedetomidine in Infraorbital Nerve Block Cases: A Clinical Study

Sandeep Khandaitkar, Vrinda Kolte - Professor, S.R. Shenoi- Shahid Hassan Professor & Head Govt. Dental College, Srinagar V.S.P.M Dental College Nagpur Abstract Abstract Background/Introduction Background/Introduction Regional anesthetic block of the cervical plexus is a safe and useful Local anesthesia is used for various diagnostic, interventional and alternative to general endotracheal anesthesia for surgery of the neck, surgical procedure in dentistry. Adjuvants are added with peripheral upper shoulder, and occipital scalp area. The sensory component of nerve blocks to increase the duration of action, reduces toxicity and the cervical plexus can be blocked separately and easily by a super- bleeding at the operative site. Dexmedetomidine is a selective alpha - ficial cervical plexus block. Both motor and sensory block can be 2- aderenoreceptor agonist that have sedative analgesic, sympa- obtained by deep cervical plexus block. Minor transient side effects tholytic, antihypertensive action and also reduces the amount of are common to deep cervical plexus blocks, but they are rarely of any anesthesia required. consequence. Recent years have seen an increase in interest in the use Objectives of the cervical plexus block, because its popularity for surgical pro- To evaluate and compare the effect of 2% lignocaine with 1: 200,000 cedures such as carotid endarterectomies has grown. An epinephrine and 2% lignocaine with 7ppm dexmedetomidine in understanding of the anatomy and principles of this anesthetic tech- infraorbital nerve block on pain on injection, onset of action & nique will enable the clinician to offer the patient and surgeon an duration of action. important anesthetic option. Methods Objectives The 60 patients were divided equally into two treatment groups: To assess the safety and effectiveness of superficial cervical plexus Group A and B using a computer generated random list and sealed (SCP) block in oral and maxillofacial surgical (OMFS) practice as an envelope technique. The control group A (L): infraorbital nerve alternative to general anesthesia in selective cases. block: 2 ml Lignocaine 2 % with 1: 200,000 epinephrine plus 0.14 ml Methods saline. In group B 2 ml Lignocaine 2 % plus 0.14 ml dexmedeto- The total number of patients was 10, out of which 6 were male and 4 midine (LpD). The two groups were evaluated for pain during were female patients. Five patients had incision and drainage of injection, onset of anaesthesia and duration of action. perimandibular space infections, two patients had enucleation of cyst Results in the body of mandible, one patient had open reduction and internal Pain on injection was more in group A than in Group B. Onset of fixation isolated angle fracture, and two patients had submandibular action of anaesthesia was more in Group A 194(11.28) sec than in lymph node biopsies. Informed & written consent were obtained from Group B 185.46(13.70) sec. Duration of action of anaesthesia was the patients after they had the procedure explained to them. Medically more in Group A 139.5(10.32) min than in group B 124.93(8.50) min. compromised patients and those who were excessively anxious and Rise in Heart rate, diastolic & systolic blood pressure were noted with apprehensive, patient who did not want the procedure to be done Group A. under regional anesthesia, and patients with a history of allergy to Conclusions local anesthetic were excluded. All patients had their surgical pro- The addition of 7ppm dexmedetomidine to lignocaine speeds up the cedures under regional anesthesia (SCP block with supplemental onset of action, prolongs the duration of action and reduces the pain nerve blocks) performed by the same surgeon under the supervision of on injection. anesthesiologist with continuous monitoring. Results References/Bibliography SCP block with concomitant mandibular nerve and long buccal nerve 1. Khandaitkar S, Kolte V, Shenoi SR, Budhraja N. A clinical study block has a high success rate, low complication rate, and high patient to determine the efficacy of 7ppm dexmedetomidine as an acceptability as shown in the study. adjuvant to 2% lignocaine in infraorbital nerve block. Br J Oral Conclusions Maxillofac Surg. 2016 Nov;54(9):997–1000. doi: Superficial cervical plexus block anesthesia is a safe and useful 10.1016/j.bjoms.2016.07.011. Epub 2016 Aug 11. PubMed anesthetic technique with the low risk of accidents and complications, PMID: 27522312. thus a good alternative for regional anesthesia in OMFS cases. 2. Bhargava D, Sreekumar K, Rastogi S, Deshpande A, Chakravorty References/Bibliography N. A prospective randomized double-blind study to assess the latency and efficacy of twin-mix and 2% lignocaine with 1. Roger D (1995) Superficial and deep cervical plexus block: 1:200,000 epinephrine in surgical removal of impacted mandibu- technical consideration. J Am Asssoc Nurse Anesth lar third molars: a pilot study. Oral Maxillofac Surg. 2013 Dec; 63(3):235–243. 17(4):275–80. doi: 10.1007/s10006-012-0372-3. Epub 2012 Nov 2. Collins VJ, ed. Principles of Anesthesiology. 2nd ed. Philadel- 10. PubMed PMID: 23143710. phia, Pennsylvania: Lea & Febiger. 1978:951–955.

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ABS00814 Section: Miscellaneous Intraoral Autogenous Grafting Prior to Implant Placement: A Case Series ABS003 Dr Deepti Vashisht Prashar, Reader (1st Author); Dr S.P.S. Sodhi, Management of Submandibular Space Infection: Case HOD (2nd Author) Series

Department of Oral & Maxillofacial Surgery, Dasmesh Institute of Lt Col (Dr.) Ashok Kumar Research & Dental Sciences, Faridkot, Punjab Army Abstract Background/Introduction Abstract The ability to augment the alveolar ridge has dramatically expanded Background/Introduction the scope of implant dentistry. Numerous studies have been done to evaluate the efficiency of various grafts for the ridge augmentation. Infections of orofacial and neck particularly those of odontogenic Autogenous bone graft from intra-oral sites remains one of the pre- origin have been one of the most common diseases in human beings. ferred methods and is gold standard too. There are various sites for Despite great advances in health care, these infections remain a major intra-oral grafting such as symphyseal region, body & ramal region, problem; quite often faced by oral and maxillofacial surgeons. Sub- coronoid process and maxillary tuberosity. This paper presents an mandibular space infection is firm swelling in submandibular region insight into the use of symphyseal and ramal bone grafts for hori- below the inferior border of mandible. Intra orally teeth are sensitive zontal ridge augmentation, convenient to harvest with minimal to percussion, mobile. Patient presents with moderate trismus and drawbacks. dysphagia [1]. Objectives Objectives To augment horizontally deficient alveolar ridge for better rehabili- Involvement - Infection of submandibular space infection is caused tation using autogenous bone from intra-oral sites. by mandibular second or third molar. The pus perforates the lingual Methods cortical plate of mandible, inferior to attachment of mylohyoid Seven patients with horizontally inadequate alveolar bone ridge for muscle and passes directly into the submandibular space. The infec- implant placement were treated with autogenous bone grafts from tion from the submandibular salivary gland may pass via lymphatics intraoral sites. Mandibular symphyseal cortex was used in five to the submandibular lymph nodes. It is also involved as an extension patients whereas ramal bone graft was used in four patients. It was of infection from submental lymph nodes via the lymphatics; when followed by implant placement 6 months later. the node fails to contain infection within them. It is also involved by Results an infection originating from middle third of the tongue, posterior part Following the procedure, minimal resorption was observed. The post- of floor of mouth, maxillary teeth, cheek, maxillary sinus and palate operative morbidity is comparatively less in ramus region than the [2]. Methods symphysis. Conclusions Case series – The case series consist of 05 patients in whom the cause The findings from the present case series support the use autogenous of infection was mandibular molars, submandibular gland and sub- bone graft from intraoral sites for horizontal ridge augmentation of mandibular lymph node. In all patients there was swelling in atrophic ridges. Both mandible symphyseal and ramal region are good submandibular region below the inferior border of mandible. One donor site options for intra-oral block grafting. Whereas, symphyseal patient reported with Ludwig’s Angina. He was in severe respiratory graft has the advantage of better accessibility than ramal graft, the distress and looking toxic. Bilateral submandibular space and sub- latter has better cortico-cancellous bulk and fewer complications like mental space were drained under local anesthesia. Patient was started paraesthesia as seen in symphyseal graft. on empirical antibiotics. Patient got relief from respiratory distress and toxemia immediately. In this patient, leukocyte count was References/Bibliography increasing day by day along with episodes of fever. So, Maxillofacial and neck CT scan was taken on 3rd day. CT scan showed spread of 1. Clavero J, Lundregren S. Ramus or chin grafts for maxillary sinus infection to left parotid and parapharyngeal spaces with midline of inlay and local onlay augmentation: comparison of donor site respiratory tract shifted towards right side. So, on same day after morbidity and complications. Clin Implant Dent Related Res tracheostomy, drainage was carried out under GA. Patient was shifted 2003; 5(3):154–160. to ICU. After this, patient was started on specific antibiotics. He was 2. Adell R, Lekholm U, et all. Reconstruction of severely resorbed put on RT feeding. He was given adequate fluids and high protein edentulous maxillae using osteointegrated fixtures in immediate diet. Gradually patient improved and was discharged after 02 weeks. autogenous grafts. Int J Oral Maxillofac Implants 1990; 5: Some degree of extra oral tenderness was present in all the other 233–246. patients. Overlying skin was red in 03 patients. All the patients were in pain. One patient also had fever. None of the other patients had symptoms of life threatening condition like respiratory distress, impaired vision, decreased level of consciousness, change in voice quality and restlessness due to hypoxia. One patient was edentulous, in others extraction of offending teeth was done along with I & D in three patients. I & D was done using Hilton’s method. Drain was left for 48 to 72 hrs. OPG was used as screening tool in all the patients. In one patient, infection resolves by extraction of involved teeth and I & D was not required. In one patient, moderate trismus was present. All the patients were given antibiotics, in 01 patient oral antibiotic were given; in 03 patients parenteral antibiotics were given.

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Results procedure; the risk of altered sensation/numbness of lower lip and All the patients were managed successfully. tongue, in group I, where patients were initially consented with the Conclusions standard consent form, followed by the RFT consent. About 90% of Early recognition of orofacial infection and prompt, appropriate the total number of patients from the study, conﬁrmed that the request therapy is absolutely essential to prevent complications. for treatment (RFT) consent process ensured a better understanding of the whole treatment process. References/Bibliography Conclusions 1. Peterson LJ: Principles of management and prevention of Request for Treatment (RFT) provides a useful and novel patient- odontogenic infections. In Peterson LJ, Ellis E, Hupp JR, et al, centred method of consent, and is likely to protect against negligent editors: Contemporary oral and maxillofacial surgery, St Louis, consent, practically highlighting patient misunderstanding early and 1993, Mosby. by providing irrefutable documentary evidence that consent has been 2. Chow AW, Roser SM, Brady FA: Orofacial odontogenic gained. It may also provide a simple method by which Gillick com- infections, Ann Intern Med 88: 392, 1978. petence can be assessed and documented. References/Bibliography: 1. Shokrollahi K. Request for treatment: the evolution of consent. ABS005 Ann R Coll Surg Engl 2010;92:93–100. 2. Khalique N. Informed consent: the dawning of a new era. Br J Request for Treatment (RFT); A Paradigm Shift Oral Maxillofac Surg 2015;53:479–84. towards an Evidence Based Approach to the Consent Process

Prof. Ramakanth Reddy Dubbudu MDS, MFDSRCS (Eng), FFDRCS ABS0043 (Ire) Efﬁcacy of Neurectomy of Peripheral Branches of the Trigeminal Nerve in Trigeminal Neuralgia: Dept. of Oral & Maxillofacial Surgery SVS Institute of Dental A Critical Review of Literature Sciences Mahabubnagar Telangana

Abstract 1. Dr B. Krishnan, Additional Professor, 2. Dr V Yuvaraj, Professor Background/Introduction Respect for patient autonomy and the principle of informed consent is 1. Dept of Dentistry, Jawaharlal Institute of Post Graduate Medical central to modern medical ethics, and the consent must be truly Education and Research (JIPMER), Pondicherry; 2. Dept of Oral and informed for it to be ethically valid. The fundamental difference Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Sri between consent and the informed consent is the patient’s knowledge Balaji Vidyapeeth University, Pondicherry behind the consent decision, and in general, the courts of law have consistently stipulated that the burden rests with the doctor, to ensure Abstract patient’s comprehension of the information. The traditional approach Background/Introduction to consent is paternalistic, as it places the patient in a permissive Of the many chronic painful conditions, Trigeminal Neuralgia (TN) passive role. Substantial evidence also points to the fact that patients affecting the orofacial region needs the particular attention of understand significantly less than we think. Request for Treatment physicians and surgeons, especially those specializing in the max- (RFT) is a new approach to consent which aims to facilitate patient’s illofacial region. Treatment protocols for management of classic TN understanding their treatment and address some of the flaws of the include pharmacology and surgical intervention. Oral and maxillo- current consent practice. I present our early experience with the use of facial surgeons have traditionally employed the peripheral Request for Treatment (RFT) consent for mandibular third molar neurectomy in the surgical management of TN. surgical extractions. Objectives Objectives This review aims to evaluate the efficacy of peripheral neurectomy in To assess and compare patient comprehension of informed consent the management of TN with regards to a) the relief of symptoms in process for mandibular third molar surgical extractions, using two comparison with standard neurosurgical procedures and b) the dura- different methods of consent; a standard consent form and a novel, tion of pain relief and complications observed compared to standard Request for Treatment (RFT) consent form. neurosurgical procedures. Methods Methods 100 patients were enrolled for the study. Patients were randomly The review of the literature was done according to PRISMA guide- divided into two groups I and II. The randomization process lines and included randomised controlled trials, reviews and allocated 45 patients to group I and 55 patients to group II. prospective clinical studies involving surgical procedures for the Patients in both the groups were consented twice using the two management of TN. The primary outcomes evaluated were a) Initial different consent forms, but the sequence was different. Patients in relief of pain b) Duration of relief of pain c) Complications observed group I were first consented with the standard consent form fol- with ablative procedures and d) Recurrence of symptoms. A total of lowed by the RFT consent. Group II patients were initially 43 studies fulfilled the inclusion criteria. consented with the RFT consent, followed by the standard consent. Results Comprehension was assessed with a simple comprehension test In a total of 7913 patients from the 43 studies, central procedures questionnaire. were found to have best results for both quality and duration of pain Results relief. Percutaneous and peripheral procedures were associated with Statistical analysis showed significant difference in the understanding increased recurrence rates. The consolidated rates of complication for of the most critical components of the third molar surgical extraction peripheral, percutaneous and central procedures were 39.46%,

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65.42% and 10.41% respectively. The use of Peripheral Neurectomy References/Bibliography alone in the management of classic TN was observed in 10 studies. Conclusions 1. Michael j. Hunter, Tanios Rubeiz, Lynda Rose. Recognition of the Peripheral neurectomy in Trigeminal Neuralgia is associated with scope of Oral and Maxillofacial surgery by the public and Health lesser quality of pain relief in comparison to central neurosurgical care professionals. J Oral Maxillofac Surg. 54:1227–1232, 1996. procedures. It also provides only short to medium term pain relief. 2. Ibrahim M. Haron, Mohammad Y. Sabti, Lars Andersson, Prem N. Most studies with the use of peripheral neurectomy involved only a Sharma. Perception of oral and maxillofacial surgery by medical small group of patients with short follow-up periods. Oral and and dental health care professionals in Kuwait. Journal of Oral and Maxillofacial Surgeons must not consider the peripheral neurectomy Maxillofacial Surgery, Medicine, and Pathology 25 (2013) 5–11. as the first surgical option in the management of classic TN. Long term results can be achieved better with appropriate central neurosurgical procedures and pharmacotherapy. ABS0064 References/Bibliography Maxillofacial Infections in Medically Compromised 1. Akheel M, Tomar SS. Comparison of microvascular decompres- Patients sion and peripheral neurectomy for trigeminal neuralgia: A prospective study. J Biol Sci Opin. 2014;2(3):214–16. Group Captain (Dr) S K Kaushik 2. Cerovic R, Juretic M, Gobic MB. Neurectomy of the trigeminal nerve branches: clinical evaluation of an ‘‘obsolete’’ treatment. J Craniomaxfac Surg 2009;37:388–391. Abstract Background/Introduction Dental infection is a common and potentially life threatening condition sometimes necessitating admissions for surgical treatment. In ABS0053 addition to localised disease, dental infections can spread regionally and haematogenously, causing serious disseminated infections, Assessment of Awareness of the Speciality especially in patients who are medically compromised. Several epi- of Maxillofacial Surgery Among Medical Practitioners demiological studies have linked poor oral health with cardiovascular disease, poor glycaemic control in diabetics, low birth-weight pre- term babies, and a number of other conditions, including rheumatoid Dr. Pathumai Murugadoss, Dr. Reena Rachel John arthritis and osteoporosis. Oral infections are also recognized as a problem for individuals suffering from a range of chronic conditions, Vinayaka Mission’s Sankarachariyar Dental College and Hospital, including cancer and infection with human immunodeficiency virus, Salem, Tamilnadu, India as well as patients with ventilator-associated pneumonia. The dental management of patients with medically compromise is sometimes Abstract complex and requires a multidisciplinary and integral approach. Background/Introduction Objectives ‘‘Oral and Maxillofacial Surgery is the specialty of dentistry which This paper aims at bringing out the intricacies involved in the man- includes the diagnosis, surgical and adjunctive treatment of diseases, agement of maxillofacial space infections in severe medically injuries and defects involving both the functional and aesthetic compromised patients and the need for customization of the manage- aspects of the hard and soft tissues of the oral and maxillofacial ment protocols. region.’’ It is an internationally recognized surgical specialty but the Methods awareness of this specialty seems lacking among public including This retrospective descriptive case study involving subjects admitted medical practitioners. at a tertiary care armed forces health care set up between 2014–16 Objectives probes the presenting signs and symptoms and the underlying medical This study was conducted to evaluate the perception and create an compromise in each case. awareness of the specialty of Oral and maxillofacial surgery among Results the medical fraternity. A total of 24 cases of medically compromised in- patients admitted Methods with severe facial space infections resulting from dental source were Survey was done among 100 medical professionals with MBBS, MS, managed with custom made protocols including surgical drainage, MD, MCh & Diploma degrees in Salem, TamilNadu, India. Ques- anti-biotic cover optimization of physiologic parameters in view of tionnaire to assess the awareness level of various procedures that are underlying medical ailment. performed routinely by maxillofacial surgeons was personally given Conclusions and collected from the medical practitioners. Appropriate statistical Orofacial infections have become an increasingly common risk-factor tests were applied to the results. for systemic disease, which clinicians should take into account. Results Clinicians should increase their knowledge of dental diseases, and The acceptance of managing maxillofacial trauma by maxillofacial maxillofacial surgeons must strengthen their understanding of general surgeons ranged from 38 – 94 % depending on the bones fractured. medicine, in order to avoid unnecessary risks for infection that With regards to salivary gland pathologies only 14 % conceded with originate in the mouth. maxillofacial surgeon’s ability. The confidence with regards to harvesting of bone grafts were higher although microvascular surgery References/Bibliography was found to be beyond our scope according to their opinion. 1. Oral and Maxillofacial Infections, 3rd Edition. Topazian, RG, Conclusions Goldberg, MH. WB Saunders Co. 1994. The most interesting part of the survey was that the awareness of our 2. Peterson’s Principles of Oral and Maxillofacial Surgery, 3rd field and our zones of surgery was high among young medical Edition. Miloro, M, et. Al. People’s Medical Publishing House. graduates with clinical experience less than 5 years than practitioners 2012. with more than 5 years of experience.

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ABS0099 Methods Lefort 1 Osteotomy for Excision of Nasopharyngeal Risk is defined as the potential that chosen action or activity (including the choice of inaction) will lead to a loss or an undesirable Angiofibroma; Our Experience outcome. Risk management is the identification, assessment and prioritization of risks and the application of resources to minimize, Dr. Choubarga Naik, Assistant Professor monitor, control the probability or impact of the adverse events. Effective communication skills deployed throughout the interaction VSS Institute of Medical Science and Research, Burla, Sambalpur, with the patient, especially during the consent process are a Odisha Email:[email protected] Mob: 09337237290 prerequisite. Results Abstract An honest reflection by a practitioner on their competence to carry out Background/Introduction a procedure considering their skills, equipment and support available Surgical access to the skull base is always difficult, especially because will result in fewer medicolegal cases. of the surrounding difficult anatomical structures. Lefort I osteotomy Conclusions provides direct view to the anterior skull base, sphenoid, nasoeth- This paper explains an overview of the negligence, Indian law related moid, nasopharynx, and it also bears less morbidity when compared to negligence and malpractice, define the risk and the elements of risk to other access osteotomies. management strategies and give advice on various surgical proce- Objectives dures that are regularly practiced in oral & maxillofacial surgical To Use Lefort 1 osteotomy for excision of the Nasopharyngeal tumor. practice. Methods References/Bibliography Retrospectively patients were evaluated over a period of 4 years who have undergone lefort 1 osteotomy for the excision of nasopharyngeal 1. Goel et al TMU j.Dent vol 1: issue july 2014 2. S.J. Hendorson, tumor, extension; intraoperative and postoperative complications; and Risk management in clinical practice. Part II oral surgery. residual tumor and/or tumor recurrence associated with the surgical approach. Results 12 patients with nasopharyngeal angiofibroma were evaluated with a ABS00123 mean follow up of 24 months. There was one recurrence. Full Mouth Rehabilitation with Implant Supported Conclusions Le Fort I osteotomy approach is a useful technique for the removal of Fixed Prosthesis (All on Four): A Case Report Nasopharyngeal Angiofibroma extending into pterygopalatine and infratemporal fossae. 1. Dr. Abhishek Saraswat, Senior Lecturer, 2. Dr. Ayani Pandey, Senior Lecturer References/Bibliography 1. Ying Lin, Le Fort I osteotomy for extensive juvenile nasopha- 1. Department Oral & Maxillofacial Surgery, RKDF Dental College ryngeal angiofibroma: a retrospective study; Advances in & Research Centre, Bhopal, Madhya Pradesh; 2. RKDF Dental Therapy Oct 2008. College & Research Centre, Bhopal, Madhya Pradesh. Address – Bhopal Dental, DK 3/1/25, Danish Kunj, Bhopal Pin – 462042 Ph. No. 9111114085, 9111114020

ABS00119 Abstract Risk Management in Oral & Maxillofacial Surgery Background/Introduction The objective of a dental prosthesis is to replace the teeth and adjacent tissue to restore function, esthetics and speech. Oral Dr. Srinivas Gadipelly MDS, FDSRCS Professor rehabilitation of an edentulous patient is an challenge. Few patients have life long problems with their complete dentures, such as diffi- Kamineni Institute of Dental Sciences, Narketpally, Nalgonda (Dt) culties with speech and mastication. Implant supported prosthesis gives an opportunity to such patients a normal healthy life for their Abstract functional and esthetics demands. Background/Introduction Objectives The doctor/dentist relationship has changed over the last two decades. The objective of this study is to present a case report on full mouth Health professionals are increasingly viewed as providers of service rehabilitation with implant supported fixed prosthesis on all on four for consideration. Public awareness of medical/ dental negligence in concept, for completely edentulous maxillary and mandibular arches. india is growing as witnessed by recent incidents of attacks on doctors Methods and dentists. Hospital authorities are increasingly facing complaints, A 50 year old female patient reported to Bhopal Dental (private dental regarding facilities, standards of professional competence and clinic) in Bhopal (M.P, India) with chief complaint of missing teeth appropriateness of therapeutic and diagnostic methods. and wanted to be replaced by fixed prosthesis to restore esthetics and Objectives speech. After taking full case history and necessary blood investiga- Oral & maxillofacial surgery is often an unpleasant experience for a tions and radiographs implants sites were planned. Two stage surgery patient for the reason of invasive nature and if managed inadequately was planned with four implants in both arches. Two implants placed can be a cause for complaint or a claim in negligence. With proper for vertically in the anterior, two placed at an angle of upto 45 degree in thought and planning the vexing issue can be controlled and made less the posterior region. anxiety producing. Results Fixed implant supported prosthesis was given to patient when implants were osseointegerated.

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Conclusions used in large perforation which might occur during sinus lifting with By tilting the two posterior implants, the bone to implant contact is the presence of an antral pseudocyst. PRF has advantages for oral enhanced, providing optimal bone support even with minimum bone surgery operation, such as no chemical additives, reduced production volume. Tilting the posterior implants also helps avoid vital struc- time, easy application, and good adaptation to the operation area. tures, such as the mandibular nerve or the maxillary sinus and results Objectives in better distribution of implants along the alveolar crest which Not applicable. optimizes load distribution and allows for a final prosthesis with up to Methods 12 teeth. Appropriate diagnosis and treatment planning is the key to Not applicable. successful full mouth rehabilitation. Results Not applicable. References/Bibliography Conclusions 1. Adell R, Lekholm U, Rockler B, Branemark PL. A 15 year study Not applicable. of osseointegrated implant in the treatment of eduntulous jaw. Int References/Bibliography J Oral Surgery 1981 Dec;10(6):387–416. Baslarli O, Tumer C, Ugur O, Vatankulu B. Evaluation of the osteoblastic activity in extraction sockets treated with platelet rich fibrin. Med Oral Patol Oral Cir Bucal 2015 Jan 1;20(1):e111-6. ABS00339 Versatility of PRF and Its Biological Application in Minor Oral Surgical Procedures ABS00341 Transcranial Pedicled Supero-Lateral Orbitotomy Dr. Fatima Hasina, Dr. Shivakumar HR, Dr. Keerthi Kumar Rai in Lacrimal Gland Adenoma Bapuji Dental College and Hospital, Davangere Dr. Seemit Shah Abstract Background/Introduction RDC Loni Complex tissue remodelling requires the co-ordination of various physiological process, which involve molecular signals that are Abstract mediated primarily by cytokines and growth factors. Platelets con- Background/Introduction tains various growth factors and cytokines that play a key role in Although various tumours usually involve the orbital lobe of the inflammation and bone healing. The use of platelet concentrates has lacrimal gland, palpebral lobe involvement is seen only in 10% of become increasingly popular during the last 15 yrs. The initial cases. These palpebral lobe tumors are freely movable and do not development was the fibrin adhesive in 1996, PRP is considered as the produce proptosis or bony changes, however orbital lobe tumours can first generation autogenous fibrin adhesive and PRF is the second produce varied orbital sign and symptoms like pain, proptosis and generation. PRF was first described by Choukran et al. in the year bony changes. There is a continuing evolution in surgical approaches 2001. its not only has a workable three dimension architecture but for accesses to these tumours. During the last century there have been exhibits varied potent local properties such as cell migration, cell frequent periods when a number of methods have competed as attachment, cell proliferation and cell differentiation. it has been alternative surgical techniques for better outcome to the patient. Each shown as an ideal biomaterial. To prepare PRF, 20 ml of the blood of these approaches is associated with pros and cons and it remains to was withdrawn from the patient’s antecubital vein and centrifuged for be seen whether these innovations are advantageous or not. We 10 min at 3000rpm per minute. In vitro studies have proved that PRF propose relatively newer approach and technique to accesses lacrimal releases autologous growth factors gradually for at least one week and gland tumours. upto 28 days. PRF when used in conjunction with bone grafts offers Objectives several advantages including better wound healing, bone growth and To compare the outcome of different approaches for lacrimal gland maturation, graft stabilization, wound sealing and hemostasis and tumors. improving handling properties of the graft materials. Clinical trials Methods have suggested the combination of bone grafts and growth factors Transcranial pedicled supero lateral orbitotomy approach for lacrimal combined with PRF may be suitable for enhanced bone density. PRF gland adenoma was done and reviewed with other existing approaches can also be obtained in the form of membrane by squeezing out fluid for the same. in the fibrin clot, thus it acts as both healing and interposition bio- Results material. As healing material it accelerates wound closure and This newer technique was better in term of accessibility and esthetic mucosal healing due to fibrin bandage and growth factor release. As outcomes. interposition material, it avoids therapy invagination of undesired Conclusions cells, thereby behaves as a competitive barrier between desired and The newer technique was a good options for lacrimal gland tumors undesired cells. Placement of DFDBA in the extraction socket pro- and can be routinely practiced for better outcomes. vide scaffold for bone remodelling around the tooth. PRF clot mixed with DFDBA allowed rapid healing. Radicular cysts were treated by References/Bibliography combination of endodontic therapy followed by surgical management 1. Balihallimath L., Harkuni U., Urologin S., Pandit V., Kale T. with PRF and bioactive glass. The results showed that its an effective Pedicled lateral orbitotomy: A new technique and a case report. modality of regenarative treatment for radicular cysts. PRF is safely Indian Journal of Health Sciences 2014,7(2);125–129.

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ABS00483 Actinomyces a common inhabitant of the oral cavity. Most of the Adherence to Consort Extension for Abstracts cases are traced to an odontogenic source with periapical abscess and post traumatic or surgical complications with poor hygiene and in Randomised Controlled Trials Published immunosupression as contributing factors. in the Journal of Maxillofacial and Oral Surgery Objectives Diagnosis is often delayed because of nonspecific and prolonged Dr. Akilesh Ramasamy, Dr. Balasubramanian Madhan, Dr. symptoms usually mimicking a malignant or a granulomatous lesion. Balasubramanian Krishnan Methods Solitary or multiple abscess and fistula formation across normal tissue planes accompany chronic draining lesions and may lead to invasion Department of Dentistry, Jawaharlal Institute of Postgraduate of viscera. Medical Education and Research, Puducherry-605006, India Results Hence, early diagnosis and multidisciplinary approach ie appropriate Abstract surgical and medical management is mandatory to reduce morbidity. Background/Introduction Conclusions Under-reporting of abstracts adversely impacts the attention, contri- In this paper, we report two cases of cervicofacial actinimycosis, one bution and utility of the published articles and assessing it is an presented with intraoral granulomatous lesion treated with surgical important quality control measure for any journal. curettage and Intravenous pencillin and another case with extraoral Objectives swelling and multiple draining sinuses treated with oral antibiotics. To evaluate the adherence of the abstracts of published in the journal of maxillofacial and oral surgery (JOMS) to CONSORT extension for References/Bibliography abstracts. Methods Jainine et al, Actinomycosis in chroni granulomatous diseases: An 737 articles published from 2011 to 2016 in JMOS were screened for emerging and unanticipated pathogen. randomized controlled trials and 65 eligible articles were included. The compliance to CONSORT extension for abstracts[1] was assessed for each of the 17 items and recorded in four categories as yes, no, partially yes and not applicable. ABS00555 Results Oblique Curvilinear Incision to Zygomatic Buttress Forty eight out of 65 articles did not identify the study as randomized in the title. Sixty three did not mention the study design. The details regarding the methodology of the study were adequate in most studies Dr. Ananth Kumar G.B. except for randomization (n=6) and blinding (n=5). The reporting of the results was poor for most parameters except number of participants K M Shah Dental College and Hospital randomized (n=51). Information regarding trial registration and funding were missing in almost all the abstracts. Overall, median number of Abstract reported items was 5 with minimum of 3(n=7) and maximum of 8(n=2). Background/Introduction Conclusions The role of a TSAD (temporary skeletal anchorage devices) is to There is a severe under-reporting of abstracts in articles published in provide reliable stability when loaded with orthodontic forces, with- JMOS. The possible reasons, implications and solutions for the same out damage to the adjacent structures, and allow easy connection to are discussed. The need for joint effort from all the stake holders orthodontic appliances with minimal discomfort to patients. The most (authors, reviewers, editors and publishers) to improve the quality of appropriate application is to enable the predictable intrusion and abstract reporting of abstracts cannot be overstated. distalization of maxillary and mandibular molars. In the posterior maxilla, centering the miniplate on the zygomatic buttress ensures the References/Bibliography best stability. Location of the incision is particularly important, more 1. Hopewell S, Clarke M, Moher D, Wager E, Middleton P, Altman so if tooth intrusion is intended. Traditionally vestibular approach has DG, Schulz KF and the CONSORT Group (2008) CONSORT for been used for fixation of zygomaticomaxillary buttress region tran- reporting randomized controlled trials in journal and conference sorally. The disadvantages are limited access and visualization of the abstracts: explanation and elaboration. PLoS Med 5(1): e20. buttress, the most distal portion of the incision is difficult to suture, and the buccal fat pad often interferes with both the operation and closure. A newly designed curvilinear oblique incision to access the zygomatic buttress, improves the access, avoids excessive muscle stripping and aids in tension free closure. ABS00534 Objectives Cervicofacial Actinomycosis and Its Management: 1. To clinically evaluate the incision for accessibility to buttress A Report of Two Cases region 2. To evaluate for herniation of buccal fat pad. 3. To clinically evaluate the fixation of plate at desired position. Methods Dr Vini Kaila A Pilot Study Was Carried Out On Evaluate The Same On 6 Zygo- matic Buttress Region. Vishnu Dental College Results All 6 Sites Developed No Infection, Gaping Of Wound Or Dehisence. Abstract Conclusions Background/Introduction The Curvilinear Incision Provides Better Accessibility To Entire Cervicofacial actinomycosis is an invasive destructive infectious Buttress and Aids In Fixation Of The Plate Higher Up On The syndrome caused by gram positive, branching filamentous bacteria, Zygoma With Less Tension To Tissues.

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References/Bibliography ABS00587 1. Kelley P, Crawford M, Higuera S, Hollier LH. Two hundred Multiple Impaction in Non-syndromic Patients: A Case ninety-four consecutive facial fractures in an urban trauma Series center: lessons learned. Plast Reconstr Surg 2005; 116: 42–49. Manjiri Chakor

VSPM’s Dental College ABS00583 Estimation of C-Reactive Protein (CRP) Abstract as an Inflammatory Marker in Monitoring Therapy Background/Introduction Effectiveness of Postoperative Antibiotics Prophylaxis Multiple supernumerary teeth are often detected on radiographs. After Mandibular Fractures These can be asymptomatic or can result in fascial space infection, resorption of root of the adjacent tooth, malocclusions, delayed or non-eruption of teeth, temporomandibular joint disorder, cyst for- Dr Mahesh Goel mation. A great challenge is management of such cases to the clinicians. Hence, correct diagnosis and treatment with the use of PGIDS, ROHTAK Haryana appropriate imaging techniques and multidisciplinary intervention are highly important. Abstract Objectives Background/Introduction The purpose of this study was to describe the clinical characteristics Maxillofacial Surgeon routinely encounter patients with facial trauma and complications of patients with non - syndromic multiple and mandibular fractures alone accounts to 61% of All fractures. The impaction. sequel of a mandibular fractures will invariably lead to swelling Methods which may be just an inflammatory response or as a result of infec- A case series of three patients is included for the presentation. Data tion, prior to treatment or post treatment. This makes it difficult for a including age, gender, number, distribution, and location of super- surgeon to differentiate between the two. There are many laboratory numerary premolars, extraction procedure, and related complications markers to evaluate the prognosis of healing. Bacterial markers (such as cystic changes, root resorption, or adjacent teeth eruption including WBC Count, absolute neutrophil count and CRP estimation disturbance) were evaluated. The results are awaited. Radiographic are considered. But off late, CRP is gaining importance. assessment has an important part to play as early diagnosis and Objectives intervention. It can help avoid orthodontic problems and dental The objective of the present study was to evaluate the efficacy of CRP pathology associated with supernumerary teeth. levels as an inflammatory marker in monitoring therapy effectiveness Results of postoperative antibiotics prophylaxis following a surgical inter- AWAITED. vention of mandibular fractures with rigid internal fixation and to Conclusions correlate the prognosis of the convalescent period. AWAITED. Methods References/Bibliography A total of 50 patients of either sex more than 14 years of age with mandibular fractures managed with ORIF and who were eligible as Gawande P, Hebbale M, Patil T, Hindocha A, Halli R. Multiple per the inclusion and exclusion criteria we’re allocated to receive the Impacted Permanent and Supernumerary Teeth in the Anterior prophylactic antibiotics treatment regimen postoperatively and were Mandible of Nonsyndromic Case: A Systematic Review and subjected to a clinical assessment including efficacy and safety. Multidisciplinary Approach to Management. J Dent Allied Sci Results 2015;4:47–51. An increase in CRP levels was noticed immediately after mandibular fractures surgery which is considered to be normal mechanism of the body. On the 7th day of the surgery, CRP levels were significantly decreased to attain normal levels indicating abolition of inflammation ABS00591 and normal healing at the surgical site. As the CRP normalize, Life Threatening Airway Challenges Encountered administration of antibiotics can be terminated, which prevents prolonged usage of antibiotics and it’s side effects. in Oral and Maxillofacial Practice Conclusions The findings of this prospective analysis indicate that CRP is an Dr. Saumya Tripathi effective marker for determining of severity of infection, efficacy of treatment regimen and length of the hospital stay for patients with Meenakshi Hospital, Thanjavur (TN) mandibular fractures. Serum CRP reflect immediate effect of the treatment. Abstract References/Bibliography Background/Introduction In a full spectrum oral and maxillofacial surgery (OMFS) practice it is Schaller B Soon er Al. The role postoperative prophylactic antibiotics inevitable to escape from a life threatening airway complication. An in the treatment of facial features: a randomized double blind placebo airway complication in a maxillofacial condition can range from controlled pilot clinical study. Br J OMS 2014;52(4):329–33. mechanical obstruction of upper airway to tracheal injury to an aspiration led acute respiratory distress. In spite of it being a potentially fatal problem, it has not been documented well except for the upper airway obstruction.

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Objectives After 36 months of loading, there wasn’t any clinical or radiograph- To find the frequency of life threatening airway emergency in routine ical complication. On an average 13 mm bone height was evident OMFS practice. To describe few rare such conditions. To establish a (ranging from 11.5 to 14 mm) with the standard deviation of 0.81 mm. protocol for early identification and management of such conditions. Conclusions Methods Direct sinus lift is an excellent technique for the rehabilitation in the This is a retrospective study of all the OMFS cases operated in this cases with severely atrophic posterior maxilla. hospital since October 2015. Only such airway complications which resulted primarily due to oral and maxillofacial trauma, pathology or References/Bibliography infection were considered. Conditions which led to airway compro- Kunal Jodia et al. Sinus elevation with an alloplastic material & mise which were not primarily due to OMFS condition were not simultaneous implant placement: A 1- stage procedure in severely included (e.g. insecure airway due to loss of sensorium, neurosurgical atrophic maxilla. J Maxillofac Oral Surg 2014;13(3):271–280. causes of tongue fall back etc). It was well-thought-out and a con- Kolerman et al. Histomorphometric analysis of maxillary sinus dition was termed as a life threatening airway emergency only if an augmentation using an alloplast bone substitute. J Oral Maxillofac immediate invasive rescue procedure was required or there was Surg 2012;70:1835–1843. mortality due to such condition. Results 8.5% of the OMFS patients required lifesaving interventions (e.g. upper airway obstruction release, emergency fracture fixation to release gagging effect, evacuation of tongue and floor of mouth ABS00632 hematoma, emergency incision drainage in space infection, aspiration Comparison of Traditional Scalpel, Diode Laser led ARDS condition management, tracheostomy, intubation and and Electrocautery for Excision of Oral Premalignant ventilator support). Lesions Conclusions The study cases exemplify the fact that an OMF surgeon’s working space is at the gateway of airway. Therefore our mere attentive Omkar A. Shetye, Rakshit V. Khandeparker, Praveen Satish Kumar, inspection can enable us to promptly identify such potentially fatal Saurabh M. Kamat conditions which is crucial for management and saving the life of the patient. A multidisciplinary and co-ordinated team approach is Abstract essential for the management. Background/Introduction Oral premalignant lesions of the oral cavity remain a diagnostic and References/Bibliography treatment challenge. They have a potential for malignant transfor- Robert M Kellman et al. Comprehensive Airway Management of mation. Management of such lesions includes observation, excision, Patients with Maxillofacial Trauma. Craniomaxillofacial trauma and ablation, or topical medical therapies. The gold standard for man- reconstruction. Volume 1, Number 1, 2008. agement of the clinically evident high-grade premalignant disease is excision or laser ablation. Laser treatment has been a well-established modality for management of premalignant lesions and has potential advantages over surgical excision and electrocautery. This study is therefore intended to compare the efficacy of 3 different options of ABS00609 managing premalignant lesions viz scalpel, diode laser and Efficacy of Direct Sinus Lift in Implant Placement electrocautery. Objectives Dr. Rajesh Sabnis To compare traditional scalpel, diode laser and electrocautery for excision of oral premalignant lesions. Methods Rungta College of Dental Sciences and Research, Bhilai, A total of 38 patients reporting to our unit with oral premalignant Chhattisgarh lesions were randomly divided into 3 groups. Group A (n=13) managed using traditional scalpel, group B (n=12) managed using diode Abstract laser and Group C (n=13) managed using electrocautery. Intra-oper- Background/Introduction atively, hemostasis and need for anaesthesia (either topical or Efficacy of direct sinus lift for the stability of implant placement. injectable) was evaluated. Post-operatively, patients were followed up Objectives at regular intervals and evaluated for pain and healing time. The data The present study was conducted with the aim to evaluate clinical was tabulated and subjected to statistical analysis. A p value less than efficacy of the direct sinus lift with simultaneous implant placement 0.05 was considered statistically significant. and bone grafting to evaluate merits and demerits of lateral approach Results for sinus membrane elevation. Traditional scalpel was associated with faster healing as compared to Methods groups B and C but required hemostasis and injectable anesthesia. This randomized prospective study consisted of 10 patients who met Diode laser had better healing than electrocautery and presented the inclusion and exclusion criteria. The patients were selected irre- better hemostasis than scalpel and electocautery. Also, minimal to no spective of the age, sex & socioeconomic status, with the residual topical anesthesia was required pre-operatively. The post-operative alveolar bone height between 1 to 4 mm in the edentulous posterior pain was least with laser followed by electrocautery and scalpel in maxillary region. Direct sinus lift was carried out with simultaneous that order. implant placement. Patients were followed up for 36 months of Conclusions prosthetic rehabilitation. Diode lasers offer superior post-op pain control, good hemostasis with Results minimal to no need of pre-operative anesthesia as compared to tra- Pre-operative alveolar bone height was on an average 2.9 mm ditional scalpel and electrocautery for managing premalignant lesions (ranging from 1 to 4 mm) with the standard deviation of 0.67 mm. of the oral cavity.

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References/Bibliography ABS00686 1. Funde S, Baburaj MD, Pimpale SK. Comparison between Laser, Role of Percutaneous Radio-Frequency in Management Electrocautery and Scalpel in the Treatment of Drug-Induced of Trigeminal Neuralgia Gingival Overgrowth: A Case Report. IJSS Case Reports & Reviews 2015;1(10):27–30. (1) Dr. Vijay Laxmy Malhotra, Associate Professor, (2) Dr. Dipender 2. Tambuvala A, Sangle A, Khan A, Sayed A. Excision of Oral Kaur, Associate Professor Leukoplakia by CO2 Lasers Versus Traditional Scalpel: A Com- parative Study. J Maxillofac Oral Surg. 2014 Sep; 13(3): 320–327. 1. Dept. of Dentistry, SHKM Govt. Medical College, Nuh, Haryana; 2. Dept. of Anaesthesia, Shkm Govt. Medical College, Nuh, Haryana

Abstract ABS00651 Background/Introduction Effect of Topical Application and Systemic (Oral) Trigeminal Neuralgia (TN) is one of the most painful neuropathic Intake of Honey in Chemo-Radiation Induced Mucositis pains with no universal treatment capable of reverting it completely. Medical therapy remains the first line of treatment but surgery and interventional treatment options are considered in refractory cases and Dr Vibha Singh Professor where side effects of medical treatment exceeds risk of interventional procedures. Percutaneous Radio-Frequency (PRF) is one such inter- K.G. Medical University Lucknow ventional procedure. Among several means of surgical treatment, PRF has proven to be an invaluable innovation with a unique longevity and Abstract has high rates of success, acceptable durability, a respected safety Background/Introduction profile, and a high level of patient satisfaction. The cytotoxic effects of chemo-radiation, in addition to their intended Objectives effects on cancer cells, unfortunately extents to normal tissue as well, The aim of this study was to evaluate the role of PRF in the man- such as gastrointestinal mucosa and bone marrow. This is mainly agement of TN. brought about by the oxidative damage caused by the generation of Methods free radicals. To the head and neck cancer patient, the most crippling 8 patients (6 females and 2 males; average age 62 years, 5 patients ill-effect of chemo-radiationisoral mucositis. In addition to being a right side and 3 patients left side affected) suffering from classic TN potentially dose limiting complication of chemo-radiation, oral that met the inclusion criteria were selected and PRF was done under mucositis lends a devastating blow to patient’s daily activities and fluoroscopic image guidance following standard procedure. Out of 8 brings about marked reduction in their quality of life (QOL). patients, in 4 patients mandibular branch (V3), in 2 patients maxillary Objectives branch (V2), 1 patient both V2 and V3 and in 1 patient all three The aim of this study was to assess the effect of topical application branches were involved. The average duration of symptoms was 37 and systemic (oral) intake of honey in chemo-radiation induced months and average follow up period was 16 months. The outcome of mucositis and to assess its clinical benefits in improving quality of life PRF was assessed in follow-up visits in every 2–3 months after the in patients of head and neck cancer. procedure. Patients were assessed using Barrow Neurological Institute Methods (BNI) Pain intensity scores. A total of 50 patients of H&N cancer (25 cases, 25 controls) were Results enrolled in the study and their QOL was recorded, at regular intervals All of the 8 patients experienced initial pain relief with PRF with BNI during radiotherapy. The study group received oral honey along with score I in 4, II in 3 and III in 1 patient. All 8 patients experienced radiotherapy while the control group received standard oral hygiene variable degrees of numbness following PRF and facial numbness instructions only. mostly subsided within 6 months after PRF. One patient suffered from Results anesthesia dolorosa. There was no mortality and no permanent cranial The QOL scores were significantly better in the study group com- nerve deficit. pared to controls after completion of radiotherapy. Conclusions Conclusions Although medical therapy remains the first line of treatment, PRF can The results obtained from this trial indicate a definite improvement of be considered in selective cases especially in elderly. quality of life in patients of chemo-radiation induced mucositis treated with topical and oral honey over controls. Honey not only References/Bibliography seems to help combat the ill effects of cumulative radiation damage 1. Roberto Carlo Rivera Diaza, Jose Libardo Bastidas, Benavidesb, pertaining to mucositis like mucosal drying, irritation and dysphagia Juliana Garcia Alvarezc, Gasserian ganglion thermal radiofre- but also speeds up recovery, expediting the process of return to a quency in patients with trigeminal neuralgia, Rev Colomb normal quality of life. Anestesiol. 2013;41:127–31. References/Bibliography 2. Byung-Chul Son, Hyung-Suk Kim, Il-Sup Kim, Seung-Ho Yang, Sang-Won Lee; Percutaneous Radiofrequency Thermocoagula- 1. Song JJ, Twumasi-Ankrah P, Salcido R. Systematic review and tion Under Fluoroscopic Image-Guidance for Idiopathic meta-analysis on the use of honey to protect from the effects of Trigeminal Neuralgia, J Korean Neurosurg Soc. 2011 Nov; radiation induced oral mucositis. Adv Skin Wound Care 50(5): 446–452. 2012;25(1):23–8. 2. Melanie Charalambous, Vasilios Raftopoulos, Ekaterini Lambri- nou, Andreas Charalambous, The effectiveness of honey for the management of radiotherapy-induced oral mucositis in head and neck cancer patients: A systematic review of clinical trials. European Journal of Integrative Medicine 5 (2013) 217–225.

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ABS00699 Methods Planning, Execution and a Benchmark: The First Review article, Protocol has been quoted from standard text of Committee on trauma by American College of Surgeons. AOMSI Surgical Skill Competition in India and Why It Results Needs to be Taken Forward It depicts the shortcomings of Indian Health System & Resources for Trauma Management. Dr Arjun Shenoy Conclusions Its easy to summarize and master the protocol and is the need of an hour to salvage trauma patients in efficient manner. Elite Hospital Dept of Maxillofacial Surgery Thrissur References/Bibliography Abstract Background/Introduction Resources for optimal care of injured by committee on trauma (ACS). We live in a world surrounded by technology, innovation and simulation. The modern methods to prepare a trainee surgeon for his role have grown leap and bounds. Simulation of procedures on mimicking Scientific E Poster structures go a long way in bolstering confidence among young trainees. Trainees getting recognized for their skill and intellectual application through the surgical skill competition platform is the Section: Cranio Maxillofacial Trauma future we should be envisioning. Keeping this in mind, We organized the first Zonal AOMSI Surgical Skill Competition comprising of Trainees from three States on August 19th 2017. This presentation aims to showcase the relevance this competition encases and the need ABS006 to get it implemented at the zonal and/or national platforms. Comparative Study of Single Miniplate Versus Two Objectives Miniplates in the Management of Mandibular Angle 1) To narrate the need for surgical skill competitions for Trainees in Maxillofacial surgery and its relevance 2) To share our experience in Fractures conducting the first AOMSI Zonal Trainee Competition in 2017 3) To convince the need for implement the competition at the National level. Dr. H. Ash Professor & HOD Methods 20 trainees from 10 institutions from 3 states 2 modules- soft tissue Bidsh Patna and hard tissue module 2 judges- One judge being the Examiner for Royal College of Surgeons 2 international observerse 1 observer from Abstract national AOMSI Education Committee soft tissue procedure involved Background/Introduction suturing on simulated tissue hard tissue procedure involved ORIF on Monocortical miniplate fixation is an accepted and reliable method human mandible specimens. for internal fixation of mandibular angle fractures. although place- Results ment of a second miniplate may theoretically provide more stability; Successful completion of the first AOMSI Zonal competition with however, the clinical importance of this issue remains controversial. minimal logistics and cost effectiveness. Objectives Conclusions The present study assessed the post operative complication and out- A presentation that wants to show the concept of design and execution comes associated with the fixation of mandibular angle fractures of this brilliant platform that needs to be at the national level. using 1 and 2 miniplates in patient with favourable mandibular angle References/Bibliography fractures. Methods Oxford Specialist Handbooks in Surgery Clinical and Procedural A prospective study of 87 patients with favourable mandibular angle Skills for MRCS Andrew Miller Stuart Enoch and David Hepburn. fractures was done. In the first group a. 4 - hole miniplate was placed at the superior border through an intra oral approach. in group 2, patient were treated with 2 miniplates, one placed at the superior border and the other on the lateral aspect of the angle at the inferior ABS00779 border through an intra oral and transcutaneous approach using a Primary Survey of Trauma Patients; ATLS Perspective trocar. post operative complication including malocclusion, malunion, and sensory disturbances associated with surgery. Results Dr Amiya Agrawal In the single miniplate group 25 patients showed lip numbness associated with surgery, 22 patients required additional use of mmf King George’s Medical University, Lucknow and 3 patients develop infection. In the double miniplate group 20 patients showed lip numbness associated with surgery, 18 patients Abstract required additional use of mmf and 1 patient developed infection. Background/Introduction None of the patients in either group showed malocclusion or malu- Trauma care is still in nascent stage in our country, The presentation nion. No significant difference was observed between the groups tries to focus institution of Primary Survey in Trauma Patients. It regarding overall complication rate. focuses on how the resuscitation process proceeds apart from con- Conclusions ventional medical education. In Favourable mandibular angle fractures was associated with athis Objectives study, use of one miniplate or two miniplates for treatment of fav To orient & sensitize the health care personnel about concepts & similar incidence of complications. Thus it seems that the use of two protocol of ATLS. miniplates in this setting may not be warranted, not cost- efficient.

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EPS0024 alignment of fractured bone pieces with plate fixation according to Perpendicular Plates in Parasymphyseal Fracture AO/ASIF principles of rigid fixation reduces morbidity. Conclusions Better functional and aesthetic results were obtained by addressing Mihika Bala both the soft tissue and bony injuries in minimum number of stages. Our strategy was to repair both soft tissue and hard tissue simulta- Guru Nanak Institute of Dental Sciences and Research neously whenever feasible which involved application of arch-bars, direct fixation by wiring or plating and soft tissue repair by meticu- Abstract lous debridement. Background/Introduction The mandible is the most frequent site among facial fractures. The treatment of mandible fracture depends on several factors like the extent of displacement, soft and hard tissue loss, tooth conditions, etc. EPS0067 Fractures with displacements are often treated by open reduction and Evaluation of Clinical Use of Indigenously Developed internal fixation with plates. Plates used for the treatment of a Delta Plate in Management of Subcondylar Fracture mandible fracture include micro-plates, mini-plates, locking miniplates, reconstruction fracture plates, etc. There have been studies Dr. Sherin A. Khalam, MDS & Dr. Kala Bagavathy (II yr PG) related to placement of miniplates in parasymphyseal region. One of them is perpendicular miniplates. Objectives Rajas Dental College & Hospital To evaluate the usage and advantages of perpendicular plates in parasymphyseal fractures. Abstract Methods Background/Introduction In this technique, one curved miniplate is placed on the middle buccal Condylar fractures make 25–35% of mandibular fractures and warrant cortical bone surface and the other on the inferior surface, with four a special consideration due to their anatomical differences and healing unicortical screws in each of the miniplates. potential. Success is considered optimal with regard to occlusion, Results improved mouth opening, absence of mandibular deviation, normal Studies have shown stress to be lowest in the perpendicular miniplates mastication, and absence of ankylosis. Previous clinical and biome- as it resists more shearing forces than parallel miniplate fixation. chanical studies have recommended two miniplates which requires a Also, there are other advantages like low rate of malocclusion, low certain size of proximal condyle fragment and so applicable in low stress shielding, low plate profile, etc. fracture; also includes excess of armamentarium and increased Conclusions exposure of condylar region. We conclude that perpendicular miniplates are better than parallel or Objectives single miniplates in treatment of parasymphyseal fractures. This study evaluates the clinical use of indigenously developed titanium delta-shaped miniplate in ORIF of subcondylar fracture. Methods Mandibular condyle is approached by Hinds incision. Delta plate is EPS0062 designed in triangular shape to provide 3-dimensional stability in Maxillofacial Gunshot Injuries: Versatility in Patterns open ORIF of subcondylar fractures-1mm thick, 20 mm long, & 5mm and Treatment: Case Series wide at top and 12 mm wide at base. Results Use of delta plates had 3 main advantages (i) neutralization of Dr. Anindita Bhagawati, Post Graduate Student Second Year, Dr. changing strains at anterior, lateral & posterior borders, (ii) additional A.K. Adhyapok, Professor and H.O.D, Dr. S.C. Debnath, Reader stabilization provided by a compression miniplate and (iii) a small osteosynthesis plate. Department of Oral and Maxillofacial Surgery (RDC), Regional Conclusions Dental College, Guwahati Adaptation of ORIF gives improved results. ORIF with 3-dimensional stability is absolutely necessary for any subcondylar fractures for Abstract early functional rehabilitation with minimal complications. Background/Introduction Maxillofacial gunshot injuries leads to considerable morbidity. Apart from emergency problems with airway obstruction and neurovascular compromise, reconstruction of bone and soft tissue is challenging. EPS0073 Objectives Submental Intubation: An Alternative Access to Airway Facial gun-shot injuries are complex and in our case series it is seen that its management requires application of sound surgical principles Dr. Jenin N.T., Ist year PG Trainee and conservative, yet necessary, care to achieve a satisfactory outcome. Rajas Dental College, Kavalkinaru Methods 3 cases of maxillofacial injuries, done by guns or rifles, were treated Abstract in our department of maxillofacial surgery. We compared type and Background/Introduction severity of the injuries to the treatment and reconstructive steps. Results Orotracheal and Nasotracheal intubation are the commonly employed The reconstruction of defects done by shotguns needed treatment to methods for airway management. However in panfacial trauma and bone and soft tissue, to get good aesthetic and functional results. Early bi-jaw orthognathic procedures they will interfere with the surgical and comprehensive surgical management of soft tissue followed by access. Traditionally tracheostomy was used as an alternative. Due to 123 S88 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 high risk of iatrogenic complications it is not preferred in all cases. To EPS0080 overcome the morbidity associated with tracheostomy submental Self Tapping Intermaxillary Fixation Screw: intubation is preferred in selected cases. Objectives An Alternative to Ivy Eyelet Wiring To see if submental intubation is a viable alternative in Panfacial trauma and Orthognathic bi-jaw surgeries. Dr. Tejinder Kaur, Dr. Jasmine Kaur, Dr. Amneet Sandhu Methods 5 cases of submental intubation in cases of pan facial trauma. Abstract Results Background/Introduction Submental intubation permits simultaneous reduction and fixation of Intermaxillary fixation is a basic and fundamental principle in the all fractures and intraoperative control of the dental occlusion without management and treatment of the maxillofacial trauma patient. It interference from the tube during the procedure. It is relatively less serves as a cornerstone of maxillofacial reconstruction, providing a technique sensitive, associated with less complications and avoids the stable base from which facial form and function can be restored. longer post-operative care needed as in cases of tracheostomy. Objectives Conclusions To compare the efficacy of self drilling, self tapping transalveolar The simplicity of the technique with no specialized equipment or screws with Ivy eyelet wiring for achieving intermaxillary fixation technical expertise required makes it especially advantageous as during open reduction and internal fixation of maxillofacial fractures. compared with tracheostomy. It also reduces the incidence of intra Methods operative and post-operative complications and eliminates the risk of Both techniques were assessed for: time required for placement and side effects of tracheostomy. removal of IMF hardware, time required for placement of IMF wires, postoperative occlusion, local anesthesia requirement during removal of hardware, oral hygiene status, glove perforation, and complications EPS0075 associated with both techniques. Results Identifying the Risk Factors Causing Iatrogenic The average surgical time taken and glove perforations were more in Mandibular Fractures Associated with Exodontia: Ivy eyelet group. The patient acceptance and oral hygiene was better A Systemic Meta-Analysis of 200 Cases from 1953 in intermaxillary fixation screw (IMFS) patients. to 2015 Conclusions IMFS is a cost-effective and viable alternative to eyelet wiring technique with satisfactory occlusion outcome in maxillofacial frac- Dr. Ashish Maheshkar tures. This technique of achieving IMF is relatively quick with minimal incidence of needle stick type injuries, less compromised SDKS Dental College & Hospital, Nagpur oral hygiene and better patient acceptance.

Abstract Background/Introduction EPS0098 Iatrogenic fracture of mandible (IFM) associated with exodontia though rare, they do occur with an incidence ranging from 0.0034 to Management of Naso Orbito Ethmoidal Fractures 0.0075%. Most of the data is in the form of case reports or a small case series. This is an attempt to amass the data available in literature The Management of Naso-Orbital-Ethmoid (NOE) Fractures Jun-Jun since the last 62 years. Wei, Zhao-Long Tang, Lei Liu, Xue-Juan Liao, Yun-Bo Yu, Wei Jing* Objectives The purpose of this meta-analysis is to identify the etiologies and risk State Key Laboratory of Oral Diseases, Department of Oral and factors leading to IFM associated with exodontia and also the mea- Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan sures to minimize the complication. University, Chengdu 610041, China Methods Articles published between 1953 and 2015 were searched in Medline Abstract database. Data was collected and analyzed based on age, gender, Background/Introduction extracted tooth, status of dentition, pathological bone lesion adjacent Abstract The bony naso-orbital-ethmoid (NOE) complex is a 3-di- to the tooth, type of impaction, angulation of the impacted third mensional delicate anatomic structure. Damages to this region may molar, site of fracture, side of fracture, time of fracture, and treatment result in severe facial dysfunction and malformation. The manage- of fracture. ment and optimal surgical treatment strategies of NOE fractures Results remain controversial. For a patient with NOE trauma, doctors should A review identified 200 documented cases of IFM associated with the perform comprehensive clinical examination and radiographic anal- removal of teeth. The reasons for its occurrence found to be multi- ysis to assess the type and extent of fracture. The results of assessment factorial with a higher incidence in the fifth decade of life with male will assist doctors to make a patient-specific program for the sake of prevalence. Risk factors more commonly identified were removal of reducing post-operation complications and restoring normal appear- the third molar, fully dentate patient, associated pathology, impacted ance and function as much as possible. The poster that I would present tooth, angle region, left quadrant, and time interval of 3 weeks focuses on the advancement of management of NOE fractures postoperatively. including symptoms, classifications, diagnosis, approaches, treatment Conclusions and new techniques in this field. IFM related to the removal of teeth is a rare complication. Identifying Objectives and addressing the risk factors will enable the surgeon to avoid the For a patient with NOE trauma, doctors should perform comprehen- complication of IFM associated with exodontia. sive clinical examination and radiographic analysis to assess the type and extent of fracture.

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Methods EPS00116 Reconstruction of the original attachment of MCT Reconstructing the Management of Floor of the Orbit Fracture: A Case orbital wall Bone tissue engineering. Results Report The results of assessment will assist doctors to make a patient-specific program for the sake of reducing post-operation complications and Dr. Chandhini Asokan restoring normal appearance and function as much as possible. Conclusions Sree Balaji Dental College and Hospital Although a number of procedures of NOE fractures have been described, management of NOE fractures remains one of the most Abstract difficult issues to fully restore the original facial appearance and Background/Introduction function due to the anatomic complexity in this region. Location of the orbit predisposes them to injury in faciomaxilllary injuries. There is a high incidence of orbital injury in faciomaxillary trauma. Trauma to the orbit can be either blunt or penerating in EPS00106 nature. Commenest bony injury to the orbit involves floor of the orbit Residual Deformity Correction and Its Outcome fracture. It is very important for a maxillofacial surgeon to be competent in handling these problems. Objectives Prof. Dr. A. Thangavelu, MDS, DNB, FIBOMS, Dr. S. Kapil Dev The purpose of this case was to assess the aesthetic and functional Kumar outcome of orbital floor reconstruction performed with titanium mesh. Methods Abstract Clinical examination, patient satisfaction and radiographic investi- Background/Introduction gations were used to assess repaired fractures. Disfiguring post-traumatic deformities of the midface sometimes Results persist even after the treatment. Such deformities, after healing, are symmetry was restored, extraocular movements were normal, globe among the most formidable challenges faced by the surgeons, apart position was normal, lid position was normal. from the psychological impact on the patients. Following the basic Conclusions principles of craniofacial reconstruction and with newer techniques, Reconstruction of orbital walls defects is a very delicate surgery and better results can be achieved. Symmetry is key to proper recon- difficult to perform. Orbital dissection should carefully be extended to struction in general and face in particular. Proper facial projection and completely expose the defect and allow proper positioning and sup- height must be re-established with harmonious occlusion. Our basic port to the reconstructive material. Titanium mesh is a approach to the evaluation of deformities and particularly useful suitable material for reconstruction of orbital fractures. techniques for their correction are presented, with a representative case of malunited panfacial fracture that we treated with titanium mesh along with correction of mandibular deformity by osteotomies. Objectives EPS00117 In Department of Oral & Maxillofacial Surgery we have encountered Management of Parasymphysis Fracture: A Case two cases of post traumatic residual deformity of zygomatic arch and Report zygomatico maxillary complex fracture. Clinically, deformities of the middle and lower third of face ranges from dentoalveolar discrepancy (malocclusion) to severe facial asymmetry. Facial disfigurement Dr. Visalakshi Kaleeswaran causes social embarrassment and compromised masticatory and speech function. It often has a severe impact on the patients self Sree Balaji Dental College and Hospital esteem and affects the quality of life. Methods Abstract Accurate assessment by history, clinical examination and special Background/Introduction investigations like plain films, dental study models, photographs and Mandible fracture occupies the second most frequent incidence of CT or MR scanning, with three-dimensional stereolithographic facial bone fracture with incidence of about 38%. Manibular fractures modeling where appropriate, treatment planning, surgery, utilizing a may lead to deformities either due to displacement of fracture frag- variety of techniques for management of soft and hard tissue deficits ments or non-restored bone loss with disturbed dental occlusion with or deformities, including osteotomies or bone grafting. or without TMJ disorder. Consequences of an untreated or an inap- Results propriately treated mandibular fracture may be severe both A person’s physical appearance is an important aspect in social cosmetically and functionally. Hence it is very important for a interactions. It is not only the individuals own perception of appear- maxillofacial surgeon to be competent enough to handle this problem. ance which not only contributes to the psychosocial effects but also Objectives the reaction of others. To improve facial aesthetic is the most pow- The aim of the study was to evaluate the efficacy of miniplate fixation erful motivating factor leading people for surgical correction. in parasymphysis fracture. Conclusions Methods Jaw deformities may cause pain, dysfunction, excessive tooth wear, Mode of injury, age and sex distribution, site of injury, associated difficulty in mastication, speaking, or breathing. Many people live injury and surgical treatment. with these problems all their lives, but there is an alternative. Results Restoring the proper anatomic relationship of the upper and lower jaw Early intervention using open reduction and internal fixation resulted helps to reestablish normal function and protect against further in minimum morbidity and complications. deterioration of the teeth and the TMJs. Maxillofacial surgery can help resolve these problems and improve a person’s comfort and self- esteem, allowing him or her to live a happier and healthier.

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Conclusions Results The use of mini plate for the treatment if parasymphysis fracture, The results of the study will be presented as per the defined protocol. decreased morbidity and complications and ensuring early return to Conclusions normalcy. Changes in the anatomy of the joint has been observed in the cases with closed management of condylar fractures based on their requirement regarding adaptation to the function. EPS00118 Management of Angle Fracture ABS00140 Dr. Vijayaravind R. Efficacy of Low Intensity Pulsed Ultrasound Therapy in Maxillofacial Bone Healing Sree Balaji Dental College and Hospital Dr Sharwan Kumar Singh Abstract Background/Introduction Chandra Dental College; Barabanki Mandibular angle fractures represent the largest percentage of mandibular fractures. There are two main reasons for the mandibular Abstract angle fracture 1. presence of thinner cross sectional area 2. presence Background/Introduction of impacted 3rd molar weakens the region treatment of mandibular Bone is a dynamic tissue and its healing is affected by various angle fracture possess a unique challenge for the surgeons. biomechanical, biochemical, cellular, hormonal and pathologic fac- Objectives tors. Delayed healing or non-union, results in functional impairment. The key objective of the study is to address patient evaluation and In order to overcome this problem low intensity pulsed ultrasound general management principles and to discuss indications for the therapy (LIPU) has been used to stimulate bone healing. satisfactory treatment of mandibular angle fracture. Objectives Methods Here we present an overview on LIPU with an insight on its mech- mode of injury, age and sex distribution, site of injury, associated anism of action, various effects (Physical, Piezoelectric and injury and surgical treatment. biological), clinical applications and future prospectives. Results Methods successful establishment of the patient’s pre injury occlusion and It was based on 3 electronic database basis (MEDLINE, EMBESE, function. Cochran database of randomized clinical trials.) For trials of ultra- Conclusions sonography and fracture healing, published from 1939-December 2014. Mandibular angle fractures continue to present challenges to recon- Results structive surgeons. A thorough history, with investigation into the It’s a noninvasive treatment modality with minimal complications or mechanism of trauma, along with a complete physical examination side effects. and proper radiographic assessment are the keys to the development Conclusions of a satisfactory treatment plan for comprehensive management of Ultrasound therapy has shown accelerated healing in delayed or non- these fractures. union, callus consolidation after distraction and on adjunct therapy for osteoradionecrosis. It is an non-invasive treatment modality with minimal complications and provides better health care for the patient. EPS00130 Radiographic Evaluation of Condyle Fracture After EPS00146 Closed Treatment Modified Retromandibular Approach in Treatment of Subcondyle Fracture Dr. Depa Anil, Dr. Ritesh Rajan, Dr. Dinesh Jhawar Suganraaj S.V. Abstract Background/Introduction Sree Balaji Dental College and Hospital The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. The Abstract literature suggest that condylar fracture account for 17.5%–52% of all Background/Introduction mandibular fractures. There is still no consensus among oral and Mandibular fractures are extremely frequent in facial trauma, and maxillofacial surgeons world wide regarding open/closed treatment of condylar fractures. 19–52% involve the condyle. Condylar fractures are classified Objectives according to the anatomic location (intracapsular and extracapsular) To radiographically evaluate condylar fractures managed with closed and degree of dislocation of the articular head. In recent years, open treatment of condylar fractures has become more common, probably treatment so as to assess the changes in the anatomy of the joint which may influence outcome on function of the joint. because of the introduction of plate and screw fixation devices that Methods allow stabilization of these injuries. Objectives Radiographical evaluation was done for the patients who reported Reviewing various approach in literature for reduction and fixation of with condylar fractures to SVS Institute of Dental Sciences, Mahabubnagar from january 2016 to october 2017 and patients who condylar fracture is important to prevent complications, in my study were managed with closed treatment. Tang’s approach to the condyle has been described in detail and advantages has been described.

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Methods Objectives By treating a condylar fracture using a modified retromandibular In Advanced Trauma Life Support (ATLS), the ‘‘Golden Hour’’ approach indirectly from the anterior edge of parotid gland. The represents a metaphorical maximum opportunity for optimal care by degree and type of mouth opening, occulsal relation ship, facial nerve emphasizing the need for swiftly transport severely injured one to function, and other complications were assessed and evaluated. definitive care i.e. from the scene of injury to Trauma Care Unit. Results Severe injuries to maxillofacial region in polytrauma patient can During followup conducted over 12 to 24 months, xray examinations complicate the early management owing to the regions proximity to revealed good healing. During follow up no case of anklyosis and brain, cervical spine and airway. Delivering the primary care is salivary fistula was observed. utmost important for survival of trauma victim. Conclusions Methods In modified Retromandibular approach involving incision from the To salvage such patients algorithm of ABCDE are followed tradi- anterior edge of parotid gland. Facial nerve in corresponding region is tionally and often modified and supplemented by other methods, completely exposed. Operation is simple and short. This approach is which needs to be started within minutes to hour after accident. A- also used for coronoid fracture, ramus fracture, and condyle fracture. airway maintenance and cervical spine protection. B- caring part of breathing and ventilation. C- circulation maintenance & hemorrhage control part. D- disability or neurologic status determination step. E-exposure or undress the patient for identification of other injury EPS00152 sites & simultaneously prevention of hypothermia. Management of Hemorrhage in Traumatic Patients Results with Bleeding and Coagulation Disorders Maximum survival rate can occur if Golden Hour is Capitalized. Conclusions Revolutionary advancement in ‘‘Trauma Care Management’’ domain Ankita Saraf for past few decades mortality rate has reduced.

Guru Nanak Institute of Dental Sciences and Research

Abstract EPS00163 Background/Introduction Infected Mandibular Angle Fracture-Risk Factor Many patients with Oral and Maxillofacial Trauma have hemato- and Management: A Literature Review logical disorders that interfere with proper clot formation or take medication that alter their coagulation status and place them at an increased risk of bleeding. Dr. Kirthika R Objectives Review of management of hemorrhage in traumatic patients with Sree Balaji Dental College and Hospital bleeding and coagulation disorders. Methods Abstract Results of various studies of management of hemorrhage in traumatic Background/Introduction patients with bleeding and coagulation disorders and those under Postoperative infection is one of the most commonly encountered medications were analysed and summarized. complications after treatment of jaw fractures. Mandibular angle Results fractures are reported to be associated with the highest rate of After taking primary care, the medications and transfusions is altered infections among other maxillofacial fractures. The cause of most according to the bleeding and coagulation disorder of the patient or by fracture gap infections is either a lack of or inadequate primary the anti platelet or anti coagulant drug he or she takes. management. Immobilization with maxillomandibular fixation and/or Conclusions splints, removal of diseased teeth in the fracture line, external fixa- Management of hemorrhage in Oral and Maxillofacial Trauma in a tion, use of antibiotics, debridement, and rigid internal fixation has fundamental skill of Oral and Maxillofacial surgeon and should be played a role in management. Perhaps the most important advance done with precaution especially with patients with bleeding and was the realization that infected fractures also result from moving coagulation disorders. fragments and nonvital bone, not just bacteria. Controlling movement and eliminating the dead bone allowed body defenses to also eliminate bacteria. The next logical step in the evolution of treatment was primary bone grafting of the resulting defect following application of EPS00161 rigid internal fixation and debridement of the dead bone. General Management of Maxillofacial Trauma Objectives To evaluate the risk factors and its management associated to Dr. Priyadarshi Sengupta mandibular angle fractures. Methods By clinical examination, usage of radiographic techniques and other Gurunanak Institute of Dental Sciences and Research, Sodpur, techniques as mentioned in various articles. Kolkata Results Oral hygiene is a key factor to eliminate and prevent postoperative Abstract infection. For patients, the immediate post-traumatic few days are Background/Introduction usually associated with the greatest inconvenience encountered Trauma is the leading cause of mortality globally. Death were clas- throughout the whole treatment course. sified as Immediate (scene), Early (In Hospital\4 hours from injury) Conclusions and Late ([ 4 hours from injury). Statistic showed 61% immediate, Different factors can increase the risk of infection, including, for 29% early and 10% Late death. example, the patient systemic condition, nature of injury, time of

123 S92 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 medical care, and type of treatment utilized. This poster was aimed to EPS00182 review these risk factors and to highlight the management of the Endoscopic Reduction of Zygomatic Fracture infected mandibular fractures.

Dr. Shakun Sharm

EPS00176 Christian Dental College Osteosynthesis Using the Delta Plates in Mandibular Condyle Fracture Abstract Background/Introduction Traditionally, Facial Fractures repair have been performed via an Dr Gaurang Thanvi open surgical approach. However, the use of endoscope may allow repair of facial fractures through small incisions with less extensive Mahatma Gandhi Dental College, Jaipur exposure. Objectives Abstract In the less severe zygomatic fracture with segmental fractures of the Background/Introduction zygomatic arch the endoscope has been used to visualize the zygoma Conventional studies has suggested closed reduction as the treatment in the subperiosteal facelift without a coronal incision. of choice for mandibular fractures for decades. With the newer Methods research and methodology the open reduction of the condylar fracture A 4 mm, 30 degree telescope inserted through a small temporal has become more favorable since osteosynthesis materials were incision. Fracture sites at the zygomatic arch and the zygomati- developed in past few decades. Condylar fractures account for cofrontal suture were exposed and fixed with miniplates under 25–35% of mandibular fractures and deserve a special attention as endoscopic control. compared to rest of the mandible due to their anatomical differences Results and healing potential. But the sequela of the condylar injuries cannot - Minimises the scalp scar. - Avoids forehead numbness. - Provides a be considered suboptimal with regard to occlusion, reduced mouth comfortable postoperative recovery. opening, deviation of the mandible, impaired mastication, ankylosis Conclusions and internal derangement. The present study evaluates the clinical use Endoscopic repair gives more accurate fracture visualization as it can of indigenously developed titanium delta-shaped miniplate in open be visualized on a television monitor, small external incision and reduction and internal fixation of subcondylar fracture. reduced soft tissue dissection. Objectives To evaluate the biomechanical stability of osteosynthesis using the Delta plate in condylar fractures. Methods EPS00184 A Study was done In 3 patients with subcondylar fracture. Mandibular Evaluation of Intergonial Width in Angle Fractures condyle is approached by-Hinds incision. A Delta shaped 3D miniplates were used in which the base of plate is oriented towards the Dr. CH Shivakanth, Dr. Ritesh Rajan, Dr. Abhinand Potturi angle of mandible so that the tensile and compressive stress lines runs parallel to the plate. Results Abstract Three-dimensional plates results in more stability than conventional Background/Introduction mini plates. The geometric pattern of three-dimensional plate, allows Angle fractures are most common fractures of mandible with an readily adaption to the anatomy of the fracture The delta plate which incidence of 20%–30% of all mandibular fractures. Various methods was used in our study was a non-compression plate made up of of plate fixation for angle fractures have been reported in the titanium. The size and shape of the plate favors the operating surgeon literature. for easy adaptation and fixation of subcondylar fractures. This delta Objectives plate can also be use by intraoral approach, Very minimal compli- To evaluate the intergonial width in treated angle fractures of cations are associated with this plating system. Just after a week of mandible. immobilization the rehabilitation and functional loading was possible. Methods Conclusions A retrospective radiographic analysis was carried out in patients who ORIF with 3D stability gives early functional stability Adapts readily reported to SVSIDS Mahabubnagar. to anatomy of fracture gives better stability and function Early Results rehabilitation & functional loading possible clinical experience with The results of the study will be presented as per the defined protocol. osteosynthesis of subcondylar fracture of the mandible using delta Conclusions plate. Maintaining pre traumatic intergonial distance in angle fractures is paramount and this retrospective radiographic study will analyse the restoration of the same as a primary outcome variable.

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EPS00209 Methods Post-Traumatic Enophthalmos: Our Experience A retrospective analysis of all mandibular fractures treated in our institution for past 3 years. Results Cynthia Scott (III yr PG), Dr Priyadarsini P. MDS (Reader), Dr. The data will be tabulated and statistical analysis to be presented. Karthik R. MDS (Reader), Dr. Saravanan C. FDSRCS (Prof), Dr Conclusions Vivek N. MDS (Prof & HOD) The outcome of this study would benefit in the definitive treatment plan and overall management of mandibular fracture patients. SRM Kattankulathur Dental College ABS00215 Abstract Background/Introduction A Parotid Fistula–Sialocele: An Uncommon Post-traumatic orbital enophthalmos is not an uncommon sequelae Complication in Sub Condylar Fracture Management following orbital trauma. Management of post-traumatic enophthal- Through Trans Parotid Approach and Its Management mos can present as a challenge to the maxillofacial surgeon. This post-traumatic deformity is primarily due to alterations in the configuration of the bony internal orbit rather than to changes in the Presenter- Dr. Anand (MDS 2nd Year). Dr. G. Harsha MDS, amount of its soft tissue contents. The treatment strategy is mainly the MOMSRCPS (Glassgow) HOD and Professor anatomic reconstruction of the internal orbit. Internal orbital reconstruction has evolved to an elegant procedure incorporating various MNR Dental College and Hospital customized biological or alloplastic implants. Objectives Abstract We present one such difficult clinical scenario with late presentation Background/Introduction of the significant orbital enophthalmos which was successfully sialocele is a collection of saliva in the subcutaneous tissue or in the managed using a simple customized method. glandular tissue, when this communicates with skin and drains it is Methods known as parotid fistula. Huge sialocele often seeks drain though an A 22 year old female patient presented to the OPD with a complaint extra oral wound, where as in the absence of extra oral fistula, saliva of unesthetic appearance of the right eye following trauma 3 years can be redirected intra orally using stent. If left untreated, a sialocele back. The patient had significant orbital enophthalmos and orbital may develop into a significantly large swelling. We report a series of dystopia. High resolution computed tomography images were cases of sialocele formation and conservative methods and surgical obtained. The enophthalmos, the volume discrepancy and the amount management for this condition discussed. of the autologous graft material to correct the enophthalmos was Objectives calculated using few simple formulae and data available in the The objectives of this study is to determine the incidence, risk factors literature. and management of sialocele and parotid fistula formation in sub Results condylar fracture reduction. A significantly improved functional and esthetic result was obtained Methods using this simple method. single institution multiple surgeons retrospective study of patients under Conclusions going sub condylar fracture reduction and internal fixation through trans Customized orbital implants are usually fabricated with the help of parotid approach under general anesthesia over two years (2015–2017). high end technology using CAD-CAM and sterolithographic models. Results This current technology is not reachable to all strata of population. The incidence of sialocele in 30 patients operated for condylar frac- However with the use of thin slices of Computed tomography and few ture reduction and internal fixation through trans parotid approach is formulae, a near perfect correction of enophthalomos is achievable. 26%. Parotid fistula- sialocele formed by parotid fascia either been damaged and probably the closure of layers was not adequately tight. Conclusions In this series of case we conclude that special compressive dressings EPS00210 and small drains are placed at the surgical site to promote proper fluid An Evolving Pattern of Mandibular Fractures: drainage as well as to close off any potential areas where saliva can A Retrospective Study accumulate. Dietary modifications are also prescribed to prevent the production of excessive saliva during the healing phase. Dr. Arya Arun (Post Graduate Student), Dr. Priyadarshini, Dr. C. Saravanan, Dr. Vivek Narayanan EPS00226 Submental Oro-Tracheal Intubation in Maxillofacial SRM Kattankulathur Dental College and Hospital, Kattankulathur, Trauma Tamil Nadu

Abstract Dr. Md. Numan, Dr. Madan Mishra, Dr. Gaurav Singh Background/Introduction Mandible fractures are among the most frequently seen injuries in the Abstract trauma care center setting. Fracture of mandible has been classified on Background/Introduction basis of etiology, age of patient, anatomical site, pattern of fracture. Securing an airway during the management of faciomaxillary injuries Objectives remains a challenge and is an important part of treatment. Oral To define current, predictable patterns of fracture based on patient intubation precludes the surgical prerequisite of checking dental demographics and mechanism of injury of road traffic accident. occlusion. Having the tube in the field of surgery is often disturbing for surgeon. Delivery of anesthesia for maxillofacial surgeries is a

123 S94 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 challenge because the anesthesiologist has to share the upper airway EPS00242 field with the surgeon. Submental intubation is an alternative to tra- Comparision of Transbuccal Trocar Placement cheostomy and it can be easily performed with little or lesser postoperative complication. and Extraoral Approach for Mandibular Angle Objectives Fractures: Our Experience To evaluate the efficacy of submental intubation in the management of maxillofacial trauma. Presented by Dr. Ayyagari Anusha (MDS Ist Year pg), Guided by Dr. Methods G Harsha MDS, MOMSRCPS (Glasgow) HOD and PROF 20 patients were studied with faciomaxillary trauma where submental intubation was indicated. The parameter used to assess the efficacy MNR Dental College and Hospital, Sangareddy-502294 were: restoration of the occlusion, duration of the surgery, presence of scar, presence of infection, damage to any vital structures or any postoperative salivary fistula. Abstract Results Background/Introduction Submental intubation allowed reduction and fixation of all fractures mandibular angle fractures continue to be a common type of facial without the interference of the tube during surgical procedure in all of injury.surgical treatment of angle fracture is typically performed by the patients. There were no intra-operative complications and none of intraoral, extraoral, transbuccal approaches.traditionally when open the patients required post-operative ventilation. There were no sig- technique are utilised, extraoral approach is performed through skin nificant post-operative complications. incision in submandibular area.however patients develop unsightly Conclusions scars and there is a risk of injury to marginal mandibular nerve Submental endotracheal intubation is a useful alternative technique of through this approach.in comparision the transbuccal approach per- airway management in patient with panfacial fractures. It demands a formed through an mucosal incision, results in minimal certain surgical skill without specialized equipment’s however, it is complications. safe and quick to execute. It allows intraoperative correction of Objectives occlusion and enables surgery for associated nasal fracture in the to determine the ease of accesibility, procedural time, ease of ana- event of concomitant skull base trauma, and avoids the dangers of tomic reduction and its complications of both the approaches. classical endotracheal intubation. Methods in a single institution, multiple surgeons retrospective review of patients undergoing angle fracture open reduction and internal fixation was studied. Section: Cranio Maxillofacial Trauma Results in extraoral approach the incidence of unsightly scar,facial nerve weakness, infection were found to be more than in that of transbuccal EPS00231 trocar placement. Conclusions Coronal Incision: Making it Simple based on our observation it was found that transbuccal approach showed fewer complications than extraoral approach. Presenter: Dr. Sharvika S. Aher (PG Trainee) Dr. Pratik N. Suthar (PG Trainee) Guided By: Dr. Pushkar P. Waknis (MDS, FIBOMS, Professor & Consultant) Dr. D. Y. Patil EPS00267 Dental College & Hospital, Pune Biomaterials for Orbital Reconstruction

Abstract Dr. DIVYA. C Background/Introduction The coronal incision a single versatile surgical approach to the upper Govt. Dental College, Kottayam and middle regions of the facial fractures. It provides excellent access to the areas with minimal complications. It’s advantages in terms of Abstract exposure of surgical field for upper and middle regions of face is far Background/Introduction surpassed by any other approach. Orbital trauma accounts for 30 to 55% of all facial fractures Orbital Objectives floor injuries, alone or combination with other facial fractures, are one To study the versatility of coronal incisions for treating fronto-naso- of the most commonly encountered midface fractures. Significant orbito- ethmoidal fractures and evaluate the advantages, indications complications can occur as a result of these injuries, including and complications associated with it. enophthalmos, persistent diplopia, vertical dystopia, and restriction of Methods gaze. Currently there is a greater understanding of the complex In this case study, A patient was treated by a coronal approach. A step anatomy of the orbit and changes that occur within the orbit from by step guide makes this method a simple one to perform. disruption of its contents caused by trauma. Practitioners generally Results agree that the optimal treatment is to restore the normal bony archi- This study attempts to remove the fear from Coronal Incisions and tecture and reduce the herniated orbital tissues. Despite advances help young surgeons to deliver quality surgery. made in understanding of the injury, wide variation still exists in the Conclusions method of reconstruction. The coronal incision provides excellent access to the fronto-naso- Objectives orbito - ethmodial fractures, aiding in good anatomical reduction and Of all the considerations in orbital reconstruction, probably no topic also has added advantages is the most of surgical scar is hidden within has more differing opinions than the selection of biomaterial with the hairline. which to reconstruct the orbital walls. This poster reviews the

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S95 biomaterials currently available for internal orbital reconstruction and Conclusions provides insight into their selection and application. All midface fractures need a comprehensive opthalmological evalu- Methods ation to rule out vision threatening injuries. As per the study the Literature review. occurence of vision threatening injuries was low. Zygomatic complex Results fractures was main midface fracture associated with highest incidence Material for reconstructing the orbit can be selected based on of opthalmic injuries. requirements of the defect matched to the mechanical properties of the material. Conclusions EPS00272 The ideal technique is inﬂuenced by many factors, including speciﬁc characteristics of the injury and the experience of the surgeon. The Bicoronal Flaps in Cranio Maxillo Facial Trauma purpose of this poster was to outline the important factors of the most commonly used materials and a few of historical interest. Prof. Dr. A. Thangavelu MDS, DNB, FIBOMS (Head, Division of OMFS), Dr. Nithin Sylesh R (PG student)

EPS00268 Rajah Muthiah Dental College and Hospital, Annamalai University Evaluation of Ophthalmic Injuries in Midface Trauma Abstract Background/Introduction Dr. SIBI JOSEPH, Email: [email protected] Bicoronal apprach is one of the most versatile approaches to various areas in Cranio Maxillo Facial surgery. Excellent exposure is an Govt. Dental College Kottayam added advantage of this approach. Traditionally used by neurosur- geons, its continued popularity among maxillofacial surgeons is due Abstract to the aesthetic advantage of the scar hidden in the hair line. Background/Introduction Objectives The orbit is a delicate pyramidal structure comprising seven bones. Aim of this study is to explore the approach and uses of bicoronal The injuries to the orbit may be isolated or combined with injuries of approach in CMF trauma in the cases that were operated at our craniofacial skeleton. In isolated injuries it may pertain to orbital rims institute in 2017. alone or sometimes extend to involve orbital soft tissues. Maxillofa- Methods:: 4 of the cases who presented to our department with h/o cial injuries of the middle third of face commonly destroy the trauma were treated via bicoronal approach. Surgical difficulties/ integrity of the orbital skeleton and range from the subtle blow-out benefits were noted and patients were evaluated over a period of 6 fracture to the highly complex orbital comminution. Such trauma to months. 3 were complex lefort II/III pan facial fractures (two with the orbit and surrounding facial structures often lead to the orbital residual deformities, one having a frontal bone fracture in addition) deformity and incapacitating visual dysfunction. Inappropriate diag- and the 4th an isolated frontal bone fracture. nosis of these injuries can result in blindness with social and medico Results legal issues. Reduction of the fracture segments with superior accuracy was Objectives achieved using a considerably lesser time than the conventional To assess the prevalence of opthalmic and orbital injuries in midface approaches. Better visibility during the surgery and better patient fractures and how often a surgical intervention is required in the acceptance after the surgery was noted. Reconstruction with titanium correction of these injuries. mesh at the frontal bone region and correction of residual deformity Methods were possible with ease due to this approach. Very minimal post The study was conducted on patients who reported to the Department operative complications were noted. of Oral and Maxillofacial Surgery OP and Causalty, Government Conclusions Medical College, Kottayam. Four hundred and one patients who Coronal approaches supplemented by preauricular extension in reported with mid face fractures was included in the study. A pro- combination with intra oral approach is found to be superior to the forma was formulated to record the patients personal details and for traditional approaches in treating the fractures of upper and middle assessment of ophthalmic and orbital injuries. Thorough evaluation third of face. Convenience and comfort, indispensable and versatile was undertaken for each patient reported with mid face fractures. The nature of this flap gives way to excellence for its usage in trauma of evaluation included 1. History taking. 2. Clinical examination. 3. upper and middle third of the face. Ophthalmological assessment. 4. Radiographic evaluation. 5. Treat- ment given. Results EPS00274 Out of the 401 patients who have ophthalmic injuries associated with Unusual Fracture Patterns of the Mandible-Our mid face fractures 15.5 % have orbital emphysema, 99.8% have periorbital edema, 96.5% have ecchymosis,98.5% have sub con- Experience junctival haemorrhage, 38.2% have chemosis, 7.7% showed mild reduction in visual acuity, 0.5% showed moderate impairment in Dr. Lakshmi Rathan (pg) Dr. Prashanthi, Dr. Karthik, Dr. Saravanan accomodation. Most frequently present severe ophthalmic injuries in Professor, Dr. Vivek Professor & HOD mid face fracture was diplopia (15.7%), hypoglobus (12.7%),1.2% of patients had optic nerve injury, loss of vision was present in 1 % of SRM Kattankulathur Dental College and Hospital patients. 0.5 % of patients each had retrobulbar haemorrhage and corneal laceration. 0.2% have gross proptosis and 1.2% had retinal Abstract injury. Background/Introduction Mandibular fractures are one of the most common fractures that account for about 60% of all facial bone fractures. There are various 123 S96 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 classifications based on anatomical site, number of fragments, rela- EPS00308 tionship of the fracture to the site of injury, presence or absence of Treatment of Malunited Mandibular Fracture: teeth, direction of fracture and favorability. However, in recent times there is change in the fracture pattern owing to varying etiology and A Report of Two Cases different type of injury. Objectives Dr. Ratna Deepika Seshagiri, Dr. D. Y. Patil To emphasize the importance of customizing the classical treatment protocol for unusual pattern of mandibular fractures. Dental College and Hospital, Pune Methods A retrospective study of the unusual patterns of the fracture mandible Abstract were analyzed. The management protocols followed for these situa- Background/Introduction tions during the period of three years (April 2014 - august 2017) were The posttraumatic complications of jaw fractures related to jaw summarized. function and facial deformity include nonunion, malunion, maloc- Results clusion, temporomandibular joint dysfunction and facial asymmetry. will be formulated. This report presents cases referred to our department for revision of Conclusions malunion and malocclusion following inadequate reduction of jaw These unusual fracture patterns do not come under any of the standard fractures. classifications and treatment protocols. Hence, there is a need for Objectives formulating an appropriate surgical approach, reduction technique Treatment of malunited mandibular fracture. and fixation modalities. Methods - Basic investigations were done. - Occlusal splint fabrication was done for guiding occlusion. - Intraoperatively osteotomy was per- EPS00304 formed in relation to malunited fracture site and occlusion was achieved and maxillomandibular fixation was done. - Postoperative Patterns of Mandibular Fracture in University Hospital followup and occlusion was maintained. of Bhubaneswar: A Five Years Retrospective Study Results Satisfactory postoperative healing and occlusion achieved. Dr. Rakesh Kumar Singh Conclusions In these patients, malunion after mandibular reduction led to maloc- Kalinga Institute of Dental Sciences clusion, and revision surgery provided satisfactory results. A precise pre-operative examination and appropriate surgical procedure followed by proper post-operative management are necessary to prevent Abstract post-surgical complications of jaw fracture fixation. Background/Introduction Mandible is the only mobile bone of the facial skeleton which plays an important role in mastication, speech and deglutition. Being a prominent bone of the facial skeleton, it is fractured most commonly EPS00321 among maxillofacial injuries. Mandibular fractures occur twice as Management of Infraorbital Rim Fractures Using often as midfacial fractures, with the etiology ranging from interpersonal violence to sports related incidents but most commonly Transconjunctival Approach because of road traffic accidents. Objectives Dr. M. M. Srikanth To evaluate the demographic data of the patients with mandibular fractures and to assess the major risk factors and prevention strategies Kamineni Institute of Dental Sciences to reduce mandibular fractures. Methods Abstract A five years cross sectional retrospective study was conducted by the Background/Introduction case records of the patients reported at University hospital of Zygomaticomaxiillay complex fractures are common among the bhubaneswar. maxillofacial injuries. These fractures commonly involve one or more Results walls of orbital cavity. The most commonly used approaches to treat Most number of cases reported in University hospital of bhubaneswar these fractures are Infraorbital, subciliary, subtarsal incisions etc. are of parasymphysis fracture followed by condyle fracture. Majority Though the complications are rare, but they often leave unaccept- of mandibular fracture occured in male than female. able scar/ectropion. To avoid these post operative complications an Conclusions alternative technique of transconjunctival approach can be used for Mandibular fractures are one of the common maxillofacial injuries minimal scar formation with superior esthetics. during trauma by any cause. Identification of the risk factors for the Objectives cause of trauma give us a clue to prevent mandibular fractures. Most Two cases of Infraorbital rim fractures with or without involving floor number. of orbit that are treated through transconjunctival approach and evaluate the amount of surgical exposure and esthetics. Methods Traction sutures are placed on the lower eyelid and incision given 3 mm below the lashes on the conjunctival surface below the tarsus.- plane dissection is followed over the orbital septum to the inferior orbital rim by avoiding septal injury during the procedure. Fracture repair done and closed with 5-0 vicryl.

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Results Close reduction 2: Open reduction 3: Endoscopic. Even the close Adequate accessibility and surgical exposure gained and no scar reduction is most popular is associated with complication/or depen- formation seen postoperatively. ded on patients complained. Hence, recently open reduction has Conclusions gained important position in the treatment of mandibular is fracture. Infraorbital rim fractures treated with transconjuctival approach show Objectives minimal scar formation and superior esthetics. Aim of presentation is to overview need for aim reduction and variety internal fixation methods in the management mandibular condylar fracture. Methods EPS00347 Article published in English from 1980 to till 2017 were included in Unusual Supero-Lateral Dislocation of Intact Bilateral study. Mandibular Condyles Associated with Right Results Parasymphysis Mandibular Fracture: A Case Report In literature there are various options are available for plating and fixation of the condylar fracture, such as two plate fixation, trilock with Review of Literature delta plates, delta plates, 3D mini plates, four hole plate, resorbable plates, trapezoidal condylar trauma plates, lambda plate, lag screws, Dr. Ankita B. Bhagat minidynamic compression plates, L shaped plates, Y shaped plate, A shaped plate. Efficacy of each plate was discussed in this study. Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Conclusions Wanadongri, Nagpur Open reduction and internal fixation gives excellent results when performed on properly selected patients. In literature 2 plates fixation give proper stability to the condylar fracture site. The outcome of 3D Abstract plates was comparable to that of 2 plate fixation. Background/Introduction The dislocation of the mandibular condyle occurs most commonly in an anterior direction due to trauma. On the contrary, posterior, superior, or lateral dislocations of the intact mandibular condyle occur EPS00351 rarely, and very few such cases have reported. Is it Wise to Do Opthalamic Assessment for All Malar Objectives To understand the aetiology, pattern, dynamics and treatment Fracture Cases? modality of such dislocations. Methods Dr. Nirdhum Shikha An extensive search for supero-lateral displacement of mandibular condyle done on online literature available in electronic media and Bapuji Dental College & Hospital, Davangere found 28 relevant articles (According to available literature we found that 68 condyles were dislocated from glenoid fossa in 49 cases). Abstract Results Background/Introduction The unilateral dislocations had occurred in 32 cases (64%) while Zygomatic bone contributes to the orbital walls so it carries high bilateral in 18 (36%) cases out of 50 cases. chances of severe dysfunction of visual apparatus as the soft tissues Conclusions absorb more energy when compared to underlying bone following Factors responsible for supero-lateral dislocation of mandibular trauma. condyle includes anatomy of joint, type of impact, direction of Objectives impact, magnitude of impact, position of mandible, laxity of joint Assessment of ophthalmic changes post-malar fracture. capsule, condition of dentition and other associated fracture. All Methods factors interplay synchronously to bring about supero-lateral A retrospective study has been designed to analyse the requirement of dislocation. ophthalmic consultation based on the scoring system1.100 patients with malar fracture from January2008 to August2017 were included from our unit. Patients with Lefort II and nasal bone fractures were EPS00349 excluded. Open Reduction and Internal Fixation Methods Results Patients reported with: Proptosis 1%, blurring of vision 3%, severe in the Management of Mandibular Condylar Fracture: vision loss 1%, required early-referral. Eyelid laceration 6%, A Review enopthalmos 5% required routine-referral category. subconjunctival haemorrhage 54%, paresthesia 6%, diplopia 5%, eyelid swelling 1%, Dr. Vaibhav D. Raut & DR. D. Y. Patil of non-refferal category. Patients also presented with motility disorder 2%, blow out fracture 1%, lateral rectus palsy 1%, palpebral palsy 1%. As per the scoring system: Early-referral (1patient), Routine- Dental College, Pimpri, Pune referral (2patients), Non-referral (6 patients) category. A total of 33 patients were referred from our unit for ophthalmic consultation. Abstract Conclusions Background/Introduction A maxillofacial surgeon should always assess and evaluate the signs Condylar fractures not only affect the functional jaw movement it also and symptoms of ocular function following malar fractures. For effect on the stability of occlusion. Primary goal of treatment to ophthalmic consultation wise decision should be made to avoid any achieve stable occlusion, maintain facial height and remove TMJ medico-legal issues and for which Al-qurainy I. A. et al scoring dysfunctions. As there are controversies around treatment of condylar system can be used. fracture different treatment strategies of these fracture in adult. 1:

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EPS00356 20 patients of zygomaticomaxillary complex fractures were treated Subbrow Incision for Nasal Fractures using single 3D plates intraorally over zygoma/maxilla to fix both infraorbital rim and zygomaticomaxillary buttress simultaneously instead of two 2D miniplates in the same regions. Patients were Dr. Sonal Anchlia, Dr. Hardi, Dr. Vikash, Dr. Nisha, Dr. Rohit assessed postoperatively for occlusion discrepancy, malar asymmetry, neurosurgery deficit, wound dehiscence, local infection, mobility of Govt. Dental College and Hospital, Ahmedabad fracture segment, nonunion or malunion, residual cosmetic deformity and Interincisal opening. Abstract Results Background/Introduction 34.54% less incisions and 29.06% less miniplates were required when Nasal bone fractures treated with open reduction and internal fixation method was used for fixing 3D plates in zygomaticomaxillary com- (ORIF) either use unsightly incisions directly in the glabellar region plex fractures. The only postoperative complications observe were or cumbersome hemicoronal or bicoronal incisions. Till date, subbrow maxillary sinusitis, wound dehiscence, occlusal discrepancy and approach has been used in management of frontal sinus fractures. infection in one patient each (13.34%). Here we propose a smaller similar version for management of nasal Conclusions fractures. A bicoronal approach offers adequate exposure but has Thus, the use of 3D plates in the management of zygomaticomaxillary several disadvantages. Other more direct incisions, such as frontalis complex fractures gives good results in terms of both function and rhytid, butterfly, ‘H’, though are smaller give conspicuous scars. The esthetics. They stabilize the bone fragments in three dimensions main problem of nasal fractures is aesthetic deformity of face and if because of their closed quadrangular geometric shape and also result the surgical approach leaves a scar, it should not be considered for in less number of incisions and less amount of hardware. treatment. Objectives To evaluate a modification of subbrow incision as an approach for ORIF of nasal fractures. ABS00364 Methods Prospective Evaluation of a New Classification For this study, 10 adult patients having nasal bone fractures requiring of Mandibular Angle Fracture Based on Inferior ORIF were selected. INCLUSION CRITERIA - Patients with dis- Alveolar Canal Displacement as Assessed on CBCT placed nasal bone fractures, with or without concomitant midface and those not possible to fix with closed reduction. EXCLUSION CRI- TERIA - Patients with undisplaced isolated nasal bone fracture. - Dr. Anbumani P Patients with cranial fractures requiring bicoronal approach. The incision line was started from the medial most part of the eyebrow to Postgraduate Institute of Dental Science-Rohtak a point slightly medial to the medial limbus axis line following precisely the lower edge of the eyebrow to obtain an inconspicuous scar. Abstract Results Background/Introduction Stable fixation, restoration of contour deformities and barely visible Almost all the classifications available in the literature help surgeon in scars with no postoperative complications were results observed using diagnosing the fracture and fracture pattern, but none of the classifi- this approach. cation helps in deciding the treatment principles and treatment Conclusions approach for their management. It becomes very difficult for surgeon The modified subbrow approach offers a good cosmetic result and to decide which approach has to be selected, how many plates to be adequate accessibility to perform ORIF of nasal bone fractures. used and where to fix the plate. Thus, there is a need of widely accepted classification system that will help surgeons to make consistent decision regarding management of angle fractures. Objectives EPS00362 To propose and evaluate a management protocol for the management Versatility of 3D Plate for Zygomatocomaxillary of mandibular angle fracture based on the degree of displacement of Complex Fracture inferior alveolar canal between proximal and distal segment. Methods Forty patients with angle fractures of the mandible were evaluated. Dr. Sonal Anchlia, Dr. Ramyata Dayatar, Dr. Shishir kumar, Dr. We categorized the fractures into 3 classes: Class 1(minimally dis- Nisarg Patel, Dr. Dhruvi Shukla placed)—fracture with displacement less than 2 mm; Class 2(moderately displaced)- fracture displacement between 2 mm to 6 Government Dental College & Hospital, Ahmedabad mm; Class 3(severely displaced)-fracture displacement more than 6 mm. Our treatment protocol is intraoral superior border approach with Abstract application of a single monocortical miniplate(adaptation in two Background/Introduction planes) according to Champy’s ideal line of osteosynthesis for class 1 Traditionally, in fractures of the zygomaticomaxillary complex, two fractures; an extraoral Inferior border approach with application of separate 2 D plates have been used, one in the infraorbital region and inferior border plate with at least two holes (bicortical screws) on the other in the zygomatic buttress/maxilla region. either side of the fracture line for class 3 fractures and by using Objectives randomization either intraoral superior border or an extraoral inferior The aim of our study was to prove the usefulness of three dimensional border approach for class 2 fractures. (3D) plates in zygomaticomaxillary complex fractures by giving it 3D Results stability, using only one 3D plate instead of two 2D plates, thereby, Among 40 patients, 10 had Class 1 fractures (25%), 20 had Class 2 not only reducing the implant material but also obviating the need for fractures (50%), and 10 had Class 3 fractures (25%). In Class 2 extraoral orbital incisions. fractures, 10 patients were managed by intraoral superior border Methods

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S99 approach (Class 2a) and 10 by an extraoral Inferior border approach EPS00377 (Class 2b). No statistically significant differences were found between Management of Isolated Condylar Fractures Using 3D the three classes in terms of occlusion, neurosensory dysfunction and clinical union. While, within Class 2 patients radiographic union, Plates functional outcomes including pain at the 1-week follow-up and interincisal mouth opening at the 12-week follow-up, status of wound Dr. Rachana Singh problem in 1 week follow-up, duration of surgery, better direct manipulation for reduction and easier approach for fixation of implant Saraswati Dental College & Hospital, Lucknow were significantly (P \ 0.05) found to be better in class 2b as compared with class 2a. Facial nerve paresis at 1-week follow-up found in Abstract five patients belongs to class 2b group which resolve completely in 12 Background/Introduction week follow-up. Mandibular condylar fractures are most commonly encountered Conclusions fractures being 17.5 to 52% of all mandibular fractures. Unilateral Our new classification based on degree of displacement of inferior fractures occurs 3 times more than bi-lateral condylar fractures. The alveolar canal between proximal and distal segment as assessed by absolute indication of open treatment are condylar fractures with CBCT can better guide clinical treatment. Class 1 (minimally dis- considerable dislocations, when closed treatment doesn’t restabilize placed) fractures treated by intraoral superior border approach, Class occlusion. Open reduction aims at anatomical repositioning and rigid 2 (moderately displaced) and class 3 (severely displaced) fractures fixation of the fragments, occlussal stability, rapid return to function, treated by an extraoral inferior border approach are suggested for maintenance of vertical ramal height, and less long term TMJ dys- better outcome. function. Methods of open reduction and internal fixation for the condylar fracture includes kirschner wires, intra osseous wiring, mini plates(2D) & lag screws. Mustafa Farmand in 1992 developed 3D EPS00370 plates and advocated better bio geometry to provide stable fixation over 2D plates. Quadrangle geometry of plates assures 3D stability of Treatment of Nasal Fractures with Novel Modified fracture sites & offers good resistance against torque forces. Splint Objectives Objective of our study was to evaluate clinical results and to assess Dr. Parth Parikh efficacy, stability and rigidity of 3D plates for osteosynthesis in mandibular condylar fracture. Faculty of Dental Science, Dharmsinh Desai University Methods In our study 10 patients underwent Open Reduction Internal Fixation of isolated condylar fracture using 2mm 3D PLATES using preau- Abstract ricular approach. All patients were evaluated for occlusal stability, Background/Introduction TMJ dysfunction, inter-incisal opening, facial nerve weakness at The nose is easily exposed to trauma because it is the most prominent regular intervals, I, e pre op, post op i.e. 1, 3 and 6 months. and anterior feature of the face. Its central position and anterior Results projection on the face predisposes the nose to traumatic injury. An Stability of fracture site was better with reduced infection rate, no injured nose can bleed from lacerations of the skin. These cuts may complain of pain during jaw movement. Only one patient complained need to be repaired and evaluated immediately. Excessive activity of facial nerve weakness. may restart bleeding. Blood can also be collected inside the nasal Conclusions septum tissue spaces. A septal hematoma can cause trouble by Displacement of condylar fragment, posterior facial heigh reduction, injuring or thickening the septal structures. Septal thickening may and deranged occlusion can be successfully treated by 3D PLATES obstruct the nose. To prevent all these complications and for patient fixation. esthetics the external modified splint is used to treat nasal fractures. Objectives This appliance is very useful to treat the early and late complications occur after the septal thickening. Deviation of the septum can be EPS00391 improved by this appliance which helps in improvement of esthetic Management of Fracture Mandible in a Child value. Methods with Osteogenesis Imperfecta-Our Experience In both the cases flail nasal bones were reduced first then they were stabilised by teflon material inside the nose after that the external Dr. Liz George, Dr. Sankar Vinod V. nasal splint was stabilised and fixed with sutures to the teflon material inside and to the nose with K wire outside. The nasal splint was Mar Baselios Dental College placed upto 21 days. Results Abstract After 6 months follow up the improvement of esthetic can be seen in Background/Introduction both the patients, moreover reduction of flail nasal bones was Osteogenesis imperfecta (OI) is an unusual heritable disease that achieved. occurs in about 1 in 10,000 to 20,000 live births. The major clinical Conclusions manifestation is skeletal fragility. Other extraskeletal manifestations This nasal splint is very useful in nasal injuries with flail nasal bones. include hearing loss, dentinogenesis imperfecta, blue/gray sclerae, The appliance can be fixed under sedation comfortably. It reduces the hypercalciuria, aortic root dilatation, and neurologic conditions. An patient discomfort as well as improves the esthetic. eight and half year old patient reported to our department of Oral and Maxillofacial Surgery with a history of fall at home while playing 4 days earlier with swelling of left TMJ area. He was diagnosed with a

123 S100 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 left subcondylar fracture which was managed conservatively. Hardly EPS00411 two months later he again reported with a right side fracture of body Traumatic Optic Neuropathy (Clinical Features of mandible which happened due to fall again while playing and was treated conservatively. Due to increased bone fragility with increased and Management) incidence of fracture the patient was sent for a through medical examination and was diagnosed with osteogenisis imperfecta. Dr. Siddharth Increased fracture risk in individuals with OI could stem from a combination of reduced bone mass, decreased bone material and Desai-College of Dental Sciences, Davangere quality. The reduced bone mass can lead to increased stresses within the bone as a result of a smaller area of bone tissue present to support Abstract physiological loads contributing to bone fragility in OI. Therefore Background/Introduction goals of the treatment in OI are to decrease pain and fractures and to Traumatic optic neuropathy (TON) is a serious vision threatening maximize mobility. Physical therapy/rehabilitation is particularly condition that can be caused by ocular or head trauma. The incidence important in children to prevent fractures as well as to increase of TON after craniofacial trauma has been reported to be 2 to 5% strength and mobility during fracture recovery as observed in our Objectives patient. To describe the clinical features and management options to the oral Objectives and maxillofacial surgeons, so that they could recognize and treat this Our experience in management of fracture mandible in a child with condition. osteogenesis imperfecta. Methods Methods It is classiﬁed as direct and indirect TON based on the cause of injury. Treated conservatively. Direct TON is caused by a penetrating injury to the area of optic nerve Results and usually presents as severe visual loss with minimal chances of Reduced fracture with proper occlusion treated conservatively. recovery. Indirect TON is caused by acceleration/deceleration forces due Conclusions to blunt head or closed globe trauma. The vision loss may vary from mild Satisfactory and successful treatment. to total blindness. There are two options for management of TON. One is megadose of steroids and the other is surgical optic canal decompression. Results EPS00408 The evidence base for these treatment options is weak, and the routine use of high-dose steroids or surgery is not without any associated From a Different Angle risks. Therefore some clinicians prefer observation alone. Conclusions Raj Lakshmi Maxillofacial surgeons should have a thorough knowledge of this condition and should work along with the ophthalmologist to achieve Manipal College of Dental Sciences, Manipal best results for the patient.

Abstract Background/Introduction EPS00415 Mandibular fractures have always posed a treatment challenge to oral and maxillofacial surgeons with regards to favourability, managing Common Approaches to Facial Trauma-An Overview teeth in the line of fire as well as the number of plates that should be used in treating these fractures. Dr. Deepak Meena Objectives To assess the different treatment modalities used for treatment of Mahatma Gandhi Dental College and Hospital angle fractures in our Institute and their success rate over the years. Methods Abstract Approximately 100 patients were assessed based on the number of Background/Introduction plates used, presence of tooth in the line of fracture, displacement of As face is plainly visible to everyone, a conspicuous area of scar can fractured fragments, approach taken to expose the fracture. make it cosmetically deformed. -If, it cant be managed intra orally, Results then extra oral approaches are applied. -the extra oral approaches may Single minimally displaced fractures could be successfully treated be required for fracture of frontal bone, orbit, condyle, ramus etc. - with one plate at the oblique ridge while dual angle fractures or those Moreover, laceration provide easy access in the treatment. with displacements required more than a single plate for proper fix- Objectives ation. Teeth in the line of fracture if impacted were removed in most The aim of this poster is to evaluate different surgical approaches for of the cases. treatment modalities for facia trauma. Conclusions Methods Over time, the management of angle fractures has evolved into a There are different approaches to facial trauma- Intra Oral & Extra plethora of different perspectives. Proper reduction and rigid fixation Oral Approaches to Mid Face- Upper eyelid approaches, Lower eye goes a long way in providing a good post operative result to the lid approaches, Tranconjuctival approaaches, Supra orbital eyebrow patient. Fate of the third molar should always be decided. Other approaches, Coronal flap, Open sky. Approaches to mandible-Pre- factors such as which approach should be carried out are primarily auricular approach, Submandibular approach, Submental approach, case based and decided by amount of displacement and ease of Rithydectomy, Retromandibular approach. plating. Results Laceration provide easy access in the treatment but approach that provide suitable exposure of the fracture site should be used and it should be aesthetically acceptable. 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S101

Conclusions transconjuctival. The transcutaneous approaches being sub-ciliary, The controversies are still going on regarding which incision is the sub-tarsal & infra-orbital incisions. most appropriate in different situations. The ultimate decision is made Objectives based on- - the area need to be exposed. -the mastery of the surgery in To compare the functional and aesthetic outcome of the three trans- that. -And obviously it should be aesthetically acceptable. cutaneous approaches to orbital floor fractures from the patient’s perspective. Methods A retrospective study of patients treated for orbital floor fractures over EPS00445 the last 3 years in our institution were included. A questionnaire based Subcondylar Fractures-Open Reduction and Internal analysis of the functional and aesthetic outcome were obtained. The Fixation final outcome of these three approaches were compiled and statistically tabulated. Results Dr. Neelakamal Hallur, Dr. Aaisha Siddiqua, Dr. Syed Zakaullah, Dr. Study in progress. The results will be statistically tabulated. Ashwin, Dr. Chaitanya Kothari, Dr. Shereen Fatima, Dr. Meenakshi Conclusions Kothari, Dr. Juhi Bendegri This study helps the clinician to make an informed decision about the incision to be used for trans-cutaneous approaches to the orbital floor. Al-Badar Rural Dental College and Hospitals Gulbarga Karnataka

Abstract Background/Introduction EPS00461 The Choice of treatment for management of condylar fractures is Aesthetic Outcome of Depressed Frontal Bone Fracture always debatable. Earlier the preference was towards closed treatment as the surgeons believed that the risks associated with the surgery Dr. Amrutha Varshini K. overweigh its benefits, but with improvisation of surgical technique and availability of good hardware system. Sdm College of Dental Sciences and Hospital, Dharwad Objectives To evaluate - Post-operative occlusion - Post operative mouth opening, - Post operative pain. - Post-operative radiographic healing of Abstract fractured site. Background/Introduction Methods Fractures of the upper face and anterior skull base are challenging The study was conducted with a sample size of 10 patients with neurosurgical, maxillofacial problem. The most appropriate treatment mandibular Subcondylar fractures. Subcondylar fracture managed by of frontal sinus fracture can be complex and at times controversial. using 3D Trapezoidal condylar plates. Fractures of the frontal sinus represent between 5% and 15% of facial Results fractures but occur commonly as a part of craniofacial fractures. Most Postoperatively, occlusion was found to be satisfactory in 90% of the frontal sinus injuries are sustained in motor vehicle collisions (44- patients. There was a significant increase in the mouth opening post 85%), with young males most commonly affected (66-91%). operatively by the end of six months. Pain was not seen in 90% of the Objectives: The objective was to analyze the incidence and aes- patients and remaining 10% of the patients had pain. The radiographic thetic outcome following surgical correction of frontal bone fractures assessment at 6th month revealed union in 80% of the patients and in our unit. non union in 20% of the patients. Methods Conclusions A retrospective study was carried on fractures of face from 2007 to The use of 3D trapezoidal condylar plates has proved to be effective 2016. This poster will highlight on parameters such as male: female in management of open reduction and internal fixation of mandibular ratio, age incidence, etiology, type, associated fractures, management subcondylar fractures in terms of stability, and functional and the associated complications. rehabilitation. Results 2160 patients with facial bone fractures out of which 65(3%) patients presented with frontal bone fracture, 45 treated with ORIF. M: F was 3:1, age incidence 20-30years, cause RTA (98%).89% cases were EPS00457 approached through coronal incision and fractures fixed using either Transcutaneous Approaches to the Orbital Floor-A mini-plate(30 patients) or titanium mesh(12 patients) which provided Patients’ Perspective excellent outcomes with significantly less complications. Conclusions Frontal bone forms an integral part of the face, hence it is important to Dr. Kavitha Arumugam (1st Year Post Graduate), Dr. Priyadarshini restore the form and function by repositioning the fractures into their MDS(Reader), Dr. C. Saravanan FDSRCS(Professor), Dr. N. Vivek anatomic position, get a good cosmetic result and most importantly, MDS, (Professor & HOD) create a safe sinus.

SRM Kattankulathur Dental College and Hospital

Abstract Background/Introduction Orbital fractures commonly occur in maxillofacial trauma causing enophthalmos and diplopia. The most commonly involved walls of the orbit are the orbital ﬂoor and the medial wall. Traditionally the approaches to the bony orbit are either transcutaneous or

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EPS00462 Conclusions Management of Bilateral Blow Out Fracture: Report Animal bites have a wide spectrum of presentation and management. In developing countries a more aggressive approach with respect to of an Unusual Case antibiotic prophylaxis and post exposure immunization against tetanus and rabies is required. Arathi S. Mohan

Pushpagiri College of Dental Science EPS00482 Abstract ‘‘Reconstruction of Orbital Floor Fractures Background/Introduction with Autogenous Bone Graft Application from Anterior Fractures of orbital floor accounts for 21 % of the fracture of max- Wall of Maxillary Sinus: A Retrospective Study’’ illofacial skeleton injuries. Orbital wall fractures present with various signs such as diplopia, enopthalmos and restriction of eyeball. Dr. Krishna Ramrao Kurawar Objectives Reconstruction of unususal case of bilateral blow out fracture with Titanium mesh. Swargiya Dadasahen Kalmegh Smruti Dental College & Hospital, Methods Nagpur The treatment consists of reconstructing the orbital floor defect with material, mainly Titanium mesh that can provide structural support Abstract and restore orbital volume. Background/Introduction Results Orbital wall fracture implies a situation where disruptions of the walls Results were satisfactory to restore the orbital volume and reposition or floor have occurred. It is a blowout type fracture where bone herniated structures which has been done by titanium mesh. fragments with torn periosteum are pushed outside of the original Conclusions bony orbit. The difficulties in management of these fractures are due to the lack Objectives of an uninjured contralateral side for comparison. To support orbital contents, free entrapped tissue and restore the original orbital volume. Methods Ten patients who underwent repair of orbital floor factures with EPS00470 maxillary sinus bone grafts were included in this study. Surgical ‘Animal Bite, Pet Or Stray; Treat it Right, to Keep procedure for harvesting graft and its fixation was almost same in all the Complications Away’ operated cases. Results The postoperative clinical course was successful in all patients with Dr. Arpita Komal/Dr. R. S. Bedi/Dr. HImanshu Chauhan full recovery of ophthalmological function except one case of postoperative epiphora which subsided on its own after some days without Saraswati Dental College, Lucknow any intervention by ophthalmologist. The preoperative and compared postoperative ophthalmological examination was normal in all oper- Abstract ated cases. The patients were satisfied with the aesthetic results. There Background/Introduction was no inflammatory, infectious complication at the surgical sites or Bite wounds have a special position in traumatology because of their in the sinus. high complication rate compared to soft tissue wounds caused by Conclusions other reasons. The mammalian bite injuries account for 10% of Reduction of orbital floor along with drainage of collection in the patients managed with soft tissue injuries in the craniofacial region. maxillary sinus can be easily done through the same approach using Dogs are the most common perpetrators. Other animals like cats, anterior wall of maxillary sinus. horses, camel, donkey and snakes may be responsible for such accidents. Due to the large number of micro-organisms in the oral cavity, animal bite wounds are contaminated making treatment difficult with the risk of infection, especially in extensive injuries. EPS00504 Objectives Condylar Fractures: Single Plate vs Two Plate Fixation To review etiology and management of facial bite injuries caused by animals. Dr. Aswathy Krishna S. Post Graduate Student Methods All patients who were managed for animal bite presenting during the Department of Oral and Maxillofacial Surgery Amrita Institute of study period were included. Medical Sciences Results Early management of complex animal injuries usually guarantees satisfactory outcome. Antibiotic prophylaxis is indicated for infected Abstract Background/Introduction bite wounds and fresh wounds considered at risk for infection, like extremely large wounds, hematoma and cat bites, that appear to be Open reduction and internal fixation of displaced condylar fractures more infected than dog bites. Tetanus immunization status and risk of allows for good anatomic repositioning and immediate function. The rabies infection should be routinely addressed in bite wound man- fixation methods should have sufficient resistance to oppose masti- agement. Prevention strategies should be considered for preventing catory forces and not interfere with the condyle position after animal bites. reduction. Use of a two plate fixation at the posterior and anterior border of the condylar neck will restore tension and compression

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S103 trajectories. Thus it provides functionally stable fixation for condylar EPS00553 neck fractures. Study on Transbuccal Fixation of Mandibular Angle Objectives To compare the function and outcome of fixation of a subcondylar Fractures fracture of the mandible with two noncompression miniplates and a single noncompression miniplate. Presenting Author: Dr. Pavan Kumar Co-Author: Dr. Manjula Dr. Methods Sujith Shetty, Dr. Saikrishna D. A retrospective study of 9 patients who had undergone open reduction and internal fixation of subcondylar fracture of mandible was anal- JSS Dental College and Hospital, Mysore ysed. Stabilisation of fracture segments was achieved with two miniplates in six cases and single miniplate in three. Malocclusion, Abstract need for postoperative intermaxillary fixation and radiographic Background/Introduction reduction were evaluated in the immediate post operative period and Management of angle fractures are technically difficult from intraoral after a period of one month and three months. approach because of poor access & difficulty in control of proximal Results fragment. This study was an attempt to evaluate the results of trans- Satisfactory occlusion was achieved for all patients with two plate buccal approach (open reduction and internal fixation) to mandibular fixation. Out of three patient with single plate fixation, one patient angle fracture fixation and to restore the anatomic form, functional developed open bite in the immediate post operative period. Two occlusion and facial esthetics. patients with single plate fixation had occlusal discrepancy which was Objectives corrected with intermaxillary fixation. Post operative orthopantomo- To evaluate and assess surgical access and effectiveness of trans- gram showed splaying of fracture segments in single plate fixation buccal approach in fixation of mandibular angle fractures. case. Methods Conclusions In this study, 20 patients were randomly selected regardless of age; Two plates for subcondylar fractures represent the best solution to sex requiring open reduction and internal fixation of mandibular angle obtain stable osteosynthesis in comparison to a single miniplate. fracture with or without other associated fractures of facial skeleton. Patients were approached transorally with transbuccal instrumentation used for fixation of miniplates, where the fracture site was approached EPS00552 through the intraoral vestibular incision. Results Orbital Roof Repair with Titanium Mesh Complications such as temporary paresthesia was noted in 4 cases (20%) who had preoperative paresthesia which gradually improved Dr. Prathibha P. M. over 2-3 weeks postoperatively. Occlusal discrepancy was seen in 3 patients (15%) corrected with 7-10 days IMF with elastics postoper- Pushpagiri College of Dental Sciences atively. Pain was mild to moderate in all patients with mean VAS score of (5.95) on first post-operative day, and mean VAS score of Abstract (2.05) on 7th post-operative day. Background/Introduction Conclusions Orbital roof fracture part of complex midfacial trauma -least inci- In all the cases of transbuccal approach, we were able to achieve the dence in maxillofacial trauma - seldom treated surgically Included anatomical reduction intraoperatively and functional occlusion and under frontobasal trauma. facial esthetics post-operatively with IMF(elastic traction) for 7-10 Objectives days. Overview of orbital roof involvement graded classification & treatment algorithm. Methods EPS00573 1)Associated injuries & complications 2) classification 3) management 4) repair material. Modalities in the Treatment of Mandibular Angle Results Fracture Treatment algorithm can be formed -associated be injuries & complications explained. Dr. Swapnil S. Sabnis Conclusions Rare occurrence in maxillofacial trauma -mostly conservative man- Sinhgad Dental College and Hospital, Pune agement - indication for surgical intervention. Abstract Background/Introduction Mandibular angle fracture is one of the most commonly encountered trauma in maxillofacial region. since centuries several treatment options have evolved for the management of these fractures. Objectives following poster summarises different modalities of management of mandibular angle fractures. Methods Open reduction and internal fixation of mandibular angle fracture with 7 hole angle plate via intraoral and transbuccal approach.

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Results plates when available, is an alternative that is gradually getting into fracture management was done successfully via intraoral exposure of active use for fracture fixation in pediatric patient. angle fracture and fixation through transbuccal approach with trocar Objectives and no complication were seen post operatively. The purpose of this poster is to review bioresorbable plates and Conclusions present a case of pediatric mandibular fracture treated using these The need for accurate fracture reduction and fixation via extraoral plate. approach has been greatly reduced since the advent of transbuccal and Methods intraoral approaches in mandibular angle region. Not applicable. Results Not applicable. Conclusions EPS00577 The review and our experience with the use of resorbable bone plate Diagnosis and Management of Late Csf Rhinorrhea in a case of mandibular fracture of a child suggests that although this in Patient With Frontal Bone Fracture option is expensive, requires specialized equipment and is technique sensitive, yet it shows satisfactory fracture healing and can be effectively used in pediatric trauma. Swapnil S. Garde

Sinhagad Dental College and Hospital EPS00596 Abstract Comparative Evaluation of Efficacy of Single Plate Background/Introduction Versus Conventional Two Miniplates in Anterior The management of persistent, post-traumatic cerebrospinal fluid Region of the Mandiblular Fractures (CSF) rhinorrhea and otorrhea remains a surgical challenge. Repair of CSF leaks has evolved from that of an intracranial approach to one that is primarily extracranial and endoscopic. 1) Dr. Sarjak Oza 2) Dr. Amit Mahajan Objectives Diagnosis and management of CSF rhinorrhea in a patient with K. M. Shah Dental College & Hospital, Vadodara frontal fracture. Methods Abstract Diagnosis of CSF rhinorrhea with CT cysternography and manage- Background/Introduction ment with dural repair using facia lata and fat and management of Locking plate systems offer advantages like, it becomes unnecessary frontal bone fracture with fixation. for the plate to intimately contact the underlying bone in all areas. As Results the screws are tightened, they ‘‘lock’’ to the plate, thus stabilizing the 6 month followup showed no event of CSF leak. segments without the need to compress the bone to the plate. More- Conclusions over it also decreases the hardware usage in the operating table and Csf Rhinorrhea Is Commonly Seen in Frontal Fracture and Noe also aids in the decrease in the operating time. It also decreases the Fractures. It Can Be Diagnosed With Ct Cysternography and Repair amount of infection and other hardware related problems. Many Can Be Done With Neurosurgical Management. studies demonstrated that treating anterior mandibular fractures with the use of single locking reconstruction plates, placed at the inferior border of the mandible, could neutralize compression and tensile EPS00585 forces, obviating the use of a second plate at the superior border of the mandible. Moreover with this study it was observed that there were no Bioresorable Plates Doing Wonders in Pediatric disturbances in the post-operative occlusion and fracture stability was Maxillofacial Trauma-Review & Report of a Case also seen post-operatively. As torsional forces in the parasymphysis region are very high, Champy had used upper plate as tension band Dr. Priya Sharma(Author) Dr. Ankita Vastani (Co-Author) but many surgeons think lower arch bar can be used as a tension band and eliminate the need for upper plate. Objectives Rishiraj College of Dental Sciences & Research Centre Bhopal To evaluate the efficacy of use of a single plate versus two miniplates (M.P.) in anterior region of mandibular fractures. Methods Abstract The study is being conducted under the general anesthesia. Treatment Background/Introduction of the Fractures for anterior region of mandible will be done by giving Background-the management of mandibular fractures in paediatric incision intra-orally or extra-orally. The fracture fragments will be patients has special considerations as compared to the management of reduced in accurate anatomic pre-traumatic occlusion state and fixa- similar fractures in adults because the anatomical characteristics of tion will be done using single plate. the developing mandible and the presence of tooth buds in the jaws of Results children and sometimes present with severe fractures in which the As it is an On-going study results are being awaited. closed approach may not be the choice of treatment. The fractures Conclusions may present with displacement, severe malocclusion, multiple frac- This study will let us know about adequate stability and fixation tures, or comminuted. Under these circumstances, open reduction and across the fracture line in anterior region of mandible. Hence in future internal fixation is the treatment of choice and there is always a search use of single locking plate in anterior region of mandible fracture can for better plating systems and resorbable bone plate is one such novel be promoted for better surgeon perception and patients compliance. choice. *Introduction-Out of the various fixation options such as compression plates, mini plates, lag screws, the use of resorbable

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EPS00602 Objectives Endoscopically Assisted Management of Mandibular To evaluate the efiiciency of microplate in fixation of midface fracture. The aim of fracture repair by rigid internal fixation through Condylar Fractures primary bone healing under masticatory forces. Methods Dr. Khushboo Changani Maximum voluntary bite force was recorded in young individuals of different age group and they treated using microplates in midface, via Abstract open reduction and rigid internal fixation. Background/Introduction Results Complications of fractures of this area include malocclusion, such as There was a progressive improvement in bite force in passsage of apertognathia, loss of posterior mandibular vertical height resulting in time provides good reduction of the fractures due to plates resistant a facial asymmetry, loss of chin projection in the sagittal plane, and properties the palbaility of plates is negligible in prominent areas of loss of function/mobility of the TMJ. Management of fractures of t0 facial skeleton. the mandibular condyle and subcondyle advocate simple closed Conclusions reduction of fractures, as well as open reduction. The semirigid fixation was done with titanium microplates and Objectives screws, there was good biocompatability and implant rejection or To provide excellent visualization of the surgical field via a small infection was minimal. incision Include acceptable minimal scarring. Decreased tissue manipulation and dissection. Decreased postoperative morbidity Quicker return to normal function. EPS00661 Methods There are two surgical approaches used in EAORIF of the condyle: an Incidence of Maxillo Facial Trauma: 10 Year intraoral approach and a submandibular approach. Advantages of the Retrospective Study intraoral approach include the lack of a skin incision, whereas its disadvantage is a smaller optical cavity to work within. The sub- Dr. Amal Suresh, Dr. Venkatesh Anehosur mandibular approach requires a 1.5-cm skin incision at the angle of the mandible, similar to a Risdon incision, placing the facial nerve at minimal risk; however, the optical cavity created has a larger working SDM College of Dental Sciences and Hospital, Dharwad space with better endoscopic orientation. Once the optical cavity is created, the endoscope is placed and the fracture is visualized. Manual Abstract reduction of the fracture is then completed via manipulating the teeth Background/Introduction or distracting the mandible in the angle region. Once reduced, a six- Trauma represents 50% of emergency consultations in developing hole 2.0-mm non compression miniplate is inserted using a right- countries, and is the third cause of death worldwide. A 10 year ret- angle screwdriver/drill or a trocar. Angled elevators and reduction- rospective study was conducted of the patient reported to SDM manipulation forceps in the Synthesis fixation set facilitate reduction Craniofacial Unit from June 2007 to June 2017 to assess the inci- and fixation of these fractures. dence, management and complicatons. Results Objectives Endoscopic-assisted open reduction/internal fixation of mandibular The aim of the present study is to evaluate the incidence, management condylar fractures is a viable alternative to traditional closed or open and complications of maxillofacial trauma from 2007 to 2017. reduction techniques. However, case selection is important. Ideally, Methods the fracture undergoing EAORIF should be easily manipulated into A retrospective study was conducted of patients reported to SDM reduction and have enough stable bone on either side of the fracture to Craniofacial Unit, Dharwad with maxillofacial fractures, from June support a bone plate. 2007 to June 2017. The Medical records were evaluated for principal Conclusions demographic, clinical, diagnostic and therapeutic data. Percentage EAORIF is a technique that should be included in the armamentarium analysis was done on the data collected. of the maxillofacial trauma surgeon when treating mandibular Results condylar fractures. 986 cases ranging from 4-77 years of age group were reported, with male: female ratio of 9:1. The most affected age group was 18-36 years at 64.34% (n=628). Road traffic accidents constituted 46.41%, (n=453) of fractures. Parasymphyseal and zygomatic complex frac- EPS00630 tures were most common. Among the concomitant injuries, Role of Microplate in Midface Fractures neurological injuries, Infections and malocclusion were frequent postoperative complications seen. Cases of malunion were also reported. Majority of the cases were surgically managed with minimal Dr. Sivagopi post-operative complications. Conclusions Sree Balaji Dental College and Hospital Trauma, mostly from road traffic accident, constitute the main aetiology of maxillofacial fractures with males being the most affected. Abstract Parasymphyseal and zygomatic complex fractures were the com- Background/Introduction monest fractures seen. Patients managed surgically have shown better The bones of middle third facial skeleton produce a superficial results with very minimal or nil post-operative complications. apperance of strength, but they are fragile and hence get fracture easily so restoration of preexisting anatomical form, functional occlusion and facial esthetics to remain as our primary objectives.

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EPS00693 Objectives Ballistic Injuries-Role of a Maxillofacial Surgeon To evaluate the clinical use of titanium delta-shaped miniplate in open reduction and internal fixation of subcondylar fracture via transoral endoEndoscopic-assisted ORIF of mandibular condylar Dr. Merlin K. Mathai, Guided by Dr. Shalini Krishnan fractures. Methods A. B. Shetty Memorial Institute of Dental Sciences, NITTE University Titanium delta plates used for open reduction & internal fixation of subcondylar fracture via transoral endoscopic assisted approach. Abstract Results Background/Introduction We have favourable results with titanium delta shaped miniplate in Ballistic trauma or gunshot wounds is a form of physical trauma open reduction and internal fixation of subcondylar fracture via sustained from the discharge of arms and munitions. Such injuries transoral endoscopic assisted approach. cause perforation injuries which is usually avulsive and causes Conclusions enormous damage to the soft and hard tissues, with severe commu- Endoscopic-assisted ORIF of mandibular condylar fractures is a nition of facial skeleton. Hence, a maxillofacial surgeon whose area viable alternative to traditional approaches. Case selection is impor- of expertise is the head and neck region, plays a very crucial role in tant. Delta plate provides optimum functional and the management of such injuries. stable osteosynthesis. As more experience is accumulated and greater Objectives efı¨ciency is achieved with these techniques, more procedures may be A literature review to discuss the most efficient modes of manage- performed. ment along with the reconstruction techniques that a maxillofacial surgeon uses in case of such ballistic maxillofacial injuries. Methods Articles published within the last 20 years were reviewed with the ABS00720 help of various search engines using the key words ‘ballistic injuries’, Comparative Evaluation of 3D Plates and Standard ‘Maxillofacial trauma’, and ‘Maxillofacial surgeon’. The articles Mini-Plates in Mandibular Fractures: A CBCT Study were studied based on the treatment protocols that the surgeons used while treating maxillofacial ballistic injuries. Dr. Dowlin David, Dr. Shoban Nandy, Prof. Dr. Uma Maheswari Results Immediate surgical intervention rendered by the surgeon prevented severe post op scarring and contractures. Recent advances in the Abstract imaging techniques like Stereolithography, 3D CT have proved to be Background/Introduction of immense help. However, a well founded and structured treatment Though the mini-plates offer good resistance to displacement, it is not protocol based on clinical experience is mandatory in providing able to provide stability in three dimensions against excessive efficient, appropriate and successful treatment. torqueing forces and thus may result in inadequate fixation. Farmand Conclusions and Dupoirieux in 1992 gave a new plating system which resolved The role of a maxillofacial surgeon in the multidisciplinary team is this problem and called it 3D-plating system, which takes advantage quite crucial in the management of maxillofacial ballistic injury since of bio geometry system to provide stable fixation. ? the quadrangular it deals with intricate reconstruction and management of maxillofacial geometry offers good stability in three dimension against heavy trauma to give an optimum aesthetic and functional result. torqueing forces. These plates are 2X4 mini-plates joined by four interconnecting cross struts. Lai operated on 30 patients with these plates and concluded that this has a promising future in maxillofacial fixation. ABS00715 Objectives Clinical Experience with 3-Dimensional Delta Plate The purpose of this prospective study was to compare and evaluate for Transoral Endoscopic-Assisted Osteosynthesis the efficacy of standard mini plates and three dimensional plates in management of mandibular fractures. of Condylar Fractures Methods INCLUSION CRITERIA: - Patients with unilateral or bi-lateral Dr. Ajit Sinha & Dr. Srivalli Natarajan mandibular fractures - Patients not medically compromised - Patients between age group of 14 to 70 years - Fracture line should be clean Abstract straight and not comminuted - Patients with no pathological bone Background/Introduction disease - Patients with clear dental landmarks EXCLUSION CRI- Mandibular condyle fractures are one of the most frequent injuries of TERIA: - Patients completely edentulous - Associated maxillary the facial skeleton. The option for open treatment of mandibular fracture - Systemic illness PARAMETERS: - Time Taken - Damage condyle fractures has become more favorable since osteosynthesis to Teeth - Nerve Damage And Paresthesia - Malocclusion. materials were developed in the past few decades. However, the rigid Results fixation techniques of treating condyle fractures remain one of the 3D plates showed that they could be plated faster, Mean for Group 1 controversial issues in maxillofacial trauma. Several techniques and being 2.06 and Group 2 being 4.94, thus reducing the operative time plate types like adaption miniplates, minidynamic compression plates, considerably, this was subjected to sample t- test and the difference resorbable plates and double plates have been evaluated biomechan- was significant. - the second parameter was nerve injury, in Group 1 ically in various experimental and clinical studies. Also various all patients retained sensation and in group 2 one patient (16.7%) approaches have been used to for ORIF. The present case report is to developed loss of sensation which on 1 month post-operative review evaluate the clinical use of titanium delta-shaped miniplate in open still complained of paresthesia. - the third parameter was damage to reduction and internal fixation of subcondylar fracture via transoral the teeth, in group 1 no patients were effected but in group 2 two endoscopic assisted approach. patients (33.3%) had teeth damage, which was easily visualized using CBCT.

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Conclusions EPS00735 The 3D plates seem to result in less complications and gives adequate Management of Maxillofacial Injuries in Pediatric stability if not more compared to standard mini plate. Since the time take to perform the surgery gets signiﬁcantly reduced and due to the Patient reduction of implant material of these plates, they offer a suitable and better alternative to Champy’s mini-plates. Dr. Akshatha K. I. MDS; Guided by: Dr. B Rajendra Prasad

A. B. Shetty Memorial Institute of Dental Sciences, Nitte University ABS00728 Mangalore Comparative Evaluation of ‘Y’ Modification Abstract of Transconjunctival Approach and the Conventional Background/Introduction Approach for Management of Zygomatic Complex Maxillofacial injuries in children are common comprising more than Fracture-A Randomized Control Trial half of all injuries sustained. In childhood generally impetuous nature and adventurous spirit combine to encourage participation in physical activities with little thought for immediate consequences. Dr. Arun Objectives To review the current literature on principles involved in treatment of Saveetha Dental College and Hospital maxillofacialfacial trauma for pediatric patient. Methods Abstract A literature review was conducted on various search engines and Background/Introduction relevant articles in indexed journals were analysed. The most important principle in treating fractures, especially those of Results the face, is the proper reduction. If the bone is not placed into the Over the past decades, in order to treat craniofacial fractures, several correct position, stabilization becomes superfluous. Many different techniques and materials for fixation have been proposed, such as treatment modalities have been advocated to repair ZMC fractures, interosseous and suspension wiring, plating and microplating system, each with variable success rate. With the advent of rigid fixation, miniplate system. In the last 30 years, the most common treatment there has been a philosophy that stresses wide visualization and consisted in the application of metal plates and screws, both for adults accurate reduction combined with 3-point fixation to precisely and for children. Although controversial, the reported problems about approximate the fractured segment. However, the disadvantages of metal fixation included: prolonged recovery, intracranial translocation three-point fixation include increased surgical time, additional sur- of plates and screws, increased inflammatory responses, interference gical scars and additional hardware. The purpose of this study was to with craniofacial growth of the peadiatric skull and interference with overcome these disadvantages, albeit obtain three point visualization diagnostic techniques. Furthermore, ankylosis at the temporo- and fixation with minimal incisions so as to reduce the surgical time mandibular joint after prolonged immobilisation requires protracted and scarring. In this study, we have used a ‘Y’ modification of the rehabilitation. transconjunctival approach and conventional approach to assessing Conclusions the advantages of it. The greatest concern when treating the pediatric patient is the effect Objectives of the injury or treatment on growth and development. This is both To determine the fracture reduction. To evaluate the aesthetic anatomically and psychologically important and may have various advantage. effects on management for the different stages of psychological Methods development. Randomized Control Trial. 12 subjects were included in the study. Group I - modification of transconjunctival approach Group II - Conventional approach ((lateral brow incision, subciliary incision and upper gingivo buccal sulcus incision) Inclusion Criteria: Isolated EPS00798 Zygomatic Complex fracture Zygomatic Complex fracture with Ballistic Injuries of Craniomaxillofacial Region orbital floor fracture Fractures involving Mandible along Zygomatic Complex fracture Exclusion Criteria: Pan facial fracture. Isolated Dr. Jagadish Patil, Dr. Abhay Datarkar Zygomatic Arch Fracture Statistics: Independent t-test. Results Government Dental College and Hospital, Nagpur Analysis of various parameters revealed between two groups shows significant differences (with better result in group I (4.66) whereas in group II (8.00) Abstract Conclusions Background/Introduction The transconjunctival approach has been used classically for treat- Ballistic injuries (also called as missile injuries) are caused by gun- ment of ZMC and orbital floor fractures. We believe that with the shot wounds or artillery, shell or grenade. Injuries resulting from transconjunctival approach an excellent surgical exposure is accom- firearms in India are fortunately rare, compare to the the United States plished when combined with Y modification of lateral canthotomy for and certain Latin American nations, where death and injury from better-fractured segmentsreduction and three point fixation. This firearms are a relatively common occurrence. Although the incidence could potentially avoid the use of a second incision in the area when has increased during past decades, People who remain alive after plating the fronto zygomatic suture. multiple injury require the coordination of multiple surgical disciplines to optimize the functional and aesthetic consequence. Definitive management of patients with ballistic injury remains controversial in terms of reconstruction of bone and soft tissue defects. However there is consensus about the four main steps in the management of patients with gunshot wounds to the face: securing on 123 S108 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 airway, controlling haemorrhage, identifying other injuries, and repair fracture. The modified closed cap splint provides adequate stability of of the traumatic facial deformities. fractured fragments and avoid intermaxillary fixation. Objectives Results To outline the management of various penetrating and perforating The clinical outcome in the present case indicates that closed cap wounds caused by high and low velocity ballistic weapons. splint is best method for the reduction of the minimally displaced Methods fracture. Closed cap splint is an effective and more reliable method A Retrospective study was conducted in the tertiary care center for than open reduction or intermaxillary fixation in terms of ease of craniomaxillofacial surgeries at Government Dental College, Nagpur application and removal, less time consumption, cost- effectiveness, in the department of Oral and Maxillofacial Surgery where 6 patients good stability during healing period and minimal trauma to sur- of different ballistic injuries were evaluated and managed in the last 5 rounding tissues. years. Conclusions Results Cap splints for treatment of pediatric mandibular parasymphysis Ballistic injuries can cause a variety of wounds including penetrating reliable fixation techniques with regard to occlusion guided fracture and perforating wounds depending on the velocity of the weapons. reduction, maximum stability during healing period, ease of appli- Cases of these foreign bodies in the craniomaxillofacial region are cation and removal, reduced operation time, minimal trauma for less reported in the literature. In our department, we have treated 6 adjacent anatomic structures, wide age group safe usage, ease of cases, out of which 2 patients suffered a blast of handmade pipe maintenance of oral hygiene, and comfort for young patients. explosive, 3 patients due to hit by a low velocity bullet and 1 by a high velocity bullet that caused penetrating injury to the midface region. All patients were treated successfully with full restoration of form, function and aesthetics. EPS00819 Conclusions Coronal Approach Work Horse Flap in Oral Gunshot related assaults results in 14o/o of cases and more than 50% and Maxillofacial Trauma a Retrospective Analysis of all gunshot cases result in head and neck injuries and out of which 30% to 620/o occur intraorally. Nerve damage, I particularly to the facial and trigeminal nerves, can be expected after severe gunshot Dr. Satish Kharde, Dr. S. R. Shenoi wounds to the face. Size & location of foreign body in these cases make it unique and challenging for the maxillofacial surgeons to treat. VSPM Dental College Thus, to obtain a satisfactory result, a multidisciplinary and correct team approach is required. Abstract Background/Introduction Various indications for the coronal approach include severe craniomaxillofacial trauma, craniofacial deformities, craniotomy EPS00810 procedures, osteotomies of upper and middle one third of face, har- Management of Pediatric Mandibular Parasymphyseal vesting of bone and fascial grafts when needed, for improved access Fracture with Acrylic Closed Cap Splint: A Case to condylar regions, and also for forehead rejuvenation. Although a Report variety of transoral and hidden incision are available providing adequate access to the face, but there are still areas of interest for maxillofacial surgeons in which these incisions fail to address, par- Jain P, Yeluri R, Gupta S, Lumbini P ticularly the upper mid-face and craniofacial regions which are better accessed by coronal approach. Abstract Objectives Background/Introduction The aim of the study was to check the feasibility of coronal approach. Dental trauma in children constitutes a major and serious dental Methods public health problem. Fractures occurring in children present prob- Patients of maxillofacial trauma requiring coronal approach from lems in achieving and maintaining stability that are quite different January 2014 to March 2017 in our institute. Out of 22 patients who from those in adults. As such, the treatment modality differs in required coronal approach to expose fracture site, 8 had been operated children due to the anatomic complexity of the developing mandible, with hemicoronal approach and 14 with coronal approach. Each case presence of tooth buds, and eruption of primary and permanent teeth. was assessed for the time required to raise the flap, visibility and Objectives accessibility to the area, need for additional approaches, postoperative The purpose of this poster is to provide an insight on maxillofacial complications including aesthetic and functional results were injuries in pediatric patient and to assist the clinician in the man- assessed. agement of Mandibular parasymphysis fracture in children with Results acrylic closed cap splint, a definitive treatment modality. Awaited. Methods Conclusions The most common treatment includes cap splints with circum- Coronal and hemicoronal approach turns out to be a highly indis- mandibular wiring, cap splint cemented onto the arch, and Erich arch- pensable and versatile approach, owing go it’s application in life array bar fixation. In this case report, a modified closed cap splint is used of craniomaxillofacial region, truly making it a Work Horse in Oral for the closed reduction in a minimally displaced parasymphysis and Maxillofacial surgery.

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EPS00839 Methods Bone Grafts in Craniomaxillofacial Surgery Both the condyle were reduced by manual pressure applied on occlusal surface of molar augmented by traction pull by loop of wire around the lower arch bar in molar region after mobilising the Dr. Ankesh Kumar Jain parasymphysis fracture using chisel mallet under GA. Patient was discharged with imf after 10 days with active mouth opening Rajarajeswari Dental College physiotherapy. Results Abstract Both the condyle were successfully reduced in glenoid fossa with Background/Introduction good functional outcome and post operative mouth opening of 30mm Bone defects in the craniomaxillofacial skeleton vary from the small was achieved after 30 days. (few millimeters) periodontal defects to the large segmental defects Conclusions resulting from trauma, surgical excision, or cranioplasty. Such defects The goal of treatment of is to return the condyle to its original typically have complex three-dimensional structural needs. Segmental physiologic position. While dealing with facial trauma cases surgeon jaw defects require restoration of mechanical integrity, temporo- should consider such type of rare presentations for better diagnosis mandibular joint function, and intermaxillary dental occlusion. A and management. bone graft is defined as any implanted material that promotes bone healing, whether alone or in combination with other material. Bone grafts can be divided into the following subtypes: autografts, allo- E-Poster Presentation grafts, xenografts, synthetic materials, and any combination. Objectives Section: Craniofacial anomalies 1) Biological principles of bone graft healing 2) Different types and sources of bone grafts. Methods Sources of autogenous bone grafts for craniofacial reconstruction can EPS0084 be harvested from iliac crest, calvaria, symphysis, tibia, rib, temporal The Many Faces of Craniosynostosis—Diagnosis, bone and ramus. Surgery and Beyond Results Bone from the ramus and symphysis was preferred for vertical and horizontal augmentation procedures. Iliac grafts are used for larger Dr. Shiju Mathew Jacob defects. Smphysis grafts were beneficial for small defects, such as cleft palate and orthognathic osteotomy defects. Mechanical stiffness Army Dental Centre (Research & Referral), Delhi Cantt of the tibial cortex can be useful in augmentation of atrophic alveolar ridge for implant placement, facial bone augmentation, or bridging an Abstract osteotomy defect. Temporal bone can be used to reconstruct maxil- Background/Introduction lary, palatal, orbital rim, orbital floor, or ascending mandibular ramus Craniosynostosis is a condition which is characterised by the pre- defects. mature fusion of one or more cranial sutures in a new born child, Conclusions often resulting in facial asymmetry and skull shape deformity. The Bone grafts remain the gold standard for reconstructing craniofacial clinical sequelae are variable and includes morphological and func- bone defects. tional deficits. Closure of cranial sutures in early childhood is a concern for both the parents and healthcare professionals. Objectives This poster aims to demonstrate the role of imaging in early detection EPS00840 and diagnosis of craniosynostosis in addition to an insight into the Bilateral Traumatic Superolateral Dislocation management of such cases using different surgical modalities and of Fractured Condyle-A Rare Case Report their outcomes. with Literature Review Methods We intend to present our institutional experience in the management of both syndromic and non-syndromic craniosynostosis. Dr. Zohaib Roshan Results The goals of surgical intervention includes the release of the affected Dept of Omfs, Zadch, Amu, Aligarh suture allowing the unrestricted development of the visceral components (eg, brain, eyes) and 3-dimensional reconstruction of the Abstract skeletal components establishing a more normal anatomic position Background/Introduction and contour. Anteromedial fracture dislocation of the mandibular condyle is Conclusions common but a superolateral dislocation of condyle is quite rare. This Craniosynostosis may be either isolated or present as part of a cran- type of dislocation is often misdiagnosed or completely overlooked iofacial syndrome with significant implications if undiagnosed. and hence inadequately addressed. A case of a 42-year-old male Surgeons caring for infants with these cranial and orbital malforma- patient who experienced bilateral superolateral dislocation of condyle tions must maintain a thorough understanding of the 3-dimensional associated with parasymphysis fracture following a road-traffic anatomy, the characteristic dysmorphology associated with the dif- accident was managed. ferent types of synostosis, and the complex interplay that exists Objectives between surgical intervention and ongoing skeletal growth. The objectives of this study is to diagnostic features and clinical management of such dislocations with the review of literature.

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EPS00478 Objectives Management of Hemifacial Microsomia Surgical extraction of an impacted mandibular 3rd molar in a patient with Sturge Weber Syndrome. with a Combination of Mandibular Distraction, Methods Orthognathic and Orthomorphic Surgery: A Case A case of a patient with Sturge Weber syndrome with a symptomatic Report impacted mandibular third molar was surgically extracted in minor OT under local anesthesia while taking all necessary precautions. There was minimal bleeding intra and post-operatively and no post- Dr. Nithi L. Prem, Dr. Pramod Subash operative complications were encountered. Detailed clinical examination, investigations and adequate precautions should be taken Amrita Institute of Medical Sciences, Kochi during the surgical procedure to minimize any potential complications and manage these effectively. Abstract Results Background/Introduction Surgical extraction of impacted mandibular third molar was done Hemifacial microsomia is the second common congenital facial wherein bleeding due to any injury or rupture of the vascular anomaly deformity. It is characterized by abnormal development of maxillo- was minimized and prevented. mandibular complex with ear deformities like microtia, accessory Conclusions preauricular tags or middle ear defects causing hearing impairment. Management of Patient with Sturge-Weber syndrome is challenging Orthognathic surgery, distraction osteogenesis and augmentation due to the risk of hemorrhage from any of the angiomatosis, so extra procedures have been the treatment of choice for facial deformity care and precaution must be taken when performing surgical proce- corrections. dures in the affected areas. Objectives Effectiveness of a new surgical protocol for the management of facial deformity in hemifacial microsomia patients. EPS00558 Methods Fronto-Orbital Advancement: A Boon A new surgical protocol was performed in a 20 year old female, who for Cranisynostosis is a known case of hemifacial microsomia. A two-stage treatment protocol has been opted for the management of the facial deformity. First step involves mandibular asymmetry correction using distraction Dr. Shahzaib Akhter Nasti osteogenesis. The remaining deformities are addressed using a combination of maxillary le-fort I osteotomy and orthomorphic surgery Abstract (reverse BSSO) of mandible along with malar augmentation. Background/Introduction Results Craniosynostosis is a pathologic condition resulting from the premature Mandibular dysmorphology was almost corrected by distraction fusion of the cranial vault sutures, resulting in craniofacial deformities. osteogenesis. Orthognathic along with orthomorphic surgery was Anterior craniosynostosis can involve a combination of metopic uni- successful in achieving optimal results and there was satisfactory coronal or bicoronal sutures. This early fusion prevents the skull from functional and aesthetic outcome. growing normally and affects the shape of the head and the face. In Conclusions addition, in syndromes like Apert’s, a varied number of ﬁngers and toes Facial dysmorphology of considerable complexity can be well are fused together (syndactyly). The head is unable to grow normally, addressed with the new two-stage surgical protocol. After correction which leads to sunken appearance in the middle of the face, bulging and of mandibular anteroposterior length deﬁciency with distraction wide set eyes, a beaked nose and an underdeveloped upper jaw leading to osteogenesis and maxillary height and occlusal cant correction with crowded teeth and other dental problems. Shallow orbits can cause vision orthognathic surgery, orthomorphic surgery is a good option to cor- problems. Craniosynostosis also affects the development of the brain rect the persisting contour deformity of mandibular angle due to lack which can disrupt intellectual development. Cognitive abilities in people of ramus width. Advancement of chin and lateral movement of sag- with apert syndrome range from normal to mild or moderate intellectual itally split ramus (reverse BSSO) provides adequate mandibular disability. Additional signs and symptoms may include hearing loss, projection and fullness in the angle region. hyperhidrosis, oily skin with severe acne, patches of missing hair in the eyebrows, fusion of cervical vertebrae and recurrent ear infections. Objectives This poster highlights the importance of Frontoorbital advancement EPS00477 and craniotomy cuts in cases of cranisynostosis and improvement of Impacted 3rd Molar Surgery in Sturge-Weber quality of life in these patients. Syndrome-A Case Report Methods Cases of craniosynostosis treated/operated in the department of oral and maxillofacial surgery with frontoorbital advancement. Dr. Akash K S, Dr. Vivek G K, Dr. Akshay Shetty Results The operated cases had increased head circumference, a normal Abstract looking forehead, Improvement in the head symmetry, disappearance Background/Introduction of harlequin sign, normal position of the eyebrow and no complica- Sturge Weber Syndrome is a rare congenital, non familial disorder tions were seen or reported postoperatively. caused by mutation of the GNAQ gene, it’s characterized by presence Conclusions of port wine nevus, neurological abnormalities and ocular manifes- Frontoorbital advancement and remodeling play a major role in cor- tations such as glaucoma. Diagnosis of Sturge-Weber syndrome is rection of cranisynostosis and encourages the patient for a better based on having two out of three diagnostic criteria, those being a quality of life, provides a good magnitude of expansion and over- facial port-wine birthmark, increased ocular pressure, and lep- correction. Different cases may require additional procedures to tomeningial angiomatosis. modify skull shape and measurements.

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EPS00613 Access through Coronal incision was achieved Bifrontal cranio- A Rare Case Report of Head and Neck Arteriovenous plpasty was performed and 2cm wide supraorbital rim was removed. Both frontal and orbital rims were remodeled using a resorbable plate Malformation in Children and screws Fronto - orbital advancement was done - fixation was done using resorbable plate and screws the gaps in between the segments Dr. Bhakti Bhusan Pati were packed by bone dust. Results SCB Dental College and Hospital A significant increase in the intercanthal distance, biocular distance, interorbital distance and intertemporal distances were noted. Patient Abstract was a Sloan’s class 2 on evaluation (classification of surgical results Background/Introduction regarding cosmetic improvement) AV malformation in children in maxillofacial region is a rare vascular Conclusions anamoly due to failure of complete involution of fetal capillary bed cranioplasty with frontoorbital advancement is a significant method which results with devlopement of abnormal connection between for correction of trignocephalic deformities. arteries and vein leading to several potential life threatening complication. Objectives EPS00671 I here by report case of av malformation and discuss its clinical features diagnosis treatment from my institutional experience. Emergency Management of Intraosseous Hemangioma Methods of Maxilla—A Rare Case Report We have operated 3 patient below 10 yrs. One on lip, one on right side of mandible involving lingual and facial artery another in the floor of Dr. Shekhar S, Dr. Ravi V, Dr. Krishnakumar, Dr. Shyamsundar, Dr. mouth and intraosseous component in the mandible with arterial Jaeson Mohanan Painatt, Dr. Girisankar feeders bilateral lingual artery and draining vein right internal jugular vein, right bracheocephallic vein. Amrita Institute of Medical Science, Cochin Results All the cases having good result, better fuctional activity of the operated site, devoid of post surgical complications and recurrence. Abstract Conclusions Background/Introduction This case demonstrate rare case of av malformation which was suc- Intraosseous hemangiomas are benign vascular malformations and cessfully treated by surgical excision. Although rare clinician should constitute less than 1 percent of all intraosseous tumors and are aware of their life threatening complication and monitor for extremely rare in the maxilla. It exhibits female predilection and peak recurrence. incidence is between second and fifth decade of life. CT and MRI imagings are gold standard in diagnosing these tumors, which typically has a ‘sunburst’ appearance. This report presents a case of a 6-year-old child with a history of brisk bleeding from the upper EPS00659 alveolus with no preceding history of trauma or pain. Surgical Correction of a Rare Case of Non-syndromic Objectives Emergency surgical intervention for intraosseous hemangioma Trignocephaly involving maxilla. Methods Dr. Tom Thomas (Resident), Prof. Dr. Ummar. M. MDS (HOD), Prof. Computed tomographic imaging and angiogram was suggestive of Dr. Premkumar, MS, Mch (Neurosurgery) arteriovenous malformation in the right lower maxilla. She was advised admission but was unable to do so. She was brought back Dept. of OMFS; MES, Dental College and Hospital, Perinthalmanna, after an episode of severe bleeding at night and was immediately Kerala intubated and oral cavity was packed to control bleeding. Embolization of the AV malformation was performed but owing to Abstract subsequent severe bleeding, she underwent right infrastructural Background/Introduction maxillectomy on an emergency basis. She underwent a second stage Premature closure of the metopic suture results in deformation of the reconstruction, with scapular flap reconstruction and tracheostomy anterior calvarium, resulting in the phenotypic features called under GA, which was tolerated well. The Histopathological exami- trigonocephaly, Trigonocephalic deformities are recognized because nation was suggestive of Intraosseous Hemangioma. of a pathognomic ‘keel-shaped’ deformity of the forehead with a Results prominent midline ridge, bilateral frontotemporal constriction with Effective control of bleeding was achieved through emergency compensatory biparietal expansion, supraorbital and lateral orbital infrastructural maxillectomy. retrusion and hypotelorism. Conclusions Objectives Maxillary intraosseous hemangiomas are extremely rare and surgical 1) To expand the volume of the cranial vault so as to accommodate intervention depends upon degree of disfigurement or repetitive the developing brain 2) To allow for normal development of the bleeding. In our case, even though embolization of larger feeder anterior cranial vault and orbits. vessels turned futile, emergency infrastructural maxillectomy proved Methods successful for effective control of the bleeding. An eighteen months old, male patient was brought to our department and was diagnosed as non-syndromic synostotic trignocephaly.

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EPS00683 pain. Its etiology, classification and pathophysiology remain an Cad-Cam Assisted Management of Depressed Frontal enigma so far. Objectives Bone Fracture and Contour Deformity To tailor an algorithm for decision making and management protocol of condylar hyperplasia. Author: Dr. Sukirti Tiwari, Co-Author: Dr. Abhay Datarkar Methods Total 5 cases diagnosed with condylar hyperplasia treated surgically Government Dental College & Hospital, Nagpur, Email Id: Sukirti. are included. Serial cephalometric tracings at 6-12 months interval [email protected] Mobile No: 7350016876; Email Id: done to evaluate the condylar activity and Bone scintigraphy to [email protected] evaluate and confirm the metabolic activity of the bone. Based on the activity of growth, the patients were divided in 2 groups: Group A Abstract consists of 3 adult patients of non-growing age and group B contains Background/Introduction 2 child patients where growth was still active. Though both groups of Frontal sinus fractures comprise 5-30% of maxillofacial fractures, patients were treated according to the severity of the facial asymmetry with isolated anterior table fractures accounting for 33% of frontal at the time of diagnosis, Group A was surgically managed by low sinus fractures. Anterior table frontal sinus fractures can result in level condylectomy and Group B was treated by high condylar aesthetically displeasing contour deformities. Acute anterior shaving. Based on the degree of facial asymmetry, Inferior border table frontal sinus fractures that are depressed may be reduced with an reduction osteotomy of the involved side was done to re-establish the open, closed, or endoscope-assisted approach. Delayed contour vertical balance. deformity camouflage can be achieved using bone grafts, titanium Results meshes, methyl methacrylate, hydroxyapatite cement, and polyether After follow up of 6 months, all patients maintain good facial sym- ether ketone implants. metry and balance and a stable skeletal and occlusal relation. The Objectives minimum surgical approach is utilized for every patient so that 1.the aim of frontal sinus fracture repair is to restore form and patients do not undergo much surgical and psychological trauma. function and to prevent delayed complications. 2. Timing of surgical However, one patient is undergoing fixed orthodontic treatment for repair of frontal sinus fracture i.e. acute versus delayed. occlusal refining. Methods Conclusions A total of 34 patients have been included having frontal sinus fracture The key in diagnosis and treatment planning is whether or not the of age 22- 58 years (male pt – 27, female pt – 7). Fractures involving disease is active at the time of presentation of the patient. Based on only anterior table are surgically corrected within 14 days of trauma. the age of the patient and the growth period, minimum surgical Depressed fractures of frontal bone involving both anterior and pos- intervention is done and a long term stable esthetic and functional terior table are considered for delayed approach. Treatment of outcome is hence achieved in all patients. depressed fractures are stereolithographically assisted for accurate contouring of frontal bone. Results EPS00777 all the cases have resulted in esthetically pleasing and precise contouring of frontal bone defect using CAD- CAM stereolithographic Recent Innovations in the Mangement of Craniofacial models. Fibrous Dyspalsia Conclusions Fractures of the upper face and anterior skull base are a challenging Dr. Vibha Wodeyar neurosurgical, plastic & maxillofacial surgery problem. Repair may take place in the acute setting, with the goal of fracture reduction with Bapuji Dental College & Hospital, Davangere or without fixation, or in the delayed setting with the aim of camouflage, rather than reduction. Abstract Background/Introduction The management of fibrous dysplasia can be challenging. It is a rare EPS00768 entity, but when it involves the craniofacial skeleton it can cause Condylar Hyperplasia: An Institutional Management severe deformity, with devastating consequences. Objectives Protocol To adopt newer advances in the overall management of craniofacial fibrous dysplasia. Dr. Shikha Tayal, Dr. Abhay N. Datarkar Methods The recent advances which have been used in the management of Government Dental College and Hospital, Nagpur CFD are haptic modelling, rapid prototyping 3D printing, stereotactic navigation system, volumetric soft tissue analysis. Abstract Results Background/Introduction The methods which have been used had significant advantages: - Condylar hyperplasia (CH) is a progressive and pathologic over- Improved interpretation of image data and preoperative planning, - growth of either or both mandibular condyles. These condylar More accurate designing of the surgery, -Clearer patient under- pathologies can adversely affect the size and morphology of the standing, -Less patient morbidity and improved esthetics. mandible, alter the occlusion, and indirectly affect the maxilla, with Conclusions the resultant development or worsening of dentofacial deformities, Management of Craniofacial fibrous dysplasia is very complex and such as mandibular prognathism; unilateral enlargement of the con- requires multidisciplinary approach. These innovative techniques dyle, neck, ramus, and body; facial asymmetry; malocclusion; and which are evolving helps the patient and the surgeon to deal with the entity in a better way.

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Section: Cleft Lip and Palate screw at the site of osteotomy cuts (junction between transport and anchorage segments: unilateral/bilateral) 6. Separately acrylize transport and anchorage units 7. Attach lingual guiding wire to lingual brackets and tubes 8. Cement appliance at the surgical table after EPS00100 giving osteotomy cuts 9. Wait during the latent period (5to 7 days) 10. Intrauterine Cleft Repair: Step toward Perfection Activate the screw with a half a turn twice a day until the transport segments dock 11. Stabilize the transport segments docking together Dr. Ramdas Balakrishna, Dr. Megha Sahu (by means of a wire joining the segments) to allow the regeneration of tissues at the site of distraction.) Results K.L.E Societies and Institute of Dental Sciences, Bangalore The tooth-borne trifocal distraction appliance was successful in the controlled closure of a large alveolar cleft with minimal invasiveness Abstract and low costs making this procedure feasible for a greater number of Background/Introduction patients. Fetal cleft repair is an attractive option for the reconstructive surgeon Conclusions considering the advantages of scar less wound healing. An endoscopic The hyrax expansion screw used as a distractor could bring about approach would eliminate exposure of the fetus to the outside envi- controlled bony transport with the desired directional vectors. Its ronment & reduce the risk of a major operation for the mother. exclusive tooth-borne usage minimizes the invasiveness of the pro- Objectives cedure, and the simplicity of the appliance eliminates the need for Review literature of Intrauterine Cleft Repair. costly distractors, making such therapy feasible for a greater number Methods of patients. Thus the HYDIS-TB can be used successfully for the Literature search and review including online published articles. controlled closure of large alveolar clefts. (Pubmed search) Results This revolutionary technique is still in its own fetal stage and requires further development and research for incorporation in future man- EPS00256 agement of cleft lip and palate in humans. Tissue Engineering in Cleft Palate Conclusions Numerous studies performed on animal models are an evidence to potential benefits of foetal surgery for cleft repairs. But its role in non- Dr. Padma E, Junior Resident life threatening malformation is restricted based on lack of feasibility and risk to benefit ratio of intrauterine intervention. Yet their appli- Govt. Dental College Calicut cation in human still awaits ethical & technical clearance. Abstract Background/Introduction EPS00255 Cleft lip with or without cleft palate is the most prevalent congenital craniofacial birth defect in humans, observed in approximately 1 in 700 A Novel Minimally Invasive Technique of Using Tooth- live births. Individuals with clefts of the lip, palate, or alveolus often Borne Hyrax Expansion Screw for Distraction require interdisciplinary treatment into adulthood. The complexity of Osteogenesis of Large Alveolar Cleft Defects (HYDIS- the tissues and structures involved in cleft palates pose a significant TB) challenge to the treating surgeon. A multitude of surgical techniques have been described to repair clefts of the lip, palate, or alveolus, Bone grafting is carried out to consolidate the dental arch correlated with the Dr. Sujata Mohanty; Dr. Anjali Verma stage of canine development the surgical repair of cleft palates is not without consequence. The disturbance of facial growth in multiple Head of Department, Maulana Azad Institute of Dental Sciences; dimensions is often the result of cleft palate surgery. Donor site mor- Post-graduate Student, Maulana Azad Institute of Dental Sciences bidity after bone graft harvest remains a recognized limitation in the reconstruction of the cleft primary palate. The field of tissue engi- Abstract neering aims to restore function to or replace damaged or diseased Background/Introduction tissues through the application of engineering and biologic principles. Restoration of alveolar cleft defects is both essential and challenging Intended outcome of an implanted tissue engineered construct is a new for the craniofacial team. Bone in maxillary cleft cases is needed to tissue that is structurally and functionally integrated into the sur- obtain arch continuity, provide bone support for the dentition, stabi- rounding host tissue. Hence tissue engineering approach for the grafting lize the maxillary segments, eliminate oronasal fistulae, optimize of the alveolus or soft tissues in the palate may be an useful alternative. nasal morphology by the nasal alar cartilage support, and complete Objectives placement of the implant. To give a brief idea on the the application of tissue engineering Objectives strategies with an emphasis on soft tissue regeneration and alveolar Because of the high failure rates, large alveolar cleft defects cannot be bone regeneration. successfully closed with bone grafting. To overcome these limita- Methods tions, a completely tooth-borne trifocal distraction appliance was Article search. devised and placed after osteotomy in a 19-year-old repaired cleft Results patient who had a 12-mm alveolar defect on the left side. Current approaches for the treatment of clefts of the lip and palate Methods include surgery and bone grafts; however, there are limitations 1. Identify large cleft defect 2. Identify the transport segments (the associated with these therapies. Tissue engineering strategies, par- number of dental units to be included adjacent to the defect) 3. Form ticularly alveolar bone engineering and soft tissue engineering, may the anchorage unit (posteriors) 4. Reinforce anchorage 5. Place hyrax provide clinicians with new alternatives. The application of these

123 S114 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 emerging technologies to a pediatric population must be well technique have been tried to reduce the protruding premaxillary considered. segment. Currently two competing philosophies have evolved: sur- Conclusions gical correction involving lip adhesion as first procedure followed by A tissue engineering approach may be a useful alternative for the definitive lip repair. Versus surgical correction in conjunction with treatment of cleft palates as it mitigates the concerns of donor site presurgical moulding of the cleft segments into a more normal ana- morbidity as well as provides additional options including scaffold tomic relationship. This study is an attempt to analyze the results of implantation and growth factor delivery. lip adhesion versus Nasoalveolar Molding procedure performed on bilateral cleft lip, alveolus and palate patients with varying degrees of prolabium and premaxilla protrusion. EPS00381 Objectives Pre-operative and Post-operative Assessment The objective of this study is to assesses the outcome of the lip adhesion versus nasoalveolar molding in patient with bilateral cleft of Auditory Defects in Cleft Lip and Palate Patients lip, alveolus and palate. Methods Dr. Priyanka (Post Graduate Student), Dr. Sahana. BA, MDS A prospective study was conducted on 20 infants with bilateral cleft (Associate Professor), Dr. Anil Kumar Desai, MDS (Professor) lip, alveolus and palate. This infants were divided into 2 groups- Nasoalveolar molding group and lip adhesion group. Pretreatment and SDM College of Dental Sciences and Hospital post treatment clinical, cast and photographic and anthropometric measurements of the individual of lip adhesion were compared with that of the nasoalveolar moulding groups. Abstract Results Background/Introduction A significant decrease in premaxillary protrusion was noted in Individuals with cleft lip and palate often demonstrate multiple Nasoalveolar molding group (9.5mm mean) when compared to problems with auditory defects a well-known complication but the 4.5mm mean for the lip adhesion group. Marginal difference noted in magnitude which is not generally appreciated in Indian population reduction of the cleft width bilaterally in both the groups. A 52 % and accounts for about 97%. reduction in cleft width was noted in post Nasoalveolar molding Objectives group where as lip adhesion group shows reduction of 43.5 %. Effect To assess auditory defects in patients with cleft lip and palate fol- of post Nasoalveolar molding on the nose was noted with the nasal tip lowing cleft repair. projection of 2.27mm when compared to 0.8mm of lip adhesion Methods group. Cleft lip and palate patients between 1 year to 7 years of age who Conclusions reported to us between July 2016 to August 2017 were assessed for We can conclude that both methods has its advantages and disad- audiometric defects which included impacted wax, discharge, vantages which has to tailored and used according to the need of the retraction pockets, tympanic membrane perforation, congestion etc patient. pre-operatively and post-operatively at 6 and 12 months. Results Out of 50 patients 30 were found to have significant otoscopic changes like serous otitis media(11 ears), retraction pockets(32 ears), ABS00579 impacted wax(48 ears), bulging of tympanic membrane with Secondary Alveolar Bone Grafting-Challenging cartwheeling of vessels(1 ear), congestion(5 ears), discharge(10 ears) which was seen to improve post palatal repair. the Challenge Conclusions Continuous follow up, with early diagnosis and treatment, will Dr. Akanshya, Post Graduate-Oral & Maxillofacial Surgery; Dr. improve hearing and speech functions and social development of cleft Pravesh Mehra, Prof & HOD-Oral & Maxillofacial Surgery patients in general. Dept of Dental & Oral Surgery, Lady Hardinge Medical College, New Delhi; Dept of Dental & Oral Surgery, Lady Hardinge Medicl EPS00543 College, New Delhi Lip Adhesion Versus Nasoalveolar Molding in Bilateral Cleft Lip Palate Surgery Abstract Background/Introduction Secondary alveolar bone grafting is a routine procedure for patients Dr. Teertha Sadashiv Shetty; Co-Authors: Dr. Anil Kumar Desai ; Dr. with cleft lip and palate for the correction of their residual deformity. Niranjan Kumar, Ms Mch (Plastic Surgery), Frcs Medical Director Since its description, it has become the accepted method for aligning and uniting the maxillary segments and providing space for the Dept. of Oral and Maxillofacial Surgery, S.D.M College of Dental eruption of maxillary canines and thus rehabilitating the patient. In Sciences & Hospital, Sattur Road Dharwad-580009; Dept. of Oral the past century, many procedures have been described for the cor- and Maxillofacial Surgery, S.D.M College of Dental Sciences & rection of the residual deformity. A careful assessment of the defect Hospital, Sattur Road Dharwad-580009; Department of Sdm and hence weighing all treatment options plays an important role in Craniofacial Unit, Sdm College of Medical Sciences and Hospital, adequate treatment planning for a patient needing surgical correction Sattur Road Dharwad-580009 of the defect. Objectives Abstract primary objective - to achieve maxillary arch continuity and correc- Background/Introduction tion of secondary deformity secondary objective - insight into careful The repair of bilateral cleft lip palate deformities continues to be one treatment planning and review of literature. of the most challenging areas of the reconstructive surgery. Various

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Methods EPS00675 A 15 year-old male having a complex residual deformity after mul- Assessing the Efficacy of Sphenopalatine Ganglion tiple surgeries for the correction of cleft lip and palate was treated for the alveolar bone defect with iliac crest bone graft after volumetric Block (SPGB) as an Adjuvant to General Anesthesia assessment of the defect and reviewing the literature for all available in Patients Undergoing Primary Palatoplasty treatment options and hence choosing the best available option. Results Dr. P. Anantanarayanan, MDS; Dr. V. G. Muruganand The surgical procedure resulted in maxillary arch continuity, optimal reconstruction and elimination of the oronasal fistulae. Also better MDS; Meenakshi Ammal Dental College esthetics were achieved after lip revision. Conclusions We present a report regarding a case of alveolar bone grafting, the Abstract challenges it threw at us and how we challenged the challenges. Background/Introduction Cleft lip and palate is the second most common congenital anomaly. Clefts of palate can be classified as complete if it involves both hard & soft palate, and incomplete when it involves only the soft palate. EPS00608 Numerous techniques have been described for surgical correction of Analysis of Airflow Dynamics in Pre and Post Cleft cleft palate and always require general anesthesia. The physical well- being and pain management postoperatively is a major area of focus Septo-Rhinoplasty Procedure Using Computational and research. The concept of Pre-emptive analgesia works by Fluid Dynamics antagonizing the nociceptive signals before injury. This study was designed to evaluate anesthetic, analgesic effect of bilateral SPGB Dr. R. Manikandhan, Dr. Priyanga R. combined with GA during primary palatoplasty procedure. Objectives Abstract Intra-operative assessment of vitals, blood loss and pain • Evaluation Background/Introduction of postoperative pain score. The human nasal airways constitute one of the most complex airflow Methods:Prospective trial, patients with complete cleft palate, planned domains in nature due to the complex internal geometry. Though the for primary palatoplasty were randomly divided into study & control nasal and septal anatomy can be studied clinically and imaging the groups. Intra operatively study group received bilateral SPGB with airflow is always not actually analyzed to know the flow pattern. To 0.75%Ropivacaine in addition to GA. Intraoperatively vitals, usage of obtain detailed calculations of flow in the naso-pharyngeal airway of a additional drugs, blood loss measured. Surgical field assessed using patient, a computational fluid dynamics model can be constructed fromme’s ordinal scale. Postoperatively pain, Hbgms% PCV values using raw data from computed tomogram (CT) images of unilateral assessed. Painfree duration, rescue analgesic used were recorded. cleft patients with deviated nasal septum. Pre and post computed Results tomograms (CT) are compared following conventional or endoscopic Statistically significant decrease in mean blood loss, postoperative Septo-Rhinoplasty procedure. pain score & the number of rescue analgesics required in study group Objectives as compared to control group. Additionally gives hemodynamic sta- To analyze the airflow dynamics of stress, pressure, temperature and bility and better surgical field in study group. velocity in unilateral cleft patients with deviated nasal septum using Conclusions computational fluid dynamics following Septo-Rhinoplasty Administration of 0.75%Ropivacaine as pre-emptive analgesic offers procedure. excellent hemodynamic stability, optimal working conditions, peri- Methods operative pain relief and smooth recovery. In unilateral cleft lip and palate patients either closed or open rhinoplasties are performed. CT scans are done to study the computational fluid dynamics of airflow in a span of 1 week to 1 month ABS00678 postoperatively. Reconstruction of Secondary Alveolar Cleft (Very Late Results Favorable airflow pattern is seen in patients with nasal obstruction Secondary Osteoplasty) with Iliac Graft and Protein and altered nasal morphology following Septo-Rhinoplasty. Rich Fibrin-A Case Report Conclusions Analysis of airflow pattern using computational fluid dynamics will 1. Dr. Divya James, 2, Prof. Dr. M. R. Muthusekhar help us analyze whether the surgery performed was appropriate and successful for that patient functionally and also help us to plan where exactly the maximum flow stress happens in air flow which we cannot 1. Saveetha Dental College and Hospital 2, Head of Department, see by any other means of imaging techniques. Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital

Abstract Background/Introduction Cleft of the palate and lip have intrigued the clinician for a very long time. Commonest congenital anomaly to affect the orofacial region and since the time of Veau (1931), and at various times efforts have been made to classify and repair these anomalies. Conﬂicting claims have been made with regard to success and time of surgery in this area. Prominent among these have been the studies of Bohn, Bjork and Skieller, Waite and Kersten and Boyne and Sands. The ilium

123 S116 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 bone is used most commonly as it is easy to access and large amount Objectives of bone can be obtained from the area. correction of vertical alar discrepancy in cleft patient. Objectives Methods 1. To restore function and form by stabilizing the maxillary segments A full thickness incision in the alar crease extending caudally to the to form a continuous arch form. 2. For provision of an osseous soft triangle and an alar base incision placed within the alar sulcus, environment which is responsive to orthodontic movement of teeth. 3. and flaf can be moved in a caudocephalad direction. For prosthodontic rehabilitation. Results Methods Alar discrepancy was corrected satisfactory in this case with good In this case, very late secondary alveolar cleft grafting were carried cosmetic outcome. out using iliac crest corticocancellous bone graft and protein rich Conclusions fibrin. Radiographic bone fill was checked post - operatively. In this procedure vertical alar discrepancy can be corrected with Results satisfactory aesthetic outcome. The case performed in the very late age group showed excellent results, clinically, with complete closure of the cleft defect and achievement of continuity of the dental arches. Good bone fill was visualized radiographically also. EPS00811 Conclusions Primary Palatoplasty: The Efficacy of Prophylactic Specific timing for undertaking alveolar cleft repair may not be all Antibiotics and Betadine Mouthwash in Preventing that crucial for a successful alveolar cleft grafting procedure. Postoperative Infections

EPS00761 Sankarsan Choudhury; Dr. B. R. Ambedkar Tongue Flap Used in Closure of Oraonasal Fistula, A Case Report Mediland Hospital & Research Centre Sonali Ghai; Institute of Dental Sciences & Hospital Dr. Sahil Kamble Background/Introduction: There are different protocols regarding the use of prophylactic antimicrobial agents in cleft palate surgery. Y.M.T. Dental College Objectives To determine the efficacy of a prophylactic antibiotic compared with Abstract a placebo in reducing postoperative infections in cleft palate surgery. Background/Introduction Methods Tongue flaps were used for intra oral reconstruction, by lexer in 1904, 20 surgical patients were randomly assigned to two groups (group 1: 5 in the field of oncology for reconstruction. Tongue flaps are used in a ml of betadine five minutes preoperatively. group 2: 30mg/kg body number of surgeries but their use in cleft lip and palate is unique weight amoxicillin parentally half hour preoperatively). Postoperative because it provides excellent vasculature and the large amount of complications (surgical site dehiscence) were assessed one month tissue they provide. Hence tongue flaps are ideal for the repair of large postoperatively. fistulas in palate scarred from previous damage. Despite the improved Results techniques of repair of cleft palate, fistula occurence is still a possi- No statistically significant difference in surgical wound dehisence was bility either due to an error in surgical technique or due to the poor found between the two groups. tissue quality of the patient. A similar case was presented at the Conclusions department of oral and maxillofacial surgery, YMT dental college on Amoxicillin and betadine prophylaxis are equally effective in a, 19 year old patient who was suffering from cleft lip and palate. And reducing postoperative infections in cleft surgery. Hence, antibiotic was treated for the same using a toungue flap. prophylaxis is not indicated for routine administration in otherwise healthy patients for such procedures.

EPS00792 Section: Orthognathic Surgery Correction of Vertical Alar Discrepancy in Cleft Patient: A Case Report EPS0074 Dr. Koustabh Kumar ‘‘Genioplasty‘‘……. Is it Miracle……?? Krishnadevaraya College of Dental Sciences Dr. Nupur Jain Abstract Background/Introduction RCDSR Alar asymmetry could be caused by disharmony of the vertical or the horizontal planes. If the alar asymmetry is attributable only to hori- Abstract zontal plane disharmony, it is relatively easy to correct using general Background/Introduction alar base surgery. However, if alar asymmetry is combination of The chin (mentum) is vital to the human facial morphology as it horizontal plane disharmony and vertical retraction, the simple alar contributes to the facial aesthetics and harmony both on frontal and base surgery will not be sufficient. In this method a flap is designed to lateral views. Osseous genioplasty, the alteration of the chin through produce total alar movement, including the alar base for correction of skeletal modification, can lead to significant enhancement of the vertical alar discrepancy. overall facial profile.

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Objectives EPS00143 1. To correct the facial aesthetics. 2. To correct the craniofacial ‘‘BAD SPLITS’’ in Bilateral Sagittal Split Osteotomy deformities. Methods Sliding Genioplasty and advancement procedure. Dr. Shahir Mansuri Results We achieved good results from Genioplasty procedure in Post TMJ Karnavati School of Dentistry, Gandhinagar, Gujarat ankylosis patient and patient with facial deformities. The facial aesthetics is very good after the procedure. Abstract Conclusions Background/Introduction The osseous genioplasty should play an important part in the arma- Segmenting the mandible in an orthognathic procedure to reposition mentarium of the aesthetic surgeon as well as the craniofacial and the toothbearing part is generally known as a bilateral sagittal split maxillofacial surgeon. It is a reliable procedure with predictable bone osteotomy (BSSO). Historically, different ways of splitting the to soft tissue responses. It allow the chin to be mobilised in all 3 mandible have been advocated.the Trauner and Obwegeser technique dimensions with predictable soft/hard tissue changes in order to (1955), the Dal Pont modification (1961), and the Hunsuck modifi- enhance the appearance of the patients, cation (1968) are the widely documented. Objectives The aim of this poster is to review unfavourable split pattern types reported in the literature, and to present appropriate salvage proce- EPS0078 dures to manage the different types of undesired fracture. the Role of 3 D Printed Surgical Splints in Orthognathic Methods Surgery A literature review for the period 1971– 2015 revealed a total of 458 cases of bad splits among 19,527 sagittal ramus osteotomies performed in 10,271 patients (i.e., 2.3% of sagittal splits reported) After Dr. Manjusha, M., Dr. Ritesh Rajan, Dr. Abhinand. P the primary screening process, the eligibility criteria were met by a total of 33 reports. Svs Institute of Dental Sciences, Mahabubnagar, Telangana Results It appears that in most cases, bad splits can be repaired with additional Abstract osteosynthesis measures without having a negative influence on the Background/Introduction postoperative course or end results. Accurate treatment planning and meticulous execution of the plan is Conclusions an important aspect of orthognathic surgery if optimum aesthetic and With surgeon’s experience and additional osteosynthesis bad splits occlusal results are to be obtained. The advent of 3D imaging and can be repaired with good out come and esthetics. printing technology have undermined the role of conventional acrylic splints made in the laboratory in orthognathic surgery owing to its superior accuracy and ease of preparation. Objectives EPS00206 The poster will highlight the role of tridimensional surgical splints Mandibular Advancement Using Bsso-A Case Report fabricated using virtual surgical planning software and the outcome of the surgeries performed with these splints. Dr. S. Ravi Raja Kumar M.D.S Professor and Hod [Author] Methods A retrospective analysis was carried out in a group of patients who underwent orthognathic surgery at our institute using a virtual sur- St. Joseph Dental College gical planning model and prefabricated 3 dimensional splint. The duration of surgery, the surgical outcome, the cost of manufacturing Abstract the splints were assessed and compared with that of conventional Background/Introduction acrylic splints fabricated in the laboratory. Orthognathic surgery involves the surgical correction of components Results of facial skeleton to restore proper anatomical and functional rela- The results of the study will be presented as per the defined protocol. tionships in patients with dentofacial skeletal abnormalities. An Conclusions important component of orthognathic surgery is BILATERAL The 3D splints have helped immensely in increasing the accuracy of SAGITTAL SPLIT OSTEOTOMY, most commonly preferred surgical outcome in orthognathic surgery by helping in replicating the indispensable surgical procedure for correction of mandibular treatment plan made more precisely. The greatest disadvantage with deformities. the 3D splints is its cost effectiveness compared to conventional Objectives splints. To achieve functional occlusion, aesthetics, dental stability and improve psycho social impairments. Methods A 40 year old male patient referred to the department of oral and maxillofacial surgery from department of orthodontics for the correction of malocclusion and backwardly placed lower jaw. After thorough clinical, cephalometric and model analysis the case was diagnosed as Angles class II malocclusion with retrognathic mandible. As a treatment modality a bilateral sagittal split advancement osteotomy was carried out through intraoral vestibular incision and the mucoperiosteal flap was raised. Inferior alveolar neurovascular bundle was identified at lingula. Medial horizontal osteotomy cut was

123 S118 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 made with a bur, just above the lingula and extended along external respectively; and 512 of 518 patients (98.8%) showed improvement. oblique line towards molar region and making vertical cut through the Rates of surgical success and cure were 389 (85.5%) and 175 lower border. Osteotomy of mandible was performed using osteotome (38.5%), respectively, among 455 patients with apnoea hypopnea preventing injury to neurovascular bundle. Procedure is repeated on index data and 44 (64.7%) and 13 (19.1%), respectively, among 68 opposite side. After 7 mm advancement planned occlusion was patients with respiratory disturbance index data. Preoperative apnoea established using thin interocclusal acrylic splint, After confirming hypopnea index of fewer than 60 events/hr was the factor most the position of both proximal and distal segments stainless steel mini strongly associated with the highest incidence of surgical cure. plates were used for fixation [2.5 mm x 6 hole]. Closure is done using Nevertheless, patients with a preoperative apnoea hypopnea index of 3-0 vicryl. more than 60 events/h experienced large and substantial net Results improvements despite modest surgical cure rates. Post-operative results were satisfactory with good occlusion and Conclusions esthetics and no associated complications encountered in post-oper- Maxillomandibular advancement is an effective treatment for ative phase. obstructive sleep apnoea. Most patients with high residual apnea Conclusions hypopnea index and respiratory dietress index after other unsuccessful Mandibular ramus sagittal split osteotomy is the most popular pro- surgical procedures for obstructive sleep apnea are likely to benefit cedure for repositioning mandible. Compared with other techniques from maxillomandibular advancement. such as vertical ramus osteotomy or inverted L osteotomy, sagittal split osteotomy provides better bony interface to supplement healing and allows easier adaptation of rigid fixation. EPS00262 The Effect of Tranexamic Acid on the Amount of Blood EPS00237 Loss During Lefort I, Anterior Maxillary Osteotomy and Genioplasty-A Prospective Study Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea Dr. Bright E. C.

Dr. Vidhya V Mar Baselios Dental College

Government Dental College Kottayam Abstract Background/Introduction Abstract Orthognathic Surgery is a well established method to correct various Background/Introduction forms of dentofacial deformity. As the orofacial region is very vas- Maxillomandibular advancement (MMA) is an invasive yet poten- cular, significant blood loss can occur and a subsequent need for tially effective surgical option in the treatment of obstructive sleep blood transfusion is often encountered. apnea (OSA) for patients who have difficulty tolerating continuous Objectives positive airway pressure and whose OSA has been refractory to other The aim of this study was to assess the effect of a single intravenous surgical modalities. Maxillomandibular advancement achieves preoperative dose of tranexamic acid on blood loss during Lefort I, enlargement of the nasopharyngeal, retropalatal, and hypopharyngeal Anterior Maxillary Osteotomy and Genioplasty under hypotensive airway by physically expanding the facial skeletal framework via Le anesthesia. Fort I maxillary and sagittal split mandibular osteotomies. Methods Advancements of the maxilla and mandible increase tension on the A prospective study was conducted consisting of 20 subjects sched- pharyngeal soft tissue, thereby enlarging the medial-lateral and uled for Lefort I, Anterior Maxillary Osteotomy and Genioplasty. anteroposterior dimensions of the upper airway. Amount of intra operative blood loss in 10 patients receiving Objectives tranexamic acid(study group) one hour before the procedure was To identify criteria associated with surgical outcomes of maxillo- estimated and compared with 10 patients not recieving tranexamic mandibular advancement using aggregated individual patient data acid(control group) for the same procedure. Estimation of blood loss from multiple studies. was calculated by Volumetric method and Gravimetric method. Need Methods for blood transfusion, operating time and pre and post operative Hb We systematically reviewed the articles from Pubmed, Cochrane and PCV were also measured. Library, Scopus, Web of Science, and MEDLINE from June 1, 2014, Results to March 16, 2015, using the Medical Subject Heading keywords Blood loss in study group was 284 ? 19 ml which is significantly maxillomandibular advancement, orthognathic surgery, maxillary lower than the blood loss in control group which was 468.5 ? 122.3 osteotomy, mandibular advancement, sleep apnea, surgical, surgery, ml. Time taken for surgery in study group(116 minutes) was signif- sleep apnea syndrome, and obstructive sleep apnea. Data were pooled icantly lower than that of control group(161.5 minutes). using a random-effects model and analyzed from July 1, 2014, to Conclusions September 23, 2015. The present study showed that single preoperative intravenous dose of Results tranexamic acid (10mg/kg) significantly reduced the blood loss in Forty-five studies with individual data from 518 unique patients/in- study group compared with control group. The operation time and the terventions were included. Among patients for whom data were need for blood transfusion was also significantly reduced in study available, 197 of 268 (73.5%) had undergone prior surgery for OSA. group compared with control group. Mean (SD) postoperative changes in the AHI and RDI after MMA were -47.8 (25.0) and -44.4 (33.0), respectively; mean (SE) reductions of AHI and RDI outcomes were 80.1%(1.8%) and 64.6%(4.0%),

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EPS00264 Instruments used, Extent of lateral bone cut (1) Patient based: Age of Transverse Displacement of Proximal Segments the patient, Presence of an impacted third molar, Mandibular anatomy- form of the mandible, height of the ramus, position of in Bilateral Sagittal Split Osteotomy-A Prospective mandibular canal, fusion of cortical plates, ramal occlusal angle (1) Study Results It was observed that the inexperience of the operator, wrong choice of Josepaul C. I. instruments, a longer lingual cut were major operator based factors which resulted in a bad split. On the other hand an age of more than 25 years, an impacted third molar, a longer and thicker ramus, fused Mar Baselios Dental College cortical plates and an obtuse angle between ramal-occlusal plane angle proved to be predictive for a bad split. Abstract Conclusions Background/Introduction This study showed that there are many operator and patient related Changes in various planes after BSSO setback had been studied by factors which predilicts for a bad split in BSSO, these factors need to various researchers. Here it is an attempt to evaluate the changes be looked into in detail in order to avoid its incidence. occurring in the transverse plane after BSSO setback and fixation with monocortical miniplates and screws. Objectives To evaluate 1. Change in intergonial width. 2. Change in interramal EPS00319 width 3. Change in condylar angulation. 4. Relationship between Orthoprint-A Virtual Reality amount of setback and transverse changes. Methods Prospective study of 15 patients who underwent BSSO setback. PA Dr. Sagar Joshi, Dr. Kalyani Bhate from Dr. D.Y. Patil cephalograms at three time periods were taken. 1. Preoperative 2. Immediate postoperative. 3. 6 month postoperative. Setback is mea- Dental College and Hospital, Pimpri sured using pre and post operative Lateral cephalograms. Results Abstract 1. Intergonial width increased after surgery but reduced further. 2. No Background/Introduction statistical evidence in the interramal width. 3. No statistical signifi- The orthognathic surgery is the standard treatment for the correction cance in the amount of setback and transverse changes. of dentofacial deformities, in order to get a stable dental occlusion Conclusions and facial harmony. The advancement of technology and the evolu- Intergonial width show a definite increase after the surgery but tion of the concepts involved in the diagnosis and treatment plan in reduced further on due to gonial remodelling. No statistical correla- this area have been immeasurable, leading to the development of new tion could be identified between amount of setback and transverse methods. One such advancement is computer-aided jaw surgery changes. system by a three-dimensional (3D) virtual surgical planning. Objectives to highlight uses of orthoprint in pre-surgical planning in orthognathic surgery. EPS00302 Methods:.stepwise method- 1. image acqusition 2. processing of ‘‘Reasons Behind Bad Splits in Bsso: Contemplating acquired images 3. 3 D virtual diagnosis 4.3-D virtual treatment With Evidence ‘‘ planning of orthognathic surgery 5. 3-D virtual treatment planning communication 6. Splint fabrication 7. 3-D virtual treatment planning transfer to operating room. Dr. Subhabrata Ghosh Results It is a very useful tool in pre-surgical planning of orthognathic Bapuji Dental College & Hospital surgery. Conclusions Abstract With all possible details, the orthoprint provides greater predictabil- Background/Introduction ity, practicality and precision in surgical planning. One of the common operative complications during BSSO is a BAD SPLIT, which is an undesirable fracture of mandible at the proximal or distal fragment. A bad split can lead to infection, bony sequestration of fragments, delayed bone healing, post operative instability, EPS00326 relapse etc. Thus the risk factors for a bad split needs to be Combination of Anterior Maxillary Osteotomy contemplated. and Anterior Mandibular Subapical Osteotomy-A Case Objectives To observe the incidence of bad splits as against anatomic variations Report to evaluate the post surgical bone splits in standard operating procedure of BSSO. Dr. Bitan Bhowmic Methods A retrospective study was designed and the sample was derived from Sree Balaji Dental College and Hospital the patients who had to undergo bilateral sagittal split osteotomy (BSSO). CBCT scans were done preoperatively and postoperatively. Abstract The patients where a bad or unfavourable split was observed were Background/Introduction included in the study. The following factors were studied in them: Maxillary excess can be either anterior or complete. Both show Operator based: Experience of the operator, Technique used, excessive gummy smile with increased over jet and deep overbite. In

123 S120 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 the anterior maxillary excess there is labial inclination of the maxil- EPS00422 lary anterior teeth and convexity in the facial profile which is limited Bilateral Sagittal Split Osteotomy VS Distraction to the upper lip region. Whereas in the complete maxillary excess in addition to above there is convexity of the inferior orbital rims and Osteogenesis for Deficient Mandible nose also. The first report of an anterior segmental maxillary osteotomy (AMO) was published by Cohn Stock in 1921. This clinical case AECS Maaruthi presents report of orthodontic treatment combined with Anterior maxillary osteotomy and Anterior mandibular subapical osteotomy College of Dental Sciences for improving the skeletal, dental, soft tissue and over all aesthetics of a 19 year old female patient. Abstract Objectives Background/Introduction Treatment objectives were to improve the positioning of the anterior bilateral sagittal split osteotomy and distraction osteogensesis are the maxilla with a reduction in the gingival exposure, to achieve an ideal most common techniques currently applied to surgically correct overjet, overbite, to correct lip incompetency and achieve an aesthetic mandibular retrognathia. profile. The maxillary excess was limited to anterior maxillary region. Objectives Methods To compare the outcomes, advantages and disadvantages of distrac- As the patient was 19years, a combined orthodontic and surgical tion osteogenesis and bilateral sagittal split osteogenesis. mode of treatment was planned. It was decided to do extract the first Methods premoalrs and followed by AMO to position anterior maxilla poste- patient with bilaterall sagittal split osteotomy- a medial osteotomy, riorly by 5 mm and superiorly by 3mm. In the mandibular arch it was sagittal osteotomy, vestibular osteotomy done with bicortical screws planned to correct crowding, molar relation, curve of spee and pro- or plate and monocotical screws is used. patient with distraction clination via extraction of the mandibular first premolars. Retraction osteogenesis - osteotomy placed in anterior or superior to mandibular of lower anteriors was planeed to create sufficient over jet to facilitate angle and lingual aspect of mandible, distraction device placement surgical correction.the patient was informed and consent was taken and screw fixation is done. for the procedure. Results Results Bilateral Sagittal Split Osteotomy give accurate lengthening and There was improvement in facial esthetics with improved lip com- lesser time consuming. Distraction Osteogenesis accurate lenghthen- petency, decreased gingival exposure on smile and rest. The patient ing and decrease potential for relapse. was very satisfied with the results of treatment. The excessive vertical Conclusions dysplasia was dramatically reduced, and most of the cephalometric both bilateral sagittal split osteotomy and distraction osteogenesis can values were brought into the normal range. be considered for lengthening of the retrognathic mandible. Conclusions Through the combined approach by orthodontist and oral surgeon, the patient had a dramatic skeletal, dental, and occlusal improvement. This case illustrates that orthodontic treatment with AMO and EPS00435 Anterior mandibular subapical osteotomy achieved stable, functional, Condylar Remodeling after Orthognathic Surgery and esthetic result. Patient also reported a better self-esteem. The overall treatment time was reduced. and Its Correlation with Condylar Displacement: Review of Literature

EPS00420 Presenting Author: Dr. Supreet Kaur Grover, Co-authors: Dr. Sujeeth Shetty and Dr. Saikrishna D Surgery First Orthognathic Approach JSS Dental College and Hospital Dr. Prasun Kumar Dubey Abstract Armed Forces Medical College Background/Introduction The position of the mandibular condyles to the temporal bone can be Abstract altered via various movements during orthognathic surgery. It can Background/Introduction lead to excessive stress to the articular surfaces causing progressive Conventionally, a patient with skeletal malocclusion is managed by condylar resorption, representing an alteration of shape and volume of preoperative orthodontics, followed by surgery and postoperative the condyle. Thus, in orthognathic surgeries, appropriate condylar orthodontics. It is widely accepted that correction of skeletal dis- position is one of the key factors in achieving postoperative stability. crepancy and surgical repositioning is possible only after removing all Objectives the dental compensations. Surgery-first approach is a new treatment To examine available literature on Condylar remodelling and paradigm for the correction of dentomaxillofacial deformities. In condylar displacement associated with orthognathic surgery and dis- certain patients with precise treatment planning, surgery first has been cuss its effects on mandibular condyle and condylar movement acknowledged to reduce total treatment time significantly and to determining the correlation between them. achieve high levels of patient and orthodontist satisfaction. Methods A systematic review was performed of literature on the Pubmed, Research Gate and Science Direct database from 1980 to 2016 using the following headings: (‘‘orthognathic surgery’’) AND (‘‘condylar resorption’’) AND (‘‘condylar displacement’’).

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Results EPS00468 Review indicated condylar displacements are evident upon sagittal Consideration for Orthognathic Surgery splitting of the rami that can occur medially, posteriorly, superiorly and condylar resorption with respect to the upper and lateral surface for Mandibular Deformities During Growth of condyle. Direction of the condylar translation was backward, upward, laterally and medially. Dr. Sulagna Pal, Dr. Avijit Bharat Conclusions Change in condylar position and condylar remodeling are likely to Bapuji Dental College & Hospital, Davangere occur after all types of orthognathic procedures. Condylar anterior surface resorption was more frequent with posterior, superior and Abstract medial displacements of condyle. Background/Introduction Waiting for growth to end prior to surgical intervention in mandibular disharmonies is unacceptable in presence of clinically severe EPS00451 mandibular prognathism/retrognathism that is psychosocially damaging to young growing patient necessitating early intervention. Evaluation of Esthetic Outcome Following However such early interventions may affect postsurgical growth Orthognathic and Orthomorphic Surgery altering initial surgical benefits resulting in less than ideal outcome. A in Mandibular Asymmetry—A Clinical Study spaced surgical procedure post growth spurt is necessary to maintain the final outcome. Objectives Dr. Neelakamal Hallur, Dr. Aaisha Siddiqua, Dr. Syed Zakaullah, Dr. General outline providing management guidelines for orthognathic Chaitanya Kothari, Dr. Ashwin Shah, Dr. Shereen Fatima, Dr. Juhi surgery in mandibular deformities during growth. Bendigiri, Dr. Meenakshi Kothari Methods Material presented is based on available literature dealing with early Abstract orthognathic intervention visa –a – vie no intervention in mandibular Background/Introduction discrepancies in young age. Orthognathic surgeries alone, often are unable to resolve contour Results defects arising from asymmetric growth. For this reason, in the Majority supports early intervention in carefully selected mandibular management of facial asymmetry, orthomorphic principles of man- discrepancy cases and advocates careful postsurgical monitoring and agement are considered to be an adjunct to orthognathic surgery in requirement of any final surgical procedure that is needed following adults. growth cessation. Objectives Conclusions The aim of study was to evaluate the changes after orthognathic - Paediatric and adolescent patients with mandibular dentofacial orthomorphic surgery in patients. deformities may require early intervention during active growth Methods because of functional and psychosocial impairments. Such treatments In patients with mandibular asymmetries, frontal photographs, P.A should be selected individually and with regard to facial growth Cephalograms, and Lateral cephalograms were taken preoperatively kinetics status and risks of initial outcome relapse requiring secondary and post-operatively. On photographs, the amount of chin deviation procedures after growth phase. were measured by recording angle between mid-sagittal line and line drawn to chin point. P.A cephalometric evaluation was done by measuring the distance of chin deviation from mid-sagittal reference line to menton point in millimetres. Lateral cephalometric evaluation EPS00507 was done in terms of advancement of chin in millimetres by mea- Pharyngeal Airway Changes Secondary to Mandibular suring distance between Gnathion point to Y- axis. Advancement Surgery By Bsso; A-Ct Based Volumetric Results The mean correction in the angle of chin deviation on photographs, Study obtained post treatment was 4.57o with ‘t’ value (-5.6) and ‘P’ value \0.001. The mean correction in the degree of chin deviation obtained Dr. Anantanarayanan, Dr. Dennis is 8.71mm on Postero-Anterior cephalograms. On Lateral cephalograms significant corrections were found with a‘ t’ value -4.36 and ‘P’ Abstract value \0.01. Background/Introduction Conclusions Bilateral sagittal split osteotomy for the correction of mandibular This study embarks upon the significance of correction with respect to growth defects is commonly performed procedure. The tongue, soft hard tissue and esthetics taking place after orthognathic- orthomor- palate, hyoid bone, and related musculature are directly or indirectly phic surgery and it was concluded that in all patients there was attached to the maxilla and mandible; therefore, the dimensions of the significant correction in mandibular asymmetry postoperatively. oral cavity and pharyngeal airway change depending on the direction and magnitude of the mandibular movements. Airway volume and respiratory function are highly relevant to maxillo-facial-surgeries. Advances in CT imaging and 3D technology allow us to calculate the volume and dimensions of the airway pre and post surgery. Objectives 1. Airway volume changes of nasopharynx, oropharynx and hypopharynx. 2. Cross sectional surface area of the airway at the level of CV1, CV2, CV3 & CV4. 3. Linear measurements such as

123 S122 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 anteroposterior and lateral diameter of the most constricted region of In Orthognathic surgery while performing anterior maxillary osteot- the airway at the level of soft palate and tongue. omy there will be alar base flare. To avoid alar base flare we will do Methods alar cinching by placing cinch suture intraorally during surgery. Prospective study done by obtaining pre and post surgical CT data. During orthognathic procedure we intubate through naso tracheal Image processing, plane fixation, airway volume changes calculated intubation to avoid occlusal disharmony while placing cinch suture using MIMICS software. tube may obstruct and mislead our visual prediction of Alar base. So Results to avoid this nasotracheal tube is switched to orally. The total volume of the airway increased postoperatively which was Objectives statistically significant with a P value of 0.045. To introduce and asses efficacy of modified nasal to oral tube switch Conclusions technique for modified Alar cinching to prevent alar flar after This study concluded that mandibular BSSO advancement caused orthognathic and nasal corrective surgery. significant increase in the total volume of the airway. Methods Changes in Alar base width, upper lip length were measured with digital vernier calipers and nasolabial angle(cotg-sn-ls) on lateral cephalogram at 1st 3rd 6th months after surgery.the time taken and EPS00508 ease of tube switch were noted.the data oibtained were tablated and AMO Combined with Subapical Osteotomy-2 Case interpreted using test of significance. Reports Results Study results showed no statistical significant diference in perinasal soft changes among both groups but tube switch appears to be ben- Dr. G.G. Sheela Prakash eficial to prevent alar flare. Conclusions Kamineni Institute of Dental Sciences Modifies alar base cinching was performed effectively in patients with modified tube switch technique it increased positive results in Abstract comparision with non shift, the technique of tube switch used is effect Background/Introduction in prevention of alar flare. Anterior segmental osteotomy has become an established surgical technique to achieve functional occlusion and improve the facial profile in the treatment of maxillary protrusion. Postoperative nasal changes, however, are somewhat unpredictable. EPS00619 Objectives A Digital Analysis of Upper Middle and Lower subapical anterior maxillary segmental osteotomy has been developed Pharyngeal Airway to avoid such unintended nasal changes. Methods A horizontal osteotomy was carried out between the apices of the Addhankisagar Guided By Dr. Anand Vijay anterior teeth and the piriform aperture, maintaining a distance of approximately 2 to 3 mm to the apices. Lateral to both canines, this Sibar Institute of Dental Science horizontal osteotomy was connected with vertical osteotomies carried out along the alveolar socket of the first premolar on the right and left Abstract sides. Background/Introduction Results To see the pharyngeal spaces difference after orthognathic surgery. Significant changes were observed in hard tissue parameters except Objectives the anterior nasal spine. The nasal tip, the alar base, and the lip width Digital difference. remain to have no significant change. The ratio of the upper lip to the Methods maxillary incisor retraction was 0.64:1. Whereas both the nasolabial By CT analysis. angle and the philtrum length were significantly increased, the pro- Results trusion of the upper incisors and the vermilion length presented Showed positive changes. decreased. Conclusions Conclusions A better way for planing surgery. Subapical anterior maxillary segmental osteotomy provides a suitable option in the treatment of maxillary protrusion. It provides improvement of the aesthetic profile without nasal changes. EPS00622 Complications in Orthognathic Surgeries EPS00537 Dr. Naman Khare; Guided by-Dr. Vikram Shetty Modified Nasal to Oral Endotracheal Tube Switch-For Modified Alar Base Cinching After Orthognathic A B Shetty Dental College, Mangalore Surgery Abstract B. Vamshikrishna Guided by Dr. P. Srinivas Chakravarthy, Dr. Background/Introduction M. Sridhar An old surgical adage states, ‘‘if you have not had any complications, you have not performed enough surgeries as yet.’’ the diverse range of Abstract procedures that collectively come under the umbrella of the term Background/Introduction ‘orthognathic surgery’ are widely recognized to be safe, although it

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S123 has been consistently stated that clinicians must expect the unex- experiment led to a significant reduction of the torque forces required pected. Numerous examples of unusual or rare complications of such for the mandibular split. procedures have been published. The purpose of this literature review Conclusions is to gather reported complications of orthognathic surgery, and The literature was reviewed, and the last modifications of the suc- provide a discussion relating to those classified as unusual or rare. cessful traditional splitting procedure are presented narrowly. It Objectives indicates the better the split is preformatted by osteotomies, the less To review current literature on the expected and unexpected com- torque force is needed while splitting, giving more controle, a better plications encountered in orthognathic surgeries. predictability of the lingual fracture and maybe less neurosensory Methods disturbances of the inferior alveolar nerve. A literature review was conducted on various search engines and relevant articles in indexed journals were analyzed. Results It is clear that orthognathic surgery is a safe area of oral and max- EPS00658 illofacial surgery, although it carries a number of rare risks depending Naso-Pharyngeal Airway Changes following Maxillary on the exact techniques used. This review has identified complications Setback and/or Superior Repositioning by Lefort I including all possibilities, from neurological, infective, bony, and Osteotomy—A Volumetric Ct Study haemorrhagic to psychological, anesthetic, and other complications. Conclusions The diverse range of procedures that collectively come under the Dr. P. Anantanarayanan, Dr. Praveen Kumar umbrella term of orthognathic surgery are widely recognized to be safe, although it has been consistently stated that clinicians must Meenakshi Ammal Dental College & Hospital, Chennai remain vigilant to the unexpected complications, which have been discussed here. Abstract Background/Introduction Orthognathic surgery produces changes in the human airway. When EPS00643 the maxilla is superiorly repositioned, there is reduction in airflow & volume of the nasal cavity. The effect of maxillary setback and/or History and Modifications of the Sagittal Ramus Split superior repositioning by Lefort I osteotomy on nasopharyngeal air- Osteotomy way is determined. Objectives Raj Jaiswal To compare the changes in pharyngeal airway and surface area at T0 (Pre-surgical) and T1(Post-surgical) after Lefort I impaction with/ without setback. Abstract Methods Background/Introduction Patients presenting skeletal Class II or Class III malocclusions who The historical development of orthognathic surgery has followed a underwent maxillary and mandibular surgery were enrolled. LeFort I rather stepwise, intermittent course. The first mandibular osteotomy is osteotomy procedure for a setback and/or superior repositioning in considered to be Hullihen’s procedure in 1849 for the correction of a isolation or concomitantly with a mandibular or chin procedure were protruded alveolar mandibular segment. The first osteotomy of the performed in the patients, and rigid fixation done. CT images were whole mandibular body for the correction of prognathism was per- taken before surgery(T0), and 6 months after surgery(T1). formed by Blair in 1897. He was also the first author to present a Results classification of jaw deformities. The operations performed, descri- The post-operative mean volume/surface area of Nasopharynx, and bed, and published by Blair and Angle marked the beginning of the Hypopharynx decreased but the post-operative mean volume/surface development of oral surgery. In 1953, the sagittal split osteotomy area of Oropharynx increased when compared to their respective pre- evolved into a procedure that could be accomplished intraorally, operative mean volume/surface area in both the groups (Lefort I without transfacial approaches and without leaving visible scars. The impaction with/without setback). bilateral sagittal split osteotomy can be considered a milestone in Conclusions surgery in general. Maxillary impaction surgery (Lefort I impaction with/without setback) Objectives has a significant impact on Nasopharyngeal airway dimensions (Sur- Objective is an attempt to isolate the modifications, which marked face area/Volume), which correlates with the nasal airway function. significant advances of bilateral sagittal split osteotomy. Methods The basic design of the sagittal ramus split surgical procedure evolved very quickly. The original operation technique by Obwegeser was ABS00725 shortly after improved by Dal Pont’s modification. The second major Tranexamic Acid Versus Haemocoagulase improvement of the basic technique was added by Hunsuck in 1967. Since then, the technical and biological procedure has been well on Intraoperative Blood Loss During Orthognsthic defined. Resolution of the problems many surgeons encountered has, Surgery however, taken longer. Some of these problems, such as the unfavorable split or the damage of the inferior alveolar nerve, have not Melvin George. A. been satisfactorily resolved. Results Saveetha Dental College and Hospitals Further modifications, with or without the application of new instruments, have been introduced by Epker and Wolford, whose modification was recently elaborated by Bo¨ckmann. The addition of a Abstract fourth osteotomy at the inferior mandibular border in an in vitro Background/Introduction

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Craniofacial region is highly vascularized due to which procedures Conclusions which require osteotomy are associated with significant amount of In comparison with the other types of genioplasty this technique has blood loss. Orthognathic surgery is one such procedure where sig- given quite satisfactory results, which are very much close to the nificant amount of blood loss can be expected. This can be reduced by anticipated preoperative results. various techniques such as hypotensive anesthesia postioning of surgical field above the heart and the use of drugs such as antifibri- nolytic agents and factor V, X activator. Objectives EPS00749 The objective of this study was to compare the intraoperative blood Splint Free Surgically Guided Orthognathic Surgery loss during orthognathic surgery following preoperative intravenous injection of tranexamic acid or haemocoagulase. Dr. G. Jeevan Kumar Methods 15 patients who underwent orthognathic surgery were selected for the Bapuji Dental College and Hospital, Davangere study. Inclusion criteria included healthy patients who required orthognathic surgery who did not have any syndromes, patients who did not have any known allergy to tranexamic acid or haemocoagu- Abstract lase. Exclusion criteria were syndromic patients and patients who had Background/Introduction known adverse reactions to tranexamic acid or haemocoagulase. The repositioning of maxillary and mandibular segments is essential Group 1 consisted of patients who were given IV infusion of 10mg/kg for aesthetic and functional outcomes in orthognathic surgery. With tranexamic acid half hour before the procedure. Group 2 consisted of the giant leap in three-dimensional (3D) computer-aided surgical patients who were given direct IV infusion of 3 IU haemocoagulase simulation (CASS) technology development, surgeons are now able half hour before the procedure. Intraoperative blood loss was mea- to simulate and test various surgical plans in a computer until the best sured by measuring the amount of blood collected in the suction jar possible outcome is achieved. minus the amount of saline used for irrigation and weighing the gauze Objectives used for soaking blood pre and post operatively. The purpose of this study was to evaluate a personalized orthognathic Results surgical guide (POSG) system for bimaxillary surgery without the use The mean blood loss in group 1(tranexamic acid group) was 417 ml of surgical splint. and in group 2 (haemocoagulase group) was 525 ml which was sta- Methods tistically significant p\0.05. Patients in both groups did not require Surgeries are planned with the computer-aided surgical simulation blood transfusion post operatively. method. The POSG System is designed for both maxillary and Conclusions mandibular surgery. Each consisted of cutting guides and three The results of this study show that preoperative IV infusion of dimensionally (3D) printed custom titanium plates to guide the tranexamic acid is better in controlling blood loss compared to pre- osteotomy and repositioning the bony segments without the use of the operative direct IV infusion of haemocoagulase in orthognathic surgical splints. Finally, the outcome evaluation was completed by surgery. comparing planned outcomes with postoperative outcomes. 1 Results All surgical procedures including double-jaw surgeries are completed successfully using POSG system without the use of surgical splint. EPS00741 All the patients achieved good final occlusion without postoperative Ugly Proportions to Beautiful Propositions elastic traction. There was no sign of abnormal bleeding, breakage of the custom plates, or any difficulty in using the POSG system. Conclusions Dr. Padma Priyanka Datla, Dr. Sridhar M The results of the study indicated that POSG system is capable of accurately and effectively transferring the surgical plan without the Abstract use of orthodontic surgical splints. Background/Introduction Asymmetry is an alteration of balance between structures. The face usually presents with a mild degree of asymmetry in majority of the population, which is usually left unperceived. When the degree of EPS00782 disharmony is more severe, the condition is rendered noticeable. This ‘‘Computational Fluid Dynamics Study affects not only the function but also the aesthetics, which in turn has of the Pharyngeal Airway Space Before and After a huge impact on the patient. Overall facial harmony and aesthetics are strongly influenced by the chin. A rare technique is carried out to Mandibular Setback Surgery’’ acquire symmetric and harmonious face in accordance with facial aesthetics. Dr. Vinitha Annavarjula Objectives To evaluate the effectiveness of surgical correction of facial asym- Bapuji Dental College and Hospital metry by a rare technique and assess the final anticipated outcome. Methods Abstract Procedure to reshape and re contour the facial asymmetry was done Background/Introduction using rotational genioplasty. During the procedure a correction of 12 In orthognathic surgery, the bilateral sagittal split osteotomy (BSSO) to 14 mm of the deviation was done along with rotation of the chin. is commonly performed for mandibular setback or advancement. Results Such surgery can improve occlusion, masticatory function, and aes- A harmonious facial contour and a reasonably good anticipated aesthetics by changing the mandibular position. But these surgeries have thetic result was achieved following the use of this technique where their influence in invading the pharyngeal airway space which will the final aesthetic result was quite satisfactory to the patient too. further deteriorate in patients with Obstructive sleep apnoea.

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Objectives and thus may be a reasonable way of treating skeletal mandibular The purpose of this study was to investigate the relationship between prognathism. the pressure drop in the pharyngeal airway space and the minimum Section: Distraction Osteogenesis cross-sectional area of the pharyngeal airway before and after mandibular setback surgery using computational fluid dynamics, in order to prevent iatrogenic obstructive sleep apnoea. Methods EPS00145 Patients with mandibular prognathism underwent bilateral sagittal Transport Distraction Osteogenesis split osteotomy for mandibular setback. Three-dimensional models of the upper airway were reconstructed from preoperative and postop- Irene Ann Shibu erative computed tomography images, and simulations were performed using computational fluid dynamics. Rajarajeswar Dental College and Hospital, Bangalore Results The pharyngeal airway space and the minimum cross-sectional area were calculated and the relationship between them was calculated. In Abstract all cases, minimum cross-sectional area was found at the level of the Background/Introduction velopharynx. After surgery, the pharyngeal airway space increased Transport distraction osteogenesis is a newer and effective method in significantly and the minimum cross-sectional area decreased the reconstruction of bony defects with an advantage of osteogenesis significantly. and histogenesis. It is used for the treatment of long bone defects Conclusions resulting from trauma, oncological resection and other severe con- The results of this study suggest that surgeons should consider genital or acquired deformities. A free segment of bone is gradually bimaxillary orthognathic surgery rather than mandibular setback moved across the osseous defect. After the transport bone reaches the surgery alone, to prevent the development of iatrogenic obstructive other end, compression forces are applied till the transport and target sleep apnoea when correcting a skeletal class III malocclusion. segments are fused. This novel biological transport disc represents an effective non-secondary injury method to enhance new bone formation in non-vascular transport distraction osteogenesis. Objectives EPS00785 1. To discuss the advantages and disadvantages of transport distrac- ‘‘Physiological Positioning’’: A New Strategy tion. 2. To review the current concepts and application of transport for Mandibular Osteotomy by Using Short Lingual distraction in maxillomandibular defects. Methods Osteotomy Without Fixation This is a retrospective analysis of patients who underwent transport distraction for the correction of different defects. After the latency Dr. Varun Kocher period of 10 days, the distraction was initiated at a rate of 0.25–1 mm/day. The distraction period continued until the segment with the Bapuji Dental College and Hospital, Davangere transport disc reached the distal base. The total consolidation periods ranged from 6 to 14 weeks. Results Abstract Transport distraction has good results both esthetically and func- Background/Introduction tionally. Bone resorption remains a critical issue for this Short lingual osteotomy adapted without rigid fixation followed by a reconstruction technique, though blood supply is continuously unique regimen including only one day of MMF called as ‘‘physio- maintained. logical positioning’’ can be used to treat mandibular prognathism. Conclusions Objectives Transport distraction osteogenesis potentially benefits patients with The efficacy of physiological positioning provides good postoperative segmental bony defects following tumor ablation. dental and skeletal stability without causing any symptoms associated with the TMJ or progressive condylar resorption. Methods A total number of 18 patients were included. The positions of SNB, EPS00266 FMA, and Me were measured postoperatively to assess skeletal sta- Determination of Efficacy of Platelet Rich Plasma bility, changes in the angle and perpendicular length of the upper and lower central incisors to assess dental stability. in Accelerating the Mineralization of New Bone Results Following Distraction Results showed that both skeletal and dental stability were excellent. The width to which the jaw could be opened recovered early, and only First Author-Dr. Shobhit Rastogi (Former Postgraduate Student) one showed disorder of the temporomandibular joint. Second Author-Dr. R.S. Neelakandan, Professor &HOD; Conclusions PRESENTER - Dr. Manish Anand (First Year OMFS PG) The technique of physiological positioning by jaw exercise after osteotomy, suggests various advantages, such as lack of serious Meenakshi Ammal Dental College; Dept of OMFS, Meenakshi Ammal complications, reduced operating time and duration of MMF, early Dental College; Meenakshi Ammal Dental College) recovery of jaw movement, and avoidance of symptoms in the TMJ

Abstract Background/Introduction The stages of Distraction Osteogenesis are under the direct control of various growth factors and cytokines produced locally at the distracted site. Modifying growth factor and insulin like growth factor

123 S126 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 have been identified to influence the process of Distraction ABS00320 Osteogenesis. Distraction Osteogenesis in Temporomandibular Joint Objectives To evaluate the efficacy of platelet rich plasma in mineralization Ankylosis process using periodical radiological investigations. To minimize the consolidated phase so that Distractor could be removed at earliest for Dr. Irene Suzette Philip patient compliance. Methods Divyajyothi College of Dental Sciences and Research, Gaziabad Six patients who went reconstruction of continuity defect in maxilla/mandible with transport distraction were selected. The Distraction Abstract regenerate was classified and compared based on the radiographic Background/Introduction classification of distraction regenerate put forth by Cope & Sam- Distraction osteogenesis is a biomechanical process of bone tissue chukov. Ten ml of venous blood was withdrawn from basilic vein of formation where the distraction forces which act between bone seg- right hand and was prepared y centrifuging via 2 step protocol.the ments affect biological potential of bone by forming callus of lower one third Platelet Rich Plasma was injected into the distracted determined length and height. callus. The assessment of PRP on mineralization was illustrated y Objectives serial occlusal radiograph and orthopantomogram. To evaluate the efficacy of distraction osteogenesis in temporo- Results mandibular joint ankylosis. Out of six patients included in this study, the maximum mineraliza- Methods tion after injecting PRP was observed in five patients at two weeks This poster is done by referring 15 articles and textbooks. Distraction and four weeks in other one. The quality of bone formed was 2c. Osteogenesis of the Facial Skeleton - William. H. Bell. International Conclusions Journal of Oral and Maxillofacial Surgery. Orthodontic Waves. PRP has a favorable effect on human osteoblast like cells, initiates Results connective tissue healing and activates macrophages. This study In patients with temporomandibular joint ankylosis, simultaneous gap opens up new perspective to demonstrate the effect of PRP in arthroplasty with distraction osteogenesis is found to be more effec- accelerating the mineralization content of new bone. tive and also helps in correction of severe dentofacial deformity. Apart from bone lengthening it also has secondary effect on lengthening of soft tissue to correct temporomandibular joint ankylosis EPS00287 associated with facial asymmetry or micrognathia, as it reduces the need for second surgery and difficulty in intubation, increases length Distract First and Release Later-Treatment Outcomes of mandible, corrects deformity, thereby resulting in an acceptable facial esthetic and function. It is safe and reliable method of Dr. Pavan Kumar Reddy. E, Dr. Ritesh Rajan treatment. Conclusions Svs Institute of Dental Sciences, Mahabubnagar, Telangana I hereby conclude that distraction osteogenesis has been one of the most innovative concepts in craniomaxillofacial surgery. It is Abstract increasingly used for correction of craniomaxillofacial deformities. It Background/Introduction enables correction of deformities earlier than osteotomy. TMJ ankylosis is a disorder of the joint which occurs secondary to trauma, local or systemic infection, or systemic disease. Surgical techniques in Distraction Osteogenesis have improved substantially in EPS00337 recent years and has become a first option in correction of many Mandibular malformations. Both intraoral and extraoral devices are Transport Distraction Osteogenesis: A Boon being marketed which have their own advantages and disadvantages. in Mandibular Reconstrcution Objectives The poster will highlight the- 1. The effective mandibular lengthening Dr. Harsh K. Desai, Dr. N.N. Andrade achievable by distraction osteogenesis. 2. Benefits of DO prior to TMJ ankylotic release. Nair Hospital Dental College, Mumbai Methods A series of cases treated at our unit with Distraction Osteogenesis preceding TMJ ankylosis release will be presented here. Abstract Results Background/Introduction The results of the cases will be presented accordingly. Oral & Maxillofacial Surgeons are often confronted for the recon- Conclusions struction of resected jaw(s). The approach in jaw reconstruction has The combination of correction of facial deformity using Distraction significantly evolved since the advent of Transport Distraction Osteogenesis as the primary procedure and release of ankylosis as the Osteogenesis. It has an advantage of eliminating donor site morbidity, secondary procedure provides good functional and aesthetic results in being popularized for its potential in growing back native ‘host’ bone. patients with facial deformity due to TMJ ankylosis. Objectives The objective is to discuss the novel and varied applications along with the advantages of Transport DOG in reconstruction of Mandibular defects. Methods 15 patients who underwent any type of resection of the mandible were taken up for reconstruction of the defect using TDOG (monofocal, bi/ tri-focal DOG). Only 2 patients reported with intraoral exposure of

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S127 the transport disc which was managed appropriately. Rest of the EPS00581 patients showed uneventful healing. Facial Asymmetry: Aetiology, Diagnosis and Treatment Results Radiographic studies were done for all patients & USG studies for most of them to assess the consolidation achieved at the distraction Dr. Sheron Mathews site. Conclusions Vydehi Institute of Dental Sciences TDOG can be considered a viable option & holds a promising future in the field of reconstruction of jaw defects. It also dispenses the need Abstract for additional bone grafting except for the minimal bone grafting Background/Introduction required at the docking site. Facial asymmetry is common in humans. Significant facial asymmetry causes both functional as well as aesthetic problems. When patients complain of facial asymmetry, the underlying cause should be investigated. The aetiology includes congenital disorders, acquired EPS00455 diseases, and traumatic and developmental deformities. The causes of Maxillary Advancement by Rigid External Distraction many cases of developmental facial asymmetry are indistinct. and Mandibular Setback by Evro in Adult Cleft Lip Assessment of facial asymmetry consists of a patient history, physical and Palate examination, and medical imaging. Medical imaging is helpful for objective diagnosis and measurement of the asymmetry, as well as for treatment planning. Components of soft tissue, dental and skeletal Arunkumar Shadamarshan R. differences contributing to facial asymmetry are evaluated. Fre- quently dental malocclusion, canting of the occlusal level and midline Armed Forces Medical College shift are found. Management of facial asymmetry first aims at correcting the underlying disorder. Orthognathic surgery is performed for Abstract the treatment of facial asymmetry combined with dental occlusal Background/Introduction problems. A symmetrical facial midline, harmonious facial profile Facial profile correction in patients with cleft lip and palate present and dental occlusion are obtained from treatment. Additional surgical multiple challenging problems for the maxillofacial surgeon. Scarring procedures may be required to increase or reduce the volume of from previous surgeries, often multiple, absence of maxillary and skeletal and soft tissue components on both sides to achieve better alveolar bone, multiple missing teeth pose special problems in max- symmetry. illary advancement. Conventional orthognathic surgeries for Objectives maxillary advancement often results in considerable relapse, less than The aim of this poster is to discuss the various aetiological factors acceptable post-operative result, facial balance and esthetics. diagnostic modalities and to throw some light of the surgical steps Objectives followed in our institution. Evaluation of Rigid External Distraction in maxillary advancement Methods and Mandibular setback by EVRO in Adult Cleft lip and Palate Two cases of facial asymmetry one secondary to hemifacialmicro- patients. somia(34/F) and other secondary to temporomandibular Methods jointankylosis(21/M)underwent distraction osteogenisis of the man- RED for maxillary advancement EVRO for Mandibular setback. dibule unilaterally. Results Results Distraction osteogenesis for maxillary advancement especially using The cutaneous scars produced by the extraoral distraction of the Rigid external distractor device, based on the concept of cranial mandibular pins are always conspicuous and are often hypertrophic. anchorage is an acceptable alternative to conventional orthognathic In the two cases presented here, an intraoral distractor was used to surgery in these patients. The results are further esthetically pleasing avoid this problem, and oblique device placement was applied to when combined with surgical setback of the mandible if indications increase the vertical and horizontal dimensions of the ramus and the exist for the same. body. Conclusions Conclusions This poster depicts a case of Maxillary advancement by Distraction Distraction osteogenesis can shorten the admission and operation osteogenesis using Rigid external distractor device combined with time, the risk of surgery, and the possibility of relapse. Above all, the setback of the mandible by External Vertical Ramus Osteotomy. The direction and amount of bony lengthening can be controlled, and soft Cephalometric changes immediate post-surgery and after 18 months tissue as well as hard tissue can be lengthened.the cutaneous scars of follow up is also presented. produced by the extraoral distraction of mandibular pins are always conspicuous and are often hypertrophic. In the two cases presented here, an intraoral distractor was used to avoid this problem, and oblique device placement was applied to increase the vertical and horizontal dimensions of the ramus and the body. Although more experience and long-term follow-up are needed, it isconcluded that distraction osteogenesiscan be useful for the resolution of facial asymmetry.

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EPS00604 Results Distraction Osteogenesis and Its Role in Post Ankylotic The expansion was achieved by turning the hyrax screw 1 mm per day after the latency period. Treatment was discontinued after achieving Deformity satisfactory over jet and occlusion. Conclusions Dr. Keerthana K. present cases obtained remarkable improvements in the patient’s facial aesthetics and occlusion without disturbing her speech SDM College of Dental Sciences & Hospital, Dharwad, Karnataka, mechanisms. India. [email protected], Ph No. 9886535292

Abstract ABS00717 Background/Introduction Distraction Osteogenesis has evolved in OMFS & gained popularity Management of OSA: Role of Distraction Osteogenesis due to the limitations of orthognathic surgery especially in asymmetry cases. The technique gained wide acceptance after Gavril ilizarov Author - Dr. Neeraj Bansal, PG Student (Oral and Maxillofacial identified the physiologic & mechanical factors governing the suc- Surgery); Co-Author - Dr. Pravesh Mehra Prof & HOD (Oral cessful regeneration of bone. Distraction osteogenesis is a new and Maxillofacial Surgery) variation of orthognathic surgical correction of dentofacial anomalies. Objectives Lady Hardinge Medical College, New Delhi, India. E-mail Id – The aim of this poster is to showcase the extended versitality of [email protected] Address – Room no. – 312 B, RMO-B, distraction osteogenesis in post ankylotic deformity where conven- New PG Hostel Lady Hardinge Medical College, Opposite Kalawati tional orthognathic surgery is not feasible. Saran Children Hospital, New Delhi -110001 Phone no.- Methods 9971338761, 8076405462; Lady Hardinge Medical College, New Retrospective study at our unit from 2011 to 2016 of 5 patients Delhi, India between the age group 18-30years. Results Abstract All patients had excellent outcomes with minimum complications. Background/Introduction Post distraction orthodontics was required in all patients to settle the Obstructive sleep apnea (OSA) is the Cessation of breathing during occlusion. sleep because of a mechanical obstruction, such as a partially col- Conclusions lapsed trachea, retropositioning of the tongue in the airway, which The corrections of secondary deformity in ankylosis pose a greater blocks airway passage, or a large amount of tissue in the upper air- challenge due to undergrowth, gross midline shift & discrepancy way. It is a common respiratory sleep disorder characterized by between soft & hard tissue growth pattern. Though Orthognathic snoring and episodes of breathing cessation or absence of respiratory surgery has a role in minor deformity, DO with its technique, precise airflow (=10 seconds) during sleep despite respiratory effort.[1] OSA planning offers excellent outcome. may occur in adults with mandibular or maxillary retrognathia or in infants and children with airway obstruction as a result of congenital micrognathia or midface hypoplasia which may be due to Treacher EPS00656 Collins syndrome, Robin sequence etc. There are various modalities available for the management of OSA ranging from conservative to Maxillary Anterior Segmental Distraction to Correct surgical. Distraction Osteogenesis (DO) is a technique of bone Maxillary Deficiencies in Patients with Cleft Lip lengthening that uses the body’s healing potential to form new bone. and Palate Because of the magnitude, morbidity, and potential instability of standard surgical techniques for large expansions of the facial skeleton, the use of DO as a minimally invasive alternative has Dr. M. Kalyani, Guided By Dr. Kishore M. become commonplace.[2] the presentation discusses the role of DO in the management of airway obstruction and OSA. Vishnu Dental College, Bhimavaram Objectives To analyse the role Distraction Osteogenesis as a modality for the Abstract management of OSA. Background/Introduction Methods Maxillary hypoplasia is a major issue in cleft lip and palate patients, Pre and post treatment lateral cephalogram and results of sleep study and predictable surgical maxillary advancement is required. The of a 22 year old male with severe mandibular deficiency were eval- treatment outcomes of cleft lip and palate including maxillary growth, uated for changes in airway space, profile and apnoea–hypopnoea speech, dental occlusion, and the facial profile, have improved index. remarkably as a result of team approaches that start in the newborn Results period and the evolution of surgical procedures. There was significant increase in airway space, with better profile and Objectives reduction in apnoea–hypopnoea index. This case report is to report the effect of Distraction done by a hyrax Conclusions screw incorporated in an acrylic plate in the treatment of two max- DO to expand the facial skeleton is an alternative to standard illary deficient cases with cleft lip and palate. orthognathic surgery for selected patients with OSA. Greater Methods advancements without a bone graft and the associated donor site After making vertical and anterior cuts between the premolars on both morbidity, scarring, and potential for infection can be achieved. sides, a hyrax screw was mounted on an acrylic plate for the slow anteroposterior expansion of maxillary arch.

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EPS00774 improvements. Deformities of the deviated nose can differ from patient Variable Treatment Options for the Management to patient, and there is no single method that can be used for every deviated nose. Correction requires a complete understanding of the of Recurrent TMJ Ankylosis in Growing Children diagnosis and the treatment plan of the patient having nasal deviation. in Overall View So it is very necessary for a Maxillofacial surgeon or a plastic surgeon to have a proper knowledge of surgical management and correction of Dr. Manikandhan the unaesthetic look of the patient in a less invasive way. Objectives To throw light on a minimally invasive technique in correcting Meenakshi Ammal Dental College deviated nose. Methods Abstract Three stab incisions were taken. Two on the lateral wall of the nose Background/Introduction and one on the dorsal hump of the nose was done. The nasal bone was Management of temporomandibular joint (TMJ) ankylosis in children explored and the osteotomy was performed as a result the deviation of is challenging for the Oral and maxillofacial surgeon as it involves the the nasal septum was corrected and the incision site was approxi- mouth opening, airway obstruction, dentofacial deformity, nutrition mated by 4 ‘0’ Ethylon suture material. Nasal splint for three weeks and quality of life. Although the surgical techniques to treat TMJ was given to the patient. ankylosis have improved, the anticipation of re-ankylosis is persistent. Results Treatment failure could be associated with surgical errors or inade- The results revealed expected facial symmetry post-operatively by quate intensive postoperative physiotherapy. Surgical treatment advocating minimally invasive surgical technique. should be individually tailored and adequate postoperative physio- Conclusions therapy protocol is mandatory for success. We can conclude that the therapeutic management based on a speciﬁc Objectives anatomical and quality of life analysis will indeed help the facial This presentation describes the case of a 12 year old boy with inability aesthetic surgeon and patient for the betterment of the patient’s to open mouth from past 4 years, who had been operated for bilateral treatment for correcting deviated nose. ankylosis with gap arthroplasty 2.5 years ago. To discuss on the various treatment modalities for Temporomandibular Joint (TMJ) reankylosis in growing children and to determine the relevant treatment for preventing relapse, reconstituting new condyle and creating neo EPS0040 condyle which will grow to attain growth equal to maxillary growth. Surgeon’s Friend: 3D-Photogrammetry Methods A case study of 12 year old boy with reankylosis of TMJ. Results Dr. Johnson A. G., Junior Resident Various treatment modalities for recurrent TMJ ankylosis would be discussed. Govt. Dental College Calicut Conclusions It is an overview to discuss correct treatment planning tailored to each Abstract patient at different stages of growth to maximize the function and Background/Introduction growth of the mandible. Medical imaging is the most important source of anatomical and functional information, which is indispensable for today’s clinical research, diagnosis and treatment, and is an integral part of modern Section: Facial Aesthetic Surgery health care. Most of the clinically evolving abnormal situations are actually evolving in space, ie. They are 3D processes. There are numerous parameters inherent to these 3D processes that have in general been understudied and have the potential to better delineate EPS0032 the actual pathologic process and probably contribute signiﬁcant Minimally Invasive Technique for Correcting Deviated prognostic information. Therefore, accurate 3D-information extrac- Nose tion is fundamental in most of the situations. Photogrammetry has an important role to play. Photogrammetry’s comparative advantage is the ability to produce process and exploit in 3D, big amounts of high- Dr. Viren Shirish Patil, Dr. Shandilya Ramanojam resolution data in a geometrically consistent, robust and accurate way. Objectives Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth To give a brief idea about the technology and a quick glimpse into Dental College and Hospital, India, Pune what this technology can do. Methods Abstract Literature review and article search. Background/Introduction Results When it comes to facial attractiveness, facial symmetry has a prime 3D-Photogrammetry is a technology that can make measurements and importance. Nasal osteotomy, also known as rhinoplasty is an aes- data collection more accurate leading to a better treatment planning thetic procedure a surgeon can perform to enhance patient’s and easier and more realistic 3D predictions which helps in better appearance and give them a new acceptable and aesthetic look. This patient education. procedure can be done in patients that present with facial asymmetry Conclusions or patients who are willing to have a new look and due to various 3D-Photogrammetry is a tool that is gaining popularity fast among the reasons such as traumatic injuries, genetic abnormalities etc. Crooked various disciplines of medicine. It is being used for various purposes nose has always been a surgical challenge for surgeons. It is of car- ranging from simple data collection to vast research purposes. The dinal importance to achieve both functional and aesthetic 3D-Photogrammetry helps us surgeons in various ways such as data

123 S130 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 collection, treatment planning, patient education, virtual surgeries and Results various research purposes. Smaller and lesser the depth of the defect a free fat graft were more desirable or precise deposition into the defect though multiple sittings were necessary. In comparison larger dermis fat graft has an ideal advantage to ﬁll in larger composite defects with more retention than EPS00134 free fat graft, probably due to better vascularity of the dermis received Scar Revision & Techniques in Oral & Maxillofacial from the recipient site. Use of PRF and PRP and stem cells along with Surgery free fat graft had an added advantage. Conclusions Both forms of replacement have its own advantages and disadvantage Dr. Anirudha Singh and the decision making was purely based on the severity of the defect. Mahatma Gandhi Dental College Jaipur

Abstract Background/Introduction EPS00186 Scar formation is an inevitable consequence of the healing process, ‘‘An Evaluation of Efficacy of Microneedling Therapy which can either result from surgical procedures or trauma. Scar in the Management of Facial Scars-A Clinical Study.’’ revision helps to make it less obvious and cosmetically/functionally more acceptable through transforming several variables by: softening irregular scars; improving the color; filling depressions; reorienting, Dr. Susmitha. Chebrolu, Co-Author-Dr. Sridhar narrowing or flattening the scar; or correcting anatomic units distortions. Sibar Institute of Dental Sciences, Guntur Objectives To discuss various techniques for revision of scar, to achieve aes- Abstract thetically agreeable outcome. Background/Introduction Methods Microneedling is known by various synonyms like collagen induction Z-plasty, W-plasty, M-plasty, Geomatric broken line closure & non therapy or dermaroller therapy. Over the decade, new innovations and surgical techniques. techniques have been emerged and is expanding with exciting Results advances in arena of facial rejuvenation to overcome this traditional Improved aesthetics form,function psychological & emotional status limitations, among which one such treatment modality is MICRO- of patient. NEEDLING THERAPY. this procedure do not damage the skin or Conclusions remove the epidermal layer, shorter healing time, used in any skin An ounce of prevention’’ Surgical planning and technique – Wound type and on all area of the body where lasers and deep peels cannot be care • Counseling • Timing • Careful analysis • Appropriate performed, convenient office procedure an cost effective than other technique. alternative therapy, well tolerated and accepted by patients, skin does not become sun sensitive, can be used after laser resurfacing or in those with very thin skin, easy to master technique with tool that has been specially designed, can be performed with topical anesthesia. EPS00135 Objectives Free Fat Graft V/s Dermis Fat Graft for Augmentation The aim of the study is to evaluate the efficacy of microneedling in of Maxillofacial Defects the management of facial scars and the objective are to compare the preoperative and post operative improvement in grading of scars to satisfy patient with his/her appearance. Dr. Manikandhan, Dr. Shalini Rudra Raju, Dr. Sailesh Kumar Methods A total number of 14 patients who needed treatment and presented to Meenakshi Ammal Dental College and Hospital the outpatient department of oral and maxillofacial surgery were included in the present study.the patients who were co-operative, Abstract motivated and esthetically conscious with facial scars due to trauma, Background/Introduction soft tissue injury scars following incision and drainage, post surgical Clinical/Therapeutic use of free fat V/s dermis fat graft is debat- scars, scars following surgery of cleft lip correction, post acne scars able for maxillofacial use. Each technique has its own advantages and were random;y selected. Pre-operatively patient and observer disadvantages in terms of procurement, processing, fixation to defect improvement scales with signed consent form which is mandatory for and retention of the graft. The authors attempt in this study is to all patients. Improvement in grading of scars post-operatively were compare the autologous free fat graft with the dermis fat graft in assessed. augmentation of maxillofacial defects. Results Objectives In the present study there is a significant improvement in the grading To compare free fat graft and dermis fat graft in augmentation of of facial scars were we assessed for height of scar, color of scar, maxillofacial defects. patient and observer satisfaction scale pre-operatively. This shows the Methods efficacy of micro-needling therapy. There was also positive patient Craniofacial defect of varying degree have been selected ranging satisfaction. No significant postoperative complications are noted. from simple lip thickness defect in cleft lip to extensive composite Postoperative inflammation subsided within two days. Pain during the defect in hemifacial atrophy. Either free fat graft from abdominal or procedure is easily tolerable by the patient and no post-operative pain thigh area were harvested or dermis fat graft from paraumbilical area is noted. of the lower abdomen was chosen as the site for donor area.

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Conclusions purposes was first investigated and reported only in the early twen- Microneedling therapy can be considered as an effective modality of tieth century. Presently, the principle of tissue expansion is being used treatment for scars in patients with an added advantage of minimal in the reconstruction of many soft tissue defects, large and small alike. downtime and effective improvement. It is simple and cost effective The reconstruction of large defects which were previously regarded as technique in the treatment of facial scars. The significant result challenge for oral and maxillofacial as well as plastic surgeons, are achieved in this study provides scope for wider and increasingly now possible using tissue expansion. Making use of the viscoelastic targeted use of microneedling for the management of facial scars. Our nature of the skin, considerable amount of tissue expansion based study included less number of cases and short duration of follow up tissue engineering is possible in the maxillofacial region. period; So further work is still required firmly establish the efficacy of Objectives microneedling for facial scars. Literature review on tissue expanders in oral and maxillofacial surgery. Methods EPS00191 Literature search and review including online published articles. Versatility of Abbe-Estlander Flap in Lip (Pubmed search) Reconstruction Results Tissue expanders can be used in a plethora of situations such as in skin contractures, skin defects, post neoplastic reconstructions, Kommuri Bajibabu alopecia reduction procedures etc. Conclusions Government Dental College & Hospital, Vijayawada The development of tissue expansion has enabled head and neck surgeons to manage defects that cannot be closed primarily. In cases Abstract where other methods of reconstruction such as local flaps, free flaps Background/Introduction and normal tissue grafts are assessed to be non viable, tissue expan- The lips are an important part of an individual’s personal contributing sion is an apt solution for esthetic reconstruction in the head and neck to aesthetics as well as having an important functional role. Various region. conditions like tumor excision, trauma, and congenital deformities are among the major aetiologies that result in lip deformities compromising the aesthetics as well as function, thus requiring lip reconstruction. Reconstruction of the lip becomes an especially challenging task due to EPS00249 various anatomic factors. There are various techniques for the lip Correction of Various Facial Deformities Using De reconstruction like Gillies fan flap, Karapandzic flap, Bilateral Epithelized Dermal Fat Graft advancement flap, Bernard-Burow flap, Nasolabial flap, Perialar cres- centic advancement flap, Dieffenback method, Depressor anguli oris flap and free flap. Another technique that has been proven very useful Dr. Neethu T S 2nd MDS Student, Dr. Jacob John Professor for the reconstruction of lip defects is the use of Abbe-Estlander flap. The conventional Abbe-Estlander flap is composed of skin, muscle, and Dept of Omfs, Azeezia College of Dental Science and Research, mucosa with the pedicle containing labial vessels. In this poster the Kollam versatility of Abbe-estlander flap, indications, contraindications, different types of techniques in lip construction are discussed. Abstract Objectives Background/Introduction To evaluate the versatility of Abbe-Estlander flap in lip reconstruction soft tissue reconstruction is frequently required in maxillofacial sur- with regard to function and aesthetic outcome. gery for the correction of developmental, posttraumatic, post surgical Methods defects.diffrent materials including alloplastic materials can be used Abbe-Estlander flap that involved the commissure was used for to correct these defects but may experiance complications like reconstruction. infection, protrusion,facial tissue in growth etc. fat harvest for aug- Results mentation in maxillofacial defects is relativly inexpensive, safe and Results in terms of aesthetic and functional outcome. readily available procedure. Conclusions Objectives Abbe-Estlander flap is safe and a reliable flap which is technically to determine the efficiency of deepithelized dermal fat graft to correct simple to perform, and provides functionally and aesthetically a soft tissue defect. pleasing result and affords versatility in flap design. Methods Two patients were selected, one with a developmental soft tissue defect in the forehead and other with a post surgical defect and scr EPS00201 contracturein relation to the lowe jaw. fat harvested from right Tissue Expanders in Reconstructive Oral abdominal area with minimal hair growth. Epidermis with hair fol- and Maxillofacial Surgery licle removed and desired amount of de epithelized dermal fat graft harvested. In the first case tunneling done through loose areolar tissue plane and fat graft placed to correct the defect. In second case Dr. Ramdas Balakrishna/Dr. Chethana supraplatysmal level dissection and tunneling done to place the graft and to correct the post surgical deformity. R/K L E Society’s Institute of Dental Sciences, Bangalore Results One year follow up done for both the cases, which reveals a good soft Abstract tissue contour without ant scarring or donor site morbidity. Background/Introduction Conclusions Physiologic tissue expansion in its natural ways has fascinated man Although there are diffrent alloplastic materials available for recon- since time immemorial. However, tissue expansion for medical stucting soft tissue defects in maxillofacial region, all of them results

123 S132 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 in various complications. As fat graft is an autologous graft it lacks conclusively. Several treatment modalities are reported ranging from host immune response, non carcinogenic and is acquired with a simple pharmacotherapy to more invasive surgical reduction. minimally invasive procedure. after performing the above two case it Objectives seems that autologous de epithelized dermal fat graft provides an To know the fate of surgical treatment. effective measure of soft tissue volume deficit restoration. Methods The patient reported with unilateral bulging on left side of the mandibular angle region and didn’t complain of any pain or discomfort. Physical examination & MRI reveals unilateral masseter EPS00316 hypertrophy without local inflammation. OPG reveals hyperplasia of Scars: Why Hide it When You Can Revise IT ramus of mandible on the left side. Results Presenter: Dr. Pratik Suthar (PG Trainee) Dr. Sharvika Aher(PG 6 months follow up was done of the case & result was good on the Trainee) Dr. Aditi Saha(PG Trainee) Guided by: Dr. Sonal Shah basis of aesthetic of the patient. (Reader) Dr. D. Y. Patil Conclusions The masseter mucle is essential for adequate mastication & plays an important role in facial esthetics. The masseter hypertrophy was Dental College and Hospital, Pune removed along with re-contouring the lower border of the angle of mandible. There is no associated complication was observed in six Abstract month follow up. Background/Introduction Scars arise from a variety of etiologies in the perioral region and among these, defects of the lip figure prominently. The high visibility of the lip complex makes even minor defects readily apparent. EPS00344 Despite a plethora of new techniques and various refinements, Modified Sagittal Split Osteotomy for Correction residual deformities continue to be a recurring feature in most of Facial Asymmetry with Posterior Open Bite patients. Scar revision involves much more than simply excising a scar and doing a better closure of the wound, and is often more challenging than the initial surgery. The pathophysiology of wound Dr. Birsubhra healing, anatomy, correct surgical techniques, proper tissue handling, and good surgical principles must be adhered to, along with proper Roy Faculty of Dental Sciences, S.G.T University perioperative care for successful scar revision. Objectives Abstract To minimize facial scarring and improve facial esthetics. Background/Introduction Methods Correction of deformities of jaw in patients with facial asymmetry is 4 patients who reported to our department with chief complaint of challenging. The degree of asymmetry increases with distance from scar over the lip were taken up for W-plasty procedures to revise the cranium. Common features include lateral mandibular deviation that scar and improve esthetics. All our patients were taken up under increases from upper to lower face with posterior open bite. Recent general anesthesia. advances in surgical techniques involving midline mandibular Results osteotomy combined with sagittal split osteotomy of the mandibular Satisfactory. ramus for systematic control of inferior third of the face have been Conclusions observed. The success of scar revision, or camouflage, is dependent on many Objectives parameters. Some of these include scar location, patient age, and To correct concurrent facial asymmetry with unilateral posterior open nature of the initial injury, condition of the adjacent tissue, skin loss, bite by using modified sagittal split osteotomy and primarily reduc- ethnic background, skin type, patient expectations, and scar orientation of enlarged tongue. tion. Best results are achieved only after considering these factors Methods during surgical planning. 21year old male patient presented with facial asymmetry, right posterior open bite and macroglossia. Presurgical orthodontic treatment carried for one year. Right deviation of chin, depressed nasal tip, short 10. EPS00322 columela & shallow mentolabial sulcus. Under GA, unilateral sagittal split osteotomy performed at right side, osteomised distal segment Masseter Muscle Hypertrophy-A Case Report was positioned, plating done using 4 hole plate with gap. Extraction of 31 with midline osteotomy done. Osteotomised segment positioned Dr. Gaurav Vishal for maximum correction and 2mm plates placed using 4 hole plate with gap. Reduction glossectomy performed, not involving the tip. Institute of Dental Sciences, Bareilly, Uttar Pradesh Results Improved esthetics & function seen 3 months postoperatively. Improved facial symmetry and significant bite correction with better Abstract intercuspation. Background/Introduction Conclusions Masseter muscle hypertrophy is a relatively uncommon condition that In our experience U/L sagittal split osteotomy combined with midline can occur unilaterally or bilaterally. It was first described by Legg in osteotomy can provide good results in the correction of facial 1880. Most commonly occurs in 2nd & 3rd decades of life. It is asymmetry with dental components of malocclusion. mostly idiopathic, although numerous factors such as malocclusion, bruxism, or TMJ disorders have been cited but not proven

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EPS00382 Objectives Autologous Cheek Fat Grafting for Facial Rejuvenation The aim of this report is to present an intra oral approach consisting of masseter muscle reduction and ostectomy of the angle region of mandible. Dr. Thara Chandra S, Dr. Ummar M Methods A case report of 14 yr old female patient with bilateral masseter MES Dental College muscle hypertrophy. Results Abstract Intra oral approach included debulking of masseter muscle and Background/Introduction ostectomy of angle region of mandible. Fat grafting has been used successfully for soft tissue augmentation Conclusions since 1983. Structural fat grafting, or lipostructure, term coined by Well designed adequately powered clinical trials are required for a Coleman, is one of those methods and possibly the most popularized definitive comment on the success of this treatment modality. one, because of it’s didactic presentation and widespread reporting. Objectives The objective of the present study was to clinically evaluate the efficiency of structured fat grafting when redefining facial contours. EPS00407 Methods Endoscopic Techniques in Oral and Maxillofacial 21 year old lady came with a complaint of hollow cheek which made Surgery her look weak and unattractive. Fat was harvested from thigh and abdomen using 10 ml syringe. After the harvest, incision (2-3mm) Dr. Tejinder Kaur, Dr. Sarika Kapila was placed and fat was placed accordingly to enhance cheek fullness. Results She had a more aesthetic and healthier appearance with cheek fullness Shri Guru Ram Das Institute of Dental Sciences and Research, when came 6 months post-operatively. Amritsar Conclusions Structured fat grafting proved to be an efficient adjuvant technique for Abstract redefining facial contours. However, the fat volume to be grafted Background/Introduction should be adequate for the specific needs of each area. Complications The endoscope has been described as an extra set of eyes and is the were minimal and a single session of grafting was enough to achieve basis of innovation across multiple surgical disciplines and the fab- the desired result. rication of a new class of instruments and surgical techniques. Endoscopic techniques have been widely used in the craniomaxillofacial region. The endoscopic techniques are presently used for the treatment of orthognathic deformities, obstructive salivary gland EPS00401 disease, maxillary sinus disorders, trigeminal nerve injuries, TMJ Surgical Management of Bilateral Masseteric Muscle disorders, Rhinoplasty and face lift surgery. Hypertrophy Objectives Not applicable. Methods Dr. Ashish Kashyap Endoscopic technique allows the surgeons to perform operations with better access through small incisions. They help to achieve equivalent Himachal Pradesh Govt Dental College Shimla or superior outcomes with decreased morbidity and faster recovery when compared with the standard techniques. Functional endoscopic Abstract nasal surgery allows a clearer view of the operative field, a more Background/Introduction accurate correction of nasal obstruction and better control of bleeding. Masseter muscle hypertrophy is characterized by unilateral or bilat- In older patients, this technique helps to minimize some of the eral enlargement of the masseter muscles affecting both females and undesirable sequelae of the traditional open procedures such as males after puberty. In most cases of masseter hypertrophy it is alopecia, scalp paraesthesia and facial edema of the subperiosteal lift. bilateral and symmetric, but asymmetry is not unusual. The masseter Other benefits include small and remotely placed incisions with muscle is essential for adequate mastication and is located laterally to acceptable scars, direct visualization of a magnified and illuminated the mandibular ramus, and thus plays an important role in facial operative field for surgeon and unobstructive view for the assistant. esthetics. A hypertrophied masseter will alter facial lines, generating There is a shorter length of hospital stay and faster patient recovery. discomfort, and negative cosmetic impacts in many patients. Muscle Results function may also be impaired, thus introducing conditions such as Not applicable. trismus, protrusion, and bruxism. Masseter hypertrophy leads to the Conclusions prominent mandibular angle which is considered to be aesthetically The current disadvantage is the expense of the equipment and the unacceptable. Here we report the management of bilateral massetric time, effort required to learn to operate remotely with visualization on hypertrophy by a surgical intraoral approach involving the debulking a 2-dimensional screen. This poster highlights the multitude array of of the masseter muscle with bicorticalostectomy of the angle of the indication and efficacy of endoscopic techniques in oral and max- mandible. The patient was satisfied with both functional outcomes illofacial surgery. and aesthetic outcomes on both facial profile and frontal view. No complication was seen intraoperatively and postoperatively after a 12-month follow-up period.

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EPS00469 Methods Knotless Barbed Sutures-An Unique Wound Closure this procedure includes analysis of degree of prominence of jowls and is complemented with neck liposuction and platysmoplasty. Tool Over Conventional Monoﬁlament Sutures Results The recovery period is 2-3 weeks. pre and retroauricular scars over 1. Dr. Krishna Madhuri 2. Dr. Sampada PVL time were imperceptible. Conclusions 1. Oral and Maxillofacial Surgery-PG 1st Year 2. (Oral and Boomerang plasty restores the mandibular contour from the angle to Maxillofacial Surgery-PG 1ST Year) Bapuji Dental College and the chin by eliminating jowls. It is a simple procedure with highly Hospital-Davanagere satisfactory and stable effects.

Abstract EPS00599 Background/Introduction Versatility of Midface Degloving Approach in Oral The introduction of barbed sutures provided an opportunity to explore the use of technology to approximate soft tissues. In recent years a and Maxillofacial Surgery number of knotless barbed self-anchoring suturing devices have become available alternative to closing and securing surgical wounds. Dr. R. S. Neelakandan MDS Dr. P. Anantanarayanan MDS Dr. Objectives Thomas Zachariah MDS To compare commercially available Knotless Barbed sutures against a Conventional Monofilament sutures. Meenakshi Ammal Dental College & Hospital, Chennai Methods It is found that Non-barbed monofilament sutures tend to migrate Abstract towards the middle of the incision where the tension is greatest, thereby Background/Introduction causing incisional inflammation and predisposing to wide scars or Traditional approaches to the midface include the Weber-Fergusson suture pull through. A bidirectionally barbed suture is placed along its incision and the lateral rhinotomy approach which leave a visible scar length which change direction somewhere near the suture midpoint to on the face. The midfacial degloving approach is used to expose create a mirror image array of barbs in the opposite direction. Therefore tumors of the maxilla, nasopharynx, orbits and central compartment when arranged in tissues, one end anchors the other. They can thereby of the anterior and middle cranial fossae. be used to close wounds or move tissue differentially along the suture Objectives towards the point at which the barbs change direction. To assess the versatility and accessibility to the midfacial skeleton Results using midface degloving approach. The Knotless barbed sutures resulted in decreased operating time, Methods improved tissue apposition, more even distribution of tension along We present 4 cases operated with the midface degloving approach: 1) the length of the wound resulting in less dehiscence, reduction of benign maxillary tumor 2) maxillary cyst 3) quadrangular LeFort1 ischemia, less suture extrusion, minimum tissue relapse and better osteotomy 4) panfacial trauma. The patients were orally intubated (to wound healing when compared to monofilament sutures. allow for endonasal incisions). This approach entails a maxillary Conclusions vestibular incision and three intranasal incisions (bilateral intercarti- Knotless, absorbable barbed sutures devices are a safe, efficacious and laginous, complete transfixion and bilateral piriform aperture viable alternative for cosmetic skin closure and yield wound strength incisions). and tissue reaction scores that are comparable to those from closures Results performed with absorbable monofilament sutures and secured with This approach had favourable outcomes in terms of accessibility and knots. esthetics. Conclusions This approach gives excellent exposure to entire midface from the EPS00487 root of zygoma from one side to the other including the infraorbital Boomerang-Plasty: A Mini Invasive Technique rims, body of zygoma, anterior maxilla, buttress and the pyriform rim. for Esthetic Restoration The advantage of this approach is that all incisions are placed within the intraoral and intranasal regions without any scars on the face. Authors: Dr. Shinja Dixit, Dr. Siddharth Rawat

School of Dental Sciences, Sharda University ABS00628 Dynamics of Superficial Muscular Aponeurotic System Abstract in OMFS Background/Introduction There is an increased demand to improve facial appearance & preserve youthful appearance for as long as possible. Minimally invasive D Y Patil University-School of Dentistry facial procedures have boomed amongst the patients with less evidence of scar, low risk & rapid recovery being some of the attractions. D Y Patil University-School of Dentistry Some patients are even interested in treatment of specific units of the face. This poster presents an alternative technique to treat jowls Abstract through limited incisions. Background/Introduction Objectives to understand the importance of smas in omfs. to describe an alternative technique to specifically correct the jowls Objectives through a minimally invasive procedure called boomerang-plasty. To understand the implications, Anatomy, Uses of smas in OMFS.

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Methods disciplines in cosmetic surgery. For being a competent Rhinoplasty Articles were referred to and review of literature was done. Surgeon, the complete understanding of the anatomy and physiology Results of the nasal structure is essential. The manipulation of the four SMAS is an important part of the head and neck anatomy which is parameters: The Tripod, Pedestal, Dorsum & Soft tissue envelope encountered on regular basis. allows the surgeon to recreate the desired alterations. An absolute Conclusions understanding of the grafting materials with the proficiency of the SMAS is encountered in various surgeries in OMFS as an important surgeon, is used to meet the unique needs of the patient. The most anatomical landmark. commonly used Autograft in Rhinoplasty is Septal Cartilage. Used in case of spreader, alar or tip grafting. The most commonly used Allograft is A-cellular Dermal Matrix, used as a graft camouflage. The Alloplastic grafts used in Cosmetic Rhinoplasty range from sil- EPS00641 icone to poly-tetra-flouro-ethylene to poly-diaxone in cases of a Aesthetic Chin Augmentation-Adjuvant to Othognathic deficient nasal dorsum. As conclusion, the Autologous septal cartilage Surgery: is the gold standard for graft material in cosmetic rhinoplasty. However incase of a deficient donor site, additional donor site has to be created adding an increased surgical risk and time. Hence at this Dr. Prajakta Wankhede, Dr. Geetanjali Mandlik, Dr. Ekta Keswani, time, Allografts are indicated. Injectable alloplastic grafts are used for Dr. Gokul Venkateshwar minor correction and can greatly improve outcomes, obviating the need for surgery. Dr. D. Y. Patil School of Dentistry and Hospital

Abstract Background/Introduction EPS00700 Introduction:Standards for an aesthetic face are dynamic. Chin forms Laser Assisted Lip-Repositioning for Gummy Smile the strong aesthetic sub- unit of the face.the idea of chin augmentation or enhancement is to preserve the inverted triangle of youth and have Dr. N. Srinath, Dr. Mahadeepa Kar a good chin projection. Objectives Krishnadevaraya College of Dental Sciences, Bangalore Indications:A receding or weak chin is a significant aesthetic impediment to a pleasing face. Poor projecting chin can hamper the outcome of a good Orthognathic surgery. Poorly projected chin is one Abstract of the indications for increasing its projection and its convexity in the Background/Introduction profile view for aesthetically pleasing facial appearance. Gummy smile is a condition in which an overexposure of the max- Methods illary gingiva ([3mm) is present during smiling.the proper diagnosis This poster discusses various procedures to augment chin using dif- and determination of its etiology are essential for the selection of right ferent types of chin implants, dermal fillers,fat grafting, etc., the treatment modality. Gummy smile can be soft tissue or hard tissue. choice of implant materials are Gortex, Silastic, Medpor, Mersilene. The aetiology may be due to anterior dent alveolar extrusion, vertical With respect to implant placement, in surgical technique, an intraoral maxillary excess, short upper lip, a hyperactive upper lip or a com- or a submental incision may be used to develop subperiosteal or a bination of these causes. Although some gingival display(gummy supraperiosteal pocket, depending on the preference. A drain may or smile) gives the impression of a youthful smile, a gingival display may not be used. larger than 3mm is considered unattractive. It can affect about 10.5% Results of the population, with a female to male predominance (2:1) Chin augmentation is an effective way of improving chin projection. Objectives Conclusions To assess the efficacy of laser assisted lip-repositioning and patient With properly sized implant, chin augmentation offers an easy and satisfaction. effective means of correcting the deficiency by derma fillers or fat Methods grafting can improve the chin soft tissue projection. Local Anaesthesia was given. Incision was marked. Frenectomy was done. Mucosal strip was removed. Lip length measurement was done postoperatively. Results EPS00669 Measurement of lip length and gingival display was done at 2nd,4th Grafting Materials in Cosmetic Rhinoplasty-Review week, 3rd, 6th month time intervals. of Literature Conclusions Since we got clinically satisfactory result, it is an efficient technique for gummy smile correction. It can be used as an excellent alternative Dr. Revati Bhaskar to more costly procedures with high morbidity rates. It is also minimally invasive with minimal postoperative pain and swelling. In YMT Dental College and Hospital, Kharghar, Navi Mumbai future we can look forward to witness this procedure for correction of gummy smile extensively alone or in combination with other surgical Abstract procedures. Background/Introduction The nose lies directly between two most important features of the face, eyes and mouth. A beautiful nose is pleasing to the eyes. Rhinoplasty has long been regarded as one of the most challenging

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EPS00706 Conclusions Surgical Scar Revision Cosmetic surgeries including facelift operation are becoming increasingly popular, and facial rejuvenation remains one of the most commonly requested aesthetic procedures. Many lifting procedures Nishedh Rahangdale can be used in order to reduce sagging of skin and subcutaneous tissues and create more youthful face. Rishiraj College of Dental Science & Research Centre, Bhopal (M.P.)

Abstract Background/Introduction EPS00791 Most surgical patients end up with a scar and most of these would want Facial Implants (Chin Implant) for the Augmentation atleast some improvement in the appearance of scar. This e-poster of Chin-A Case Report reviews the principles of prevention and treatment of suboptimal scars. Objectives Dr. Krishna Shama Rao, Dr. Chethana, Dr. Uroof To review various relevant techniques of scars in maxillofacial region. Methods CKS Teja Dental Sciences and Research Institute, Chadalawada NA. Nagar, Tirupati, Andhra Pradesh Results NA. Abstract Conclusions Background/Introduction Surgical techniques of scar revision includes Z-plasty, W-plasty, The chin plays a very important role in overall facial appearances and V-Y-plasty, Geometrical Broken-line closure, Fusiform elliptical aesthetic procedures to augment the chin in patients with microgenia excision etc. Using sound techniques for wound closure surgeon can can improve overall facial balance. to a certain extent prevent suboptimal scars. Post operative care and Objectives other adjuvent therapies of scars have also been described. Further Usefulness and versatility of the porous high density polyethylene emerging trends in scar revision and reduction are Gene therapy and implants for correction of various facial deformities as an augmen- Autologous fat grafting. It is hoped that this review helps the surgeon tation of chin. to formulate a comprehensive plan of management of scars of Methods patients. Prefabricated porous high density polyethylene implants were used in two patients with microgenia for augmentation of chin. Results Good esthetic results were achieved in all the patients treated with EPS00722 porous high density P olyethyelene implants with no complications. Facelift: Facial Rejuvenation Conclusions Porous high density polyethylene alloplastic implant is an excellent biomaterial for augmentation of chin. Dr. Hirak Patel (Trainee)

Karnavati School of Dentistry, Uvarsad, Gandhinagar EPS00796 Abstract Nasal Bridge Augmentation: Costochondral Graft Background/Introduction Versus Silicone Implants A facelift, technically known as rhytidectomy. Facelifting is a facial rejuvenation procedure in which by dissection of subcutaneous layers and different suturing techniques we stretch the skin and make patient Dr. N. Srinath, Dr. Arundhati Singh look younger. It can be roughly divided into facelift surgery and nonoperative, less invasive procedures, like fatgrafts, ﬁllers, botox Krishnadevaraya College of Dental Sciences injections, thread-lifts or laserbrasion. Facelift surgery is procedure most directly associated with rejuvenation, due to its fundamental Abstract ability to restore anatomical changes caused by aging. Various Background/Introduction methods of facelifting have been developed over years. Saddle nasal deformity characterized by a hypoplastic nasal bridge Objectives with or without a poorly supported nasal tip is one of the craniofacial To evaluate aesthetic results after surgical facelifting. developmental anomalies and a possible consequence of trauma. Methods Other potential causes are syphilis, Wegners granulomatosis and post Facelift Surgery involves removal of excess facial skin, with/without rhinoplasty. The popularity of augmentation rhinoplasty is increasing tightening of underlying tissues and redraping of skin on patient’s among the Asian population. Various autologous and alloplastic face and neck. Surgical facelifts are performed under general anes- materials are available for the procedure but still there is a contro- thesia or deep twilight sleep. Original concept of facelift involves versy regarding which material is best. Bone graft can be harvested simple excision of excessive skin in lateral portion of face. The from calvarium, iliac crest or rib while cartilage grafts are obtained procedure then evolved to include subcutaneous undermining and from nasal septum, ear concha or costochondral. Here, we are pre- redraping of skin ﬂap against gravity. senting the merits and demerits of both costochondral graft versus Results silicone implants in nasal bridge augmentation. High patient acceptance and good aesthetic results were achieved, Objectives with almost complete restoration of facial symmetry 1 year To evaluate and compare the surgical procedure, outcome and the postoperatively. patient satisfaction in both the cases.

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Methods they are highly prized because face is highly visible and its an Study was done on 20 patients. Rhinoplasty performed. Costochon- important outlet for expressing thoughts and emotions beyond words. dral grafts and silicone implants placed. Objectives Results To accentuate a smile, thus increasing the perception of attractive- Silicone implants were shown to be less effective due to a higher rate ness, sociability, and facial beauty by creating cheek dimples of infection, extrusion and rejection in spite of it’s less bulkiness and surgically. can be shaped easily when compared to costochondral grafts. Methods Conclusions We used a simple technique for creation of dimples, marking the So, overall costochondral grafts are better for nasal bridge augmen- dimple site extra orally and giving an intraoral incision and suturing tation procedures when compared to silicone implants. the buccinator muscle. Results This procedure is safe, reliable and easily reproducible. As no tissue is excised, chances of bleeding is less. EPS00817 Conclusions Botox and Derma Fillers-The Twin-Face of Cosmetic With this procedure, the patient satisfaction rate is very high. Dentistry

Dr. Richa EPS00841 Esthetic Correction of Frontal Hypoplasia Using Tissue Guru Nanak Dev Dental College and Hospital, Sunam Expander

Abstract Background/Introduction Dr. Shajee. Mk, Dr. Ummar. M (Prof&H.O.D) Botulinium toxin and derma fillers are well known for their use in aesthetic dentistry. Dept of Omfs MES Dental College and Hospital Objectives Botulinum toxin and derma fillers have made their way into dentistry Abstract for both dental aesthetic and therapeutic uses. They provide most Background/Introduction significant, minimally invasive procedure at low cost with limited to Tissue expansion in its natural ways had fascinated man from pre no recovery time. This information will be focused on the mechanism historic times itself. but tissue expansion for medical purpose was first of action and various uses of botox and derma fillers in the max- tried and reported only in the early half of 20th century. Presently the illofacial areas along with its future implications in dentistry. principle of tissue expansion is being used in reconstruction of many Methods hard and soft tissue defects of larger dimensions which were previ- Advances in better understanding of both the static and dynamic ously regarded as great challenge for maxillofacial and plastic relationship of soft tissues on the oro-facial complex have opened surgery. Making use of the viscoelastic nature of skin, considerable new avenues in treatment, and so through the use of botox and derma amount of tissue engineering is possible in the maxillofacial region. fillers oro-facial complex can be safely sculpted and functionally Objectives modulated. To evaluate the versatility of tissue expanders for reconstruction of Results hypoplastic frontal bone. There is significant improvement in aesthetics through the use of Methods botulinum toxin and derma fillers. Their use as a part of cosmetic A 24 year old male presented to our department with frontal treatment can relieve pain, restore pain, restore function and help to hypoplasia. Plan was to reconstruct the defect cosmetically with create a perfect smile. acrylic implant. As tissue approximation was not adequate to increase Conclusions the amount of tissue required for anastomosis we used a tissue In summary, use of botulinum toxin and derma fillers appears to be a expander.a crescent shaped silicone expander were implanted under effective method for cosmetic treatment in maxillofacial region. the galea. Over several weeks, saline was added to the expander through a injection port. The surface area of over lying skin was gradually increased through a process of ‘‘biologic creep’’ providing increased tissue to reconstruct the defect. After adequate inflation has EPS00820 occured the expander was removed and defect was reconstructed. Its Simple-Your Dimple Results We were able to achieve increased surface area over the tissue by Dr. Namrata Chourasia mechanical creep and biological stretch which was used for resurfacing of the defect. It improved the quality and quantity of soft tissue and facilitated primary wound closure and reduced the incidence of Abstract wound dehiscence and exposure of bone graft. Background/Introduction Conclusions Facial dimples are considered as an important part of a beautiful Knowledge of tissue regeneration in tissue expansion is important for smiling face. They occur in both sexes with no particular prepon- its clinical application. Ultimately one is able to achieve increased derance, may express unilaterally or bilaterally and are genetically surface area of the tissue by mechanical creep and biological stretch.it inherited as a dominant trait. Natural dimples appear upon smiling improves the quality and quantity of soft tissue and facilitate primary and perhaps because of that, dimples are generally associated with wound closure and reduced the incidence of wound dehiscence and cheerfulness. As the awareness about and willingness to undergo exposure of bone graft. tissue expansion has certainly earned the cosmetic surgery has increased, the demand of surgical creation of status of being an indispensable adjunct for reconstructive procedure dimples on face has also increased. When dimples occur on the face in maxillofacial surgery.

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Section: Maxillofacial Implant height of the bone is often less. Hence, to avoid sinus lift and bone grafting procedures, the present study was aimed. Objectives The present study was aimed at evaluating the efficacy of the Hybrid ABS004 implant in overcoming the height and width problem of the alveolar Application of 3D Printing in Oral and Maxillofacial bone in the maxillary posterior edentulous region. Surgery: A Case Report Methods 12 implants were placed in the maxillary posterior region. Inclusion Criteria:- This was a prospective research design with 10 adult Dr. Ayesha Moin, Dr. Akshay Shetty patients included in this study wherein - Patients with inadequate bone height in maxillary posterior edentulous region - Patients with Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru close approximation to maxillary sinus Exclusion Criteria: - Medi- cally compromised patients - Maxillary anterior and mandibular Abstract edentulous regions the implant was a prefabricated thin laminar plate Background/Introduction having a vestibular part with three screw holes and a palatal part with Three dimensional (3D) printing has been widely adopted in medical two screw holes. This implant is placed subperiosteally and is fixed to fields. Application of the 3D printing technique has even been the cortical bone. extended to bio-cell printing for 3D tissue/organ development, the Results creation of scaffolds for tissue engineering, and actual clinical Implants were placed in an average bone height of 7.7 mm. All the application for various medical parts. Of various medical fields, patients experienced pain during the 1st week postoperative period craniofacial plastic surgery is one of areas that pioneered the use of but that gradually decreased in intensity. No mobility of implants or the 3D printing concept. Rapid Prototype technology was introduced any bone loss during the postoperative period was observed. Two in the 1990s to medicine via computer-aided design, computer-aided cases showed screw exposure, one on the buccal and one on the manufacturing (CAD-CAM).the medical models or bio-models based palatal side. on the 3D printing technique represent 1:1 scale portions of the Conclusions human anatomical region of interest obtained via 3D medical imag- Hybrid implants showed good stability and minimum complications, ing. The procedure for the fabrication of medical models consists of while preventing sinus lift procedures and bone graft requirements in multiple steps: (1) acquisition of high-quality volumetric 3D image the maxillary posterior region. data of the anatomical structure to be modeled, (2) 3D image processing to extract the region of interest from the surrounding tissues, (3) mathematical surface modeling of the anatomic surfaces, (4) EPS00170 formatting of data for rapid prototyping, (5) model building, and (6) Quality assurance of the model and its dimensional accuracy. Anatomic Root-Analogue Dental Implants Objectives This paper presents a case report of secondary deformity correction Dr. Ramandeep Singh Bhullar, Dr. Amit Dhawan following a Pan facial trauma using 3D printing technique for the reconstruction of temporal bone segment. Sri Guru Ram Das Institute of Dental Sciences and Research, Methods Amritsar This is a a case report of secondary deformity correction following a Pan facial trauma using 3D printing technique for the reconstruction Abstract of temporal bone segment. Background/Introduction Results In a quest to provide best-quality treatment, results, and long-term Nil. prognosis, physicians must be well versed in emerging sciences and Conclusions discoveries for more favorably suitable options to patients. Bio Despite advances in 3D printing there are significant barriers and engineering and regeneration have rapidly developed, and with them, controversies; some of which are unrealistic expectation regarding the options afforded to surgeons are ever-expanding. Rapid devel- tissue/organ printed, safety and security issues, and regulatory opment in biomedical engineering demands the application of modern approvals. Regardless of the challenges, 3D printing is expected to computerized measurement techniques. Computer aided co-ordinate play an important role in the trend towards personalized medicine and measuring technique can be particularly applied to evaluate the shape revolutionize healthcare. of non-technical structures with high accuracy. Dental implants are one of those advancements in dentistry. EPS00133 Objectives Screw Retained Hybrid Implant for Maxillary (Not Applicable) Posterior Edentulous Ridge Methods (Not Applicable) Results Dr. Sonal Anchlia, Dr. Shishir Kumar, Dr. Ramyata Dayatar, Dr. Root analogue dental implants are the immediate anatomic zirconia/ Hrushikesh Gosai ceramic dental implant. Their are designed to fit perfectly into the space left behind when tooth is extracted. The principle of ‘differ- Govt Dental College and Hospital, Ahmedabad entiated osseointegration’ dictates the innovative implant design. Root analogue dental implants involves a simple procedure, are Abstract logical, non-surgical technique, no sinus lift procedures required and Background/Introduction no bone augmentation procedures needed. There are negligible The need of sufficient bone around the endosseous implant is critical alterations in natural anatomy of the root. Since no metal is used, the for the success of implant. In the sinus area of the maxilla, the vertical results are the most aesthetic.

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Conclusions paraliel to the posterior wall of the maxillary sinus. They allow Thus my poster enhances our perception towards the root analogue anchorage in posterior atrophied maxilla without sinus lift procedures. dental implants. Objectives This study was performed to evaluate clinically and radiographically the success of dental implants placed in the posterior atrophic maxilla. Methods EPS00177 10 participants (4males, 6 female, Average age - 35 years) with partial Efficacy of 2mm 3D Locking Mini-Plates edentulism associated with narrow atrophic alveolar ridges with in the Management of Anterior Mandibular Fractures adequate height and willing to participate in the study were included. Initial drill was made followed by consecutive drills and simultaneous implant placement was performed. A total of 10 implants were Dr. Neelakamal Hallur, Dr. Aaisha Siddiqua, Dr. Syed Zakaullah, Dr. placed. No graft material were used. Stability, achieved ridge width Ashwin Shah, Dr. Chaitanya K., Dr. Shereen Fatima and radiographic crestal bone loss were assessed 3 months postoperatively. Al Badar Dental College and Hospital Gulbarga Results All the implants were clinically and radiographically stable at the end Abstract of 3rd month follow up. All ten implants were surrounded by ade- Background/Introduction quate amount of bone required for successful functional To treat Anterior Mandibular fractures dynamic compression plate, rehabilitation. eccentric dynamic compression plate, lag srews & monocortical non Conclusions compression plates were used which is fixed at lower border. Thus Placing the implants in posterior atrophic maxilla will help in main- fixing of plate at lower border fails to control the superior border taining the alveolar ridge width and height. It also decreases the fanning so tension band is required for better stability. To overcome rehabilitation time and improves quality of bone support. these shortcomings 3D locking plates were introduced. Objectives To study the efficacy of 2mm 3D locking titanium mini plates in management of anterior mandibular fractures. EPS00185 Methods Socket Shield Technique: Neoteric Approach for Ridge 20 patients with displaced, undisplaced fracture of anterior mandible Preservation & Immediate Implant Placement: A Case underwent open reduction and internal fixation using 2mm 3D tita- Report nium locking mini-plates and 2mm — 10mm locking screws. Study parameters included were, assessment of intra-operative stability of fracture segments after fixation and clinically for occlusion and Dr. Priyanka R. Sawadkar, III Yr. M.D.S.Trainee (P.G.), Dr. Yogesh healing. Radiographic healing at 1st, 6th and 12th week was assessed Kini, Prof. & Guide, Dr. Mukul Padhye, Prof. & Dean Faculty, Dr. using Digora software. Gokul Venkateshwar, Prof. & H.O.D. Results Postoperative clinical evaluation showed the occlusion to be satis- D. Y. Patil University, School of Dentistry, Navi Mumbai factory in all 20 patients. Radiographic healing of fracture was assessed in terms of bone density achieved on OPG and PA mandible Abstract using Digora software between 1st, 6th and 12th week and was found Background/Introduction to be statistically significant. No case of wound dehiscence, plate/ Implant therapy is in the age of being increasingly aesthetically dri- screw fracture, screw loosening was observed. ven, not merely restorative. With the increasing popularity of Conclusions immediate implants, particularly with anterior tooth extraction, the The use of 2mm 3D titanium locking plate has proved to be effective relevance of socket changes following extraction has come to the in the management of anterior mandibular fractures. fore. Healing of extraction sockets undergoes a remodelling process which leads to horizontal and vertical bone loss. There have been several strategies employed to minimize these aesthetic problems EPS00178 using grafting technique to retain the original dimensions of the bone after extraction which require the use of bone grafting materials, An Evaluation of Clinical Outcome of Placing additional surgical site morbidity and there still remains an uncer- the Tubero-Pterygoid Implants in Posterior Atrophic tainty of the long term outcomes. Socket shield technique has Maxilla-A Clinical Study demonstrated the potential in preventing buccal bone from resorption in animal and clinical studies. Objectives Author- Dr. Suvvari Ramakrishna, Co-author- Dr. P.S. Chakravarthi To corroborate a cost effective & minimally invasive method to preserve alveolar ridge & simultaneous implant placement. SIBAR Institute of Dental Sciences Methods 1 subject advised for extraction & immediate implant placement with Abstract maxillary right lateral incisor was anaesthetized using local infiltra- Background/Introduction tion. A sliver of tooth (12) on the facial side attached to the pterygoid implants has been defined as implant placement through the periodontal ligament was left in situ using a straight fissure bur & an maxillary tuberosity and into the pterygoid bone. The use of pterygoid appropriate size implant was placed consecutively & followed up for implants was first described by Tulasne in 1992, in which implants 1 week, 1 month & 3 months post operatively for consecutive were anchored in the pterygoid area, which provide a stable anchor as procedures. it is very dens bone. This techniqe used smaller implants which are

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Results outcome for the patient. Socket Shield Technique preserves the buccal Single implant placement with good post operative outcome was bone thereby preventing the resorption of the bone.and giving the best achieved with minimal ridge resorption. treatment outcome for the patient. Conclusions Objectives This presentation reviews a clinical case to show the socket shield The objectives of this study is to evaluate the buccal\facial bone technique & its advantages. height mainly in anterior maxilla in immediate implant placement with Socket Shield Technique using Cone Beam Computed Tomography. EPS00245 Methods Patient with an uninfected root or fractured crown which requires Horizontal Bone Augmentation for Implant Placement immediate implant placement was chosen for the study, pre operative in Deficient Alveolar Ridges CBCT was taken and required implant was chosen, the thin shield of root in the buccal surface of the socket is left remained in the socket Dr. Parth Shah with the remaining part removed with minimal trauma to the socket and surrounding tissues followed by immediate implant placement. 4 month post operative CBCT was taken to correlate the buccal bone D. Y. Patil School of Dentistry Nerul, Navi Mumbai height pre and post operatively. Results Abstract our study showed that the buccofacial bone resorption is very minimal Background/Introduction compared to conventional immediate implant loading. With the advancement of reconstructive techniques, implants have Conclusions become an increasingly available option for replacing missing den- Socket shield technique is an ideal technique for anterior immediate tition in patients. One of the challenges with implant placementis an implant placement if there is any uninfected root or tooth present unfavorable local condition of the alveolar ridge due to atrophy, which requires implant placement. which may cause insufficient bone volume in the horizontal and/or vertical dimensions. Many options for treatment of alveolar ridge defects are available, including varying surgical techniques as well as bone graft options. EPS00285 Objectives Evaluation of Hybrid Implant in Posterior Edentulous This review evaluated the success of different surgical techniques for Maxilla with Inadequate Bone the reconstruction of edentulous deficient horizontal alveolar ridges and the survival/success rates of bone grafts placed in the augmented areas. Dr. Varghese Mani, Dr. Aabu Varghese Methods 30 cases done at our institute with mean follow up of 6 months were Mar Baselios Dental College, Kothamangalam included. The procedures considered were onlay bone grafts, khoury technique, ridge split, sandwich technique, bone shield and Titanium Abstract mesh. Success and related morbidities of the augmentation procedures Background/Introduction were analyzed. In the field of prosthodontics the ultimate objective is to provide Results artificial teeth which remains firm under normal oral activities and A total of 30 cases were reviewed. However, it was difficult to will appear natural to the sight. The hybrid implant was invented by a demonstrate that one surgical procedure offered better outcomes than senior oral and maxillofacial surgeon Prof Dr. Varghese Mani. The other. invention is a piece of art, which is a combination of both sub peri- Conclusions osteal and endosseous implant. Every augmentation procedure requires substantial planning and Objectives different augmentation technique. Every surgical procedure presents To study the rehabilitation and evaluation of posterior maxillary advantages and disadvantages. Priority should be given to those edentulous space i.e. Maxillary- premolar, 1st molar and 2nd molar procedures which are simpler and less invasive, involve less risk of area with hybrid implant and evaluate the hybrid implant post oper- complications and reach their goals within the shortest time frame. atively for 6 months (1stmonth, 3rd month, 6th month). Methods All patients above 20 years who reported to outpatient department ABS00281 of Mar Baselios Dental College, Kothamangalam for replacement of the missing tooth according to the inclusion and exclusion cri- Evaluation of Buccofacial Bone Height in Immediate teria. All the patients were explained about the method of the study, Implant Placement with Socket-Shield Technique Using about the new implant system, possible complications and other Cone Beam Computed Tomography alternative methods of replacement of missing teeth and a detailed consent is taken from patients who are willing to participate in the study. Dr. Ahamed Irfan K.A. Results When evaluated the hybrid implant showed good stability with the The Oxford Dental College and Hospital, Bengaluru Periotest values showing significant p- value of 0.007. None of the patients developed any post-operative complications during the study Abstract period. Overall according to the evaluation during the study period Background/Introduction the hybrid implant system proved to be a stable, patient and clinician Preservation of bone and soft tissue in the anterior region is the most friendly, economic implant system. It also prove to be a safer alter- important and challenging task to deliver best functional and esthetic native to sinus lift and bone grafting for placement of endosseous

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S141 implants in areas of posterior maxilla with inadequate bone and also EPS00317 avoid complex surgical procedures and long treatment period. The Alveolar Ridge Split & Immediate Implant Placement- limitation of this study is that the implant system was analyzed only for a shorter period of time with lesser number of patients in a single Case Reports center. Conclusions Dr. Bhavik Miyani Hybrid implant system is an effective system for the rehabilitation of posterior maxillary edentulous spaces with inadequate bone for Narsinhbhai Patel Dental College & Hospital; Visnagar endosseous implant placement and also cost effective and patient friendly. It proves to be a safer alternative for sinus lift and bone Abstract grafting. Further long term studies and multicenter studies and Background/Introduction modifications in design are needed for a more confirmatory efficacy Lateral ridge split technique is a way to solve the problem of the about the hybrid implant system. width in narrow ridges with adequate height. Simultaneous insertion of dental implants will considerably reduce the edentulism time. Objectives EPS00296 For correction of defective ridges some solutions presented including: Onlay lateral ridge bone grafting, horizontal osteodistraction and Ligaplants-Tissue-Engineered Ligament Implant Guided bone regeneration techniques. Lateral ridge split technique is a way to solve the problem of the width in narrow ridges with ade- Sweta Parna quate height. Methods Deb (Institute of Dental Sudies & Technologies) Two patients were treated with ridge split technique & immediate implant placement. Submerged implants were used and 3 months later Abstract healing caps were placed. Patients were clinically re-evaluated at least Background/Introduction 6 months after implant loading. The combination of PDL cells with implant biomaterial is known as Results Ligaplants. The ability to use autologous dental progenitor cells Mean value for presplit width was 3.20 ± 0.34 mm while post-split (DPCs) to form organized periodontal tissues on titanium implants mean width was 7.57 ± 0.49 mm. Mean gain in crest ridge after ridge would be a significant improvement over current implant therapies. splitting was 4.37 ± 0.15 mm. Periodontal ligament (PDL)-derived DPCs can be used to bioengi- Conclusions neer PDL tissues on titanium implants. PDL dental progenitor cells Ridge splitting technique in both jaws showed the predictable out- can exhibit differentiative potential characteristic of stem cells. comes, if appropriate cases selected and special attention paid to PDL DPCs can organize periodontal tissues in the jaw, at the site details; then the waiting time between surgery and beginning of of previously lost teeth, indicating that this method holds potential prosthodontic treatment can be reduced to 3 month. as an alternative approach to osseointegrated dental implants. It ensures that the formation of PDL Collagen fibers oriented perpendicular to the implant might improve cementum formation on its EPS00350 surface. Objectives socket Shield Technique Placement of ligaplants can alleviate problems that conventional implants are commonly faced with; such as gingival recession and Dr. Fahad Khan bone defects of the missing tooth site. Methods Chandra Dental College, Barabanki Ligaplants can be applied in cases of periodontal bony defects, where the conventional implants can’t be installed. The cultured PDL cells Abstract that surround the implants will act as support and anchorage in the Background/Introduction place of normal PDL. The socket shield technique provide a promising treatment adjunct to Results better manage risks and preserves the post extraction tissues in aes- Ligaplants as tooth replacement has decisive advantages as compared thetically challanging cases. with osseosintegration devices due to their property of periodontal Objectives tissue regeneration. post extraction healing is normally associated with with loss of Conclusions alveolar ridge width and height; this alteration of ridge ridge contour Ligaplants is relatively easy, because the implant is not tightly fitted compromioses the three dimensionalpositioning of implant. & to its site. Patient may not have to undergo bone grafting, inconve- accordingly hampers the the required primary stability. nience and discomfort with the ligaplants placement. The ligaplant Methods system mimics the natural insertion of natural tooth roots in alveolar in 2010 Hurzeler introduced this in which it was advised to retain bone. partial buccal root fragmentsand immediate implant placement should be done. Results here we present a case report of this technique in restoration of 21, till the period of 1 year, in fallowup it was found thatt osseointigration was successful without anycomplication.

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Conclusions EPS00385 The socket shield technique provide a promising treatment adjunct to Immediate Dental Implant Placement with or Without better manage risks and preserves the post extraction tissues in aesthetically challanging cases. Autogenous Bone Graft-A Comparative Study

Dr. Sonalika Kabi EPS00361 Scb Dental College & Hospital, Cuttack Comparison of Two Regimens of Amoxicillin in Early Clinical Outcome Following Two Stage Dental Implant Abstract Surgery: A Clinical Study Background/Introduction Replacement of missing tooth has evolved from removable dentures to fixed dentures and recently to dental implants. The need of suffi- Dr. Remya G., Dr. S. Mohan cient bone around the endosseous implant is critical for the success of the implant.the present study was aimed to evaluate the efficacy of Government Dental College, Kottayam autogenous bone graft for replacement of the missing teeth. Objectives Abstract To prospectively evaluate the various outcome like intraoperative, Background/Introduction perioperative and post operative in terms of implant survival. Dental implant is a foreign material embedded within the living tissue Methods of maxilla or mandible to support or replace missing or diseased teeth. A prospective research design with a follow up after 1st week,2nd Dental implant generally has a high success rate, but there is a group week,3rd week,1st month,3rd month,6th month and 1st year postop- of cases in which implants fail. Infection is thought to play an eratively. 2. Sampling method Population: All patients who reported important role in the failure, as implant placement surgery is of the for replacement of missing teeth. Inclusion criteria 1. All patients clean contaminated type. The contamination of the implant surface by above the age group of 16years 2. Patients who need replacement of bacterial biofilm during surgical procedure can lead to an inflamma- single or multiple teeth in the anterior or posterior region of the tory process of the hard and soft tissues thus decreasing the implant maxilla and mandible. Exclusion criteria 1. Medically compromised success rate. Many different techniques have been used to avoid patients. 2. Patients having craniofacial syndromes. 3. Sample size 5 infection during surgical procedure such as the use of chlorhexidine patients were selected taking into consideration the inclusion and mouth wash rinse before the intervention, double aspiration to avoid exclusion Criteria. salivary contamination of the surgical wound, reducing the amount of Results saliva secreted using atropine and by the use of various prophylactic Results PAIN All the patients were non symptomatic during the 1st antibiotic regimens. Many studies suggested that use of prophylactic month to 1st year postoperative periods. Mobility We experienced antibiotic prior to implant surgery will significantly reduce implant mobility during the 1st and 2nd postoperative periods where the failure. implants were inserted in the mandibular molar region. Bone loss Objectives Radiographic assessment showed no bone loss during the postoper- To compare the early clinical outcome between two regimens of ative periods. amoxicillin in two stage dental implant surgery. Conclusions Methods immediate implant placement with autogenous bone graft showed A total of 20 subjects needing dental implant placement were ran- good stability and minimum patient discomfort during one year domly allocated to one of the two antibiotic prophylaxis regimen postoperative period evaluation. The implant system leads to new groups. In the first group, dental implants were placed after the prospect in the field of prosthetic rehabilitation. administration of a single preoperative dose of antibiotic (2 g of amoxicillin); no postoperative antibiotics were given. In the second group, dental implants were inserted without any antibiotic prophylaxis; only postoperative dose of 500mg amoxicillin given every EPS00417 eighth hourly for 3 days. The surgical sites were assessed for pain, Ridge Splitting with Immediate Implant Placement: swelling, erythema, wound dehiscence, and pus formation at 3rd,7th, Review of the Rationale 14th day. Results The results showed that there were no statistically significant differ- Presenting Author: Namitha M H Co-authors: Dr. Saikrishna. D, Dr. ences between the two antibiotic regimens for the variables compared. Sujeeth Shetty Conclusions A single preoperative antibiotic dose may be as effective as a post JSS Dental College, Mysore operative course of antibiotics for 3 days, in obtaining a similar success rate for dental implants. Abstract Background/Introduction The treatment of patients with atrophic ridge who need prosthetic rehabilitation is a common problem in oral maxillofacial surgery. Several techniques are available to enhance bone volume for implant placement. Expansion of existing residual ridge is a novel method to prepare the atrophic maxilla and mandible for immediate implant insertion and augmentation. This technique, being only suitable for enhancing ridge width, requires the availability of adequate bone height. The goal is to expand the ridge to allow placement of an

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S143 appropriate size implant for proper prosthetic contour and biome- Conclusions chanical support. The statistical evaluation of data shows that for LASAK BIONIQ Objectives implants, a healing period reduced to four weeks for maxilla and six To understand biomechanics of ridge splitting technique and its weeks for mandible. efficacy as a method to overcome prolonged and repeated follow ups for implant placement. Methods Publications on the subject were searched up to August 2017 on EPS00480 electronic databases (Pub-Med, MEDLINE, ScienceDirect, Zotero) Zygomatic Implants a Graft Less Solution in Atrophic for articles published in pre-reviewed journals using key words Maxilla [(Dental implant) (Dental implantology AND Narrow ridges) (Thin ridge augmentation) (Alveolar ridge splitting) (Split crest technique)]. Results Dr. Venkatesh Balaji Hange Alveolar ridge splitting may be considered as an approach that demonstrates high implant survival rate, adequate horizontal bone K.D. Dental College and Hospital, Mathura gain and minimal intra and post operative complications. Conclusions Abstract Alveolar split expansion is an excellent tool for regaining alveolar Background/Introduction ridge width but the procedure should avoid bone fragment dislodge- Implants have been more sensitive in maxilla as compared to the ment or flap detachment of the out-fractured plate, which leads to mandible when the maxilla is severely resorbed and atrophic, there- bone devitalisation and subsequent remodelling resorption. fore usually bone grafting or sinus augmentation is required. In Europe an alternate technique for the placement of maxillary implant without using graft or sinus augmentation developed called zygomatic technique which used in zygomatic implants. EPS00471 Objectives Bioactive Surface Dental Implants Alternative solution to bone grafting in severely atrophic maxilla i.e. graft less technique. Dr. Rachakonda Swamy Methods Intrasinus technique/classical technique, modification of intrasinus technique, extra maxillary implants, zygomatic implant without Kamineni Institute of Dental Sciences anterior standard implant, sinus slot technique, immediate loading. Results Abstract The introduction of zygomatic implant by branemark in 1997 showed Background/Introduction 97% success rate and this new technique offers as alternative to bone Branemark introduced the Osseo-integration system in 1977, a heal- grafting or sinus lift procedure, which involves rather invasive ing period of at least 3-4 months without loading has been advocated surgery. to achieve Osseo integration of dental implants. Branemark’s proto- Conclusions cols have been reevaluated and modified significantly by the Currently the gold standard procedure to treat a severely resorbed development of non submerged healing for two-stage implants, maxilla is by grafting but failure rates of 10-30% have been reported. immediate or early implant placement after tooth extraction, and The zygomatic implant shown better results as compared to bone immediate or early loading. Moreover, with the improvement of bone graft and present a new gold standard procedure in compromised implant surface technology, which has shortened the loading waiting maxillary bone. period from 12–24 weeks to 6–8 weeks without reducing the success rate, faster and steadier. Osseointegration can be attained. A three- step surface treatment that combines mechanical and chemical treatment methods to achieve a unique, three dimensional, macro, EPS00505 micro and nanostructured bioactive titanium surface - the Bio surface. Comparative Analysis of Proprietary Preimplant: The Bio surface stimulates cell attachment, differentiation and bone Guided Surgery Planning Softwares Namely Nobel matrix synthesis leading to an increased bone-implant contact in a shorter time. Clinician Tm and Cs 3d Imaging Software Tm Objectives To assess stability of early loaded dental implants using bite force and Dr. Manodh, Dr. Praveen Kumar study the level of osseointegration. Methods Meenakshi Ammal Dental College and Hospital Pilot drill was used to give an initial ditch over the crestal bone and using a depth gauge/paralleling pin, implant position is confirmed. Abstract After sequential osteotomies using 1.5mm, 2.8mm, 3.2mm and Background/Introduction 4.8mm drills with a predetermined depth were carried out. An To optimize implant placement and reduce surgical complications, appropriate Implant fixture was screwed into the osteotomy cut with the clinician must have full knowledge of bone anatomy so any adequate torque, and cover screw was placed and screwed tightly. osseous topography & bone volume excesses or deficiencies can be Flaps were closed using 3-0 black braided silk with interrupted corrected before implant placement. The 3D computer-assisted suturing. interactive preimplant planning software has accuracy and reliability Results required for implant placement and aids in shorter surgical & healing The Implants had more stability with bone quality and the osseoin- time, minimally invasive and less complications. tegration is found to be good.

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Objectives overcome problem of angulation and alignment of implant placement. To analyse and compare the following parameters: - Bone height, socket shield technique: This technique has got advantage by pre- width & length - Implant angulation, length & diameter - Location of venting labial cortical plate in condition like thin labial cortical plate safe zone. but disadvantage is this is technique sensitive. Methods The CBCT study was carried using Kodak 9500 Cone Beam 3D system, the exposure was 90KV and 10MA, 200lmx200lmx200lm voxel size,10.8 sec acquisition time & 184x206mm field of view. EPS00584 Nobel clinicianTM & CS 3D imaging softwareTM was used to Platelet Rich Fibrin in Immediate Implant Placement analyse the parameters. Results Dr. Taradevi Narayan P.V The precision of the measurement of available bone height, width & length and location of safe zone was similar in both the software Abstract packages and it was not found to be statistically significant. Whereas, Background/Introduction the implant length and diameter was statistically significant as it was Loss of tooth in the anesthetic zone is a traumatic experience. more precise in Nobel ClinicianTM software when compared to CS Immediate implant placement increases psychological confidence, 3D Imaging SoftwareTM. decreases total treatment time and fewer surgical procedures. During Conclusions immediate implant placement, various materials are used to fill the This study had detailed two proprietary softwares and also the gap for better osseointegration. Platelet rich fibrin (PRF) is a simple, essential differences between the two for facilitating implant planning natural and inexpensive alternative. and surgery. Thus, 3D imaging and its analysis with appropriate Objectives software packages can make our implant planning, execution of Effect of platelet rich fibrin following immediate implant placement. surgery and prosthesis foolproof. Methods The tooth is carefully removed and a thorough curettage of the alveolus is performed. Modification of the alveolar socket is carried EPS00514 out and appropriate implant is placed. The gap between the implant A Light on Clinical Outcome of Implant Placement and socket wall is filled with PRF which is prepared from the patient’s blood sample. The sample is taken without anticoagulant in a in Freshly Extracted Socket with Different Techniques glass/glass coated tube and immediately centrifuged at 3000 rpm for in Anterior Maxillary Region and Limitations Posed By 10 minutes. Three layers are formed: cellular plasma, PRF clot and Each red corpuscle base at bottom. The PRF clot is isolated and put in a sterile cup. It is transformed into a membrane through compression between two sterile gauze. After placement of PRF suturing is done. S. Sridhar Guided by Dr. P. Srinivas chakravarthi. Dr. M. Sridhar, Results Dr. Raja Sathish PRF helps in healing process and facilitates osseointegration. Immediate post operative inflammation and discomfort is less. Abstract Conclusions Background/Introduction PRF is an acceptable, minimally invasive technique with low risk and Aim of this study is to evaluate success of dental implant placement in satisfactory clinical results. PRF in patients after tooth extraction and freshly extracted socket in maxillary anterior region by three different immediate implant placement show high - success rate of bone graft, techniques. anti - infective ability. It also facilitates a natural healing and matu- Objectives ration of the peri implant bone and soft tissue around the implant. 1. To preserve alveolar ridge height before implant placement and check loss or gain after implant placement 2. To prevent the second surgical intervention and reduction in rehabilitation and treatment time. ABS00649 Methods Basal Implantology Three different techniques have been used to evaluate the success of implants clinically, radiographically as related to hard tissue and osteointegration. Technique 1:ridge expansion technique in immedi- DR. MD. Manzer and Divya Jyothi ate extraction socket Technique 2:conventional method of implant placement in immediate extraction socket Technique 3: Socket shield College of Dental Sciences and Research Institute technique in immediately extracted socket. Results Abstract Those three different techniques have been used in this comparative Background/Introduction study where all the implant clinically and radiographically stable at Basal implanvology also known as bio cortical implanvology. It is the end of 3 months follow up. All the implants were surrounded by modern implanvology system which utilized the basal cortical portion adequate amount of bone and required for successful functional of jaw for retention of implants. Basal bone is defined as osseous rehabilitation. tissue of the mandible and maxilla under lying the alveolar process. It Conclusions is relatively fixed and unchanged. Traditional implant use alveolar Above those three technique of implant placements has got their own bone which is lost after teeth removal and decrease throughout life as advantage and disadvantages. Ridge expansion technique: By using function is reduced but basal bone remain intact throughout life. Basal this technique we can place implant even in narrow or atrophied implants have many advantages over conventional implants. alveolar ridge of maxilla. conventional technique: This technique is best as we have got good access to site of implant placement to

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Objectives EPS00692 The objective of poster is the appropriate use of basal bone, which not Zygomatic Implants: A Valuable Alternative absorbed in the course of life time and anatomically remains the same. Thus implant which take support from the basal bone as an for Acquired Maxillary Defects—A Review excellent and long lasting solution for tooth loss. Methods Dr. Dnyaneshwar Chitte I Mds Guided by Dr. Gopinath Thilak This poster is done by reviewing 19 articles from NATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY. A. B. Shetty Memorial Institute of Dental Sciences, Nitte University, Results Mangalore Immediate loading (prosthesis is fixed within 72 hours), one piece implanvology (so minimum interface problem between connections), Abstract minimum invasive, better distribution of masticatory forces. Background/Introduction Conclusions The reconstruction of acquired maxillary bony defect after pathology Basal implant are used to support single and multiple unit restoration removal, debridement or avulsive trauma is among the most chal- of upper and lower jaw. They can be placed in extracted socket and lenging areas in oral and maxillofacial reconstruction. The goal is to also in healed socket. improve patients quality of life by restoring form and function. Zygomatic implants were developed by Prof. Branemark and are being used to obtain stable retention in post maxillectomy patients EPS00679 with an insufficient bone for conventional dental implant placement. Objectives Efficacy of Direct Sinus Lift in Implant Placement To review current literature on role of Zygomatic Implants in restoring Acquired Maxillary defects. Dr. Mukesh Kumar Kashyap Methods A literature review was conducted on various search engines and Rungta College of Dental Science and Research, Bhilai, C.G. relevant articles in indexed journals were analysed. Results Abstract Zygomatic implants could represent a viable surgical option to obtain Background/Introduction a satisfactory oral function rehabilitation even in case of extensive The present study was conducted with the aim to evaluate clinical maxillary defect. efficacy of the direct sinus lift with simultaneous implant placement Conclusions and bone grafting to evaluate merits and demerits of lateral approach Zygomatic implant is a valuable alternative in reconstruction of for sinus membrane elevation. acquired Maxillary defects. Objectives -To evaluate clinical efficacy of the direct sinus lift with simultaneous implant placement and bone grafting. -To evaluate merits and EPS00711 demerits of lateral approach for sinus membrane elevation. Methods Indirect Maxillary Sinus Lift through Hydraulic This randomized prospective study consisted of 10 patients who met Technique for Endosteal Dental Implants with PRF the inclusion and exclusion criteria. The patients were selected irre- mixed Alloplastic bone Graft vs Alloplastic Bone Graft spective of the age, sex & socioeconomic status, with the residual Alone: A Comparative Clinical Trial alveolar bone height between 1 to 4 mm in the edentulous posterior maxillary region. Direct sinus lift was carried out with simultaneous implant placement. Patients were followed up for 36 months of Dr. Darshalkumar D. Panchal prosthetic rehabilitation. Results Narsinhbhai Patel Dental College & Hospital, Visnagar Pre-operative alveolar bone height was on an average 2.9 mm (ranging from 1 to 4 mm) with the standard deviation of 0.67 mm. Abstract After 36 months of loading, there wasn’t any clinical or radiograph- Background/Introduction ical complication. On an average 13 mm bone height was evident Deficit bone height along the maxillary sinus portrays a significant (ranging from 11.5 to 14 mm) with the standard deviation of 0.81 mm. difficulty for placement of implants in posterior edentulous maxillary Conclusions jaw. As Maxillary Sinus Pneumatisation is an inevitable natural aging Direct sinus lift is an excellent technique for the rehabilitation in the process by which the volume of sinus increases by compromising cases with severely atrophic posterior maxilla. vertical maxillary bone height, newer techniques have been developed to increase the vertical bone height to place an adequate length endosteal implant in such posterior maxillary edentulous areas by vertical sinus floor augmentation. Objectives Evaluate amount of resultant bone height gain comparatively. Methods Indirect Maxillary Sinus Lift Procedure to be performed under Local Anaesthesia by Hydraulic Sinus floor Augmentation Technique (HSAT) with simultaneous vertical augmentation by PRF (Platelet Rich Fibrin) mixed alloplastic bone graft material Vs Alloplastic Bone Graftl alone with follow up of 6 months.

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Results 1. Less time spent for repairing provisional restorations as a result of Results show that bone formation takes place with slightly higher no or less frequent fracture. 2. Predictable ﬁxation and immobility of predilection in PRF mixed alloplastic bone graft group, but there there implants in the early stages of bone healing. 3. Reduction of treatment no statistically signiﬁcant difference in between the two groups. time for immediate restoration. Conclusions Conclusions Autogenous bone graft material is considered to be the gold standard Conclusion of my case study is, when immediate loading is planned, for bone grafting but PRF mixed alloplastic bone graft can be an adequate stability of implants is essential to prevent the risk of micro innovative and effective way of achieving predictable results as an movements and loss of implants for bone formation at the implant- autogenous bone graft substitute. boneinterface (osteo integration site). The problems related to meso structures or supra structures design at surgical stage is not affected.

EPS00765 Intraoral Welding for Dental Implants EPS00767 or SynCrystallization A modiﬁed subperiosteal implant: resurrection of the lost technique Dr. Krishna Shama Rao, Dr. Chetana, Dr. Uroof Dr. Lily Rajput, Guide-Dr. Sanjeev Kumar, Co-Guide-Dr. Amit Gupta CKS Teja Dental Sciences and Research Institute, Chadalawada Nagar Renigunta Road, Tirupathi 517506, Andhra Pradesh I.T.S-C.D.S.R, Ghaziabad, Uttar Pradesh

Abstract Abstract Background/Introduction Background/Introduction Implant initial stabilization became an unsurpassed advantage with Subperiosteal implants had been in existence for over 60 years and respect to rehabilitation with individual implants, because it allows a had been extensively used for replacement of completely edentulous. more balanced dissipation of mastication loads;as a result, a lower But due to high complication rates, including implant loss, exposure, risk of implant loss during and after osteointegration can be expected. and flap dehiscence, subperiosteal implant has become lost in the Objectives mists of time. However the limitations of conventional osseointe- The main objective of my case study is to splint all of the implant grating dental implants, need for solutions to challenging hard-tissue heads in the arch by welding intraorally a titanium bar by Syn crys- situations have prompted the need for the revival of this age old tallization technique to prevent micro movements and loss of implants technique. in the implant- bone interface. Objectives Methods To assess the effectiveness of hybrid implant(modified subperiosteal The methods and procedure of Intraoral welding for welding for implant) in replacement of missing teeth by: 1. Assessing the patient dental implants includes, after all the blood investigations and radi- acceptance by evaluating pain or discomfort after placement of ological findings..the patient is now ready for the treatment..in the implant and stability of hybrid implants. 2. Evaluating peri implant edentulous jaw..the number of implants placed was equal to the health status. 3. Documenting the complications arising after place- number of teeth to be rehabilitated or greater in case of posterior ment of the implant. sectors, where prosthetic elements was supported by one or two Methods implants. The implant insertion point into osseous bed has been This prospective study design consisted of patients requiring defined according to guidelines of implantology. The angle of implant replacement of missing teeth meeting the established inclusion cri- insertion followed..the principles of Anatomically guided implantol- teria. Clinical measurements at each visit included pain or discomfort, ogy. According to these principles, implant fixtures are inserted on mobility of implant, peri-implant health status, any complications, axes that best exploits sites with greatest bone volume. Subsequently bone loss around screws and esthetic outcome. in the my study, the implants are splinted directly in the mouth by Results welding a lingula bar.the production of a caste bar to be fastened to 10 implants were placed and the patients were followed up for a the implants with screws or with placement of a metal reinforced minimum period of 6 months. No mobility was detected post opera- screwed cemented temporary prosthesis, the technique allows the tively while screw exposure was noticed in three patients. One patient practitioner to splint all of implants heads in the arch by welding a was lost to follow up. titanium bar intraorally by Syn Crystallization technique. The welding Conclusions process is electrical, protected by Argon gas supply (syn crystalliza- The results of this study suggested that this modified subperiosteal tion). by welding of metallic elements directly in the mouth. After an implant can be a viable option in replacement of missing teeth in the adequate healing period to allow osteo integration to occur, the bar is areas where inadequate bone height and width precludes the place- removed by sectioning. Following 3 months of post surgical healing, ment of endosseous implants. the bar splinting of all implants are removed to test the implant osteo integration.the porcelain fused to metal prosthesis was fabricated and cemented in place..the patient was followed at regular intervals. Results In my study 5 patients came to my department which the patients has undergone intra oral welding for dental implants for improved implant stability with 100 % success rate by syn crystallization technique. The advantages of syn crystallization technique includes:

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EPS00784 whose sinus lining are low and thin. Rehabilitation is done with To Assess and Evaluate the Efficacy of Basal Implants promising positive result. Objectives in Partially Edentulous Maxillary/Mandibular Ridge Hybrid implant is been introduced as an alternative method to conventional implant placement in cases where there is (bone resorption, 1. Dr. Mohit Mangla 2. Dr. Sanjeev Kumar substantial pneumatization of the sinuses, atrophic maxilla with no requirement of sinus lift up. 1. Department of Oral & Maxillofacial Surgery, ITS-CDSR Methods Muradnagar, Uttar Pradesh, India. 2. Department of Oral & Patient with missing teeth at the maxillary region. Hybrid implant was Maxillofacial Surgery, ITS-CDSR Muradnagar, Uttar Pradesh, India placed at the compromised bone. Avoided sinus lifting after proper radiographic examination. Abstract Results Background/Introduction Good stability, patient comfort with proper follow up with no bone The term ‘‘Basal Implants’’Á refers to the principles of utilizing basal loss. bone areas free of infection and resorption, and the employing of the Conclusions cortical bone areas. Hybrid implant showed promising positive result. With better sta- Objectives bility, less pain with proper follow up. Better than Endo osseous 1. To evaluate the stability of Basal Implants. 2. To evaluate bone implants in terms of less time consuming and less expensive. One density around the basal implant. 3. To assess the patient acceptance time procedure. after placement of Basal Implants. Methods This prospective study design consisted of ten patients requiring EPS00801 replacement of missing teeth meeting the established inclusion criteria. Lignocaine 2% with 1:200000 adrenaline was used for nerve Treatment Modalities for Atrophic Maxilla block. Implant placement was done as described in Principles of BOI1. The patient were recalled after 3 days for final prosthesis Dr. Avantika Sharma, PG Resident followed by 1st, 3rd, 6th and 12th months postoperatively for follow up. Following parameters were recorded for every patient included in Christian Dental College the study- 1. Stability of implant was assessed by placing two rigid instruments against the implant and labiolingual force was be applied Abstract as described in literature. 2. Patient acceptance was evaluated in the Background/Introduction form of pain experienced by the patient and complications noted Implant rehabilitation of the severely atrophic maxilla presents a during and after the treatment. Complications like wound dehiscence, surgical and prosthetic challenge and requires a variety of procedures, fracture of the implant, fracture of the prosthesis was evaluated. 3. which not only differ technically, but also differ in their results. Bone density around the implant was measured by using CBCT. Objectives Results The placement of implants in the alveolar bone remains a challenge At the 12-month follow-up, one out of 20 implants was fractured. The because of the resorption of the residual ridge resulting in insufficient mean HU value 12 months after implantation was 980.879± bone volume in one or more dimensions. So need of the hour is to 107.565HU. No mobility was detected during and after the treatment, review the various options to rehabilitate atrophic maxilla with/ resulting in a good stability. No major complication encountered. without bone modification procedures. Patient acceptance and esthetics outcome was good. Methods Conclusions A thorough knowledge of conventional augmentation procedures such Within the limits of this study, preliminary short-term data (12-year as bone augmentation techniques, guided bone regeneration, alveolar post-loading) suggested that basal implants can be successfully used distraction, maxillary sinus elevation techniques with or without as a minimally invasive alternative to bone augmentation in resorbed grafting and contemporary techniques of implant placement provide ridges. However, larger and longer follow-ups of 5 years or more are effective long-term solutions in the management of the atrophic needed. maxilla. Results Appropriate treatment planning is crucial and various factors need to EPS00799 be considered before placing implants in atrophic alveolar bone. Conclusions Hybrid Implant: A Novel Implant System The reconstruction of edentulous, atrophic jaws according to functional and esthetic factors not only restores chewing function, but Dr. Anshika Grover and Hitkarini leads to positive psychosocial effects and thus also improves the patient’s quality of life. Dental College and Hospital

Abstract Background/Introduction Hybrid implants is been introduced for replacement of missing teeth. The ultimate goal is to provide one or more artiﬁcial teeth which work under the normal oral activities. On Recent advancement a new design is made for replacement of missing teeth to those patients

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EPS00830 Conclusions Dento-Alveolar Fracture Rehabilitation Surgical robotic system enables surgeons to do just in time image recording, treatment planning, navigation, robot assisted operations with Autogenous Bone Grafts and Implants for maxillofacial surgery.

Dr. Chandni Mathur Section: Oral Precancer and cancer Maharishi Markandeshwar College of Dental Sciences & Research

Abstract Background/Introduction EPS00111 Dental implants have been successfully used for dental rehabilitation Dilemmas in N0 Neck for Early Squamous Cell for missing teeth, insufficient bone caused by trauma can compromise Carcinoma of Oral Cavity esthetics and mastication. Objectives Dr. Md Shaik Ismail (Ii Mds), Dr. Ritesh Rajan (Prof and Head) The objective of this treatment was to restore esthetics and masticatory functions after dento-alveolar fracture. Methods Svs Institute of Dental Sciences, Mahabubnagar, Telangana Present case highlights: harvesting of autogenous bone graft from the chin region and placement of harvested graft to the dentoalveolar Abstract fracture site, anterior region of maxilla and to place endosteal Background/Introduction implants. Squamous cell carcinoma of oral cavity is the sixth leading cause of Results cancer worldwide. Neck node metastases is the single most important The patient’s esthetic and masticatory functions were successfully prognostic factor in head and neck cancer, particularly in squamous achieved. cell carcinoma. Conclusions Objectives This poster presentation came to elaborate the dental rehabilitation This poster will review and discuss the various protocols and strategies after dento alveolar fracture. described in the literature and various other institutes for managing N0 neck in squamous cell carcinoma of head and neck region. Methods This is a review of the literature and also includes the most followed EPS00837 recommendations of the renowned institutions. Robotics in Maxillofacial Surgery Results The results of the study will be presented according to the standard protocol. Tapati Biswas (1st year PG) Conclusions The management of clinically negative (N0) neck has been contro- Rajarajeswari Dental College and Hospital, Bangalore versial, for multiple reasons like variable lymphatic drainage and different and unpredictable patterns of metastasis. Abstract Background/Introduction The first surgical robot was introduced in 1985 by Kwoh et al. Robotic-assisted surgery has gained popularity in several surgical EPS00295 specialties and many institutions are now investing in medical robotic Surgical Management of Squamous Cell Carcinoma: technology. A Case Report Objectives To discuss the use of robotics in oral and maxillofacial sugery. Dr. Aneesh Ganguly 2nd Year PG resident Methods Patients three-dimensional data is taken, 3D position and orientation with ROL are used in the operation sequence graft optionally. Exe- Institute of Dental Studies and Technologies cution control system reads the sequence graft and commands are sent to the user interface manager and interactive skills controller. It is Abstract used in two modes-NPR and WPR. Teached movements and inter- Background/Introduction actions are completed in the form of large or small movements. Squamous cell carcinoma account for about 90% of all head and neck Sequence of movement types, interaction positions and skills are cancers. It may be ulcerative and invasive, fungating and exophytic, clearly defined. For brachytherapy rigid catheters are implanted. or both. The diagnostic evaluation of suspected patients should con- Implanting bone fixtures can also be done. sist of thorough case history and the physical examination. The Results histopathological tissue diagnosis and imaging and evaluation of the Robotic surgery is a minimally invasive technique offering 3D deep extent of the primary tumor and of the neck nodes help in visualisation and magnification upto 10-15 times which enhances determining the extent of surgery. Usually, surgical resection of the surgeons capability to distinguish normal tissues from tumours and primary tumor is preferred, including a neck dissection to remove the helps in preserving normal tissues with minimal morbidity and neck nodes at risk which may be followed by reconstruction. Pec- accelerated functional needs breaking the limits of human hand. toralis Major Muscle Flap (PMMC) and Delta Pectoralis Flap are preferred for closure and reconstruction in the oro-facial region as it satisfies the reconstructive requirement in 90% of cases owing to its vascularity and ease of harvest.

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Objectives EPS00333 A 32-year-old male reported to our department with a chief complaint Surgical Interventions in OSMF of swelling on the left side of his face. On preliminary clinical examination which was followed by an incisional biopsy a diagnosis of moderately differentiated squamous cell carcinoma was estab- Dr. Mithun MS lished. Tumor resection, radical neck dissection followed by reconstruction using pectoralis major myocutaneous flap along with Yenepoya Dental College delta pectoral flap was done. Methods Abstract Case report. Background/Introduction Results Oral submucous fibrosis (OSMF), now labelled as a ‘‘potentially The patient underwent radiotherapy post-surgery and a follow-up of 1 malignant disorder’ which is caused by areca nut or betal quid year have shown no sign of recurrence. chewing habit. The progressive irreversible fibrosis of the submucosa Conclusions causes reduction in mouth opening, Burning sensation while having Surgical management is the mainstay treatment option for oral cancer. spicy food. Predictably the release of the fibrotic bands has been the A thorough clinical and radiological diagnosis can pave the way for a basis of all surgical techniques employed, while medical interventions prećised surgical technique for excision of the tumor. Flap design (Stage I & II) have delt on the suppression of the inflammatory such as the Pectoralis Major Muscle Flap are very reliable for closure response and prevention of progressive fibrosis. Surgical intervention and reconstruction after radical neck dissection owing to its rich is recommended for patients with severe reduction in mouth opening vascularity and sufficient bulk of tissue, ease of harvest and close (Stage III & Stage IV) the surgical management of this condition proximity to the surgical site. involves releasing of the fibrous bands and interpositional grafts to retain the increased mouth opening. Various procedures and graft material have been utilised with differing success rates. Different Surgical modalities include Lasers, Usage of Local Flaps (Intraoral EPS00331 &Extraoral), Grafts, Coronoidectomies/muscle myotomies. This Photodynamic Therapy: Recent Treatment Modality Poster mainly aimed at depicting the various surgical modalities for for Cancers of Head and Neck the treatment for OSMF. Objectives Not applicable. Dr. Pooja Kapse Methods Not applicable. Institute of Dental Studies and Technology Results Not applicable. Abstract Conclusions Background/Introduction Not applicable. PDT (Photo dynamic therapy) was 1st reported by Raab etal in1990. PDT is an excitation of photosensitizers induced in the body by exposing it to light of appropriate wavelength. Objectives EPS00338 PDT is a Minimal invasive therapy and overcomes the complications Oral Sub Mucous Fibrosis: The Endless Enigma of conventional surgical procedures, chemotherapy and radiotherapy that are associated further with tissue impairment and cosmetic Dr. Divya. R. Kamath defects. Methods PDT is local than a systemic treatment, involving photosensitizers e.g. Terna Dental College & Hospital, Nerul, Navi Mumbai Photofrin, ALA, Foscan that are preferentially concentrated in neoplastic cells, followed by local illumination of tumor with an Abstract appropriate light wavelength to activate the specific drug which Background/Introduction interacts with the molecular oxygen and generates the singlet oxygen Oral Submucous Fibrosis (OSMF) is a crippling disease of the mouth that is highly toxic and reactive. This singlet oxygen kills the tumor with high malignant potential. It has high prevalence rate in India and cells by apoptosis or necrosis diffusing 0.02 micrometer tissue. So, South East Asia. It is a chronic insidious disease characterized by tissue penetration depth is desirably restricted by the wavelength of progressive submucosal fibrosis of the oral cavity and oropharynx. light used to activate the photosensitizers. The treatment of patients with OSMF depends on the degree of Results clinical involvement. My poster highlights the etiology, pathophysi- PDT is effective over conventional therapies for the treatment of early ology and different treatment modalities in the management of (Cis, T1, T2) squamous cell cancers of the head and neck. OSMF. Conclusions PDT a promising therapy used in association with surgery to increase tumor-free margins that ultimately increases the cure rates. Hence, PDT is used in curative and palliative treatment of refractory head and neck squamous cell carcinoma with minimum recurrence but maximum success rates. Clinical trials & evidences proves PDT to be a good treatment substitute for localized, superficial tumors, and precancerous lesions with excellent & functional cosmetic results that enhances the quality of life of squamous cell carcinoma patients.

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EPS00368 Methods Incidence & Management of Carcinoma of Tongue: The author presents a case of an early invasive squamous cell carcinoma of maxilla which was treated with wide local excision, An 8 Year Experience modified radical neck dissection and reconstruction with an implant supported prosthesis after 6 months. Dr. Kaustubh Kulkarni, Dr. Venkatesh Anehosur Results Excellent post-operative healing of the operated site with restoration SDM College of Dental Sciences and Hospital, Dharwad of form and function was achieved. Conclusions Abstract The author intends to show how early diagnosis is life changing, Background/Introduction offers a good prognosis for the patient and makes for an extremely Oral cancer is one of the most fatal health problems faced by mankind satisfying oncological career for the maxillofacial surgeon. today. In India because of cultural, ethnic, geographic factors and the popularity of addictive habits, the frequency of oral cancer is high. Tongue cancer constitute about 42 % of all oral cancers its incidence EPS00380 being 4.7 per 100,000 Males & 1 per 100,000 Females1. Objectives Ameloblastic Carcinoma-A Rare Odontogenic 1. To gauge the incidence of carcinoma tongue and highlight surgical Malignancy management of the same including reconstruction used at our centre. 2. To analyse the outcome of the type of reconstruction. 3. Account Dr. Aditya Verma for the disease free survival period. Methods Subharti Dental College This poster highlights a Retrospective study conducted at our centre consisting of patients of carcinoma of tongue & floor of mouth who Abstract underwent resection & reconstruction for the same from 2009-2016. Results Background/Introduction A total of 37 Patients with M: F ratio of 2.3:1 and a mean age of 47 It is a rare malignant lesion with characteristic histologic features and years were included, the most common site being the Lateral border behavior that dictates more aggressive surgical approach than that of a of the tongue. All tongue movements improved in radial forearm free simple ameloblastoma. Objectives flap group than split thickness skin graft group. Radial forearm flap improved speech intelligibility & conversational understandability To present the clinical features and treatment of a case of maxillary with a better speech perception. 5 years disease free survival rate was ameloblastic carcinoma. Methods around 54%. Conclusions A 29 year adult male was referred to the department of oral & Aggressive primary treatment including wide excision, appropriate maxillofacial surgery with the chief complain of fast growing swel- neck dissection & reconstruction followed by post operative chemo- ling on the left side of the face since past 5-6 months. Diffused radiotherapy & speech therapy to avoid recurrence of the disease and swelling involving left side of face extending from the alae of the give a good functional outcome is the key to the management. nose involving the zygomatic buttress region and intraorally extending from 24 to 26 region and an ulcero-proliferative mass was also present involving 27 and 28 region. Swelling was firm to hard in consistency. Radiographic features reveal bone erosion and destruc- EPS00379 tion involving left posterior maxilla, involving sinus and extending Early Diagnosis-Highway to a Good Life for Patients upto the floor of the orbit. Root resorption seen irt premolars and first molar. Incisional biopsy was performed and confirmed the with Oral Cancer Ameloblastic Carcinoma. As clinically as well as CT Neck & Chest confirmed no sign of metastasis, surgical treatment was planned for 1. Dr. Pranav Sathe (PG Student) 2. Dr. Gandhali Limaye (PG hemi maxillectomy (with local wide excision) under GA and then Student) temporalis based coronoid graft was used for the reconstruction of the orbital floor. Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune-18 Results Patient was kept on regular checkup and after 2 years of follow-up, Abstract there was no sign of recurrence. Background/Introduction Conclusions Oral squamous cell carcinoma is one the most common variety of Ameloblastic carcinoma is a very rare malignant odontogenic tumor cancer seen in the Indian sub-continent and South-east Asia. Most of with characteristic histopathological and clinical features, which can the cases however present in an advanced stage where surgery is be treated with aggressive surgical treatment and surveillance. either difficult or impossible. With advances like neo-adjuvant chemotherapy however, times are changing for head and neck oncology and patients who were previously untreatable have a new lease of life. Objectives The objective of this poster is to highlight that the goal and the challenge still remains early diagnosis and prompt treatment so as to prevent advanced stages of the oral squamous cell carcinoma which greatly hamper the life of the patient.

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EPS00413 extent occuring in absence of tumor necrosis, recurrence or metastatic Pro and Cons of Neck Dissection Incisions disease. It is an avascular necrosis of bone caused by three-H tissue effects of radiotherapy. Infections associated with osteoradionecrosis are secondary infections due to exposure of bone and deep tissue Dr. Ashif Ikbal Khan planes. Overall spontaneous incidence is 39 percent. Objectives Haldia Institute of Dental Sciences and Research Aim is to evaluate the surgical management of Osteoradionecrosis. Methods Abstract Two cases diagnosed as an Osteoradionecrosis were treated by sur- Background/Introduction gical resection. Neck dissection in its various forms is the standard surgical treatment Results for clinical and subclinical metastatic cancer to the neck. Elimination of infection, multiple fistulae and overall improvement of Objectives general health of patient were achieved. This poster is a review of the anatomy of the neck and specific types Conclusions of neck dissection, indications, advantages and disadvantages in the In early cases of, Osteoradionecrosis conservative approach with local treatment of metastatic neck disease. care is effective, another most common treatment option that is rad- Methods ical resection with primary closure, using local flaps is treatment The patient should be prepared as for any major operation. All routine modality in most places of India. While treatment with HBO therapy laboratory tests must beperformed, including electrocardiogram and and reconstruction with vascularized free flap is available at tertiary chest radiographs. Preoperative evaluation is accomplishedby the cancer care center located in metro cities of India. anesthesiologist prior to surgery. Premedication is used according to the anesthesiologist’s choice. Prophylactic antibiotics are given according to the usual protocol. General instruments used in functional and selective neck dissection. (A) 1, scissors; 2, knives(#10, EPS00440 #15); 3, needle holders. (B) 1, atraumatic and toothed tissue forceps; Assessment of Primary Caregiver’s Burden 2, suction tips; 3, monopolarforceps. (C) 1, Volkmann retractors; 2, on Oncology Patients: A Descriptive Study Howarthraspatory; 3, Desmarres vascular retractor; 4, Deschampsli- gature needle; 5, skin hooks; 6, Farabeuf retractors; 7, Dr. Anand Amirthraj Langenbeckretractors. (D) 1, straight Pe’an’s forceps; 2, large and small Duval forceps; 3, large and small Allis forceps. (E) 1, right- angle forceps; 2, large and small curved Pe’an’s forceps; 3, Dandy A Manipal College of Dental Sciences, Mangalore hemostatic forceps; 4, mosquito forceps. Some popular skin incisions for functional and selective neck dissection. (A) Gluck incisionfor Abstract unilateral and bilateral neck dissection. (B) Double-Y incision of Background/Introduction Martin. (C) Single-Y incision. (D) Schobinger incision. (E) Conley Little is known about how the burden of caring for cancer/oncology incision. (F) Mac Fee incision. (G) H incision. The skin flaps have patients affects primary caregivers. Caregiver burden refers to peo- been raised, preserving the superficial layer ofthe deep cervical fascia ple’s emotional response to the changes and demands of giving (right side). US, upper skin flap; SG, submandibulargland; tc, trans- support to another. Caregiver burden is a concept that emphasizes the verse cervical branch from the superficial cervical plexus; SC, negative components of caregiving, rather than the positive elements, sternocleidomastoid muscle; ga, great auricular nerve; Erb’s point. which may be an important motivation for the caregiver. Some of the Results challenges faced by family caregivers are documented in the litera- We would like to emphasize that it is not the preservation of ture. Caregivers report high levels of stress and poor physical and anatomicalstructures that makes functional neck dissection different emotional health, as well as career sacrifices, monetary losses, and from radical neck dissection, but theapproach to the neck through workplace discrimination. fascial planes. Objectives Conclusions 1. To assess the burden of primary caregivers of oncology patients. 2. The neck is carefully inspected for bleeding points and surgical To associate the burden with selected demographic variables. sponges. Careful hemostasis istime consuming but rewarding. The Methods entire field is thoroughly irrigated with normal saline. Finally, the skin Research design Descriptive survey design Setting Oncology ward- is closed in two layers over a large suction catheter. The platysma is Kasturba Medical college, Mangalore Population Caregivers of sutured with absorbable buried sutures, and the skin with skin clips. A oncology patients Sample Primary caregivers of oncology patients moderately tight dressing is applied withspecial attention to the with advanced cancer. Sample size 50 Sampling technique Non supraclavicular fossa because this is the area where most serohe- probability purposive sampling technique. matomas develop. Results Coming to the questionaire results, the 22 questions were prepared so as to focus on various aspects of the psychological, psychosocial and EPS00432 basic thought process that the caregivers possess while taking care of Osteoradionecrosis of the Mandible their relatives. The first few questions were set to bring about an insight into the relationship of the caregiver with the relative (patient) where the response of the caregiver to some of the demands or some Dr. Shaikh Shahed Anwar of the behavioral factors of the relative were studied, i.e, a positive OR negative response to overdependence on the caregiver, effect on Abstract personal and social life of the caregiver, etc. About 36 patients felt Background/Introduction that they did not feel embarassed over their relatives behavior, nor did Osteoradionecrosis is a slow healing radiation induced ischemic they feel that they were stressed or losing out on personal time necrosis of the bone with associated soft tissue necrosis of variable because of taking care of the patient. Anger was not a factor seen

123 S152 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 among any caregiver except 3 cases where the caregiver was young weeks (single prick method). Adjuncts employed; Micronutrient and financially compromised which might have been the main supplementation OD, tab curcumin 300mg, alovera & amla juice 15 problem. Almost 90% of the caregivers were afraid and uncertain of ml each, Topical curcumin & placentrax based ointment B.I.D., warm what the future holds for their relative. The remaining 10% were saline gargle Q.I.D. & Physiotherapic exercises Group B patients financially and education wise more well to do, more aware and had received ONLY intralesional injection in the similar pattern & an idea about what the prognosis of the disease could be. Strain and Physiotherapic exercises. Effects on interincisal distance, burning health was not seen to be a hindrance factor in about 37 patients. The sensation, tendency of ulceration& taughtness of mucosa were eval- remaining, including the ones over 55 years of age, had health uated during the study, at the interval of 1st, 2nd, 4th & 6th month. problems of their own and were suffering from the same. Financial Results expenses were found to be significant in this study with most of the A definite Improvement in interincisal distance was noted (net gain of caregivers being below Rs. 5000 p.m slab. But owing to various 10 ± 2 mm), with reduction in burning sensation & taughtness of insurance schemes a little of the burden was found to be taken off mucosa in group A. Statistically significant difference (p\0.05) was from the caregivers mind. Even then almost 95% of the caregivers observed between the groups, in regards to interincisal distance, thought that what they were doing for caring for their relative was not burning sensation & taughtness of mucosa. enough and they wanted to do a better job at their treatment. About 20 Conclusions caregivers felt that they have lost control of their private life since the The use of adjuncts with intralesional injection improved the clinical onset and diagnosis of the patients illness but when questioned about outcome in treatment of OSMF. the same, about 10 patients had personal problems of their own in the household which made balancing the jobs difficult. About 98% of the caregivers felt that their relative had full expectations of ONLY him/ her to take care of him/her. Only 2 caregivers thought that they would EPS00544 like to probably hand over the care of their relative to someone else as Medical Management of Oral Submucous Fibrosis: they thought themselves incapable of taking care of the patient longer. Update on Current Evidence-Based Practices Most of the care givers except the well placed ones, felt little or moderately burdened with the situation. 48 caregivers were of the opinion that they would if they could like to do a better job in their Dr. Akash Menon, Post Graduate care for their relative. 2 caregivers felt that they had gone out of their way to do what was required and had left the rest to fate. Dept. of Oral and Maxillofacial Surgery, ABSMIDS, Mangalore Conclusions We can make out that majority of these caregivers, even though Abstract burdened a little, financially and psychologically, share a common Background/Introduction platform of concern and love for the suffering relative. Out of the 50 Oral Submucous Fibrosis is a morbid premalignant condition of the samples, the % of caregivers who were unhappy in taking care of their oral mucosa associated with the habit of areca nut chewing. Caused relatives is not significant at all. This study has given us an important due to an insidious, chronic change in fibroelasticity, OSMF is insight into the mind of the caregiver of the cancer patient and also characterized by a burning sensation in the oral cavity, blanching and enables the clinician to have a measure of the psychological and stiffening of the oral mucosa, oropharynx, and trismus. High-level socioeconomic situation of the caregivers while combatting this evidence supporting any one conservative modality is few and rare in deadly disease. reported literature. Objectives To review current literature on trends in conservative/medical treatment modalities for OSMF. EPS00467 Methods Interdisciplinary Management of Oral Submucous A literature review was conducted on various search engines and Fibrosis relevant articles in indexed journals were analyzed. Results Intralesional steroids such as dexamethasone are the main treatment Dr. Vimi Jain modality, commonly used with hyaluronidase, a proteolytic enzyme. Antioxidants like Alpha-Lipoic acid and Lycopene (anti-proliferative, V.Y.W.S. Dental College & Hospital, Amravati antinflammatory) are also commonly used as first line of treatment. Novel therapies include Zinc acetate tablets and Vitamin A. Also, Abstract Salvianolic acid-B(antifibrosis, anticoagulation, antitumor activities) Background/Introduction used with triamcinolone acetonide represents a promising new mode Complete cure of OSMF, a progressive and refractory premalignant of management. Turmeric, Immunomodulatory drug Levamisole, condition, has not been achieved with any of the present treatment Vasodilator Pentoxyfilline, Placental extract, Human interferon modalities. This study attempts to formulate a treatment protocol gamma, Spirulina, Colchicine, Herbal antioxidants Oxitard and Aloe using interdisciplinary approach. Vera are also showing positive trends in the management of OSMF. Objectives Physiotherapy, local heat delivery and microwave diathermy have an To evaluate the effect of treatment modality utilizing interdisciplinary additive role to effective OSMF therapy. adjuncts in management of OSMF. Conclusions Methods Selecting the right combination of drugs to effectively counter the Clinicaly diagnosed cases of OSMF were included in the study, progressive fibrosing nature of the disease is a challenge. It requires divided randomly into two groups(13 each). Group A patients the clinician to be adept at early diagnosis and customized treatment received intralesional, submucosal injection of hyaluronidase (1500 plans based on the clinical staging. IU), dexamethasone(8mg) & lignocaine HCL(0.5ml) biweekly for 5

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EPS00547 Objectives Application of Laser in Management of Oral The aim of this study was to analyse the different surgical approaches for the treatment of oral squamous cell carcinomas (OSCC) at dif- Precancerous Lesions ferent subsites and to analyse the outcomes for the same. Methods Dr. Shreyas P. Naik, Dr. Vikas Dhupar, Dr. Francis Akkara, Dr. A retrospective study conducted on patients with OSCC requiring Omkar Shetye surgical intervention reporting to our Craniofacial research centre between 2010 to 2017. Total of 225 patients having OSCC of dif- Abstract ferent subsites were included in the study. Background/Introduction Results Laser is a monochromatic, collimated, coherent and an intense beam The different approaches for different subsites performed included of light produced by stimulated emission of radiation of a light Peroral, Pull through technique, Lower cheek flap, Upper cheek flap, source. Lasers are classified according to different factors among visor flap, Mandibulotomy and wide excision and resection. The which is the classification based on laser active medium such as gas, numerical data will be highlighted in the poster. liquid, solid and semi-conductor, which identifies and distinguishes Conclusions the type of emitted laser beam. Recently, there have been rapid The data will be statistically analysed and the complications of var- developments in laser technology and better understanding of bio- ious approaches will be highlighted in the poster, hence the preferred interactions of different laser systems which have broadened the approach for OSCC for different subsites will be concluded. clinical use of laser in dentistry. Objectives To evaluate the safety and efficacy of surgical stripping of oral pre- EPS00576 cancerous lesions using laser. Methods Photobiomodulation: Eliminating the Fiasco Patients of all ages with precancerous lesions of oral cavity measuring of Chemoradiotherapy in Head and Neck Cancer greater than 10mm in diameter were included in the study. The mucosal stripping was carried out using a diode laser. Patients were Dr. Parvathy Reghunadhan, Dr. Vani N R followed up at 3 days, 1 week and 1 month post operatively. Results Bapuji Dental College, Davanagere No significant adverse events occurred; minor local adverse effects were observed during the procedure. The intra-operative bleeding was minimal. The post-operative pain and swelling was significantly Abstract lower compared to that seen with conventional techniques of mucosal Background/Introduction stripping. Chemoradiotherapy is the standard treatment for advanced head and Conclusions neck cancer. Chemoradiotherapy presents with mucositis, pain, dys- Mucosal stripping with laser could be used to achieve regression of phagia, infections, salivary changes, dysgeusia and dermatitis etc. oral precancerous lesions. The treatment is safe and well tolerated and Photobiomodulation (wavelength of 600–1000nm) drives Adenosine the recovery is faster. The high-power laser used in this study allows Triphosphate production enhancing bioavailability to power the completion of laser therapy within 2 to 5 minutes. Further studies are functions of cellular metabolism and transient burst of reactive oxy- necessary to determine the optimal laser radiant exposure and drug gen species which generate fibroblast growth factor, pro-inflammatory application to maximize the response rate. cytokines that are involved in tissue repair. Objectives To assess the effects of Photobiomodulation in management of side effects of chemo-radiation therapy in head and neck cancer. EPS00565 Methods ‘Surgical Approaches for Different Subsites for Oral Evaluation of photobiomodulation mechanisms of action, dosimetry, Squamous Cell Carcinoma’ and safety considerations with adequate doses photobiomodulation, the irradiation parameters, including the energy delivered, power density, pulse structure. Dr. Twinkle Thakker (Postgraduate), Dr. K. Gopalkrishnan Results (Professor, Omfs), Dr. Venkatesh Anehosur (Professor and Hod, ‘‘Low level laser’’ uses light absorbed by endogenous chromophores, Omfs) triggering non-thermal, non-cytotoxic, biological reactions through photochemical or photophysical events, leading to physiological Sdm College of Dental Sciences and Hospital changes, enhancing wound healing significantly reducing inflammation, and prevents fibrosis, reduces pain and improves function Abstract thereby increasing the loco-regional blood flow that contributed to Background/Introduction better local oxygenation. Oral cancer is the 6th most common cancer worldwide. 90% of the Conclusions oral cancers are squamous cell carcinomas. There is an increasing Photobiomodulation mechanisms based on its recognized therapeutic emphasis on preservation or restoration of the form and function to effects has no carcinogenic effects on normal cells. Titrating adequate improve the quality of life. The oral cavity is divided into various doses and defining the other required photobiomodulation parameters subsites: The lip, anterior two-thirds of the tongue, floor of mouth, can result in beneficial effects in chemoradiotherapy. gingiva, retromolar trigone, buccal mucosa, and hard palate. Tumors of different subsites demonstrate distinct clinical behavior and lymphatic spread.

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EPS00597 cases one occurred within the dissected area, another case was ipsi- Radical Versus Supraomohyoid Neck Dissection lateral, not in the dissected area (no adjuvant radiotherapy was used in these two cases), and a third case recurred in the contralateral side of in the Treatment of Squamous Cell Carcinoma the neck (this patient underwent postoperative radiotherapy). In 22 of the Inferior Level of Mouth pN? patients there were level Ia metastases in 5 cases, Ib metastases in 6 cases, IIa metastases in 8 cases and level III metastases in 7 cases. Dr. Shashank local (RL), regional (RR) and local-regional (RL?RR) recurrences in this group. There was no statistically significant difference between the absence (pN0) and presence (pN?) of metastases on histology and Sree Balaji Dental College the diagnosis of isolated regional recurrence as a function of neck dissection. Finally, there was no significance in the incidence of Abstract isolated unilateral events in 230 unilateral neck dissections (p=1.0). Background/Introduction Radiotherapy was done in 9 cases (5.6%) of recurrence out of 160 The presence of lymphatic cervical metastases in patients bearing neck dissections; 4 cases of recurrence (5.7%) out of 70 were not epidermoid carcinoma (or squamous cell carcinoma) of the lower irradiated. portion of the mouth predicts an unfavorable prognosis. This explains Conclusions a constant concern and strategy changes in the treatment of the neck The choice of selective neck dissection in levels I to IV in cases of with this malignancy. Initially, this procedure was used in necks with squamous cell carcinoma in the lower region of the mouth associated no metastatic lymph nodes (cN0) and in those cases with lymph node with palpable metastases at level I is feasible without loss of onco- metastases up to 2 cm with no rupture of the capsule (pN1).9-17 logical results. These studies underlined our proposition to change the extension of neck dissection for the surgical treatment of necks with clinical metastases (cN1) from squamous cell carcinoma in the lower region of the mouth. EPS00627 Objectives Pentoxifylline 1 Tocopherol: A Smart Combination Most common carcinoma in oral cavity is squamous cell carcinoma.metastatis in the spread of head and neck disease is the most to Treat Radiation Induced Fibrosis common factor.most common site larynx, pharynx, hypopharynx.- and Osteoradionecrosis lymph mode metastasis reduces the survival rate of patients with squamous cell carcinoma. Dr. Vikas Gunishetty, Dr. Padmaraj Hedge Methods A retrospective analysis was made of 460 charts of patients diagnosed A.B. Shetty Memorial Institute of Dental Sciences, Mangaluru, with squamous cell carcinoma in the lower region of the mouth. The Karnataka Research Ethics Committee approved the trial (number 353). Eligi- bility criteria were as follows: previously untreated patients with squamous cell carcinoma in the lower region of the mouth (tongue, Abstract Background/Introduction floor of the mouth, retromolar region and the lower gingiva) that underwent radical or selective (supraomohyoid) neck dissection, with Osteoradionecrosis and radiation induced fibrosis are well established a minimum follow-up period of 12 months or until death. 18 Patients pathophysiological processes after radiotherapy. They became a were classified according to age, sex, site of the primary tumor, and prime concern for the surgeons due their devastating nature, by clinical and pathological staging (TNM 2002). The mean age was increasing the morbidity of the patient. Despite of many treatment 54.5 years, the median age was 53 years (Q25-75% = 47 - 62), the advancements, they still pose a constant challenge to surgeons for minimum age was 22 years and the maximum age was 87years. There treatment. Objectives were 406 men (88.3%) and 54 women (11.7%), an 8:1 ratio. The tumor sites were the floor of the mouth (180 cases, 39.1%), the tongue To review the evidence based literature on the use and outcomes of (136 cases, 29.6%), the retromolar region (74 cases, 16.1%) and the Pentoxifylline and tocopherol in treating radiation induced fibrosis lower gingiva (70 cases, 15.2%). and osteoradionecrosis. Results Methods There were 445 radical neck dissections, distributed according to A literature review was done on various search engines and relevant metastasizing levels. In 273 cases N? that excluded 2Nx, the cases articles were analysed. were distributed according to those levels and TNM staging. The Results distribution of lymph nodes according to the four sites of the lower Use of Pentoxifylline and tocopherol have shown promising results region of the mouth was sub-classified for the dissections. In both in preventing and treating radiation induced fibrosis and supraomohyoid neck dissections (among the total 573), the rates of osteoradionecrosis. Conclusions local, regional and local-regional recurrence for those 106 pN0 cases (82.9%). There was regional recurrence in 27 cases (6.1%) of 445 This combination of drugs has a long established positive track record neck dissections. Of these 7 cases (4.0%) were pN0 and 20 cases in the management of radiation induced fibrosis and osteora- (7.3%) were pN?. In those 7 pN0 cases, 5 cases recurred within the dionecrosis. In the near future, this treatment modality will be widely dissection area and 2 recurred in the contralateral side of the neck; followed, thereby limiting the effects of radiation induced fibrosis and these 7 were not irradiated. Of the 20 pN? cases, 11(2,2%) occurred provide a part of solution to treat its consequences. in the neck, 2 within the dissected area and 9 in the contralateral side of the neck;. Regional recurrence occurred in 9 cases (7.1%) of 128 supraomohyoid neck dissections, of which 6 cases (7.3%) were pN0 and 3 cases were pN? (6.5%). Recurrence was within the dissected area in 2 of the 6 pN0 cases, and in the contralateral side of the neck in 2 cases; none of these cases were irradiated. In 3 pN? recurrence

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EPS00666 ABS00681 Effective Surgical Treatment modalities Reconstruction of Squamous Cell Carcinoma of Tongue for Proliferative Verrucous Leukoplakia (PVL): Our with Cheek Flap: A Case Report Clinical Experience Pynkmenlang War; Divya James; Prof. Dr. Rinku George Dr. Damyanti Walkey, Dr. Abhay Datarkar, Dr. V.N. Hazarey, Oral & Maxillofacial Surgery Saveetha Dental College and Hospital, Chennai; Saveetha Dental College and Hospital, Chennai; Head of Oncology Department, Govt. Dental & College, Hospital, Nagpur Saveetha Dental College and Hospital, Chennai

Abstract Abstract Background/Introduction Background/Introduction White lesions both physiologic as well as pathologic are relatively Squamous cell carcinoma of the tongue has tobacco smoking and frequent in the oral cavity, the most common pathology being oral alcohol ingestion as major risk factors and spans two regions: The leukoplakia. There are many variants of Oral Leukoplakia, one of anterior two-thirds (oral tongue) is a common subtype of squamous which is proliferative verrucous leukoplakia (PVL). PVL is a rare cell carcinoma of the oral cavity whereas the posterior third (base of clinico pathological entity, which is slow growing, long term pro- tongue) is considered part of the oropharynx. Epidemiology and risk gressive lesion, but remains an enigmatic and difficult to define. The factors are similar to squamous cell carcinomas elsewhere in the etiology of PVL remains still unclear. Tobacco use does not seem to upper aerodigestive tract, with tobacco smoking and alcohol ingestion have a significant influence on the appearance of PVL. These lesions being major risk factors. Of note, the role of human papillomavirus may occur both in smokers and non smokers. Various case have (HPV) as an aetiological factor for squamous cell carcinoma is presented PVL as a disease with aggressive biological behavior due to strongest in oral cavity (compared to other regions in the head and its high probability of recurrence and a high rate of Malignant neck), with HPV DNA isolated from up to 50% of cases, and thought transformation. Prognosis is poor for this seemingly harmless responsible for the tumour in over half of these. appearing lesion of the oral mucosa. The complete excision and Objectives definitive treatment modality are need of time. - To make patient free from disease. - To reconstruct the defect and Objectives provide a better quality of life. To evaluate the use of different treatment options in the management Methods of PVL. Patient reported to the department of oral and maxillofacial surgery Methods with a complain of pain in the right inferio - lateral border of the All patients reporting to Dept.of Oral & Maxillofacial Surgery tongue since one month. Initially it was small in size but gradually between June 2015-June 2017 were included in study. Total 28 increased to the present size. Patient also complained of burning patients [M-19, F-9] age 25 yr to 58 yrs with leucoplakia lesion on sensation while eating spicy food. Biopsy was taken and the diagnosis more than one sight in same oral cavity were included in study. was given as well - differentiated squamous cell carcinoma of tongue. Histopathological diagnosis were confirmed on Biopsy. Patients with Treatment Done: Wide local excision, neck dissection and recon- medically compromised condition & with biopsy showing malig- struction with cheek flap. nancy were excluded from the study. Patients with single lesion 0.5 Results cm & above were treated with wide local excision followed by Post operatively, patient was stable. The flap was released from the reconstruction. Patient with multiple lesion less than 0.5 cm were tongue after two weeks. treated with laser ablation. Follow up was done 1month, 3 month, 6 Conclusions month,1year. Although, a radial forearm free flap was the ideal flap for recon- Results struction, we were able to give a better quality of life with the cheek Total 28 [M-19, F-9] patient age 25yrs to 58 yrs with mean age flap. 32.7yrs out of which 10 Patients with single lesion 0.5 cm & above present over buccal mucosa [5], palatal mucosa [2], retromolar region [3] were treated with wide local excision followed by reconstruction ABS00698 with collagen sheet, buccal fat pad. 18 Patient with multiple lesion less than 0.5 cm were present over buccal mucosa & retromolar Pectoralis Major Myocutaneous Flap a Versatile Flap region, labial mucosa, or combination of either of these were treated in Head & Neck Reconstruction with laser ablation. Conclusions Dr. Devesh Ostwal, Dr. A. Garg, Dr. S.R. Shenoi, Dr. V. Kolte, Dr. To conclude, PVL need special consideration for early management K. Bang, Dr. P. Ingole, Dr. N. Budhraja as there are more chances of malignant transformation, Histopatho- logical confirmation is needed wide local excision of the primary VSPM’s Dental College & Research Centre, Nagpur lesion along with 1-2 cm safe margin with different adjuvant procedure like reconstruction, laser ablation is must, alveolectomy, as and when required provide the effective treatment modality avoiding the Abstract further recurrence. Background/Introduction Oral squamous cell carcinoma is one of the most common malignancies, especially in developing countries. Its early diagnosis is relatively easy but it is usually reported at an advanced stage. Reconstruction following head and neck cancer surgery is a difficult task and free flaps are considered as the gold standard for the reconstruction but the resources are limited and require long training

123 S156 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 to master. Pectoralis major myocutaneous (PMMC) flap owing to its EPS00719 good vascularity and easy learning curve for surgeons is still a Detection of Cervical Lymph Node Metastasis workhorse at centers with limited resources. Here we discuss about versatility of Pectoralis major myocutaneous flap reconstruction fol- with Magnetic Resonance Imaging in Head and Neck lowing head and neck surgeries. Squamous Cell Carcinoma and Its Correlation Objectives with Histopathological Diagnosis: A Prospective Study To evaluate the versatility of the flap. of 12 Cases Methods We have analysed 23 case of malignancy involving alveolus and buccal mucosa and rehabilitation with the help of PMMC flap from Dr. Anuj Agarwal, Dr. Amit Kumar July 2016 to July 2017. Results ITS Dental college & Research Center, Greater Noida Study is under statistical analysis. Conclusions Abstract Awaited. Background/Introduction The presence of cervical lymph node metastasis and its identification is important for the treatment and prognosis prediction of head and neck squamous cell carcinoma. Clinical palpation is not satisfactory EPS00709 for the accurate diagnosis of cervical lymph node metastasis. Mag- A Comparative Evaluation Between Different Timings netic resonance imaging (MRI) has been increasingly used to evaluate of Removal of Neck Drains Following Oral Squamous the status of cervical lymph node. Cell Carcinoma Surgery Objectives The primary objective of this study is to investigate the MRI features of cervical lymph nodes metastasis of head and neck squamous cell Dr. Nikhil Moriwal, Dr. S. R. Shenoi, Dr. A. Garg, Dr. V. Kolte, Dr. carcinomas, and its accuracy to diagnose the presence of metastasis. K. Bang, Dr. P. Ingole, Dr. N. Budhraja Methods An Prospective Observational study which included evaluation of 56 VSPM’s Dental College and Research Centre, Nagpur nodal levels and 498 lymph nodes in 12 patients with head and neck squamous cell carcinoma were analyzed on MRI and compared with Abstract their histopathological diagnoses. Background/Introduction Results Neck dissection is a mainstay of treatment for patients with head and Of the 498 lymph nodes in 56 nodal levels, 20(4%) lymph nodes were neck malignancies for both therapeutic and diagnostic reasons. The proved pathologically as metastases, level II was the most commonly purposes of neck drains are to obliterate dead space and to reduce involved. False-positive and false-negative rates of MRI diagnoses seroma and hematoma formation, thus improving skin apposition and were higher in levels I than in levels III, IV, and V. On MR images, wound healing. This study aims to determine different timings, for Central nodal necrosis was seen in 20 nodal levels were proved better decisions on drain removal and its sequelae. histopathologically as metastatic nodes. Extracapsular nodal inva- Objectives sions in 8 nodal levels, Perineural Invasion seen in 11 nodal levels and To compare - Between different timings of removal of neck drains Lymphovascular Invasion seen in 10 nodal levels. The diagnostic and its sequelae. - Total drainage volume based on type of surgery criteria of metastasis as the minimal nodal diameter of [/= 8 mm or and subsite of lesion. - Duration of hospital stay following surgery. central nodal necrosis. The diagnostic sensitivity was 87.50%, Methods specificity was 75%, and disease prevalance was 66.67%. Patients, who needed to undergo resection of tumor and supra omo- Conclusions hyoid neck dissection with closed suction drain inserted were The incidence of cervical lymph nodes metastasis head and neck included in the study and divided into three groups A, B and C, squamous cell carcinoma is highest in level II. MRI diagnostic criteria depending upon the timing of neck drain removal. Complications of cervical lymph nodes metastasis are nodal size, central nodal associated such as salivary fistula, wound dehiscence with abscess, necrosis, and irregular contour of lymph nodes were assessed. MRI wound dehiscence without abscess and seroma or hematoma forma- accomplishes the criteria of the minimal nodal diameter being [/= tions were evaluated. Also total drainage volume and duration of 8mm for a metastatic lymph node and therefore may diagnose lymph hospital stay following surgery was observed. node metastasis with optimum accuracy. Results Results are awaited as the study is under statistical evaluation. Conclusions Awaited. EPS00794 Non Destructive Tissue Analysis for Ex Vivo and In Vivo Cancer Diagnosis Using a Handheld Mass Spectrometry System: THE MasSpec PEN

Jialing Zhang, John Rector, John Q. Lin, Jonathan Young

Abstract Background/Introduction Tissue assessment and diagnosis are critical in the clinical management of cancer patients and more so during surgical excision for

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S157 margin evaluation. Conventional methods for histopathological tissue Results diagnosis are labor- and time- intensive and can delay decision The lesion was treated by wide surgical excision and healing of the making during diagnostic and therapeutic procedures. Molecular palatal mucosal defect by secondary intention. analysis of cancer tissues offers the exciting opportunity to incorpo- Conclusions rate cancer specific biomarkers into clinical decision making for This case report highlights the need for proper diagnosis and treat- improved cancer detection and diagnosis, one of them being Mass ment plan in the cases of malignant tumors as it can lead to morbidity Spectrometry Imaging. and mortality. Objectives One of the greatest challenges cancer surgeon faces is determining the delicate boundary between cancerous and normal tissues to achieve negative margins for invasive and carcinoma in situ while optimizing EPS00803 aesthetic outcomes. Thus, accurate negative margin assessment and Maxillofacial Access Osteotomies: Creating a Route complete tumour excision are highly desirable for prolonged disease to the Inaccessible free and overall survival. Methods The MasSpec Pen was designed to operate directly on tissue speci- Dr. Nancy Mathew mens independently of tissue stiffness and morphology. It was used for ex vivo molecular analysis of 20 human cancer thin tissue sections Christian Dental College, Ludhiana and 253 human patient samples inclusing normal and cancerous tissues from the breast, lung, thyroid and ovary. Abstract Results Background/Introduction The mass spectra obtained presented rich molecular profiles charac- A plethora of pathologies occur in the cranial base and deep spaces of terized by a variety of potential cancer biomarkers identified as the neck, treatment of which poses a surgical challenge owing to the metabolites, lipids and proteins. Statistical classifiers built from the anatomical complexity, difficulty in access and proximity to vital histologically validated molecular database allowed cancer prediction structures. A multidisciplinary approach is often required in these with high sensitivity(96.4%), specificity(96.2%) and overall accuracy situations. of 96.3%. Objectives Conclusions To discuss various Surgical accesses that aid in removal of inacces- The results provide evidence that the application of an automated, sible tumors of craniomaxillofacial region. biocompatible, disposable handheld device, the MasSpec Pen, could Methods potentially be used as a clinical and intra-operative technology for There is a multitude of surgical accesses for the facial skeleton based direct, real-time, non-destructive ex-vivo and in-vivo sampling and on the concept of modular osteotomies.the surgical approaches molecular diagnosis of tissues. involving the disarticulation of the craniofacial skeleton aimed at providing increased and more direct exposure of both the pathology and the surrounding structures while avoiding the need to resect the uninvolved structures. Three-dimensional access to skull base tumors EPS00802 is obtained by wide soft-tissue exposure and selective osteotomy and Peninsula of Extra Tissue: Mucoepidermoid Carcinoma removal of parts of the facial skeleton. Results Dr. Abdulla kirash Dr. Rahul Kumar Sanklecha Any technique of access osteotomy can be done with good esthetic and functional results with proper pre-op planning, instrumentation, and regular follow-up. Sri Hasanamba Dental College and Hospital Conclusions Access osteotomy allows the surgeon a better view and a better access Abstract of the surgical field to resect the tumor completely with safer margins. Background/Introduction Thus, in the process helping to preserve vital structures, preoperative - Mucoepidermoid carcinoma is the epithelial salivary gland neo- function and reduce post operative complications. plasm of the oral cavity. It accounts for less than 3% of all head and neck tumours. Mucoepidermoid carcinoma of minor salivary gland origin is rare. It is composed of mucous producing, squamous and intermediate type cells. EPS00813 Objectives Assess Speech Quality After Treatment for an Oral To present a case of low grade mucoepidermoid carcinoma of palate Malignancy and Tips to Treat and discuss the various surgical treatment options. Methods We hereby present you a 65 years old female patient with the chief Dr. Ramya Narahari complaint of ill fitting maxillary denture and swelling on the right posterior part of hard palate since 2 years. The swelling was inspected K.L.E Institute of Dental Sciences Bangalore over the right side of the palate involving the right alveolus. The size of the swelling gradually increased and reached 4 x 3.5 cm size by the Abstract end of first year and thereafter the size remained constant. She gave Background/Introduction history of self exfoliation of teeth in the same region. Swelling was Speech outcome after treatment for an oral malignancy often results non tender, soft in consistency, compressible, fluctuant and non pul- in articulation difficulties due to tissue loss and structural alteration of satile. The incisional biopsy of the lesion confirmed the diagnosis as various speech organs. low grade mucoepidermoid carcinoma.

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Objectives is mandatory to restore the oral function and speech. Various methods The aim of this presentation is toThe aim of this presentation is to of immediate reconstruction are implemented by different authors understand quality after treatment for an oral malignancy. time to time including autogenous non vascularized bone graft, Methods allogenic bone graft or reconstruction plates and others. Each has its A specific speech characteristic that influences intelligibility and own advantages and disadvantages including donor site morbidity, speech quality is voice-onset-time (VOT) in stop consonants. failure and others. The purpose of the present case report is to Results establish that micro vascular free fibula is a better option to other Problems with speech production in patients treated for oropharyngeal methods in the immediate reconstruction of mandibular continuity cancer often includes nasal resonance and velopharyngeal defect. inadequacy. Objectives Conclusions Anatomical, functional and esthetic rehabilitation of patients after The aim of this presentation is to understand quality after treatment mandibular resection. for an oral malignancy. Methods Revascularization of free fibula graft by microvascular anastomosis of fibular artery with facial artery at the segmental defect site of Section: Reconstruction mandible. Results Remarkable contour, cosmesis and early functional rehabilitation of the patient. EPS002 Conclusions Versatility of Submental Flap in Soft Tissue Defects Microvascular reconstruction with fibula is the better option for defect correction and early rehabilitation in patients with mandibular continuity defect. Dr. Wasim Pathan, Bharati Vidyapeeth

Dental College and Hospital, Pune EPS0065 Abstract BRIDGING THE GAP-Osteomyeltis and Temporalis Background/Introduction Muscle Flap The reconstruction of post operative oral and maxillofacial defects frequently presents a challenging dilemma for the surgeon. Various techniques to reconstruct the oral and maxillofacial defects include Dr. Rakshita Malik skin graft, local or regional flap and free vascularise tissue transfer. The locoregional pedicled cutaneous (submental) flap is a simple, less FODS, SGT University morbid and offers equal if not superior patient outcomes than the other microsurgical flaps. Abstract Objectives Background/Introduction The submental flap is often served as work horse for soft tissue Osteomyelitis an inflammatory condition of bone beginning as reconstruction of mandible and due to its greater arc of rotation it can infection of the medullary cavity, rapidly spreads to Haversian system also be used for reconstruction maxilla and skull base defects. and involves periosteum of the infected areas, generally seen in Methods mandible due to its higher density; it is not often encountered in This versatile flap was successfully used for soft tissue reconstruction maxilla due to its richer vascularity and presence of sinus spaces, of maxilla and mandible. which aid in local spread of pus and other exudates. Results Objectives No major complications were noted. In all patients, the results were To Rehabilitate osteomyelitic maxilla following partial maxillectomy satisfactory, with acceptable cosmesis. with temporalis muscle flap. Conclusions Methods The submental artery island flap is safe, rapid, and simple to raise and 47 yr old, male, with uncontrolled diabetes, presented with leaves a well-hidden scar. osteomyelitis of left maxilla wrt 25,26,27 region associated with pain and pus discharge. CBCT revealed sclerotic alveolar bone (necrotic bone) surrounded by radiolucency(osteolysis). Patient’s blood sugar was controlled using insulin. Under GA partial maxillectomy was EPS0019 performed irt 25,26,27 region, curettage done, fresh bleeding Mandibular Reconstruction for Ameloblastoma Using achieved & Using alkayat bramley approach, Temporalis Muscle flap Free Fibula Graft: A Case Report dissected & tunneled below Zygomatic arch intraorally for Intraoral reconstruction. Results Dr. Debasish Sinha Primary closure was achieved. No evidence of dehiscence and fistulas was noted after a follow up of 3 months. Sree Balaji Dental College and Hospital Conclusions In our experience the myofascial temporalis flap demonstrated to be Abstract safe and versatile option, due to both anatomical proximity to the Background/Introduction midfacial region and easy transference, this flap is an excellent choice In maxillofacial surgery tumour ablation often causes continuity for reconstruction, especially in patients with poor recovery potential; defect of the mandible which results in anatomical and functional with only major drawback, temporal area hollowing. morbidity of the patient. The reconstruction of the mandibular defect

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EPS0082 degree celsius from 30-90 minutes. After this fetal bovine serum is Application of INVERSE PLANNING in Maxillofacial added. Then it is mixed to disintegrate adipose tissue aggregates. After the material is centrifuged, it is possible to seperate adipocytes Reconstruction-‘‘Jugaad Technique from the stromal vascular fraction (SVF). After the separation of SVF from the adipocytes is complete, the sample (SVF) is incubated in ice Dr. Amit Dhawan, Dr. Ramandeep Singh Bhullar, Dr. Tejinder Kaur, for 10 minutes in lysis buffer. Then the sample is washed in PBS Dr. Mehak Malhotra containing P/S and once again centrifuged. Cellular expansion is initiated in appropriate culture medium (e.g. Dulbecos modified Sri Guru Ram Das Institute of Dental Sciences and Research, Eagles medium). The adipose derived stem cells obtained may be Amritsar used in various protocols of cell characterization. Results Abstract Based on so many in vitro and in vivo research results, cell therapies Background/Introduction using adipose derived stem cells are widely promising in various The ultimate goal of maxillofacial reconstruction is to provide func- clinical fields, such as facial lipoatrophy reconstruction, cardiovas- tional and esthetic balance along with quality of life. Free fibula cular tissue regeneration, craniofacial tissue regeneration etc. provides extensive bone and skin that can be cut and shaped accu- Conclusions rately to fit the recipient site, and allows all types of reconstructions The potential of adipose tissue to be a prolific source of multipotent for ablative defects of mandible and maxilla. adult stem cells has garnered a great deal of attention in the field of Objectives regenerative medicine. The aim is to introduce a technique for planning functional maxillofacial reconstruction with dental implants. Methods EPS00126 Preoperative dental casts were made on Hanau Articulator and a fibula analogue was then placed in an ideal functional reconstruction Residual Deformity Due to Zygomatico-Orbital position. Drill holes for the placement of implants were placed Fracture through the acrylic base denture or surgical stent. This denture base or stent formed act as a guide to position the fibula transplant during Dr. Manoj Kumar. K.P&Dr. Aswathi Vinod surgery. Results KMCT Dental College, Calicut This technique was useful in producing functional and rehabilitative outcomes in cases of both maxillary and mandibular reconstructive Abstract surgeries. Conclusions Background/Introduction The Jugaad technique’’denture based inverse planning’’is a cost Disfiguring post traumatic deformities persist even after the treatment, effective method for planning and executing maxillofacial recon- such deformities after healing are formidable challenges faced by structions using mock surgery on casts and interim dentures. surgeons, apart from psychological impact on the patient. Immediate treatment sometimes leaves secondary defects like depression in malar region or ocular deformities such defects are addressed sec- ondarily by refracturing and realigning the malunited fragments or by EPS00104 camouflage procedures. History of RTA 5 months back with diplopia, Adipose: As a Potential Source of Stem Cell in Tissue enophthalmosis,flattening of right malar eminence & trismus and diagnosed as residual deformity after zygomatico orbital wall Regeneration fracture. Objectives Dr. Abhishek Patley To correct the level of pupil,flattened malar eminence and to improve mouth opening, to restore function and facial aesthetics. New Horizon Dental College and Research Institute, Bilaspur Methods (Chhattisgarh) Surgical correction of fractured zygomatic arch, elevation of herniated orbital contents by restoring orbital floor and improving mouth Abstract opening. Background/Introduction Results Adipose tissue has a self- renewal ability, high proliferative capacity Patient was satisfied with aesthetic outcome, and diplopia was and potential of tissue differentiation in vitro and in vivo studies of corrected. tissue regeneration. Adipose derived stem cells represent as enticing Conclusions pool of multipotent adult stem cells because of their relative abun- In post operative reviews we weren’t satisfied about the aesthetic dance, ease of isolation and expandability. results though there is marked improvement from the initial fattening Objectives of right side of face. Excellent results in mouth opening and correc- To reveal potential of adipose derived stem cells to be prolific source tion of diplopia. of multipotent stem cells in tissue regeneration. Methods The adipose tissue is grinded and washed in phophate buffered saline (PBS) containing penicillin/streptomycin (P/S). With the addition of collagenase, the digestion phase begins. The tissue is incubated at 37

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EPS00128 Methods Versatility of Tongue Flap for Repair of Palatal Fistulae Review of literature. Results After the review of litrature it was found that successful management Presenting Author: Dr. Saubhik Dasukil Co-Author: Dr. Sujith Shetty, of various oral and maxillofacial defects was done using buccal fat Dr. Saikrishna D pad. Conclusions JSS Dental College and Hospital, Mysore Extraction of BFP from the deep facial region is a safe procedure with minimal risk of complications. Due to the unique features of the BFP Abstract such as its location, easy accessibility, rich blood supply, high rate of Background/Introduction epithelialisation and minimal donor site morbidity, makes it a reliable An oroantral/palatal fistula is an abnormal communication between soft tissue graft. the oral and nasal cavity. It can occur after primary surgical repair of cleft palate or by trauma, cyst, neoplasm, irradiation, or infectious diseases like syphilitic gumma, leprosy, noma etc. Most fistulae greater than 5 mm in diameter requires surgical closure. This study EPS00162 was taken to assess the functional and clinical outcome of closure of Intraoral Sites for Harvesting Bone Grafts palatal fistulae with tongue flap. Objectives Dr. Jaya Sarkar 1. Clarify the technique of elevating and insetting tongue flap to fit palatal defect. 2. Study the outcome of tongue flaps in terms of K. D. Dental College, Mathura functional and aesthetic results. 3. To study donor site morbidity. Methods In this study, 10 patients having palatal fistula were treated with Abstract Background/Introduction anterior/posterior based dorsal tongue flap. The patients were evaluated for outcome in terms of flap uptake and efficacy, correction of Osseous defects occur as a result of trauma, prolonged edentulism, oronasal regurgitation, speech and articulation, donor site morbidity congenital anomalies periodontal disease, etc. A commonly used and aesthetics. method for the repair of maxillofacial bony defect is the utilization of Results autogenous bone grafts from intraoral donor site. Objectives The study revealed results in support of the technique mentioned, showing good success rate in terms of flap uptake and correction of To quantify the amount of bone in terms of area, thickness & volume oronasal regurgitation, significant improvement in speech and artic- that can be harvested from the mandibular symphysis, ascending ulation with imperceptible donor site morbidity. ramus, coronoid process, zygomaticomaxillary buttress, mandibu- Conclusions lar/palatal tori. Advantages being easy accessibility, low rate of Use of tongue flap for repair of palatal fistulae is a successful tech- morbidity, less cost. Methods nique as it provides appreciable quality and quantity of well vascularized tissue for fistula closure with negligible functional and Osteotomy is performed with a surgical bur and completed with a aesthetic morbidity associated with donor site. mallet and chisel; bone scraper;piezoelectric device. Results Ramus has the highest average cortical bone surface area and volume harvested, while symphysis has the highest average thickness. EPS00160 Conclusions Applications of the Buccal Fat Pad in Oral The use of appropriate surgical technique with sound knowledge of bone biology optimizes ridge augmentation and other surgical pro- and Maxillofacial Surgery cedures, wherein (a)intraoral bone is preferred over extraoral bone, (b)mandibular donor bone is preferred over maxillary bone,(c)donor Dr. Thushara Kumari, Dr. Anand Amirtraj bone which is contiguous with recipient site is preferred over intraoral bone from second distant location. Manipal College of Dental Science, Mangalore

Abstract EPS00165 Background/Introduction BFP as a pedicle graft has become more common; the relatively easy Reconﬁgurating the TMJ-Diversiﬁed Options use and the location of the BFP are anatomically favorable and minimal dissection allows it to be harvested and mobilized; good rate Dr. Sayantan Ghosh of epithelialization and low rate of failure have made it the preferred option for oral and maxillofacial applications. The repair of oroantral Haldia Institute of Dental Science & Research and oronasal defects, the repair of pathological or traumatic defects, the repair of congenital cleft palate defects, use as a biologic mem- Abstract brane for covering bone grafts, and its application in Background/Introduction temporomandibular joint surgery are some of its common Many physiologic function such as speech and mastication depend on applications. TMJ. Anatomical structural damage of TMJ such as trauma, tumour, Objectives resorption and ankylosis require removal of pathologic structure and Through this poster we aim to highlight the applicability of buccal fat reconstruction of TMJ. Reconstruction of the TMJ is one of the most pad for the reconstruction of various Oral and Maxillofacial defects. challenging procedures because the joint has complex anatomy

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S161 packed in a small space and unique motion under high pressure. A Results successfully reconstructed TMJ should reproduce normal joint In patients, we noticed excellent esthetic results after reconstruction structure, provide functional articulation and permit adaptive growth using FFF. We encountered some of the problems such as edema of and remodelling. donor leg, walking difficulties in initial days, unesthetic scar on the Objectives donor leg, etc. But apart from that patients were satisfied with the results. To evaluate the prognosis of different method of TMJ reconstruction Conclusions in different situation. Thus, we conclude that it has made a significant impact on preserving Methods the patients quality of life. Selected a patient randomly irrespective of their cast, creed, sex and socio-economic status indicated for TMJ reconstruction. Recon- struction procedure are- Reconstruction using 1. Sternoclavicular graft (SCG), 2. Costochondral graft, 3. coronoid process, 4. Iliac crest, EPS00225 5. Metatarsopharyangeal joint either vascular or nonvascular, 6. Free Orbital Floor Reconstruction Using Biomaterials fibula, 7. Combination of no. 5 and no. 6, 8. Posterior border of ramus, 9. Distraction osteogenesis, 10. Hydroxyapptite colagen, 11. Alo- Dr. Gourab Mandal plastic Tmj reconstruction. Results Haldia Institute of Dental Sciences and Research Reconstruction opinion can be divided into autogeneous or aloplastic and the current state of art is such that there is no single best option for all situations. The ideal reconstruction technique needs to be Abstract customized to the individual patient and TMJ defects. Background/Introduction Conclusions Orbital fractures are often common fractures of the midface. As such, The myriad of available TMJ reconstruction options reflect the fact it numerous techniques and materials exist for the repair of this region, remains on evolving field. Although no gold standard currently exist, each with inherent advantages and disadvantages. A comprehensive the various technique each have their own indication and potential review of materials used in orbital reconstruction and possible new advantage and drawbacks. Current reconstruction technique lie in directions in orbital floor reconstruction are presented. favour of autogenous replacement in children and alloplastic in adults. Objectives The balance seems to be swinging towards alloplasts in older To evaluate the prognosis of using various biomaterials in orbital children. floor reconstruction. Methods Selected patients randomly irrespective of their caste, creed, sex and socioeconomic status indicated for orbital floor reconstruction using ABS00219 the following biomaterials: Autograft, Autologous bone, autologous Reconstruction of Maxillofacial Surgical Defects Using cartilage, autologous fascia, autologous periosteum, allografts, Free Fibula Flap: A Case Series xenografts, collagen membrane, porous hydroxyapatite and calcium phosphate, bioactive glasses. Results Dr. Trupti S. Nikalje, Co- author- Dr. N. N. Andrade The general goal for orbital wall reconstruction is to restore the normal anatomical relations of the internal orbit while avoiding Nair Hospital Dental College complications of the procedure and implant. Given the large number of graft materials available for orbital fracture repair, it is therefore Abstract important to analyze these materials within their respective Background/Introduction categories. The maxilla and the mandible are major components of human facial Conclusions appearance and have a great contribution to orofacial function. Thus, The ideal material for orbital floor fracture repair is one that is post surgical reconstruction is of paramount importance with a graft resorbable, osteoconductive, resistant to infection, minimally reac- that is viable and allows prosthetic rehabilitation. Hidalgo first tive, does not induce capsule formation, has a halflife which would reported the use of a fibula vascularized flap for mandibular recon- allow for significant bony ingrowth to occur, and is cheap and readily struction. The main advantage of the free fibula flap is its ability to available. provide the largest bone length that allows reconstruction even after complete jaw resections. Objectives EPS00247 Aim: To document our experience using the free vascularized fibular flap for comprehensive reconstruction of discontinuity defects in the Recent Trends in Mandibular Reconstruction: jaws, after resection of benign odontogenic tumors. Objectives: To An Overview document 1. Indications & contraindications of FFF. 2. Advantages & disadvantages of FFF. 3. Prosthetic rehabilitation techniques. 4. Dr. Kamini Dadsena Advances in FFF. Methods New Horizon Dental College and Research Institute Sakri, Bilaspur, Materials & Methods: A total of 10 cases were included in the case Chhattisgarh series. These patients reported to the OPD, Dept. of Oral & Max- illofacial Surgery, Nair Hospital Dental College, Mumbai with orofacial tumors for which they underwent surgical resection and Abstract reconstruction with free fibula flap. Background/Introduction Mandibular reconstruction has changed significantly over the years and continues to evolve with introduction of newer techniques.

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Mandibular defects may result from trauma, inflammatory disease and Results benign or malignant tumours. Mastication, speech and facial aes- There was normal and natural healing of irradiated tissues and oro- thetics are often severely compromised without reconstruction. The cutaneous fistula with no trismus and pain. Patient is back to her goal of mandibular reconstruction is to restore facial form and normal routine with minimal facial deformity. A 1 year follow up was function, implying repair of mandibular continuity. done and there is no complication still now regarding the recon- Objectives structive surgical method done for this patient. The aim of my poster presentation is to summarize the reconstruction Conclusions options available for mandible, the various donor sites and current Intraoral plating of recon- plate above the mucosa reduces chances of reconstructive options. orocutaneous fistula than plating it under mucosa. Methods Many reconstruction modalities have been attempted. These modalities include reconstruction plates with or without pedicled myocutaneous flaps, alloplasts, free grafts, pedicled osteomyocuta- EPS00342 neous flaps, and a variety of free vascularized bone flaps. Recent PMMC Flaps the Prefered Option for Maxillofacial advances like 3D printing, stereolithographic models, and the use of Reconstruction custom-made implants can aid and improve the accuracy of existing reconstructive methods. Other tech. like DO, tissue engineering and robotic surgery drives us in new era of reconstruction. Dr. Israel Nathanael Raj Results Current trends in mandibular reconstruction aim to achieve reestab- Sree Balaji Dental College & Hospital Chennai lishment of a viable mandible of proper form and maxillary mandibular relationship while decreasing the need for invasive Abstract autogenous graft procurement. Background/Introduction Conclusions Reconstruction of the head and neck involves the selection of an apt Mandibular defects following ablative surgery or trauma impact both flap. PMMC flap being the most appropriate flap for the reconstruc- form and function and require a multidisciplinary approach to opti- tion of lower face and neck region. mize functional and cosmetic outcomes and refinements in techniques Objectives continue to improve patient quality of life. To state the importance and success factors in reconstruction of head and neck with pectoralis major. Myocutaneous flap. Methods Review of litereture, and case study involving 9 cases. EPS00297 Results Bend it Like Mandible: A New Approach Satisfactory prognosis after pmmc reconstruction. for the Surgical Management of Osteoradionecrosis Conclusions PMMC flap is the undenied technique for all lower face reconstructions. Dr. Anjali Unnithan, 2nd Mds Student, Dr. Jacob John, Professor

Dept. of Omfs, Azeezia Medical College EPS00345 Abstract Reconstruction in Oral and Maxillofacial Surgery Background/Introduction osteoradionecrosis is a chronic, non- healing wound caused by Dr. Priyanka Tripathi and Dr. Girish Giraddi hypoxia, hypocellularity and hypovascularity of irradiated tissue. In regular treatment modality HBO therapy followed by segmental GDC&RI Bangalore mandiblectomy and reconstruction with a recon plate is a commonly practised treatment option. Formation of orocutaneous fistula with plate exposure is main complication that we can face in this treatment Abstract method. Background/Introduction Objectives In past resection of oral tumours had been associated with significant To determine the efficacy of plating the recon plate intraorally over disfigurement and loss of function. As a result demand for function- the mucosa to reduce the chance of orocutaneous fistula and to correct ally successful and esthetically pleasing. Reconstruction of oral and the lost segmental part. maxillofacial soft tissue defects after benign and malignant pathology Methods can be achieved using various techniques including regional and A case reported to our outpatient department with orocutaneous fis- distant flaps. These flaps provide both functional and cosmetically tula with necrotic bone and history of irradiation for the management pleasing results. of CA tongue right side. A modification in surgical method has been Objectives implemented in this case after resection of the irritated bone and The present study aims to review types, indications and surgical fixing the recon plate from the remaining proximal end of the techniques of reconstruction using various regional and distant flaps Condylar region and bending in such a way to establish the of defects in oral cavity. mandibular contour intaorally over the mucosa, recreating vertical Methods ramus height. The plate is again bend horizontally over the alveolar Review of techniques of oral soft tissue reconstruction of patients mucosa to recreate the alveolar process and then adapted to the treated in department of Oral and Maxillofacial surgery, Government mandibular symphysis region. prosthetic rehabilitation done by Dental College and Research Institute, Bangalore. placing dentures with buccal flanges above to the horizontal part of recon plate.

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Results EPS00360 Various techniques of reconstruction gained from our experience and Donor Site Morbidity After Free Fibula Flap Transfer learning in treating patients with malignant tumors. Conclusions for Reconstruction of Maxillofacial Defects Incidence of malignancies in Head and neck region is rising.the natures of illness mandates aggressive treatment that is resec- Dr. Himani Joshi tion…Tumour resection results in poor quality of life both functionally and esthetically. Therefore following resection there S.C.B. Dental College & Hospital must be reconstruction. Regional and Distant flaps provide optimal results both functionally and esthetically. Abstract Background/Introduction The vascularized free fibula flap (VFFF) was first described by Taylor EPS00359 in 1975 and popularized by Hidalgo in 1989. The fibula(calf bone) is a leg bone located on the lateral side of the tibia, it transmits 6-16 % of Utility of Superiorly Based Masseter Muscle Flap body weight. It has got attachments to major muscles like flexor for Postablative Retromaxillary Reconstruction hallucis longus. The distal part of fibula helps in stabilising ankle joint. 10 cm of lower part of fibula is very important for stability of Dr. Sagar Ajay Naidu ankle joint. Study of perforators & vascular supply of fibula is desirable. It is currently used to reconstruct bone defects, particularly Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital during limb reconstruction and in maxillofacial reconstruction fol- Dr. Sagar Ajay Naidu Institute-Swargiya Dadasaheb Kalmegh Smruti lowing benign & malignant jaw tumour ablation. Larger fibular flaps Dental College and Hospital are preferably taken from left side as it is non-dominant. Though it has several advantages, the procedure can lead to disrupt lower limb’s function. Complications like dorsiflexion of great toe & stress fracture Abstract of tibia can occur, albeit rarely. The muscles in the antero-lateral and Background/Introduction posterior (lower) leg play an important role during gait as their main Resections in the posterior component of the oral cavity usually lead function is to control the joint stabilization within the foot from the to severe functional compromise and lower quality of life for patients. compressions created by tendons abrupt change in alignment. The anatomic and physiologic rehabilitation of the defect to a rea- Objectives sonable outcome with low morbidity and mortality remains the To examine the early post-operative donor site morbidity and the founding basis of any surgical reconstruction. presence of any long term deficits of donor leg function associated Objectives with removal of vascularized free fibula flap for mandibular Evaluation of Masseter muscle flap for retromaxillary reconstruction reconstruction. for its structural and functional integrity. Methods Methods patients who underwent free fibula flap reconstruction are followed up Study type- A retrospective study from 2006 to 2015 was performed. regularly and the findings are recorded. Method- Patients underwent surgical resection with neck dissection Results depended on grade of the tumor. Reconstruction was performed in all complications like delayed wound healing, weakness of flexor hal- cases using the regional masseter muscle flap and advancement of the lucis longus muscle, transient peroneal nerve palsy, dorsiflexon of palatal flap into the defect. The necessary findings and observations great toe and gait abnormalities rarely stress fracture of tibia are were tabulated. noticed, Results Conclusions 76 patients who presented at the hospital having retromaxillary though free fibula flap is associated with several morbidities but most malignancy, amongst them 53 patients underwent resection of retro- of them resolve within a period of 4-6 months, so it provides us a maxillary malignancy with masseter muscle reconstruction, 48 versatile reconstructive option of correction of various maxillofacial showed a satisfactory outcome. Postoperative infection was noted in 5 defects. patients and 2 of these patients needed debridement. Postoperative wound contracture with muscular spasm and decreased mouth opening in the early postoperative period were a general observation. In all patients, the vitality of the flap was excellent, with epitheliza- EPS00412 tion and adequate mouth opening within 3 weeks. Postoperative Pectoralis Major Myocutaneous Flap: The Workhorse speech, swallowing, and facial esthetics were satisfactory and acceptable. Flap for reconstruction of Oro-Facial Defects Conclusions The masseter muscle flap is a promising reconstruction alternative for Mustafiziur Rahaman, Dr. R Ahmed retromaxillary reconstruction because of advantages such as regional access, ease of harvesting, optimum bulk, flexibility, pliability for Dental College & Hospital larger defects, and minimum postoperative morbidity. Abstract Background/Introduction Ablative surgeries in orofacial region due to cancer results in large soft tissue defect that requires reconstruction. Although free flap using microvascular technique is the standard of care, its use is limited by the availability of expertise and resources in developing world. As a result Pectoralis major myocutaneous flap, which is versatile and less

123 S164 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 technique sensitive method of reconstruction of soft tissue defect, is EPS00430 still a handy tool in surgeons armamentarium. It still remains the Recent Advances in Reconstructive Oral workhorse for head and neck reconstruction in developing countries thanks to its ease of harvest, and minimal requirements in term of and Maxillofacial Surgery instrumentation. The present poster depicts the ability and result of pectoralis major myocutaneous flap in reconstruction of soft tissue Dr. Shameekcha Mishra defect in ablative surgery in oral cancer. Objectives College of Dental Sciences, Davangere to evaluate effectiveness of pmmc as reconstruction of facial defects. Methods Abstract 3 patients with buccal sqamous cell carcinoma were undergone wide Background/Introduction local excision of primary tumor along with neck dissection. The Reconstruction following head and neck surgery has become a very defect caused by the primary resection was reconstructed with pec- tedious task, more so recently due to patient’s expectations regarding toralis major mayocuteneous flap. their quality of life after surgery, and hence, the need for functionally Results and aesthetically high-quality reconstruction is now greater than ever. The defect was successfully reconstructed with pmmc with slight Objectives decrease of the mouth opening. The main aim and objective of this poster is to create awareness about Conclusions the recent advancements and ongoing researches in the area of PMMC can be used for reconstruction of facial defect in oncologic reconstructive surgery. In the last decade, researches were more ablative facial surgery. concentrated on the improvement of pre-operative planning. Now, as a result of advancements in the computer technology, the researches have extended beyond the scope of planning and moving towards EPS00428 surgical procedure itself. Methods 3D Printing in Oral & Maxillofacial Surgery: Review of literature. Systematic Review of Its Utilisation, Merits, Demerits Results Development of navigation, three-dimensional imaging, stereolitho- Dr. Syed Ahmed*, Dr. Rahul Laturiya*, Dr. Priyanka Samel* graphic models and use of custom -made implants can aid and improve the accuracy of existing reconstructive techniques. Robotic *MIDSR Dental College, Latur, Maharashtra, India surgeries allow access to the certain benign and malignant tumors in stage T1 and T2 in oropharynx without the need for mandibulotomy and helps in reconstruction of defect. Tissue engineering and dis- Abstract traction osteogenesis avoid the need for autologous tissue transfer, Background/Introduction thereby avoiding donor site morbidity and providing conservative Introduced in Oral and Maxillofacial Surgery (OMFS) in 2012 with a method of reconstruction. Facial allotransplantation allows the 3D printed mandible, 3D printing in OMFS now occupies 24.12% of transfer of whole anatomical units to be replaced along with com- all 3D printed models in Surgery. pletion of reanimation in a single procedure. Objectives Conclusions To review surgical and non-surgical applications, prospects, merits, All the above-mentioned innovations have their share of advantages and demerits of 3D printing in OMFS. and disadvantages and we as oral and maxillofacial surgeons should Methods imbibe the newer techniques and strive to achieve the best outcomes Electronic searches (PubMed, Medline, Cochrane) were conducted. for the welfare of the patient. Key words used were oral, maxillofacial, surgery, 3D printing, and reconstruction. Systematic search and analysis of full text papers and articles dating from beginning of time till July 2017 in English language were done as per Preferred Reporting Items for Systematic EPS00464 Review and Meta-analysis (PRISMA) guidelines. Histopathological Differences of the Pedicle Artery Results The uses of 3D printed models include surgical templates, for hands- in Commonly Used Free Flaps: The Influence of Age, on experience, personalised prostheses amongst others. Merits include Gender, and Side decreased surgical time, easier surgical protocol, and predictable results. Demerits include unwanted artefacts, high costs incurred, and Dr. Anurag Basak need for strict quality assurance protocol. Conclusions Abstract 3D printing has merits, myriad applications, and bright prospects in Background/Introduction regular OMFS practice, but needs aggressive research to tame its The evolution and advancement of microsurgical techniques in demerits. reconstructive surgery have improved functional and aesthetic outcomes. Often, failure is the result of a multitude of factors. Occlusion of nourishing vessels from thrombosis is an important cause and has been reported to be as high as 10 to 12%. Objectives This study examined the condition of the arterial wall of commonly used free flaps for histologic changes and the impact of age, gender, and anatomic side. The authors’ hypothesis was that vessels from different donor regions would show different atherosclerotic changes.

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Methods EPS00500 Light microscopic examinations of vessel walls were performed on Tissue Expander specimens of the nourishing artery of commonly used free vascularized flaps. The condition of the vessel wall was evaluated1. The peroneal artery (PA), radial artery (RA), inferior epigastric artery Dr. Pooja Patel, Guided by Dr. Amit Mahajan (IEA), deep circumflex iliac artery (DCIA), and circumflex scapular artery (CSA) were examined. Differences of histologic changes in the K M Shah Dental College and Hospital arterial wall and the effect of age, gender, and body side were investigated. Abstract Results Background/Introduction All examined vessel specimens displayed mostly Class II changes. PA The ability of our tissues to stretch and expand gradually over time showed the greatest atherosclerotic changes, followed by the RA, has been observed and documented, both in physiological and IEA, DCIA, and CSA. Age had a meaningful effect on PA and RA. pathological situations, throughout medical history. The phenomenon Anatomic side was important for PA and DCIA, whereas gender had a of tissue expansion is observed in natural all the time. The same minor influence on vessel condition. properties of the human skin to stretch and expand and yield extra Conclusions skin if placed under continuous stress over a prolonged period of time The vessel wall of different flaps showed different atherosclerotic has been utilized for reconstructive purpose in oral and maxillofacial changes depending on age, anatomic side, and gender. These differ- surgery and plastic surgery. ences should be considered in flap selection. Objectives Tissue expansion is an alternative to reconstruction by providing donor tissue of the same color and texture and similar thickness and sensation with minimal scar formation and minor donor site EPS00491 morbidity. Complication of Free Fibula Flap in the Mandibular Methods Reconstruction The physiological phenomenon is observed daily in medical practice. Skin, mucosa and muscles progressively expand over an underlying hematoma or a slowly growing tumor. The use of silastic tissue Dr. Pooja Shroff expanders extends this natural principle by utilizing the property of human skin to stretch and expand over a period of time under constant VYWS Dental College and Hospital, Amravati stress with actual increase in the amount of skin available, along with increased vascularity in the expanded skin. Abstract Results Background/Introduction As per the literature this technique shows good results with less Reconstruction of mandibular defects after tumor resection is one of minimal complications and when it compare with tissue graft it shows the most challenging problems faced by oral&maxillofacial surgeons. better result in quality, vascularity, elasticity and texture. As per the The fibula provides the longest segment of bone with 20 to 30 cm present literature, tissue expansion requires more study for facial available for harvest.the use of the FFF for reconstructing mandibular reconstruction. continuity defects in patients may be associated with postoperative Conclusions complications. Osteoradionecrosis is a delayed complication from This is a proven technique to increase the amount of local tissue radiation therapy which causes chronic pain, infection and constant available for transfer with the same quality of color and texture which deformity after necrosis. Adjuvant or neo-adjuvant radiotherapy is importance in facial reconstruction. (RTH) increases susceptibility to hypovascularity and subsequent infections and too much manipulation of the pedicle during anastomosis may cause thrombosis due to infection. Objectives EPS00517 To evaluate the complication of free fibula flap in mandibular Electric Burn in Perioral Region: A Rare Case Report reconstruction after the radiation therapy. of a 10 Year Old Boy and an Update Methods In 2 cases free fibula graft were used for reconstruction of defects caused because of resection of benign and malignant tumors. Dr. Rahul Thanvi, Dr. Ajit Joshi Results This 2 cases showed complication such as Osteoradionecrosis, Mul- Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital tiple fistulae and Skin dehicence. Conclusions Abstract Vascularized fibular free graft offers the patient a great deal of ben- Background/Introduction efit, however this graft as a concomitant high risk of complications Electric perioral burns are rarely reported in the literature. Perioral and outright rejection of soft and hard tissue of free flap. Great electric burns represented less than 2% of the total burn. The present attention to details must be paid to prevent postoperative case is reported of oral commissure burn due to electric current. There complications. was mild swelling and pain over the perioral region. This report signifies the perioral electric burns in children would be a reconstructive challenge and may affect the standard of living psychologically. Objectives To understand the principles of the injury and possible treatment options. To achieve acceptable functional and cosmetic outcomes with proper surgical management. 123 S166 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

Methods as pain, including in head and neck areas, abnormal jaw movement Curettage and debridement of necrotic slough was performed metic- and clicking or crepitus sounds, classified as temporomandibular ulously, followed by identification of blood vessels and copious disorders. irrigation was performed. Objectives Results The aim of this poster will be to facilitate our knowledge about the Patient was followed up for 6 months postoperatively. The corner of various reconstruction modalities of the TMJ, which includes the the mouth was involved in the perioral electric burn that caused mild condyle, the coronoid fossa and the condylar capsule. microstomia secondary to surgery. Patients parents were advised for Methods the treatment of microstomia and secondary scar revision but they various reconstruction modalities have been shown in the poster after were satisfied with the result and didn’t turn up for further cosmetic a thorough literature research. revision. Results Conclusions autogenous costochondral graft is an effective procedure for TMJ Electric perioral burn requires peer review and criticism as there are reconstruction. less reported cases and few treatment modalities available. Further Conclusions studies should be carried out for its surgical and perioperative man- The complex etiopathogenesis and the variability of symptoms agement, so that its aesthetic and reconstructive challenges will complicate the adoption of standardized diagnostic and therapeutic conclude to a better understanding and treatment protocol for optimal approaches, as suggested by the number of treatment modalities that function and aesthetic. have been proposed, such as occlusal splints, physiotherapy, behavioral and physical treatments, drugs and surgery. But, surgical approach to the disorder of the TMJ is reserved to certain number of cases who do not respond to traditional and conservative therapies. EPS00535 For these situations, joint reconstructive surgery becomes necessary. Tissue Engineering

Dr. Jaseema Farwin EPS00572 Weber-Fergusson Incision Modiﬁed to Include M.D.S Department of OMFS 1st Year, Madha Dental College and Hospital, Chennai Reconstruction: Borle’s Novel Approach

Abstract Dr. Divya Chadda, Dr. R. Ahmed Background/Introduction Tissue engineering is a rapidly advancing discipline that combines Dental College and Hospital, Kolkata attributes of biochemical and biomaterial engineering with cell transplantation. Abstract Objectives Background/Introduction As a reconstruction of normal architecture of face is always a chal- The Weber–Fergusson maxillectomy incision was first described in lenging task, tissue engineering aids to create bioartificial tissues and 1842 as a transfacial approach to the midface for the resection of organs. maxillary tumours. This was modified multiple times to improve the Methods access in and around that area. review articles. Objectives Results To increase the awareness regarding this novel approach which made literature of articles. it possible to perform both resection and reconstruction in the same Conclusions incision with the help of case reports performed in our institution. tissue engineering is an emerging remedy in reconstruction. Methods Modified Weber Fergusson incision was extended (Borle’s extension) from the lateral canthus of the eye to the temporal region in the shape EPS00549 of a question mark to harvest temporalis muscle flap. Results Various Reconstruction Modalities for TMJ No second incision was required for harvesting temporalis muscle Reconstruction flap. Postoperatively, there was no facial nerve injury and the quality of the scar was satisfactory. Dr. Abhijit Das Conclusions Modified Weber Fergusson incision with Borle’s extension ensures a sufficient visual field, yields a satisfactory esthetic outcome, and is Jaipur Dental College relatively safe, suggesting the potential use of this method when the reconstruction of maxillectomy defect is planned with temporalis Abstract muscle flap. Background/Introduction The temporomandibular joint is responsible for the mandible movements and consists a set of bones, muscles and ligaments. It is a subject to various diseases such as congenital, acquired (traumatic), local and systemic diseases and can lead to signs and symptoms such

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EPS00578 EPS00618 Submental Flap in Reconstruction of Orofacial Defects Use of Temporalis Myofascial Flap in Maxillary Reconstruction Dhavalkumar Jamubhai Palas Dr. Anuj Mathur Mahtma Government Dental; College, Thiruvananthapuram-Kearala 695011 Gandhi Dental College Jaipur Abstract Background/Introduction Abstract The microsurgical techniques with free flaps are the ‘‘Gold Standard’’Á Background/Introduction in the immediate reconstruction of post-cancer defects of the head and Ameloblastoma is a benign odontogenic neoplasm of the mandible neck. However, procedures are complex, requiring a high degree of and maxilla. 1,2 However, it is reported that maxillary ameloblastoma specialisation, and has complications and morbidity. The submental behave more aggressively and have a poorer prognosis compared with flap is an alternative reconstruction technique in the maxillofacial mandibular ameloblastoma. 3 the painless and slow growth of the field in cases where the microsurgical reconstruction is not indicated. lesion and the thin bone of the maxilla are the main factors involved Objectives in delay in recognizing a maxillary ameloblastoma. 4 Conser- vative To explore the feasibility, advantage and disadvantage of the sub- treatment of an ameloblastoma usually results in recurrence and mental island flap in the repair of Oral & maxillofacial defects. possible malignant transformation. 5 Radical excision of the tumor Methods followed by adequate reconstruction can improve survival and Review of online articles based on submental flaps for reconstruction provide more satisfactory functional and cosmetic results. 6 However, of various oral and maxillofacial defects. reconstruction of multifaceted maxillary defects is a challenge to Results therecons- tructive surgeon, as it requires provision of adequate anato- Submental flap is a good alternative to other reconstructive method mical structural support to separate the oral and nasal cavities, and to for oral and maxillofacial surgery, it excludes microsurgical proce- obliterate the dead space in the maxillary sinus. Here, we report on a dures which require high degree of specialisation. recurrent maxillary ameloblastoma that was successfully treated with Conclusions radical excision and simultaneous reconstruction using tem- The submental flap constitutes a valid alternative for the reconstruc- poromyofascial flap for the maxillary antrum, oral and nasal cavities. tion of orofacial defects, especially in elderly patients or patients that, Objectives due to deteriorated general condition require less aggressive treat- Reconstructing maxilla to its functional and anatomical form. ments and reduced surgical times. Methods The temporalis muscle was exposed through a coronal incision. The technique of flap elevation and transposition is the same as described EPS00612 by Wolfe. 14 the zygomatic arch and the coronoid process were divided as the flap was used to cover maxillectomy defects. The two Emerging Biomaterials in Trauma laminas of the deep temporal fascia were separate from the zygomatic arch up to the area of fusion. Attachment of the deep temporal fascia Dr. Shraddha Baburap Patil to the muscle was reinforced by few absorbable sutures, and the muscle is covered with a skin graft. The temporalis muscle is then Midsr Dental College Latur used to reconstruct the oral cavity. The entire muscle is rotated into the infratemporal region, on to the size of the palatal defect. Deep sutures are used to secure the flap, and resorbable sutures are placed Abstract intraorally to oppose the flap and the remaining palatal mucosa. Any Background/Introduction remaining posterior temporalis muscle is secured to the lateral orbital Injuries of the facial skeleton pose unique and complex challenges to rim to fill the temporal fossa. The scalp incision is closed. the maxillofacial trauma surgeon. Over the past few decades, sig- Results nificant advances in biotechnology have provided materials and tools Class I AND Class II Maxillary defects can be well managed by soft to more efficiently, predictably and reliably reconstruct and rehabil- tissue myofascial grafts. itate patients who have suffered such injuries. Conclusions Objectives The temporalis muscle was exposed through a coronal incision. The 1) To find replacement constructs that can replicate both in form and technique of flap elevation and transposition is the same as described function of any lost or missing native tissue. 2) the ideal character- by Wolfe. 14 the zygomatic arch and the coronoid process were istics of such constructs must mimic native tissues regarding weight, divided as the flap was used to cover maxillectomy defects. The two density, strength, and modulus of elasticity. laminas of the deep temporal fascia were separate from the zygomatic Conclusions arch up to the area of fusion. Attachment of the deep temporal fascia Although cumbersome at times, an understanding of material science to the muscle was reinforced by few absorbable sutures, and the and emerging biomaterials for those treating maxillofacial trauma is muscle is covered with a skin graft. The temporalis muscle is then an essential and ever-evolving facet of the surgeons armamentarium. used to reconstruct the oral cavity. The entire muscle is rotated into New and exciting technology in such a field is rapidly expanding as the infratemporal region, on to the size of the palatal defect. Deep an era of demand for improved outcomes and less morbidity is sutures are used to secure the flap, and resorbable sutures are placed entered. In particular, the arena of bioengineered tissue is making intraorally to oppose the flap and the remaining palatal mucosa. Any large strides in the forward direction of clinical applicability. All remaining posterior temporalis muscle is secured to the lateral orbital being avidly studied and are expected to make positive changes in the rim to fill the temporal fossa. The scalp incision is closed. operative management of the trauma patient.

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EPS00625 operative colour doppler showed appropriate result to harvest free Tissue Expanders in Oral and Maxillofacial Surgery fibula flap. Out of these, 1 case was diagnosed with peronea arteria magna in which free fibula flap couldn’t be used and reconstruction was done with recon plate. Dr. Neha Borkhade, Dr. Geetanjali Mandlik, Dr. Gokul Results Venkateshwar doppler imaging is not reliable as Peroneal Magna couldn’t be evaluated and hence, ct angiography must be used. Dr. D. Y. Patil School of Dentistry, Nerul, Navi Mumbai Conclusions CT angiography is a valuable imaging tool for preoperative assess- Abstract ment of donor site vascular supply for lower extremity flaps. It can Background/Introduction also reduce intra-operative dissection time and minimizes surgical Reconstructive maxillofacial surgery demands constant surgical error in the identification of vascular anatomy. innovation in order to meet the challenging management of congenital defects, acquired defects and residual deformities in oral and maxillofacial region. Tissue expansion technique induces a controlled in situ skin and mucous membrane growth by stretching it beyond its EPS00701 physiological limit & the mechanotransduction pathways are invoked the Submental Flap in reconstruction of Maxillofacial by which there is increase in mitotic activity and collagen synthesis. Defects Objectives IN TREATMENT OF Cleft lip and palate repair Vertical ridge aug- Prof. Dr. I.B kar, Assoc. Prof. Dr. Niranjan Mishra, Dr. Abhipsa mentation Post traumatic or post operative alopecia - Male pattern Mishra baldness - Expansion of forehead skin before total nasal reconstruction - Expansion of post auricular skin before external ear reconstruction - Expansion of cheek or neck skin to allow scar revi- S.C.B. Dental College and Hospital sion and burn excision. Methods Abstract 1) Self filling osmotic tissue expander, consisting of osmotic active Background/Introduction hydrogen which contain vinylpyrrolidone & methylmethacrylate. The microsurgical techniques with free flaps are the ‘‘GOLD Once implanted it absorbs body fluids which leads to gradual swelling STANDARD’’ in the immediate reconstruction of post cancer defects of the device to a pre-determined volume and size 2) Silicon tissue in head and neck area. The submental flap is an alternative recon- expander, A device consisting of silicon elastomer inflatable expander struction techniques in the maxillofacial field in cases where the with remote injection dome. The expander and injection dome are for microsurgical reconstruction is not indicated. The submental flap was subcutaneous or submuscular implantation. intoduced in 1993 by Martin et al, who first reported the advantages of Results this flap, applied for postoperative repair of oral facial defects, with clinical trial with large sample size and long term observation is respect to highly consistent colour and flexibilitycompared with the required. head and neck skin, simple harvesting, high innervation and easy Conclusions suturing at donor site with small scar. It is a novel method to increase the amount of local tissue available Objectives for reconstructing the defect with the same quality of colour and The Submental island flap is becoming increasing popular as an texture which is of paramount importance in facial reconstruction. alternative reconstruction techniques.the objective of this e-poster is to show the applied anatomy, various modifications, indications, advantages and disadvantages of the Submental flap in the field of Oral and Maxillofacial Surgery. EPS00638 Methods Current Role of CT Angiography in Fibula Flap: A literature review was performed, we paid attention to the submental A Rare Case Study of Peroneal Arteria Magna region anatomy, especially to submental artery and vein., surgical techniques for various variants of this flap, indications, merits and demerits of this flap in maxillofacial reconstruction procedures were Dr. Sayali Takalkar, Dr. Maina G, Dr. Mukul P, Dr. Charu G., Dr. assessed. Gokul V Results The Submental Flap has proven to be a reliable alternative in recon- D. Y. Patil University School of Dentistry, Navi Mumbai struction of composite oral cavity defects for its thinness, pliabilty, and versatility in design. This Flap can be easily raised and is of excellent Abstract choice in patients with a high ASA risk score and elderly patients. Background/Introduction Complex defects resulting from surgical excision of facial cancer although doppler imaging could be used to predict exact location of requires reconstruction using micro vascular free tissue transfer.tissue perforator, angio-computed tomography (CT) is necessary in patients transfer from areas distant from the face can involve many problems and needed for reconstruction with free flap from lower extremities. A less often provide a good cosmetic match. The Submental Flap helps reported case of Peroneal arteria magna. surmount in this problem. Cervical skin has similarities with face skin Objectives and as a regional flap, it eliminates microsurgical risks. this study is to evaluate necessity of angio-computed tomography Conclusions (CT) as a planning tool in free flap surgeries from lower extremities. With advances in anatomy and surgical techniques, Submental flap is Methods increasingly used to repair various types of head and neck defects. 20 patients with mandibular benign pathology (ameloblastoma) This flap has a wide of rotation hence is easy to rise and has low donor undergoing free fibula flap for reconstruction within 25-45 years of site morbidity. It is a safe, simple and predictable method for age group over a period of 3 years were included in study. After pre- reconstruction of oral cavity. 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S169

EPS00730 EPS00745 3D Reconstruction of a Craniofacial Defect Uses of Nasolabial Flap in Soft Tissue Defects in Orofacial Region Sameep M. Bumb Nidhi Gupta SDCH Pune B. H. U., Varanasi Abstract Background/Introduction Abstract The use of cranial implants is well documented.the types of materials Background/Introduction used is dictated by several factors, the most important of which are Nasolabial flap is the most common and oldest method soft tissue for size and location of the defect. This technique is particularly useful reconstruction of oral cavity. for cranial defects in esthetic areas or for defects previously consid- Objectives ered difficult to restore. Nasolabial flap uses in soft tissue defects after trauma, excision of soft Objectives tissue. To Reconstruct An Unaesthetic Defect in Left Temporal Region of A Methods Patient Due To Neurofibromatosis Type 1. Case of lower lip reconstruction, case of oronasal communication, Methods case of oral submucous fibrosis. Titanium Prosthesis Was Made Using 3d Printing Technique. Results A Hemicoronal Incision Was Taken. Titanium Prosthesis Was Fixed, Satisfactory. Residual Defect Was Filled With Iliac Crest Bone Graft And Conclusions Reconstruction Was Achieved. Nasolabial flap is a versatile flap with advantage of rich blood supply. Results One Month Follow Up of the Patient Showed No Complication And It Showed Acceptable Aesthetic Results. Conclusions EPS00755 Aesthetic Corrections In the Craniomaxilofacial Defects Can Be Made Stem Cells in Oral and Maxillofacial Surgery With the Help of Prosthesis Made By Cad Cam Technique And Stereolithographic Models As It Is Difficult To Harvest Autogenous Bone Graft of Such A Huge Size. Also To Prevent Donor Site Mor- Dr. Salma bidity. With the Aid of Cad Technology, All Currently Used Alloplastic Materials Are Suited Even for Large Skull Defect Cranioplasty. Sultana From Kamineni Institute of Dental Sciences

Abstract Background/Introduction EPS00743 Stem cells have enormous potential to alleviate sufferings of many Options in Mandibular Reconstruction diseases that currently have no effective therapy. The research in this field is growing at an exponential rate. Stem cells are master cells that Dhanashree Deshpande ABSMIDS have specialized capability for self-renewal, potency and capability to differentiate to many cell types. At present, the adult mesenchymal stem cells are being used in the head and neck region for orofacial Abstract regeneration. CASE REPORT: Ameloblastoma is a histologically Background/Introduction benign tumor, but it shows a tendency of locally aggressive behavior. Mandibular reconstruction is done in defects of mandible resulting To our knowledge, this is the first report of a successful reconstruction from trauma, infection, osteoradionecrosis and most commonly due to performed for treating a mandibular defect by using autologous ablation surgery of oral cavity and lower face to restore the function, human bone marrow mesenchymal stem cells in a patient with form and esthetics of face to be as close to normal as possible. plexiform ameloblastoma. In this article, we report the result of the Various techniques have been reported to be developed over the mandibular reconstruction with autologous human bone marrow period of time to obtain optimal results. mesenchymal stem cells and autogenous bone graft, followed by the Objectives placement of osteointegrated dental implant and prosthodontic treat- To review current literature or the various options available in ment in a patientwith plexiform ameloblastoma. mandibular reconstruction. Objectives Methods reconstruction with autologous human bone marrow mesenchymal A literature review was conducted on various search engines and stem cells and autogenous bone graft, followed by the placement of relevant articles in indexed journals were analyzed. osteointegrated dental implant and prosthodontic treatment in a Results patient with plexiform ameloblastoma. The current standard of care for mandibular reconstruction consists of Methods free flaps of bone with or without soft tissue and skin. The vascularized Under general anesthesia, the patient’s right mandibular defect was free flaps allow long term reliability and stability alongwith ability to exposed via intraoral approach. The cortical block bone was harvested osseointegratein one primary stage. The current available free flap in the opposite buccal area. It was fixed using plates and screws as a choices are fibula, radial forearm, scapula, anterolateral thigh flap, scaffold for the formation of a bone tray. Then, AHBMMSCs (4.8 107 PMMF. Recent advances in medical modeling is considered as new tool. cells/1.6 mL) were injected into the scaffold. Differentiated autolo- Conclusions:Every technique has their own advantages and disad- gous osteoblasts (RMS Ossron; Sewoncellontech, Seoul, South vantages, however, the optimal reconstruction depends not only on Korea) were mixed with fibrin glue (Greenplast; Green Cross, Yon- donor site but also on time of surgery and method of reconstruction. gin, South Korea) in a 1:1 ratio and applied (Fig. 2). At a 123 S170 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 postoperative 3-month follow-up, AHBM-MSCs were injected again EPS00793 into the mandibular defect area for the acceleration of bone formation. Comparison of Titanium Mesh Vs Prolene in Orbital Results Good results of mandibular reconstruction with autologous human Floor Reconstruction bone marrow mesenchymal stem cells (AHBM-MSCs) and autogenous bone graft, followed by a placement of an osteointegrated dental Dr. Haris Ali Bhat implant and prosthodontic treatment in a patient with plexiform ameloblastoma. Abstract Conclusions Background/Introduction Surgeons are tirelessly working to reconstruct continuity defect in Treatment of traumatic orbital injuries has long beena formidable maxillofacial region for more than a century. Enormous progress has challenge to the maxillofacial surgeon. Surgical technique have made especially over the last 40 years. Technique such as microvas- become more aggressive, with primary surgical repair directed at cular autogenous graft procedures have proved better options for restoring bony orbital volume and contour while repositioning her- reconstructing large and complex defects, but morbidity associated niated orbital tissues. Numerous materials - both naturally occurring with harvesting bone graft is a major disadvantage. Alternatively, use and synthetic substances - are available for reconstructing damaged of tissue engineering showed exciting promising results at preclinical orbital walls to restore orbital volume. Autogenous materials remain level and in the limited clinical trial. Yet refinement of the technique the gold standard to which other materials are compared yet Allo- and identification of the ideal scaffolding are necessary before wider plasts have gained popularity for orbital wall reconstruction for their clinical application. Further studies are required to produce an evi- ease of use and elimination of the need for a second operation and its dence based practice in tissue bioengineering clinically. This could associated morbidity. have significant impact on the reconstruction of maxillofacial defects Objectives due to bone loss following trauma or cancer resection. This paper seeks to address the controversy regarding application of two very commonly used alloplastic materials—Titanium mesh and Prolene through a series of cases. EPS00789 Methods Titanium mesh has good biocompatibility and is easily adjustable. It Comparison of Bite Forces in Patients of Maxillofacial is easy to trim and mould exactly to the orbital contour. Because of Pathologies Who Undergone Resection of Mandible the mesh structure, connective tissue can grow around and through the and Reconstruction with Either Recon Plates or Free implant, preventing its migration. It can be reliably fixed with screws Fibular Flap in areas such as the infraorbital border and can be sterilized in autoclaves. Prolene mesh is composed of high-density micropores connected to each other, which allows fibrovascular tissues to Dr. Anshul Jain advance into the implant. This structure provides certain rigidity to the polyethylene and allows it to automatically fixate to the adjacent I.T.S.CDSR, Muradnagar tissues. It is strong yet flexible and easy to contour and shape using scissors or a scalpel, and it can be contoured into the desired shape. Abstract Results Background/Introduction Both materials showed satisfactory results with certain limitations as Occlusal bite force is dependent upon the integrity of the muscles of well. mastication, TMJ, mandible, dentition, and the status of the sur- Conclusions rounding hard and soft tissues. Surgical resection of a portion of the Autogenous materials remain the gold standard to which other mandible, muscles of mastication, and some teeth can cause an materials are compared yet Alloplasts have gained popularity for imbalance of the remaining muscles of mastication, altered and orbital wall reconstruction for their ease of use and elimination of the restricted mandibular movements and a decreased forceful mandibular need for a second operation and its associated morbidity. closure. Mandibular reconstruction is important to maintain esthetic and functional integrity of the maxillo facial structures. Objectives EPS00812 The comparative evaluation of bite forces of patients treated using Recon plates or Free Fibular Flap who has undergone resection of Partial Maxillectomy: A Challenge To Reconstruct mandible for maxillofacial pathologies. Methods Priyanka Das Jesabel The study was divided into two groups. Group I included patients who had undergone reconstruction of mandibular defect with recon plates Krishnadevaraya College of Dental Sciences and those reconstructed with Free Fibular Flap were taken in Group II. Bite forces on non-operative site are measured and compared post Abstract operatively using bite force measurement machine. Background/Introduction Results Reconstruction of lost tissues of the body has remained an enigma Results shows that patients who has undergone mandibular recon- since time immemorial. Holy Grail of tissue regenerative material is struction with Free Fibular Flap have higher bite force capability than still a mirage. Although, autogenous cancellous bone is considered as those reconstructed with Recon plates. a ‘‘gold standard’’Á of bone replacement; it poses certain degree of Conclusions donor site morbidity. To counter this, array of biomaterials have been Within the limitation of study, it was concluded that the free fibular utilized with variable degree of success. In this case report we have flap can be considered as a reliable option for reconstruction in used a new alloplast Polycaprolactone for guided tissue regeneration. comparison with Recon plate as the patient can bear more bite forces postoperatively.

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Objectives EPS0037 In this case report, we have used Polycaprolactone scaffold for guided Arthrocentesis of Temporomandibular Joint: Single tissue regeneration, to check its efficacy in bone regeneration. Methods Versus Double Needle Technique Here we are presenting a case report of Maxillary implant supported fixed prosthesis in patient who underwent partial maxillectomy due to Gourab Das & Sardar Patel ameloblastoma:followed by guided tissue regeneration using Poly- caprolactone scaffold along with platelet rich plasma and PG institute of Dental & Medical Sciences demineralised bone matrix. Followed by implant placement and prosthetic rehabilitation. Abstract Results Background/Introduction Polycaprolactone scaffold is certainly a good alternative to conven- Arthrocentesis is the method of ?ushing of temporomandibular joint tional bone grafting materails and techniques and that it 1) Eliminates (TMJ) by placing needles into the upper joint compartment using the need for an autogenous;donor site; 2) Is available in unlimited ringer’s lactate or physiological saline under LA-the process is quantity and consistent quality; 3) Has a highly porous and honey- referred to as lysis and lavage. There are two techniques-single needle comb-like architecture that facilitates the infiltration of new osteoid and two needles. and bone trabeculae; 4) Does not evoke an undesirable prolonged Objectives inflammatory response. The aim of the study was to compare the effectiveness of five weekly Conclusions two needle arthrocentesis in the same protocol performed with a Edentulous patients with maxillectomy defects presents a significant single needle technique in patients with inflammatory degenerative challenge for prosthetic rehabilitation and the adaptive capabilities of disorders of the temporomandibular joint. the patient as retention is highly compromised. hence, the option of Methods using endosseous implant is highly effective and important to increase Patients with TMJ osteoarthritis were randomly assigned to the two retention of prosthesis. Poly-e-caprolactone is a novel, synthetic, needles or single needle protocol and followed up for 6 months after biodegradable polymer that helps in regeneration of bone with treatment. Several outcome parameters, such as maximum pain at rest desirable outcomes and following advantages: Controlled and slow and maximum pain on chewing, subjective chewing efficiency, lim- degradation profile Highly porous scaffold for easy infiltration of itation in jaw function, jaw range of motion in mm, were recorded at bone. Honeycombed structure facilitate biophysical stimulation baseline and multiple follow up assessments. Excellent ease of shaping, contouring and customization. Results Both treatment groups recorded significant improvement with respect to baseline levels in almost all outcome variables. The rate of Section: TMJ Surgery improvement was not significantly different between the treatment protocols in any of the outcome variables. Conclusions The present investigation did not support the existence of significant ABS0021 differences in the treatment effectiveness for inflammatory degener- TMJ Ankylosis ative TMJ disorders of a cycle of five weekly arthrocentesis performed according to the classical two needles or the single needle Dr. Piyush Kumar Chhabra technique.

Buddha Institute of Dental Science and Hospital EPS0047 Abstract Supratemporalis Approach for Temporomandibular Background/Introduction Tempro mandibular joint ankylosis is a pathologic condition where Surgery the mandible is fused to the fossa by bony or fibrotic tissue. This interfers with mastication speech, oral hygiene. Trauma is the most Dr. Koyel Bhowal, 1st Year Pgt common cause of tmj Ankylosis, followed by infection. Objectives Guru Nanak Institute of Dental Sciences and Research. Email- To create gap and movement of tmj. [email protected]. Contact No-8900139250. Postal Address- Methods B-9/6, Mangalik Co Op Housing Society, Baghajatin, Kol-94. Dist- Surgical condylectomy. South24 Pargana, State-Westbengal. Country-India Results and Conclusions Any pathology that afflicts the tmj and mouth opening hence carries a Abstract mental sigma. Tmj not only hinders the the integrity of cranio facial Background/Introduction skeleton, but also affects the normal growth. Preservation of the functional integrity of the facial nerve (FN) is a critical measure of success in temporomandibular joint (TMJ) surgery.the Supratemporalis approach provides an additional layer of protection (the deep layer of the temporalis fascia and the superficial temporal fat pad) to the temporal and zygomatic branches of the FN and thus, is the safest method to avoid FN injury. Objectives The facial nerve remains at risk of injury with the preauricular approach, the incidence of facial nerve paresis ranges from 1 to 32%

123 S172 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 following this surgery. The aim of this approach to prevent facial EPS0092 nerve injury in temporomandibular joint surgery. Management of Temporomandibular Joint Methods The temporal skin incision made 45 degree to zygomatic arch. The flap consisting of skin, subcutaneous tissue, superficial temporalis Dr. Vishalakshi Srivastava fascia, subgaleal fascia and deep temporalis fascia. Results Career Post Graduate Institute of Dental Sciences & Hospital, Facial nerve injury were observed in the traditional preauricular Lucknow approach and no facial nerve injuries were observed in the supratemporalis approach. Abstract Conclusions Background/Introduction The supratemporalis approach prevented facial nerve injury and did The ankylosis of tmj is a challenging problem for both patient and not increase the frequency of other complications. surgeon. a variety of techniques for treatment of tmj ankylosis have been described in literature. There are three basic techniques currently employed gap arthoplasty, interpositional arthoplasty, joint recun- structions, however no single method has produced uniformly EPS0069 succesful results.limited range of motion and reankylosis are most Arthrocentesis for Chronic Temporomandibular Joint frequently reported complications. Pain Objectives The purpose of this study was to evaluate and compare the techniques of gap arthoplasty and interpositional arthoplasty using temporalis Dr. S. Ravi Raja Kumar, Mds Prof& Hod fascia to achieve maximum interincisal mouth opening for treatment of ankylosis. St. Joseph Dental College [Author]., Dr. P. Venu Sameera Pg Methods [Presenter] Cases with clinicoradiological diagnosis of tmj ankylosis were selected and treated by gap arthoplasty and interpositional arthoplasty Abstract using temporalis fascia and patient were followed for one year. Background/Introduction Results Temperomandibular joint arthrocentesis is a form of minimally There is no significant difference in post operative mouth opening in invasive surgical treatment in patients suffering from chronic tem- both the cases. poromandibular joint pain with limited mouth opening. It consists of Conclusions washing the joint with suitable irrigants for the removal of chemical From the result there is no significant difference between the patient inflammatory mediators and changes in intra articular pressure. treated with gap arthoplasty and interpositional arthoplasty the overall Objectives out come of the treatment depends upon active physiotherapy patient To evaluate the efficacy of TMJ arthrocentesis for relieving TMJ pain cooperation and regular follow up. with limited mouth opening in patients who had proved refractory to conservative management. Methods A 15 year old female patient presented with reports of pain in right EPS0095 and left TMJ, bilateral clicking sounds.mild deviation to left side, and Temporomandibular Joint Arthrocentesis limited mouth opening. As treatment modality, arthrocentesis on right and left TMJ was done with traditional two needle technique under Dr. Tejinder Kaur, Dr. Amit Dhawan, Dr. Sarika Kapila aseptic condition. Holmlund-Hellsing line was drawn from tragus of ear to lateral canthus of eye. One needle placed 10mm forward along this line and other 2mm below it. Joint lavage done with Ringer SGRD Institute of Dental Sciences and Rresearch Lactate solution followed by intrajoint steroid injection. Bilaterally impacted upper molars were removed simultaneously and a soft splint Abstract was given to patient followed by post operative antibiotics and Background/Introduction analgesics. Arthrocentesis of the temporomandibular joint is regarded as a sim- Results ple, non- invasive, inexpensive and highly effective procedure for Significant improvement was seen in the immediate post operative patients suffering from multitude of temporomandibular disorders. period along with reduction in pain, increased mouth opening. Restores mobility of joint by reestablishing joint lubrication and Conclusions fluidity. Arthrocentesis is a valid treatment option for Chronic Tempero- Objectives mandibular Joint pain with limited range of motion in patients where To highlight the efficacy of a non-invasive and most pre- other conservative modalities have failed. dictable treatment that can be readily available to the patient and the full restoration of function with improvement of the quality and quantity of life. Methods Two points are marked over the skin of the affected joint indicating the articular fossa and eminence. Followed by injection of a local anesthetic to block the auriculotemporal nerve. A19-gauge needle is then inserted into the superior compartment at the articular fossa followed by injection of Ringer Lactate’s solution to distend the joint space. Another needle is inserted into distended compartment to enable a free flow of solution through superior compartment.

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Results Objectives This technique is useful in increasing maximum mouth opening To evaluate the effect of sequential treatment of TMJ Ankylosis by decrease in pain level and inflammation of joint by massive irrigation gap arthroplasty, mandibular lengthening by distraction osteogenesis and lavage of joint space. & chin correction by genoplasty. Conclusions Methods This technique is easy and reproducible. It is highly effective pro- We included 6 cases between the age group of 14-18 yrs, all of them viding significant improvement in maximum mouth opening and having unilateral TMJ Ankylosis. Sequence of treatment was gap lateral movement. arthroplasty, intraoral distraction osteogenesis & genoplasty. Results All patients had TMJ Ankylosis secondary to trauma. The amount of mouth opening (33-35mm) & distraction range from (16-20mm). The EPS00144 most common post operative complication was development of open Role of Arthrocentesis in Internal Dearrangement: bite which could be corrected with help of intraoral elastics. A Pilot Study Conclusions Our study suggests that gap arthroplasty, distraction osteogenesis & genoplasty can be considered as a sequential treatment for TMJ Dr. Vishakha Lal Ankylosis. This protocol is better for gross facial asymmetry, TMJ function & correction of occlusal cant. However, there is still some Institute of Dental Sciences, Bareilly controversy over proper sequencing of management for the ankylosis patients. Abstract Background/Introduction Internal derangement is defined as an abnormal relationship of the articular disc to the mandibular condyle fossa and articular eminence. EPS00171 Clinically internal derangement are characterized by interference of Use of Temporalis Fascia as an Arthoplasty in Tmj restriction of joint function during mandibular movement. Joint noise, Ankylosis: Prospective Study especially clicking, is a common finding. The conservative means of treatment are medication, bite appliances, physiotherapy and manipulation of joints. When it fails to provide a solution, surgical Dr. Neelakamal Hallur, Dr. Aaisha Siddiqua, Dr. Syed Zakaullah, Dr. intervention such as surgical disc repair and re-positioning are used. Ashwin Shah, Dr. Chaitanya K., Dr. Shereen Fatima One of the most acceptable minimal invasive surgeries is arthroscopic lavage/arthrocentesis if the superior joint compartment. Al Badar Dental College and Hospital Gulbarga Objectives Is to investigate the condition of TMJ relative to the effectiveness of Abstract arthrocentesis under sufficient hydraulic pressure in patients with Background/Introduction chronic closed lock. Ankylosis is defined as ‘‘Inability to open due to either a fibrous or bony Methods union between the head of the condyle and the glenoid fossa’’. It causes We performed arthrocentesis as a treatment. The changes in the disturbances of facial growth and acute compromise of the airway, maximum mouth opening, joint pain and clicking sound were which invariably results in physical and psychological disability. examined to determine the effectiveness of the treatment before the Objectives treatment and after the treatment. The present study was conducted to evaluate the use of temporalis Results fascia as an interpositional arthroplasty material in TMJ ankyloses After 2 months follow up maximal mouth opening of patient increases, with respect to improvement in post-operative mouth opening. joint pain at mouth opening and clicking sound were reduced. Methods Conclusions This study was conducted on 10 patients who were diagnosed with Arthrocentesis is a simple, less invasive, inexpensive and highly tmj bony ankylosis and where operated under general anaesthesia efficient procedure which can be performed under local anaesthesia using fiber-optic naso tracheal intubation, AL-KAYAT BRAMLEY for the treatment of internal derangement. incision, aggressive resection of ankylotic mass, ipsilateral/contralateral coronoidectomy, interpositional arthroplasty using temporalis fascia flap, early mobilization and aggressive physiotherapy was performed. Evaluation of functional outcome and recurrence EPS00148 was assessed by preoperative, intraoperative and postoperative mouth Ladder for TMJ Ankylosis: Management opening for a period of one year. Results Chhattisgarh Dental College & Research Institute (C.G.) In this study mean pre-operative mouth opening was 4.0mm ? 2.86mm and mean post-operative mouth opening was 35.1 ? 6.76mm after one month, 35.8 ? 6.85mm after six months, and 36.6 ? 7.71 Chhattisgarh Dental College & Research Institute (C.G.) mm after one year. Comparison of pre and post-operative mouth opening was done using student t-test which showed significant dif- Abstract ference in mouth opening. Background/Introduction Conclusions TMJ Ankylosis can be accompanied by various degrees of functional In this study we had 100% success rate with no case of recurrence. and esthetic problems such as reduced mouth opening, malocclusion, This study concluded that interposition of temporalis fascia in tmj facial asymmetry and respiratory problem. The surgical procedures ankylosis produced good results in mouth opening and jaw function may include release of ankylotic mass, mandibular lengthening & and is reliable method to prevent recurrence of ankylosis and achieve correction of chin. long term good results.

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EPS00181 Although it is widely accepted that the treatment out-comes of open TMJ Arthrocentesis: A Case Report reduction and internal fixation are superior to those of conservative treatment for grossly displaced condylar fractures. Historically, maxillomandibular fixation, external fixation, and surgical splints Dr. Kalyani Gelada, Bharati Vidyapeeth with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Treatment depends on the age Dental College and Hospital, Pune of the patient, the co existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the Abstract level and displacement of the fracture, the state of dentition and dental Background/Introduction occlusion. Temporomandibular joint dysfunction (TMD) is a clinically signifi- Objectives cant condition which can be a source of acute or chronic orofacial To evaluate current treatment modalities of mandibular condylar pain and dysfunction including limitation of mandibular movement, fracture. pain with mandibular function and joint sounds. Usually there are two Methods types of treatment given, surgical, which includes arthroscopy, A review of world English literature search concerning current acupuncture, arthrocentesis in TMD and non surgical, includes treatment modalities of mandibular condylar fractures was performed physical therapy, pharmacotherapy, NSAIDS, local anesthetics, TMJ and evaluated. injections, muscle relaxants, antidepressants, occlusal appliance Results therapy and occlusal adjustments. Arthrocentesis is joint lavage which Despite of all the controversies most surgeons have advocated open washes out the inflammatory mediators, thereby, relieving pain. treatment based their decision, on the position of the fractured Arthrocentesis is a relatively simple office procedure which allows condylar process and the degree of displacement and dislocation. expansion of the joint space, lysis of adhesions and lavage via blind Conclusions input and outflow catheters. However, surgeons can be faced with A trend is emerging in the surgical literature confirming superior some clinical difficulties with two needles during the procedure such functional results following open reduction and internal fixation of as displacement of the needles during the irrigation and difficulty of condylar fractures. Radiographically, a better anatomic reduction of inserting the outflow needle in the right place. To combat this diffi- the condylar process was seen in the patients treated with ORIF. New culty, TMJ lavage with double needle in a single canula has been technology to facilitate transoral ORIF has offered the promise of documented in the literature. However it was not in routine use eliminating some of the adverse sequelae associated with ORIF probably because of the lack of presentation. The purpose of this through a transfacial approach. presentation is to describe this instrument and state the advantages of the technique. Objectives The purpose of this study is to demonstrate a temporomandibular EPS00195 lavage instrument with double needles in a single canula that make Arthrocentesis of Temporomandibular Joint: Single the procedure easier for surgeons. Versus Double Needle Technique Methods Comparison between two surgical procedures for TMJ lysis and Dr. Akshay Kumar, Dr. Gaurav Singh, Dr. Amit Gaur, Sardar Patel lavage was performed. Results The upper joint space was successfully lavaged with 50 mL of 0.9% Post Graduate Institute of Dental and Medical Sciences saline solution. Maximal mouth opening and lateral jaw movement increased and jaw functions improved immediately after the procedure. Abstract Conclusions Background/Introduction A simple alternative to classical arthrocentesis with two needles that it Arthrocentesis is a minimally invasive surgical intervention of the is easy to use and enables to perform lysis and lavage with a single temporomandibular joint. It is indicated for patients with joint disc puncture. displacement with and without reduction, disc adherences with mouth opening limitations, synovitis/capsulitis, painful articular noise during mouth opening/closing, as well as a palliative in acute cases of rheumatoid arthritis. EPS00194 Objectives Abstract Topic: TMJ Surgery To compare single-needle arthrocentesis of the temporomandibular joint (TMJ) with the conventional two-needle arthrocentesis. Methods Patients with TMJ osteoarthritis were randomly assigned to the two- Condylar Fractures: Current Trends and Controversies needle or single-needle protocol and followed up for 6 months after treatment. The present investigation did not support the existence of Dr. Dhritiman Pathak, Dr. Gaurav Singh, Dr. Madan Mishra, Sardar significant differences in the treatment effectiveness for inflammatory Patel degenerative TMJ disorders of a cycle of five weekly arthrocentesis performed according to the classical two-needle or the single-needle Post Graduate Institute of Dental and Medical Sciences technique. Results Abstract Both treatment groups recorded significant improvement with respect Background/Introduction to baseline levels in almost all outcome variables. The rate of The incidence of condylar fractures is high, but the management of improvement was not significantly different between the treatment fractures of the mandibular condyle continues to be controversial. protocols in any of the outcome variables.

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Conclusions The purpose of this study was to evaluate and compare the two Both techniques are equally effective at reducing pain and increasing available techniques of gap arthroplasty to achieve maximum inter- the maximal mouth opening. The single needle technique was easier incisal mouth opening for the treatment of TMJ ankylosis and the to perform and required a shorter operative time. objective was to select postoperative regimen and better technique to minimize reankylosis. Methods EPS00196 Twenty patients with TMJ ankylosis were included in the study and Condylar Fractures: Current trends and Controversies selected patients were of age in range from 5 to 25 years and divided in two groups. In group I patients, gap arthroplasty was performed and Dr. Dhritiman Pathak, Dr. Gaurav Singh, Dr. Madan Mishra in group II patients, interpositional arthroplasty with temporalis fascial flap was performed and both groups was compared on varies parameter such as interincisal opening (mm), swelling, infection, Sardar Patel Post Graduate Institute of Dental and Medical Sciences facial nerve weakness, pain, wound dehiscence. Regular follow up was done for 1st, 2nd week, 1, 3, 6 month and 1 year postoperatively. Abstract Results Background/Introduction There is no statistically significant difference observed in both the The incidence of condylar fractures is high, but the management of group when compare for postoperative mouth opening, pain and fractures of the mandibular condyle continues to be controversial. swelling. None of the cases in both the groups had wound dehiscence, Although it is widely accepted that the treatment out-comes of open infection and facial nerve weakness at any time interval. reduction and internal fixation are superior to those of conservative Conclusions treatment for grossly displaced condylar fractures. Historically, max- We conclude that there is no significant difference between the illomandibular fixation, external fixation, and surgical splints with patients treated with interpositional arthroplasty and gap arthroplasty. internal fixation systems were the techniques commonly used in the The overall outcome of the treatment depends on patient’s coopera- treatment of the fractured mandible. Treatment depends on the age of tion, active physiotherapy and regular follow-up. the patient, the co existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and dental occlusion. Objectives EPS00222 To evaluate current treatment modalities of mandibular condylar Efficacy of Pterygoid Disjunction in the Treatment fracture. Methods of Internal Derangement of Temporomandibular Joint A review of world English literature search concerning current treatment modalities of mandibular condylar fractures was performed Dr. Gajendra Bagri and evaluated. Results RUHS College of Dental Science, Jaipur Despite of all the controversies most surgeons have advocated open treatment based their decision, on the position of the fractured Abstract condylar process and the degree of displacement and dislocation. Background/Introduction Conclusions In our study of the technique of Pterygoid Plate Disjunction, A trend is emerging in the surgical literature confirming superior decompression of the joint takes place indirectly. The joint space is functional results following open reduction and internal fixation of not encroached upon, but since the pterygoid plates from which both condylar fractures. Radiographically, a better anatomic reduction of the pterygoid muscles originate are detached, the spasm in these the condylar process was seen in the patients treated with ORIF. New muscles is presumably relieved. The anterior and upward pull on the technology to facilitate transoral ORIF has offered the promise of condyle is reduced, which in turn reduces the pressure on the eliminating some of the adverse sequelae associated with ORIF retrodiscal lamina and alleviates the pain. Since the joint space is through a transfacial approach. under less pressure, there is a better chance for the marginally displaced disc to return to its normal position. It can be deduced that the EPS00212 joint becomes lax and the movements become smoother, thus Management of TMJ Ankylosis: A Comparison inducing less strain in the posterior lamina. Objectives Between Gap Arthroplasty and Interpositional The purpose of this study is to study the effectiveness of pterygoid Arthroplasty Using Temporal Fascia plate disjunction in the management of the TMJ pain and dysfunction in patient with internal derangement of temporomandibular joint. Methods Post Graduate Institute of Dental and Medical Sciences All the patients with internal derangement of temporomandibular joint having anterior disc displacement with reduction with com- Post Graduate Institute of Dental and Medical Sciences plaints of pain and limited opening of mouth, of all age group reporting to the Department of Oral & Maxillofacial Surgery, GDC Abstract Jaipur 8 patients were included in the study. Background/Introduction Results Temporomandibular joint ankylosis is a debilitating condition. It is In our study, All the patients are satisfied at the 6 months follow up. the fusion of articular surface of glenoid fossa and condyle with bony Conclusions or fibrous tissue. It may be caused by trauma, infection, degenerative It is concluded that, disjunction and displacement of the pterygoid joint disease, prolonged maxillo-mandibular fixation, inflammatory plates is minimally invasive and can be done as a day care procedure. conditions like rheumatoid arthritis and polyarthritis. No intensive physiotherapy or intermaxillary fixation is required. Objectives

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ABS00239 the intra-articular injection of sodium hyaluronate which is a mini- Prospective Evaluation of EMG Activities of Masseter mally invasive technique and has shown to be safe and effective. Objectives and Temporalis Muscle in TMJ Ankylosis Patients: To compare the efficacy of Temporomandibular joint arthrocentesis A Case Series with and without injection of sodium hyaluronate in treatment of internal derangement. Dr. Pawan Kumar, Dr. Virendra Singh Methods In this prospective study 20 subjects who had been clinically diagnosed with internal derangement of TMJ were selected and randomly PGIDS Rohtak Haryana divided into 2 groups. Group-A subjects got only arthocentesis treatment and Group-B was treated with arthocentesis with intra-ar- Abstract ticular injection of sodium hyaluronate. For each subject, pre- Background/Introduction treatment and post-treatment (1 week and three months follow-up) Ankylosis is defined as a chronic limitation of motion. Jaw movement level of pain, maximum interincisal opening (MIO) were recorded is limited as a result of the fibrous or bony fusion of a temporo- along with lateral excursive movements, joint noises and deviation. mandibular joint. Electromyography is considered as a tool to Results measure the muscle activity In the present study the electromyo- In Group A; mean preoperative pain was 2.6. On 3 months follow-up graphic activities of masseter and temporalis muscles in patients with the mean was 1.2. Mean MIO was preoperatively 42.0mm and unilateral TMJ ankyloses were measured on the affected and normal postoperatively 42.0mm. In Group B; preoperative pain was a mean side before and after surgery and the clinical significance of the of 4.4 and postoperative 0.6 on 3 months follow-up. Preoperative change in EMG activity evaluated. MIO was 34.2mm, postoperative mean of 39.4mm. Objectives Conclusions To evaluate the change in EMG activity of masseter and temporalis Both treatment modalities achieved improved results of mouth muscle in TMJ ankylosis patients on the affected and normal side opening and jaw functions with reducing pain but the addition of before and after surgery. injection of sodium hyaluronate fetched better outcomes than Methods arthrocentesis alone. In 10 patients of unilateral TMJ ankylosis Electromyography of Masseter and Temporalis muscle of operated site and contralateral site was done before surgery, 1 week, 1 month, 3 month and 6 month interval after surgery. Amplitude levels (peak to peak) before surgery EPS00248 and after surgery were compared statistically under maximum the Efficacy of Prolotherapy in Temporomandibular clenching state. For measuring EMG of masseter muscle the needle was inserted 2.5cm above and in front of angle of mandible and for Joint Dysfunction Temporalis muscle needle is inserted 2.5cm behind the lateral margin of orbit and above the upper border of zygomatic arch. Dr. Hardeepsinh Mori Results EMG activity of the Masseter and Temporalis muscle at the operated Govt. Dental College & Research Institute Bangalore site was reduced at 1 week after surgery as compared to pre-operative value. There was increase in EMG activity at regular follow ups after Abstract 1 week. After physiotherapy there was better increase in EMG Background/Introduction activity on operated sides in 1 month, 3 month and 6 month follow-up One of the most common causes of orofacial pain is the Temporo- are statistically significant (p\ 0.05). mandibular Joint Disorder (TMD), a collective term used to describe a Conclusions group of disorders causing temporomandibular joint (TMJ) pain and EMG study plays a key role in measuring the activity of muscles and dysfunction. Prolotherapy is a short for ‘‘proliferation injection ther- it helps in determining the duration of physiotherapy required after apy’’. The basic principle of Prolotherapy is to inject a substance that surgery of TMJ Ankylosis patients. will cause a low-grade inflammatory process within the joint, drawing in fibroblasts that strengthen the attachments of tendons and ligaments. The process stabilizes the joint, improves the range of motion EPS00241 in a hypomobile joint, helps prevent dislocation in a hypermobile joint and relieves pain. Efficacy of Arthrocentesis with and Without Injection Objectives of Sodium Hyaluronate in Treatment of Internal Prolotherapy is an injection-based complementary treatment, which Derangement of Temporomandibular Joint has shown promising results in the different musculoskeletal disorders. The aim and objective of this study is to determine the therapeutic efficacy of dextrose prolotherapy on pain, range of Presenting Author: Surabhi Sarkar; Co-authors: Shyam Sundar, motion, and function in patients with TMJ disorders. Sujeeth Shetty, Saikrishna D Methods After obtaining consent, the procedure will be explained to the patient JSS Dental College and Hospital, Mysore and each of the patients who will meet the above said criteria will be selected. Injection site will be prepared and wiped with alcohol. one Abstract inch, 30-gauge needle will be used. The injection solution consists of Background/Introduction 0.75mL of 50% dextrose, 0.75mL of bacteriostatic water, and 1.5 Internal derangement of the TMJ is the most commonly encountered mLof 2% lidocaine into a 3-mL syringe for each TMJ. The result will TMD with symptoms of pain, joint sounds, restricted mouth opening be a dextrose concentration of approximately 12.5%. Our standard and impaired jaw functions. One of the various treatment methods is program will be to repeat the injections three times, at two-week,

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S177 four-week, and six-week intervals. This total four injection appoint- EPS00260 ments over twelve weeks. Novel Technique for Harvesting the Sternoclavicular Results Data obtained will be subjected to statistical analysis and conclusion Graft will be arrived at. Conclusions Dr. Sujata Mohanty, Dr. Rudra Deo Kumar, Maulana Azad Data obtained will be subjected to statistical analysis and conclusion will be arrived at. Institute of Dental Sciences

Abstract EPS00253 Background/Introduction Originally introduced for mandibular reconstruction more than 40 Application of Computer Assisted Surgical Navigation years ago, the sternoclavicular graft (SCG) has gained widespread in Temporomandibular Joint Ankylosis popularity for the reconstruction of the ramus-condyle unit (RCU) owing to its anatomic and histological likeness to the normal Dr. Tejinder, Dr. Jasmine, Dr. Amneet mandibular condyle. Conventional longitudinal osteotomy design for its harvest has been fraught with considerable complications at the Sri Guru Ram Das Institute of Dental Sciences and Research, Sri donor site including fracture clavicle and major neurovascular injury. Amritsar In an attempt to alleviate these ill effects, a new technique for procuring the sternoclavicular graft is presented. Objectives Abstract A new technique for procuring the sternoclavicular graft is presented Background/Introduction in an attempt to alleviate the ill effects of conventional longitudinal Temporomandibular joint (TMJ) ankylosis involves fusion of osteotomy design for its harvest. mandibular condyle to the base of skull, which can cause speech Methods impairment, difficulty with mastication, facial disfigurement, airway A split-thickness cortico-cancellous graft was harvested form the compromise and psychological stress. sternal end of the clavicle along with the articular disk with the Objectives osteotomy cut oriented parallel to the coronal plane, with limited soft Rehabilitating the mandibular movement and function, preventing tissue dissection. Donor site complications were assessed in terms of reankylosis and promoting mandibular growth are the main treatment incidence of clavicle fracture, neurovascular injury, pleural tear and objectives. Treatment for TMJ ankylosis includes interpositional radiographic healing as seen in the six-month postoperative chest arthroplasty, gap arthroplasty and reconstruction of joint using auto- radiograph. genous or artificial materials. Results Methods 17 patients suffering from unilateral temporomandibular joint anky- In patients with TMJ ankylosis, the irregular ankylotic bone has no losis underwent SCG harvesting for RCU reconstruction following clear margin with normal anatomic structures. There is high risk of osteoarthrectomy. No adverse events were seen in the intra and post- haemorrhage resulting from damage of internal maxillofacial artery, operative period in any patient and satisfactory radiographic osseous duramater exposure, nerve injuries and cerebrospinal fluid leak. The healing was observed after six months. intraoperative real-time display of the surgical position and its Conclusions relationship with the surrounding structures can significantly The proposed harvest technique for SCG results in reduced donor site increase the accuracy of operation and reduce the risks especially morbidity and favorable healing and greater patient comfort. for high risk operations such as gap arthroplasty. Acquired images of TMJ(MRI or CT scan) can be loaded into an intraoperative navigation system to guide joint space manipulation. Radiography is not performed intraoperatively, changes in soft tissues such as those EPS00275 caused by synovitis or changes in disk position may not be detected Surgical Management of TMJ Dislocation (Iatrogenic): by CT scans or MRI. Thus; only bony structures in relation to TMJ act as reference. A Rare Complication of OSMF Management Results 1. Decrease of error in access; 2. decrease of risk of damaging intra- Dr. Meghali Diwaker, Dr. Bibhu Prasad Mishra articular tissue and structures by instrumentation; 3.more accuracy in detecting and treating intra-articular disease. I.T.S Dental College & Hospital, Greater Noida, I.T.S Dental College Conclusions & Hospital, Greater Noida In conclusion, use of computer based, image guided navigation system is of great benefit for TMJ gap arthroplasty because of reduced Abstract surgery time, promoted surgical security, minimally invasive access Background/Introduction and reduced risk to surrounding vital structures. Dislocation of the temporomandibular joint is not an uncommon condition. It may be unilateral or bilateral and can be acute, recurrent and rarely chronic. There are various reasons causing TMJ dislocation like iatrogenic, spontaneous, systemic diseases, trauma, anatomical factors and use of certain pharmacological drugs. Iatrogenically it can occur during intubation/laryngoscopy procedures or during dental and throat procedures. In this case report we are presenting a TMJ dislocation case due to OSMF management complication which is a very rare entity and has not yet been reported in the literature.

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Objectives Conclusions • the patient reported to our department with the chief complaint of It is true that the use of th edermis fat graft is a safe and effective inability to close his mouth and difficulty in speaking and chewing procedure in the management of TMJ Ankylosis. since 1 month. As it already was a treated case of OSMF, treating this case was a challenge for us as we had to bring about closure of the mouth to prevent dislocation of joint and simultaneously we had to maintain a mouth opening to prevent fibrosis of mucosa and recur- EPS00306 rence of OSMF. Also the sufficient vertical height had to be Post -Traumatic Adult TMJ Ankylosis: A Case Report maintained. • So the main objectives were: o Repositioning of condyle into glenoid fossa and prevention of recurrence. o Closure of Dr. Pratiksha Dwivedi 1st Year PG Student mouth and to restore normal physiological functions. o Maintaining a minimum mouth opening of 35 mm. Institute of Dental Studies and Technologies Methods The treatment planned was planned under GA in the following manner: • Reflection of surgical site with Alkayet Bramley incision. • Abstract Condylectomy on the dislocated side and condylotomy on the other Background/Introduction side. • Reconstruction with temporalis fascia flap. • Post operative - Limited mouth opening can be caused by bony or fibrous ankylosis of Aggressive physiotherapy. the TMJ as a sequel to trauma, infection, autoimmune disease or Results failed surgery. It is a disabling condition leading to malocclusion, The surgical procedure was carried out as planned. The dislocation alter eating habits and speech problems, OSA and poor oral hygiene. was corrected by performing condylectomy on the affected side. The Post-traumatic ankylosis in adults can be caused by ossification of post operative oedema was controlled by the placement of drains on hematoma, maltreated facial fractures, systemic diseases such as both the sides operatively. We were successful in achieving the mouth ankylosing spondylitis and rheumatoid arthritis. The basic treatment opening of 35 mm. By post operative day 2 the mouth opening used on adult patient is condylectomy with gap arthroplasty. achieved was 33 mm. The patient is still under aggressive physio- Objectives therapy. The patient is very much satisfied by the results as he can This poster presents a misdiagnosed case of condylar fracture leading now both open and close his mouth. to ankylosis over a period of 4 years in an adult and its management. Conclusions The mean maximal incisal opening (MIO) in the preoperative period TMJ is one of the most peculiar area of oral and maxillofacial region. was 8 mm and in the postoperative period it was 32 mm. Any anatomic and functional disturbance in TMJ should be treated in Methods earlier stage. TMJ dislocation cases can be treated easily at acute A 26 year old male reported to the department with chief complaint of stages otherwise fibrosis of joint space will transform the condition difficulty in mouth opening following RTA 4 years back. On the basis into chronic stage which is more difficult to treat and require surgical of clinical and radiographic examination, the case was diagnosed as intervention. TMJ ankylosis and gap arthroplasty was performed followed by maxilomandibular fixation and vigorous oral physiotherapy. Results Gap arthroplasty followed by physiotherapy shows good results in EPS00277 posttraumatic TMJ ankylosis. The patient on a regular follow up of Efficacy of Dermis Fat Graft as Interpositioning one year postoperatively maintained a mouth opening of 30 mm. Material in the Management of TMJ Ankylosis Conclusions The findings of case supports the use of gap arthroplasty with physiotherapy in adult post traumatic TMJ ankylotic patients. Dr. Ritesh Kumar

Govt. Dental College and Hospital, Jaipur, Rajsthan EPS00329 Surgical Approaches to Temporomandibular Joint Abstract Background/Introduction Dr. Aniket Kakade TMJ ankylosis is one of the most incapacitating and common problem in developing countries.gap arthroplasty and interpositional arthro- Terna Dental College & Hospital, Nerul, Navi Mumbai, Maharashtra plasty are the treatment options and various interpositional material like temporalis muscle fat and fascia, costal cartilage, masseter muscle, silastic sheet, Dermis fat graft etc. Abstract Objectives Background/Introduction This study purpose is to determine the efficacy of dermis fat graft in Surgical access to the temporomandibular joint is an exacting pro- the management of TMJ ankylosis. cedure. It requires technical skill and a thorough knowledge of Methods anatomy of the area. Temporomandibular joint has got close prox- All the patients with TMJ ankylosis, according to shaneys classifi- imity to the main trunk of the facial nerve with its branches in the cation of all age group & unilateral or bilateral, reporting to the temporal and facial areas. It has also got close proximity to the department of OMFS, GDC Jaipur were included in the study. auriculotemporal nerve and the abundant vascular supply. The inci- Results sions used in temporomandibular joint (TMJ) surgery represent a In our study 10 patiets of TMJ ankylosis wre treated by gap arthro- compromise between the need for adequate access and the desire to plasty and interpositioning the dermis fat graft taken from groin achieve a cosmetically acceptable postsurgical scar. This poster region.post operative mouth opening of 3.15 cm mean were obtained depicts the various approaches and incisions to Temporomandibular during the 12 month followup period which indicate the effictiveness joint surgeries, Indications for the selection of the incision and of procedure and no patient has recurrence of ankylosis. technique of each incision.

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ABS00334 EPS00355 Comparision of Approaches for Rigid Fixaton Comparison of Clinical Treatment Outcomes in Tmj of Subcondylar Fractures of Mandible Dysfunction Between Conventional and Ultrasound Guided Arthrocentesis a Quasi Experimental Study Presented By Dr. M. Anil Kumar, Dr. G. Harsha, Mds, Momsrcps (Glasg) (Prof&Hod) Dr. Jayalakshmi Jayakumar, Dr. S. Mohan

Abstract Government Dental College Kottayam Background/Introduction The most common manibular fractures is the condylar fracture, Abstract involving neck & subcondylar fractuers.the frequency of condylar Background/Introduction fractures accounts for more than a third of all mandibular fractuers. Temporomandibular joint disorder (TMD) is term used to describe the Objectives manifestation of pain and dysfunction of temporomandibular joint. The parameters evaluated are: injuries to the seventh cranial nerve(- Internal derangement (ID) is a functional disorder of the temporofacial nerve paralysis), mouth opening, lateral and protrusive mandibular joint (TMJ) most frequently caused by anterior and movements of jaw, pain, occlusion, an assessment of the surgical scar. medial displacement of the articular disc, which can cause various Methods degrees of pain and dysfunction. Patients who do not respond to A prospective randomized case control study conducted on 30 nonsurgical therapy may require more invasive procedures such as patients reporting to the dept of oral and maxillofacial surgery at mnr arthrocentesis and arthroscopy. TMJ arthrocentesis aims in releasing dental college and hospital, sangareddy, comparing three incisions i.e the articular disc and to remove adhesions between the disc surface preauricular, risdons incision and retromandibular incisions which and the mandibular fossa and hence identification of the upper joint where divided into 3 groups. space is important for successful lysis and lavage. Results Objectives Group A: immediate postoperatively 4 patients had facial nerve Aim of the study is to compare the clinical outcome of ultrasound paralysis and at 2 to 3 months postoperative followup no facial nerve guided TMJ arthrocentesis with conventional arthrocentesis in indi- paralysis seen group b: facial nerve paralysis not seen immediately viduals with TMJ dysfunction at third day, after one week and one group c: immediate postoperatively 1 patient had paralysis. month post operatively. Conclusions Methods To conclude, comparision of the complications could not ascertain the Twenty temporomandibular joint internal derangement patients who superiority of any approach over the other since the outcomes were were not responsive to conservative treatment modalities were not statistically significant. included in the study. Patients were divided into two groups. Group 1 underwent conventional arthrocentesis and group 2 underwent ultrasound guided arthrocentesis. Difference in the degree of mouth EPS00335 opening and pain on movements were compared between both groups Treatment Protocol in Temporo Mandibular Joint after three days, one week and one month of the procedure. Results Disorders Difference between pre-operative and post-operative inter-incisal distance and VAS score were significant in both the groups. When Maj Abhishek Mishra Group 1 and Group 2 patients were compared Group 2 showed significant reduction in VAS score only at the third day follow up of the AFMC Pune procedure. There was not significant inter-group difference in improvement of mouth opening. Conclusions Abstract Based on this study we conclude both conventional arthrocentesis and Background/Introduction ultrasound guided arthrocentesis are effective in management of TMJ Temporomandibular disorder (TMD) is the general term used to dysfunction. Ultrasound guide in arthrocentesis is not resulting sig- describe the manifestation of pain and/or dysfunction of the tem- nificant difference improvement of symptoms when compared to the poromandibular joint (TMJ) and its associated structures. conventional arthrocentesis. Objectives presentation of various types of TMDs and its managements protocol. Conclusions The etiology of TMD is presumed to include trauma, parafunctional EPS00374 habits, malocclusion, joint overloading, arthritides, psychological To Evaluate the Effectiveness of Platelet Rich Fibrin factors, and ergonomic positioning of the head. The dilemma for the clinician is exacerbated by the broad spectrum of results and claims with High Condylectomy in Internal Derangement that use a seemingly endless variety of surgical and nonsurgical of Tmj strategies. There are absolute indications where surgical intervention would be of primary benefit, and the questions would be whether Dr. Nikunj Makwana there is still a role for nonsurgical therapy in these patients, and if so, when it should be instituted and for how long. Abstract Background/Introduction Internal derangement of the temporomandibular joint (TMJ) may be defined as a disruption within the internal aspects of the TMJ in which there is a displacement of the disc from its normal functional

123 S180 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 relationship with the mandibular condyle and the articular portion of EPS00405 the temporal bone. Retrospective Study on Open and Closed Reduction Objectives The purpose of this study is to evaluate the effectiveness of platelet Methods for Management of Condylar Fractures rich fibrin with high condylectomy in the management of the TMJ pain and dysfunction in patient with internal derangement of TMJ. Author: Dr. Shruti Gunashekhar, Co-Authors: Dr. Abhay. T. Kamath, Methods Dr. Chithra. A All the patients with internal derangement of temporomandibular joint having anterior disc displacement without reduction with com- Abstract plaints of pain and limited opening of mouth, of all age group Background/Introduction reporting to the Department of Oral & Maxillofacial Surgery, GDC This retrospective study evaluated the complications with the use of Jaipur 20 patients were included in the study. various methods to treat condylar fractures. Amongst all the Results mandibular fractures, the most common site being the condyle. The Inter-incisal mouth opening at one month Postoperative follow up study primarily focused on the treatment benefits to the patient and mean was 25.05, and Post Operative six month was 28.5 and at 12 compared the relative risk involved with both the treatment modalities month follow up mean inter incisal mouth opening was 31.85. Pre like pre treatment, intra treatment post treatment outcomes. The operative pain mean value was 9.2 with standard deviation 1.005 and success rates were compared with other published data. Analysis of at one month follow up 1.7 at six month was 0.4 and at twelve month the epidemiology and treatment of condylar fractures reveals the follow up was 0. incidence, etiology, patient gender and age, oral health, time between Conclusions injury and treatment, patterns of treatment (open and closed methods There was significant increase in mouth opening post-operatively complications (Swelling, pain, hematoma.ecchymosis, bleeding, using the procedure of high condylectomy with PRF placement into malocclusion, trismus, crepitations, paraesthesia, deviation of the joint space. Most of the patients were asymptomatic after 1 year of mandible), and long-term follow-up of the condylar fractures. follow up. Objectives To compare the efficacy of management of condylar fracture using open and closed reduction. Objectives:To evaluate the effectiveness EPS00393 of the treatment. To evaluate the epidermiology and complications associated with the treatment. To assess the outcome based on the Arthrocentesis of TMJ: A Review of Lysis & Lavage treatment. Techniques & Modifications Methods A protocol for the retrospective study of treatment methods of Dr. Hemant Yadav condylar process fractures was developed that included absolute and relative indications and contraindications. To evaluate the results of this protocol, about 10 patients treated with CRMMF and about 10 Abstract treated by ORIF were recalled after a minimum of 6 months and Background/Introduction examined for gender, race, diagnosis, age at injury, time since oper- In 1960s arthrocentesis of large joints, the knee in particular, became ation, and cause of the fracture. Each group was assessed for a recognized treatment. Physicians carried on to develop various maximum interincisal opening, right lateral excursion, left lateral techniques of lysis and lavage for other joints, such as the hip, excursion, protrusive movement, deviation on opening, scar percep- shoulder, tarsus, and wrist. It was then found that the mechanical lysis tion, motor function, sensory perception, contour perception, of adhesions & lavage of the temporomandibular joint (TMJ) was occlusion, and perception of pain. Nonparametric data were compared often successful in treating various internal derangements. for statistical significance with a chi-square analysis and parametric Objectives data with an independent samples t-test (P \.05). Aim of this poster is to review described techniques of lysis & lavage Results of the TMJ & to discuss their possible advantages & disadvantages. No statistically significant differences existed between the ORIF and Methods CRMMF groups for gender, race, diagnosis, or cause. Moreover, no There were 8 different methods for the lysis & lavage of the TMJ & a differences existed for age at injury, maximum interincisal opening, modification reported in various books & journals were referred for right lateral excursion, left lateral excursion, protrusive movement, this review. deviation on opening, or occlusion. Differences were noted between Results groups for time since operation, scar perception, and perception of There were 8 different methods for the lysis & lavage of the TMJ pain. Using the protocol outlined, there were no differences between published in 8 papers, & modification reported in a book. These were: the ORIF and CRMMF groups for ranges of motion, occlusion, arthroscopic lysis and lavage, two-needle arthrocentesis using an contour, and motor or sensory function. The ORIF group was asso- irrigation pump, modified two-needle arthrocentesis, the double- ciated with perceptible scars. The CRMMF group was associated with needle cannula method, single-needle arthrocentesis, use of a single chronic pain. Shepard cannula with two ports & two lumens, two-needle arthro- Conclusions centesis, single-puncture arthrocentesis, & two- needle arthrocentesis Both treatment options for condylar fractures of the mandible yielded with new anatomical landmarks. acceptable results. However, operative treatment, irrespective of the Conclusions method of internal fixation used, was superior in all objective and The modified two-needle technique, single needle technique, & sin- subjective functional parameters. gle-puncture technique with the dual-needle device, may be useful for lysis & lavage of the TMJ to treat joints with fibrosis or advanced arthrosis.

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EPS00443 This report presents a case of collateral chronic osteomyelitis of jaw Temporomandibular Joint Replacement Surgical (SCO) secondary to trauma followed by chronic suppurative parotitis causing ankylosis of TMJ as result of coronoid hyperplasia. Guidelines with Alloplastic Graft Methods Radiological evaluation using OPG and CT revealed presence of Dr. Harikrushna Vekariya radiolucent areas combined with progressive osteosclerosis, lytic lesions (radiolucency) and laminations of periosteal new bone. Bac- Jaipur Dental College, Jaipur terial contamination of bone tissue was determined by FNAC. Succeeded by surgical procedure which included complete resection Abstract of affected condyle followed by reconstruction of condyle using the Background/Introduction hyperplastic coronoid process. All procedures were carried out under The TMJ replacement system is implanted in the jaw to functionally antibiotic coverage. reconstruct a diseased and/or damaged TMJ. The TMJ replacement Results system is a 2-component system comprised of mandibular condyle Post OP- Mouth opening increased from 11mm to 28mm without and glenoid fossa components. Both components are available in infection. multiple sizes as right and left side specific designs and are attached to Conclusions the bone by screws. Osteomyelitis of condyle is rare, may lead to suppurative parotitis due Objectives to direct extension. This case was successfully treated with aggressive To evaluated total TMJ replacement with alloplastic prostheses. surgical debridement, reconstructive surgery and intravenous antibi- Methods otic therapy. Chronic parotitis should be monitored cautiously 1)Exposure of the Ramus 2)Exposure of the Zygomatic Arch 3)Ex- because it can involve deeper layers of gland and infiltrate TMJ posure of the entire joint 4)PDQ Retractors to prepare for osteotomy resulting in ankylosis. 5)Dissection medial to condylar neck 6)Ramal exposure 7)Dissecting around the mandibular branch of the facial nerve 8)Masseter reflection 9)Ramal exposure 10)Begin osteotomy with 1mm fissure burr ABS00522 11)T-bar osteotome to finish osteotomy 12)Two-step osteotomy - Phase II 13)Reciprocating rasp flattens fossa eminence 14)Sizing and Efficacy Temporomandibular Joint Arthrocentesis Implantation of Fossa Component 15)Inter-maxillary fixation With Injection of Sodium Hyaluronate 16)Fitting and Placement of the Mandibular Component 17)Final and Dexamethasone in Treatment of Internal Screw Placement. Derangment: A Prospective Clinical Trail Results Postoperatively, patients about their normal everyday activities related to their articulating prostheses (for example, capacity to chew Dr. Amit Kumar, Dr. Anuj Agarwal their favorite foods, talking, yawning, among others). Conclusions ITS Dental College & Hospital, Greater Noida, U.P. Correct indication and ideal surgical planning are critical as therapy for TMJ alterations. This way, multiple procedure which make the Abstract diagnosis unfavorable are avoided. Background/Introduction Internal derangement of the TMJ is one of the most common forms of TMDs. It may be defined as a disruption within the internal aspect of TMJ, in which there is a displacement of from its normal function EPS00485 relationship with the mandibular condyle and articular portion of Autogenous Reconstruction of Osteomyletic Condyle temporal bone. The triad of symptoms – clicking, locking and pain. Associated with Parotitis Using Hyperplastic Coronoid: Hyaluronic acid (HA) is a polysaccharide of the family of gly- A Case Report cosaminoglycans. HA has been shown to improve and restore normal lubrication in joint, provide nutrition to the avascular articulating disc, and stabilize the joint. Presenting Author: Chirag Nakum Co-authors: Saikrishna D Objectives The objective of this study is to evaluate the treatment outcome of JSS Dental College and Hospital, Mysuru temporomandibular joint arthrocentesis with the follow up interval of pre-operative, post-operative, 1st week, 1st month and 4th month. The Abstract patients are evaluated for: • Maximum mouth opening (in mm using Background/Introduction scale) • Maximum pain at rest (Visual Analogue Scale) • Maximum Osteomyelitis is inflammation of bone cortex and marrow which pain on chewing (Visual Analogue Scale) develops after chronic infection. When untreated, leads to compound Methods fractures that fail to heal. Secondary chronic osteomyelitis of jaw The study includes 25 patients reporting to the Department of Oral (SCO) occurs due to spread from a contiguous foci of infection (direct And Maxillofacial Surgery with the cheif complaint of pain in join. bacterial inoculation which gain access by contaminated fracture or Detailed examination and investigation are done and all patients tissue) without vascular insufficiency, often seen after trauma or diagnosed with temporomandibular joint internal derangment will be surgery. Inoculation of infection at condyle may lead to its extension selected for the study. A total 100 ml of ringer lactate solution is use into parotid glands causing parotitis, characterised by pain, swelling to lavage the joint. Manipulation of patient jaw in vertical, protrusive and trismus in severe conditions. and lateral excursion to help free the disc further and break adhesions. Objectives 1ml of hyaluronic acid mixed with dexamithasone (4mg) is injected into the joint.

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Results The chin deviates toward the affected side. Vertical height of the A total 25 patients, 16 males and 9 female received intra-articular affected side is shorter when compared with the unaffected side. The injection of 1ml sodium hyaluronate and dexamethasone after main causes of TMJ ankylosis are trauma and infection. Trauma arthocentesis in 36 joints. Post operatively this technique increased associated ankylosis constitutes 13 to 100% of ankylosis cases and maximal mouth opening, lateral movements, and function, while infection constitutes 10 to 49 % of ankylosis cases.the most com- reducing tmj pain and noise. monly used treatments include gap arthroplasty and interpositional Conclusions arthroplasty and joint reconstruction with autogenous and alloplastic We conclude that patients with either disk displacement with reduc- materials. tion and closed lock benefitted from arthrocentesis. However, Objectives arthrocentesis with Sodium Hyaluronate injection seemes to be The present study was done to evaluate the efficacy of interpositional superior to arthrocentesis alone. arthroplasty with temporalis muscle and fascia (myofascia) flap in preventing the re-ankylosis, to evaluate the growth of mandible, and to assess Al-Kayat and Bramley’s incision for its versatility in allowing muscle transfer and excellent exposure of the joint. This EPS00532 poster is a case series of the surgical treatment for patients with TMJ Surgical Management of TMJ Ankylosis ankylosis under GA, which is being followed at our department. The and Assesments case series were treated with resection of the ankylotic mass using Al- Kayat Bramley incision and Interpositional arthroplasty with temporalis myofascial flap. Chandana Jyothsna Guided by Dr. Anand Methods 2 patients with ankylosis were treated with interpositional arthro- Abstract plasty with temporalis myofascia flap. Maximum Interincisal Opening Background/Introduction (MIO) was measured at different periods, i.e. preoperative, intraop- TMJ ankylosis is a situation in which mandibular condyle is fused to erative, immediate post operative, 1 month post-operative, 6 month glenoid fossa by bone or fibrous tissue which is caused mainly by post-operative, 1 year post-operative. condylar fractures resulting in restriction of jaw mobility and causes Results and disturbances in facial and mandibular growth. A statistically significant difference of 35mm was obtained between Objectives pre-operative and post-operative interincisal opening after a period of Purpose of this poster is to present an easy and versatile methods like one year follow up. gap arthroplasty, interpositional arthroplasty using costochondral Conclusions grafts, alloplastic joint reconstruction materials for treatment of TMJ The temporalis myofascia flap is an efficient interpositional material. ankylosis to decrease post operative complications such as It is a biologic, autogenous tissue, so there is no question of any reankylosis. rejection. It is a pedicled flap, so it maintains its viability. It can be Methods procured by the same incision used for exposure of the joint. It is A total of 10 cases (unilateral and bilateral) ankylosis of TMJ easily mobilized and made to cover the complete area of the glenoid underwent surgical release after performing gap arthroplasty through fossa. Thus it acts as a barrier and prevents the chances of reankylosis pre auricular approach, costochondral grafts or temporalis facial flap to a greater extent. Also the mandibular growth continues as normal was transposed to gap and used as interpositional material Early after the temporalis myofascia interposition. mobilisation, physiotherapy and strict Follow up are essential to prevent postop adhesions. Results There were no signs of recurrence in any patients and gained maxi- EPS00605 mum inter incisal opening. Recent and Comprehensive Surgical Management Conclusions of Tmj Ankylosis Surgical treatment of TMJ ankylosis with gap arthroplasty, interposition of temporalis facial flap and costochondral grafting is an effective and easy procedure for preventing of reankylosis.the auto- Prof. Dr. A.Thangavelu, MDS, DNB, Dr. R. Dhivya genous nature and close proximity to joint are the main advantage of temporalis facial flap when compared with other interpositional Rajah Muthiah Dental College and Hospital materials. Abstract Background/Introduction EPS00563 TMJ forms the cornerstone of cranio facial intergrity. Ankylosis of TMJ is a dysfunction of the joint, very often the disease is diagnosed Temporomandibular Joint Ankylosis: Our Protocol too late in spite of many symptoms!! Objectives Dr. Satya Priya Shivakotee Treat problems like impairment in speech, difficulty in mastication, poor oral hygiene, malocclusion, facial deformity, the role of inter- Abstract positional materials are discussed in detail with review of litreature. Background/Introduction Methods Ankylosis is a Greek terminology, meaning stiff joint. Hypomobility Removal of ankylotic mass with placement of various inter-positional of joint can lead to partial or complete inability to open mouth. TMJ materials like free fat dermis, temporalis etc. ankylosis is very distressing structural condition that retards Results mandibular growth, effects aesthetics and results in limited mouth Functional rehabilitation, acceptable mouth opening. opening. Facial asymmetry is the classic feature in unilateral cases.

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Conclusions compromise. Alloplastic reconstruction eliminates the need for a Cases are discussed with long term follow up, this poster highlights second surgical site with the associated morbidity and minimizes the recent and comprehensive management of tmj ankylosis. effects of connective tissue/autoimmune disease, ankylosis, etc, which can cause destruction of autogenous tissues used in TMJ reconstruction. Objectives ABS00644 To review various alloplastic joints available for reconstruction and to The Retromandibular Anterior Parotid Transmassetric introduce our indigenous total joint prostheses in the management of Approach in the Management of Condylar Fractures: extensive primary and recurrent TMJ ankylosis. Our Clinical Experience Methods Prospective study of 9 patients (6 bilateral & 3 unilateral) TMJ ankylosis (15 joints) patients who underwent alloplastic reconstruc- Dr. Divya Gada, Dr. Mukul Padhye, Dr. Charu Girotra, Dr. Gokul tion of temporomandibular joint following arthroplasty with our Venkateshwar custom made prosthesis. Results Abstract all our unilateral & bilateral TMJ ankylosis cases, there was signifi- Background/Introduction cant improvement in mouth opening, also reduction in the pain while Introduction: Mandibular condylar fractures are very common. There mouth opening and jaw function and there was a change in diet is a general agreement that an intra-capsular requires conservative pattern of patient from liquid to solid food. There was no re-ankylosis treatment but ORIF for extra-capsular fracture is controversial. Extra noted during our study. oral approaches have different advantages and disadvantages. There is Conclusions a possibility of transient facial nerve parasthesia, salivary fistula or Holistic approach of joint release and secondary deformity correction infection post operatively. among contemporary surgeons has lead to great dilemma with regards Objectives to treatment planning. In an attempt to carry out both the procedures AIM: To evaluate the incidence of facial nerve paralysis during the simultaneously there is loss of vector control of the distal segment and open reduction internal fixation of condylar fracture by this approach. the risk of pseudoarthrosis at the osteotomy site. This combined Methods problem could be overcome by the use total alloplastic joint pros- In our series of cases for treating condylar fracture with open thesis which offers a firm posterior stop for the proximal segment and reduction internal fixation we have used retromandibular anterior negates aggressive physiotherapy. parotid transmassetric approach. Where in the superficial muscular subcutaneous system were dissected anterior and superior aiming to the fracture, the parotid myofascia was pulled backward, with blunt dissection the masseter muscular fibers were gently divided in a EPS00695 fashion that parallel is the facial nerve fibers. Through the dissection A Novel Approach for Low Level Condylar Fractures: of the masseter muscle, the mandibular periosteum was reached Modified Tragus Edge Approach vs Retromandibular incised and elevated until the fracture stumps appeared. The fracture Transparotid Approach a Comparitive Study fragments were reduced and fixed with titanium plate. The drain was kept for 48 hrs and aggressive physiotherapy was given post operatively. Parameter assessed: Facial nerve palsy, postoperative pain and Dr. Deepak Mehta (Ab Shetty) swelling, postoperative mouth opening. Results Abstract There was no facial nerve palsy observed, post operative mouth Background/Introduction opening was adequate with minimum pain and swelling. Mandibular fractures are extremely frequent in facial trauma, and Conclusions:: Though various approaches can be used for sub- 19–52% involve the condyle. Condylar fractures are classified condylar fractures like pre-auricular, submandibular, retromandibular according to the anatomic location (intracapsular and extracapsular) transparotid, but anterior parotid transmassetric approach seems to be and degree of dislocation of the articular head. a safer approach since the injury to braches of facial nerve is Objectives minimized. To determine the better surgical approach for low level Condylar fractures. Methods The time required and the complications developed with both the EPS00674 approaches were compared. Total Alloplastic Temporomandibular Joint Results Reconstruction: A Holistic Approach for Management There are advantages and disadvantages with both approaches, but the of Tmj Ankylosis disadvantages with retromandibular transparotid approach are comparatively less. Conclusions Dr. R.S. Neelakandan, Dr. Arun M. Krishnan The retromandibular transparotid approach provides good exposure and facilitates accurate reduction and fixation of the subcondylar Abstract fragment with positive outcomes, good cosmetic results, and rare Background/Introduction major complications. Most facial nerve injuries are transient in nature Temporomandibular joint (TMJ) ankylosis involves the fusion of the after this approach. mandibular condyle to the glenoid fossa, the skull base. It is a serious and disabling condition that may cause problems in mastication, digestion, speech, appearance and hygiene. It can also cause disturbance of facial and mandibular growth associated with acute airway

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ABS00707 (ABI) around the articular capsule/or into the articular cavity has been God Gave Us Extra Ribs for a Reason! described. The procedure is easy, and causes no foreign body reaction. Objectives Prof. Dr. Senthil Nathan, Dr. Abdul Wahab, Dr. Madhulaxmi, Dr. Evaluate the efficacy of autologous blood injection in the treatment of Viveka P, Saveetha chronic recurrent dislocation of the temporomandibular joint (TMJ). Methods Dental College and Hospital Here, we present the management of recurrent temporomandibular joint dislocation by autologous blood injection in an 35 year old Abstract mentally retarded male patient came to OMFS dept. Local anesthesia Background/Introduction was given to the auriculatemporal nerve. The articular fossa was Ankylosis of the temporomandibular joint (TMJ) is an intracapsular assumed as located at a point 10 mm anterior to the tragus of the ear union of the disc condyle complex to the temporal articular surface and 2 mm inferior to the tragal-canthal line. Five mL blood was that restricts mandibular movements. Being a serious disability that withdrawn from the patients’ anticubital fossa. Four mL blood with a has an adverse effect on mastication, digestion, speech, appearance 21- gauge needle was injected in the articular cavity and 1mL was and hygiene, and causing disturbance of facial and mandibular growth injected in the pericapsular tissue. After the completion of the and acute compromise of the airway invariably resulting in physical injection, an elastic bandage was applied and left for 24 hours to and psychological disability, diagnosis and treatment of TMJ anky- constrain the joint movements. losis should be done as early as possible and specifically tailored to Results the age and growth status of the patient. After the treatment, although the right & left condylar process had Objectives settled just beneath the articular tubercle, the dislocation had To increase the mouth opening by resection of ankylotic mass, hence improved and the patient was able to close his mouth without improving the quality of life of the patient. difficulty. Methods Conclusions Surgical resection of ankylotic mass and placement of costochondral In conclusion, it can be stated that the technique of autologous blood graft; with bilateral coronoidectomy. injection for treatment of recurrent TMJ dislocation is a simple, safe Results and cost effective procedure. This conservative approach can be tried Sufficient mouth opening was achieved intra-operatively and main- prior to performance of more invasive surgical intervention. tained post operatively by continuous physiotherapy. Conclusions TMJ ankylosis can be treated effectively surgically and reconstructed to achieve both form and function adeptly using costochondral graft. EPS00733 Role of Arthroscopy in Management of Internal Derrangement of Temporomandibular Joint EPS00713 Autologous Blood Injection for Treatment of Recurrent Dr. Shweta Wadekar, Dr. D. Y. Patil Tmj Dislocation: A Case Report Dental Hospital, Navi Mumbai

Dr. Kishan Ravaliya, Narsinhbhai Patel Abstract Background/Introduction Dental College & Hospital, Visnagar, Gujarat Internal derangement of the temporomandibular joint (TMJ) is common. The patients with displaced discs are usually treated Abstract conservatively, and treatments include mandibular manipulation and Background/Introduction bite splints. Most patients with articular disc displacements either Dislocation of the temporomandibular joint occur when the head of improve spontaneously or can be managed efficiently with appro- the condyle moves anteriorly over the articular eminence into such a priate conservative measures. Open arthrotomy of the TMJ has been position that it cannot be returned voluntarily to its normal position. widely advocated for treatment of internal derangement with closed Recurrent Temporomandibular joint (TMJ) dislocation is character- lock when conservative treatment has failed. More recently, arthro- ized by a condyle that slides over the articular eminence, catches scopic surgery of the TMJ has increased in popularity because it is briefly beyond the eminence, and then returns to the fossa. There are less invasive than open surgery, is associated with few complications, well-documented surgical and conservative treatments for chronic and requires a shorter hospital stay. recurrent dislocation of the TMJ, and the injection of sclerosing Objectives solution around the articular capsule and/or into the articular cavity Arthroscopy allows surgeons to diagnose and treat intra-articular has benn proposed as a nonsurgical treatment, and Autologus blood conditions directly with a minimally invasive technique that reliably injection around the articular capsule and/or into the articular cavity reduces pain and increases the mandibular range of movement. also recently used. 1973 Schulz was the first to report experience with Methods it to treat recurrent condylar dislocation. The rationale of ABI is that Here we present an arthroscopic surgical approach to correct dis- blood is injected into the pericapsular tissues and the superior joint placement of the anterior disc without reduction of the TMJ and with space. The bleeding into the pericapsular tissues as a result of the limitation of mouth opening. This includes arthroscopic inspection of introduction of a needle will create a bed for the formation of fibrous the superior compartment, lysis of adhesions formed between the disc tissue. The role of ABI into the superior joint space is not fully and the fossa, and release incision anterior to the attachment tissue of understood, but it may lead to the formation of intercompartmental the disc to reposition the ectopic disc. adhesions. Importantly, restrained mandibular movement is the key to the success of the procedure. recently injection of autologous blood 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S185

Results EPS00795 Arthroscopy useful in management of closed lock jaw. It reduces pain Management of TMJ Ankylosis in Old Patient a Case and increases mandibular range of movement, and the disc may move normally. Report Conclusions Arthroscopic surgical procedures are safe, minimally invasive, and Dr. Ashish Gupta effective in the treatment of pain in the TMJ and improving the range of movement. Most of the positions of the displaced discs were Krishnadevaraya College of Dental Science improved. Compared with open operations, the risks are minimal and complications are rare. The rate of recovery is rapid, and the success Abstract rate is high. This is an effective treatment for anterior displacement of Background/Introduction the disc without reduction of the TMJ. TMJ ankylosis is usually treated in early years of life, ho wever the treatment may get delayed in some instances due to various reasons. Here we report a case of 65 year old lady edentulous with bilateral tmj EPS00760 ankylosis, challenges faced in rehabilitation of this patient. Objectives To Compare the Efﬁcacy of Concentric Needle-Single To rehabilitate patient with minimal challenges. Puncture Technique with the Conventional Two Needle Methods Technique for Temporomandibular Joint Distraction followed by interpositional gap arthoplasty. Arthrocentesis Results Satisfactory result with sufﬁcient mouth opening. Conclusions Dr. Amit Kumar, Dr. AmitGupta and Dr. Harsha Jain Surgical management in TMJ ankylosis results in adequate mouth opening but active and vigorous physiotherapy in both immediate and ITSCDSR muradnagar Ghaziabad U.P. later post operative days can only prevent reankylosis.

Abstract Background/Introduction Section: Craniofacial research Temporomandibular disorders are a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex. TMJ arthrocentesis is performed under local anesthesia for lysis and lavage of the superior TMJ space EPS00187 and release of the joint, which improves function, increase range of Maxillofacial 3D Planning-A Vision Based 3D Capture motion, and decreases the pain in these disorders. System Objectives To compare the efficacy of concentric needle-single puncture technique with the conventional two needle technique for Dr. Saibal Bhattacharyya temporomandibular joint arthrocentesis. Methods Awadh Dental College & Hospital, Jamshedpur Patients reporting to the Department of OMFS with chief complain of pain and clicking sound in temporomandibular joint were included in Abstract this study. Twenty joints were randomly selected and divided into Background/Introduction Group A (concentric needle technique) and group B (two needle The human face is 3-dimensional and dentofacial surgeons deal with technique) for arthrocentesis under local anesthesia using Ringer’s the physical relationship among the parts of the human dentofacial lactate solution Measured Parameter • Mouth opening • Postoperative structures. These 3-dimensional physical relationship change through pain relief • the operative time in minutes. • Pain at rest • Efficacy of the course of growth, development and treatment. Therefore, analysis chewing • Limitation of jaw functions • Tolerance of treatment • of the results of corrective surgery in 3-dimension is requred and Effectiveness of treatment. idelly it should also be possible to visualize the expected results of Results planned surgery postoperatively. Various technique of mesuring The results show significant difference in operating time between facial morphology have been reported including Direct Anthropom- concentric needle technique and two needle technique arthrocentesis. etry, Laser Scanning system, Facial Plaster model, Moire Stripes and There was also significantly better mouth opening at 3 months in Liquid Crystel Range Finder. Recent innovation in Computarized Group A but no significant difference in Post Operative Pain, Pain at Stereophotogrammetry (C3D) provide a useful technique for 3D Rest, Pain on Chewing, Effectiveness of Chewing, Limitation of Jaw recording of the face. We describe a Vision-based 3-dimensional Function, Tolerance and Effectiveness between the two groups. facial data capture system designed for the planning of Maxillofacial Conclusions Surgery. Concentric needle technique is better as it is less time taking and Objectives minimally invasive as compared to the two needle technique. The aim of this poster is to provide a detail information about the newly developed three-dimensional(3D) imaging system in recording facial morphology.

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EPS00390 Methods Role of Multi-functional Theranostic Nano-particles Successful regeneration can take as long as six months from the time of injury to functional recovery. Following injury, fluid accumulates in Head and Neck Oncology: A Systematic Review within the lumen of the conduit and the distal nerve stump undergoes Wallerian degeneration. When contact with neurons is lost, Schwann Dr. Janice John cells in the distal segment change their genetic programming from producing myelin-associated proteins to synthesizing growth factors Govt. Dental College, Nagpur such as nerve growth factor, brain-derived neurotrophic factor, and neurotrophin- 3. Abstract Results Background/Introduction The function of the bioartificial nerve graft is to stimulate axon Head and neck cancers represent the sixth most common cancer growth and guide it toward the distal target in a timely manner. The globally and are diagnosed with biopsy, treated by surgery, irradiation conduit itself acts as a physical guide as well as offering protection for and chemotherapy. This results in delayed diagnosis, healthy tissue the newly formed tissue. By modeling the transport of nutrients and destruction, adverse drug reactions, ineffective drug concentrations, growth factors within the conduit, the design can be optimized with drug resistance and higher mortality. Nanotechnology has revolu- respect to porosity, wall thickness, and Schwann cell seeding density tionised cancer management with the detection of salivary so that growth factors are concentrated within the lumen while biomarkers, high contrast tumor imaging, targeted drug delivery to ensuring that sufficient nutrients are provided for the cells until the mutant cells, monitoring of treatment progress, in brachy-therapy and neovasculature is formed. break-through pain management. Conclusions Objectives Significant recent advances are the use of biodegradable channels, The aim of this review is to describe nanoparticles, methods to controlled release of trophic factors and conduits seeded with Sch- functionalize nanoparticles, their applications in head neck oncology wann cells. All of these discoveries are making their way into the and to outline therapeutic commercialization. clinic and showing great potential in nerve regeneration. Methods Database search was done on Pub-med, Cochrane library, Interna- tional Journal, British Journal and Journal of oral and maxilla-facial EPS00550 surgery from inception till August 2017, using key words ‘nanotechnology’ and ‘head and neck cancers’. Access Osteotomies-Transfacial Approaches Results to the Skull Base Tumors The search yielded 160 relevant articles. Nano-electromechanical system, and optical nanobiosensor help in diagnosis. Quantum dots Dr. Preetika Gupta-Sinhgad enable gene sequencing and detection of DNA methylation. Cadmium nanoparticles facilitate accurate cancer excision. Nano-emulsions Dental College and Hospital, Pune containing genistein serve as pre and post-operative maintenance therapy. Conclusions Abstract Nano-technology is a nascent science and requires clinical trials to Background/Introduction determine safety and efficacy, to improvise drug-delivery modules, One of the most challenging and difficult problems of a surgeon is to drug dosing and to translate research concepts into personalised treat a neoplasm of the cranial base. The requirement to obtain dis- cancer therapy. ease-free margins without significant morbidity is often a daunting task. The cranial base is surrounded by structures that are vital for life and normal function. Many cranial base lesions are slow growing and non-metastasizing, which makes them amenable to surgical treatment. EPS00463 These same characteristics often make these lesions resistant to Bioartificial Nerve Graft for Peripheral Nerve radiation therapy. Objectives Regeneration This poster describes case of lateral approach to the orbit and anterior cranial base to access the removal of neoplasm (pPNET-Peripheral Dr. Samyak Vakil Primitive Neuroectodermal Tumor) of lateral orbit in 28years old male patient that the oral and maxillofacial surgeon performed with Abstract neurosurgeon. Background/Introduction Methods More than any other form of trauma, nerve injuries complicate suc- Fronto Temporo Orbito Zygomatic Craniotomy and Zygomatic cessful rehabilitation. Under the right conditions, however, axon Osteotomy. extensions can regenerate over gaps caused by injury, reconnecting Results with the distal stump and eventually re-establishing functional con- Tumor was successfully excised and Patient underwent chemotherapy tacts. Peripheral-nerve injuries that result in long gaps require surgical postoperatively. implantation of a bridge or guidance channel between the proximal Conclusions nerve end and the distal stump in order to restore full function. The last two decades have seen tremendous advances in neurosurgery, Objectives otolaryngology, and craniomaxillofacial surgery. These advances To evaluate autogenous nerve grafts and artificial tubes as conduits include rigid fixation and bone grafting techniques, which make for the repair of continuity defects in the peripheral nerves. surgical treatment of these neoplasms possible.

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EPS00616 Methods Role of Stem Cells in Oral and Maxillofacial Surgery Poster will be prepared using the needful pictures representating the advantages of stem cells. Results Dr. GURMEJ SINGH Advantages of stem cells in Craniomaxillofacial surgery. Conclusions Punjab Government Dental College Amritsar This poster focuses on reported clinical advantages of stem cells in Craniomaxillofacial surgery. Abstract Background/Introduction In this present world of medicine, loss of tissue due to trauma, disease or congenital abnormalities is a major health care problem. when this ABS00751 occurs in the craniofacial region, severe physiological and psycho- Evaluation of Changes in Cerebral Hemodynamics logical consequences occurs which directly or indirectly affect in Cranioplasty Patients Using Magnetic Resonance individual’s life. Therefore it is mandatory to reconstruct craniofacial Perfusion area to its aesthetic and functional level. Objectives Objectives of this poster presentation are to address the determined Dr. Chandan Misra recent research efforts in role of stem cells in oral and maxillofacial surgery like repair of craniofacial defects, salivary gland regeneration Army Dental Centre (Research & Referal), Delhi after radiation therapy, in the treatment of lichen planus and regeneration of dentine, pulp and teeth. Abstract Methods Background/Introduction For this purpose data were gleaned from a literature search of Cranioplasty is defined as the surgical repair of a residual calvarial available medical and dental databases. The search phrases included bone defect secondary to decompressive craniectomy either due to the main set Tissue engineering in Oral & Maxillofacial Surgery, trauma or stroke. The primary aim of cranioplasty to give protection Regenerative Medicine in Oral & Maxillofacial Surgery with defined to the brain and also for cosmetic rehabilitation. However marked subsets such as Craniofacial bone tissue engineering, TMJ tissue improvements in the neurological status and in terms of daily routine engineering and many more. physical activities after cranioplasty have been shown in several Results studies. The generally accepted explanation is that this improvement This poster will therefore present the significant advancement that might be due to a reduction of local cerebral compression effects by have been made in the application of stem cells in oral and max- atmospheric pressure. Eliminating the effects of atmospheric pressure illofacial surgery, as well as its future potential. might lead to increased cerebral blood flow(CBF), thus leading to Conclusions neurological improvement. Literature review reveals very few studies The future dentistry will be more of regenerative based, where in cranioplasty patients correlating clinical symptoms with cerebral patients own cells can be used to treat diseases. Stem cell therapy has hemodynamics using imaging modalities. Therefore, the present study got a paramount role as a future treatment modality in dentistry. On has been undertaken to evaluate the changes in cerebral hemody- the other hand, stem cells should be differentiated to the appropriate namics in patients undergoing cranioplasty with the help of MR cell types before they can be used clinically, otherwise it might lead to perfusion. deleterious effects. Longer patient follow up is needed to study the Objectives life time of regenerated tissue. The present study is undertaken with the aim to evaluate the changes in cerebral hemodynamics in patients undergoing cranioplasty using Magentic Resonance (MR) Perfusion. The secondary objective is to establish a correlation between changes in neurologic status measured EPS00624 via global disability parameters and cerebral hemodynamics post Role of Stem Cells in Craniomaxillofacial Surgery cranioplasty. Methods Dr. M. Sowmya Guided By Dr. Kishore This prospective study was conducted on patients reporting to the Department of Oral and Maxillofacial Surgery, Army Dental Centre (R & R) for cranioplasty post decompressive craniectomy for M Vishnu Dental College intractable intracranial hypertension. Cerebral hemodynamics was studied by MR perfusion using the parameters of cerebral blood flow, Abstract cerebral blood volume and mean transit time before and after cran- Background/Introduction ioplasty and the results were compared with the possible neurological In Craniofacial Surgery the hard and soft tissue defects that are caused and neuropsychological parameters. All these patients were assessed due to congenital deformities, trauma and pathologies affect the life preoperatively by global disability parameters viz. Barthel index and supportive processes, delivery of senses, social interaction and aes- Modified Rankin Scale followed by MR perfusion imaging to assess thetics of the patient. To correct the architecture and function of these the neurological status and cerebral hemodynamics before cranio- defects a new modality of Regenerative Medicine has evolved using plasty. The same parameters were evaluated four weeks after the Stem cells. The stem cells can regenerate fully functional tissues of procedure and compared to establish a correlation between the cere- skin, muscle, cartilage, bone and Neurovascular tissue without sec- bral hemodynamics, its possible impact on neurological outcome and ondary donor site defect and provided novel therapies for the surgeon. as a prognostic factor. Objectives Results To focus the advantages of stem cells in Craniomaxillofacial surgery. Our study showed a statistically significant improvement only in CBF in ipsilateral frontal lobe. For the remainder we found an

123 S188 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 improvement in clinical and cerebral perfusion parameters from the Section: Oral Pathology: Benign first to the last examination with significant improvement in CBV in ipsilateral parietal lobe and MTT in contralateral frontal lobe. This improved cerebral hemodynamics is in sync with with the improvement in neurologic status as measured by the global disability ABS0018 parameters suggesting a definite correlation between the two factors. A Dentigerous Cyst in Impacted Mandibular Canine: The neurological improvement after cranioplasty may be due to the A Case Report increase in CBF velocities at all vessels including the ipsilateral and contralateral side resulting from elimination of the effects of atmospheric pressure on the brain. Dr Abhishek Kumar & Bidsh Conclusions Neurological improvement after cranioplasty can be explained by Patna improvement of cerebral hemodynamics irrespective of the material used for rehabilitation of the defect. The inference of our study is in Abstract concurrence with various previous literature reports based on CBF Background/Introduction changes after cranioplasty obtained utilizing Magenetic resonance A dentigerous cyst is the most common developmental odontogenic perfusion imaging which is a noninvasive, radiation hazard free cyst and is frequently noted as an incidental finding on radiographs. imaging modality. In our study, we propose to reemphasize the theory The most common teeth affected are impacted mandibular third that cranioplasty is carried out not only for preserving normal molars and permanent maxillary imapacted canines. appearance and physical barrier but also for neurological Objectives improvement. To enucleate the cystic lesion and to restore normal oral health. Methods Surgical enucleation of cyst under general anesthesia. EPS00790 Results Good prognosis after enucleation. 3D Printing Conclusions This case involves an unusual clinical and radiographic presentation Pil-Young Yun; Joseph Krajekian of a dentigerous cyst. It shows a new variant of presentation.

Abstract Background/Introduction EPS0020 Medical applications for 3-D printing are expanding rapidly and are expected to revolutionize health care. Recent advancements in sci- Cemento Ossifying Fibroma ence and technology have resulted in important changes in the field of surgery. Dr. Manisha Anand Objectives Creation of customized prosthetics, implantable devices and medical B.I.D.S.H models - Pharmaceutical drug dosage forms delivery and discovery. - Bioprinting tissue and organ; Abstract Methods Background/Introduction Use of 3D-printed rapid prototyped models before oral cancer surgery The cemento ossifying fibroma is classified as the fibro osseous or orthognathic surgery for treatment planning and simulation has lesions the jaw. It represents as progressively growing lesions that can been established to assure more precise and safe surgeries2. More- attain enormous size with resultant deformity, if left untreated. The over, surgical stents are fabricated using computed tomography (CT) cemento ossifying fibroma is a central neoplasm of bone as well as the images in the field of dental implantology3. It is necessary to move periodontium. forward and adopt this technology in the fabrication of complex forms Objectives of molds in order to provide individualized medical services. For To excise the fibroma. example, easier production of customized and reconstruction plates Methods and morphologic reconstruction of bony defect areas are possible uses Excision. of 3D printing in fracture surgery or reconstructive surgery. The 3D Results printing technique can also be utilized in other areas of oral and Good. maxillofacial surgery. For example, it would be very helpful to be Conclusions able to design and fabricate a customized non-absorbable barrier of These lesions are thought to arise from the periodontial ligament and titanium mesh. are composed of varying amounts of cementum bone and fibrous Results tissue. The recommended treatment is excision, due to good delam- 3D printing is an evolving field. It has shown compliment the surgery ination of the tumor. and enhance the surgeon’s perspective. Conclusions It is necessary to move forward and adopt this technology in the fabrication of complex forms of molds in order to provide individualized medical services. This would ultimately benefit the patient. Increased precision of the technique will also result in a wider range of applications for 3D printing. In conclusion, the role of 3D printing in oral and maxillofacial surgery should be a focus of interest since the technique could offer endless developmental possibilities.

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EPS0046 Objectives The Enigma of Dentigerous Cyst in Maxilla Differential diagnosis and surgical management of the destructive lesion. Methods Dr. Anoop Kumar Dixit Excision biopsy. Results Career Post Graduates Institute of Dental Sciences & Hospital, Actinomycosis. Lucknow Conclusions Not all destructive lesions are carcinomas ‘‘If you think you’ve seen it Abstract all take another look’’. Background/Introduction Dentigerous cyst are most common developmental odontogenic cyst arising from the crown of impacted, embedded or unerupted teeth. Involved mostly mandibular third molar and max canine 70% in the EPS0070 mandible and 30% in maxilla, in this presentation cases of A Case of Surgical Management of OSMF dentigerous cyst and there treatment at different location in maxilla. Objectives Dr. Arshad Khan To evaluation of clinical presentation of dentigerous cystic lesion in maxilla, their relation to radiological picture and treatment planning Career Post Graduates Institute of Dental Sciences & Hospital, and patients needbased treatment. Lucknow Methods The case with clinico-radiological diagnosis of dentigerous cyst in Abstract maxilla were selected and treated surgically and diagnosis was corelated to eventual histopathological diagnosis. The patients were Background/Introduction followed for 1 to 2 year. OSMF is a chronic condition characterized by progressive stiffening Results of oral mucosa with the resultant inability to open the mouth. It is a The patients were on regular followup for long period and were pre malignancy condition of the oral cavity with the major etiological asymptomatic. factor being the consumption of areca nut. Conclusions Objectives The choice of therapeutic approach for a dentigerous cyst should not To evaluation of clinical presentation of OSMF and their relation to be randomly selected but customized to patient need, based on the radiological picture and treatment planning and patient need best size and location of the cyst, patient age, affected dentition, status of treatment. Methods root completion of associated tooth, clinical course, histopathological presentation, relationship with the surrounding structure and patient Case with clinico-radiological diagnosis of OSMF was selected and compliance for a particular treatment. treated surgically with collagen sheet and PRF placed. The patient was followed for 1 year. Results The patient was on regular follow up for the long period with normal EPS0063 three finger mouth opening and asymptomatic. The Chameleon of the Maxilla Conclusions OSMF described in the present case was difficult to manage in part caused by the continuous tobacco consumption and poor oral hygiene Vipul Varma Iind Year Post Graduate maintenance. In addition she was found to be a poor family background and this made monitoring and condition difficult. Various Sri Ramachandra University Faculty of Dental Sciences Chennai, TN treatment modalities and are used as for the stage of disease. The case deals with surgical intervention grafting and habit breaker. Abstract Background/Introduction Actinomycosis is a chronic granulomatous infection caused by Actinomyces species which may involve only soft tissue or bone or EPS0076 the two together. Actinomycotic osteomyelitis of maxilla is relatively Management of Odontogenic Keratocyst involving rare when compared to mandible. These are normal commensals and Lower Jaw: A Case Report become pathogens when they gain entry into tissue layers and bone where they establish and maintain an anaerobic environment with K. Sandeep extensive sclerosis and fibrosis. The portal of entry may be pulpal, periodontal infection, and so forth which may lead to involvement of adjacent structures as pharynx, larynx, tonsils, and paranasal sinuses St. Joseph Dental College and has the propensity to damage extensively. The chronic clinical course without regional lymphadenopathy may be essential in diag- Abstract nosis. The management of actinomycotic osteomyelitis is surgical Background/Introduction debridement of necrotic tissue combined with antibiotics for 3–6 Odontogenic Keratocyst is a distinct entity of jaw cysts exhibiting months. This E-poster report a case of 34 year male who developed an Keratinization of their epithelial lining. Various treatment modalities extensive, destructive lesion in the left maxilla with restricted mouth have been described to manage Odontogenic Keratocyst. This poster opening in 6 months, following a rare aetiology, the relevant litera- highlights a case of OKC involving lower jaw that has been managed ture, clinical course and its successful resolution. by Enucleation, Peripheral Ostectomy and Chemical Cauterization using Carnoy’s Solution.

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Objectives lesions. Lipoma, rarely, occurs in the oral cavity and it corresponds to To Manage a case of Odontogenic Keratocyst in the lower jaw by less than 4.4%, of all benign oral soft tissue tumors. Here, we are Enucleation, Peripheral Ostectomy and Chemical Cauterization using reporting a case of lipoma that occurred in the soft palate, which is Carnoys Solution in order to avoid its recurrence. extremely rare. Methods Objectives After the conformation of the diagnosis with incisional biopsy, Case Lipoma in soft palate should be surgically excised at the earliest as it was posted under GA, Crevicular incision is given from 45 to 37 can lead to dysphagia and dyspnoea. region and pathological site was exposed. The bony perforation seen Methods at the previous incisional biopsy site was widened using bone ron- MRI neck reveals well deﬁned, nodular, fat signal intensity lesion of gour. Then the cystic lining was removed along with the impacted 43 right side of soft palate suggestive of Lipoma. Tumor excision was and 44. Then Peripheral Ostectomy was done with a vertical cuts done under GA. distal to 45 and 36 and then with a horizontal cut by maintaining the Results lower border. Carnoys solution is applied on the residual bony mar- Patient’s complaint of dysphagia was addressed and no signs of gins. Layer by layer closure done using 3-0 Vicryl. recurrence after 6 months follow-up. Results Conclusions Post operatively patient followed for 6 months with no recurrence and This case of Lipoma of the soft palate justiﬁes the inclusion of this complications till date expect for paresthesia in the lower lip. lesion as a rare possibility in the differential diagnosis of swellings of Conclusions the soft palate and also adds a note on clinician awareness for the As the OKC has high recurrence potential, multiple modalities have same. to be applied during its surgical management i.e, Enucleation, Peripheral ostectomy, Chemical Cauterization and Resection etc., Also, A long term follow up is mandatory. EPS0089 Intramuscular Hemangioma of Masseter Muscle, EPS0083 Treated with Surgical Excision: A Case Report Rare Lesions of Maxillary Anterior Alveolar Palatal Complex Dr. Manoj Kumar K.P, Dr. Mohammed Faisal

Dr. Mihir T. Dani, Dr. Mohan Baliga KMCT Dental College

Abstract Abstract Background/Introduction Background/Introduction The maxillary anterior alveolar palatal complex is an unique entity Intramuscular hemangioma, is a type of vascular tumor occurring which compromises of maxilla, the alveolar process and the anterior within skeletal muscle. Most Intramuscular Hemangioma are rarely palate, its unique anatomic location predisposes this area to varied located in head and neck region. Hemangiomas of skeletal muscle number of disease, some presenting in the area are rare & require represent 0.8% of benign vascular neoplasm. Of these 13.8% occur specific attention in their management, these are osteogenic sarcoma, in the head and neck region. Studies show that intra-muscular glandular odontogenic cyst and desmoplastic ameloblastoma. haemangioma mostly present before the age of 30. Involvement of Objectives the masseter has a definite male predominance. Intramuscular Through this poster we aim to highlight these rare occurrences of such hemangioma arise as abnormal embryonic sequestrations. Surgical lesions so that appropriate identification and management of such excision was performed and histopathology confirmed the lesions are possible. diagnosis. Methods Objectives From the archives of the department. Intramuscular Hemangioma in cheek result in unaesthetic facial Results appearance need to be surgically excised. Successful management of such lesions has been done. Methods Conclusions FNAC, USG was performed suggestive of inflammatory lesion. Tumors in the anterior maxilla are common yet a challenging clinical Surgical Excision was done under G.A and histopathological diag- entity owing to a broad differential diagnosis. A clear understanding nosis confirmed intramuscular hemangioma. of the varying clinical presentation, facial anatomy & pathological Results etiologies helps narrow down the differential diagnosis considerably. A regular follow up was done and cosmetic results were satisfactory. Conclusions Hemangiomas are rare in the head and neck region. It should be EPS0088 considered in the differential diagnosis of masses in these regions. Lipoma in Soft Palate: Report of a Rare Case Initial diagnosis is usually parotid tumor, hemangioma being rarely suspected. Dr. Manoj Kumar K.P, Dr. Aswin M

KMCT Dental College

Abstract Background/Introduction Intraoral lipomas are benign mesenchymal neoplasms that originate in mature adipose cells with differential diagnosis of other soft tissue

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EPS0090 diagnosis as was observed in the case, where in the patient reported Epidermoid Cyst in the Floor of the Mouth Mimicking with mere dental slight pain and swelling but thorough evaluation lead to diagnosis of Gorlin-Goltz syndrome followed by prompt Plunging Ranula: A Case Report treatment of the patient. So as to reduce the long-term sequele and mortality imposed by Gorlin syndrome, early diagnosing and treat- Dr. Manoj Kumar K.P, Dr. Tina Abraham ment should be the mainstay for patient beneﬁt.

KMCT Dental College EPS00103 Abstract Background/Introduction Life Threatening Arterio-Venous Malformation Epidermoid cysts are benign, slow-growing and painless lesions that of Mandible: Lacunae in Diagnosis and Treatment can occur anywhere in the body, predominantly in areas where embryonic elements fuse together. Occurrence of only 7% in the head Maj Vinay Singh Parihar and neck area, with the oral cavity accounting for only 1.6%. Majority of them occur in sublingual region. They can cause symptoms of Army Dental Centre (R&R), Delhi Cantt dysphagia and dyspnoea and have a malignant transformation potential. Found in any age group but show preponderance between Abstract 15-35 years of age with no gender predilection. Objectives Background/Introduction Sublingual epidermoid cyst causing unaesthetic facial disfigurement Intraosseous Arteriovenous Malformations (AVMs) in the head and should be diagnosed and treated at the earliest. neck region are very rare and potentially life-threatening. Manage- Methods ment is challenging due to their unpredictable behaviour and high Excisional biopsy was done under GA. Histopathology report reveals recurrence rate. Objectives Epidermoid cyst. Results This poster reviews an unusual case of high flow AV malformation A regular follow up was done and there were no signs of recurrence which presented as a cystic lesion and underwent series of compli- so far. cations prior to successful treatment. Diagnostic dilemmas and Conclusions management will be presented. Methods Epidermoid cyst of the oral cavity is an uncommon entity. Ample understanding and vigilance about this slow growing painless mass is Six years old male presented with intraoral swelling. History essential not only because of the symptoms it produces but also due to revealed right ECA ligation for torrential bleed during intraoral its malignant potential. biopsy. Radiologically it was an osteolytic lesion with serous aspirate. Incisional biopsy suggested Dentigerous cyst. Hence enucleation carried out under GA. HPE confirmed Dentigerous cyst. Swelling recurred after two months. Aspirate revealed blood and EPS00101 CT-angio was suggestive of intraosseous AVM. He was subjected ‘‘Gorlin-Goltz syndrome’’: A Rare Multiple OKC to embolization by interventional radiologist. Post embolization there was huge swelling which regressed and then increased more Anomaly aggressively within associated soft tissues. MR-angio showed multiple feeders from both carotids. He was then taken up for Dr. Pradeep Kumar Das, FDS segmental resection of right mandible under carotid control. Intra- operatively he survived massive blood loss and hemodynamic SGT University collapse. Results Abstract Postoperatively draining sinus developed which infected repeatedly Background/Introduction but healed with minimal scarring. Gorlin–Goltz syndrome is an autosomal dominant inherited condition Conclusions comprising the principle triad of basal cell carcinomas, multiple jaw AVM can present concomitantly with cystic lesions. Prompt diag- keratocysts, and skeletal anomalies. It is an uncommon hereditary nosis with multidisciplinary approach prevents complications. condition caused by mutations in the PTCH1 gene causing a wide Embolization of all possible feeders of high flow lesions is not the range of developmental abnormalities. definitive treatment and should be followed by aggressive surgical Objectives excision of the lesion. Incorrect sequencing and incomplete treat- Management of 2 blood brothers with Gorlin-Goltz syndrome. ment can cause aggressive recurrence of lesion. Multiple silk Methods suturing and SSI may help by causing fibrosis of the residual 2 brothers with multiple odontogenic keratocyst (Gorlin–Goltz syn- lesion. drome) in both maxilla and mandible undergone surgical enucleation of all multiple OKC’s with chemical cauterization with Cornoy’s solution. Results Primary closure was achieved. No evidence of recurrence were noted after a follow up of 6 months. Conclusions Thorough clinical, histopathological and radiological examination supplemented with appropriate investigations reveal the concerned

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EPS00149 EPS00169 Conservative Approach for Large Cyst & Tumours: Intramasseteric Spindle Cell Hemangioendothelioma: Still an Option A Rare Case Report with Review of Literature

Dr Sagar Bhure, Co Author: Dr. Shivamurthy D.M, Dr. Rajdeep Dr Abhivyakti Tewari, Dr Madan Mishra and Dr Gaurav Singh Singh, Dr. Rohan Gupta SPPGIDMS, Lucknow Chhattisgarh Dental College & Research Institute, RJN (C.G.) Abstract Abstract Background/Introduction Background/Introduction Spindle cell hemangioendothelioma (SCH) was first described in Treatment of large cyst and tumours like Odontogenic keratocyst 1986 by Weiss and Enzinger as a vascular neoplasm, characterized by (OKC) and unicystic ameloblastoma still remain controversial, whe- cavernous blood vessels and spindled areas reminiscent of Kaposi’s ther to go for conservative or radical approach. The aim of our study sarcoma. SCH typically presents as a single tumor or multiple nodules is to see the outcome of conservative approach. involving the dermis and subcutaneous tissues of the distal extremi- Objectives ties. The head and neck region is rarely involved with extremely rare The objective of our study is to establish the outcome of conservative muscular involvement, this being the first case of intramasseteric management in patients with mandibular odontogenic keratocyst and SCH. unicystic ameloblastoma. Objectives Methods This report attempts to add this rare case to the pre-existing data along Our study includes 6 patients between age group 15 to 30 years out of with the review of literature. which 4 patients with odontogenic keratocyst and 2 patients with Methods unicystic ameloblastoma, all the patients were confirmed with A clinically and radiographically misdiagnosed case (FNAC, contrast histopathological diagnosis and were treated conservatively by mar- CT, HR USG, angiogram and MRI) of intramasseteric vascular supialisation and enucleation along with adjunctive therapy like malformation reported with a history of gradual enlargement of the chemical cauterization. swelling over the past two and a half years, which increased in size in Results reclined position and regressed in erect position and compression. All the lesions were present in mandible, and the average follow-up of Due to incomplete resolution of the lesion with intralesional Sodium cases was 2-3 years. All cases monitored with panoramic radio graph tetradecyl sulphate, patient underwent surgical excision under Gen- and clinical evaluation, no recurrence was reported in any of the case. eral Anaesthesia and healing was uneventful. Conclusions Results Large cyst and tumours in young patients treated by radical approach Based on the histopathological report, the final diagnosis was made can lead to facial deformity and impaired function. So, conservative as, intramasseteric spindle cell hemangioendothelioma. The review of approach can be done in a view of maintaining the integrity of jaw current literature showed that, to date only seven cases of SCH of the and function particularly in young patients. head and neck have been reported. Conclusions STH poses a great challenge to the clinician in making a final diagnosis. Surgical excision and histopathological examination is the only EPS00153 way to solve such a mystery. Case of Unicystic Ameloblastoma-Mural Variant

Dr. S. Harshad EPS00199 A Case Report of Mandibular Odontogenic Abstract Background/Introduction Myxofibroma Unicystic ameloblastoma is a distinguishable entity of ameloblastomas, characterized by slow growth and being relatively locally Dr. Luke Kale aggressive. Three histological types are recognized according to the degree of ameloblastomatous epithelial extension, namely, luminal, Sinhgad Dental College and Hospital Pune intraluminal, and mural types. Objectives Abstract This classification has a direct bearing on their biological behavior, Background/Introduction treatment, and prognosis. However, there is difficulty in determining Odontogenic myxofibroma present a small portion of odontogenic the most appropriate form of treatment for unicystic ameloblastoma. tumors. It arises from mesenchymal portion of tooth germ either Conservatively managing the lesion to retain the function and dental papilla or follicle of PDL. It is a non encapsulated benign esthetics of the patient. mesenchymal tumor of ‘stellate’ cells within a mucoid ground Methods substance. It is rare in children under 10 years of age. Reported Managed by decompression to shrink the size of the lesion and later mostly in mandible for general population. Although rare in pedi- surgically managed by enucleation. atric population it should be included in differential diagnosis of Results radiolucent as well as mixed radiolucent and radiopaque lesions of No recurrence in 4 year follow up. both jaws. Conclusions Conservative management of the lesion should be the primary treatment objective for preserving the function and esthetics of the patient.

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Objectives ABS00243 To present the occurrence of a lesion rarely presented in the pediatric The Gasping Breath: Massive Lesion Obstructing age group and to discuss the treatment modalities associated with this lesion. the Airway Methods Discussion of an operated case along with its post-operative follow up Lipin Peter, 2nd yr PG period of 1 year. Results Dept of OMFS, Azeezia College of Dental Science and Research Dr Treatment done in our case was met with excellent results and patient Jacob John, Professor, Dept of OMFS, Azeezia College of Dental has no complications in 1 year follow up. Science and Research, Kollam, Kerala Conclusions Occurrence of Odontogenic Myxofibroma should be considered in the Abstract differential diagnosis of tumors of the oral cavity even in Pediatric Background/Introduction patients. Massive lesion in the oropharyngeal region can cause severe deformities and obstruction of the airway leading to fatal disorders. The diagnosis, treatment plan and its execution are both challenging and EPS00223 difficult. Difficulties faced by the surgeon are access to the site and getting optional airway at the time of surgical procedure. Reporting a Ameloblastic Fibro-Odontoma (AFO) a Rare rare massive lesion of size 10*8 cm, disfiguring the tongue and Odontogenic Tumor obstructing the airway in an elderly male patient which is charac- teristically increasing in size since past 10 years, which was Dr Fazeel Ahmed/Dr Akshay Shetty successfully managed without opting for additional airway. This case is of interest in maxillofacial literature as its a rare unreported Sri Rajiv Gandhi College of Dental Science Bangalore-32 pathology of such long standing lesion of upto 9-10 years. Objectives To dissect out the lesion on the tongue without distructing the normal Abstract anatomical structures and further to recreate the distorted morpho- Background/Introduction logical appearance. Ameloblastic fibro-odontoma (AFO) is a rare odontogenic tumor. It Methods is commonly associated with a painless swelling and an associated Patient prepared and intubated followed by dislocating the mandible absence of eruption of a tooth, AFO presents as a mixed radiopaque to get access. Infiltrating the lesion with la with adrenaline. Dissecting and radiolucent lesion in the younger population with a predilection out the lesion as a whole mass in proper anatomical plane. for the posterior region. Histologically, it shows the characteristics Results of an immature complex odontoma with irregularly arranged Three separate lesions were dissected out, which was sent for enamel, dentinoid, cementoid-like structures and ectomesenchymal histopatholgical examination. The result came out as schwanoma of tissue. First described by Hooker in 1967, AFO has since been tongue. extensively studied in literature. However due to its rare occurrence, Conclusions the available literature has remained restricted to mainly single case Its a rare case of schwannoma of tongue, which is a benign tumor of reports. nerve sheath origin. Objectives The ameloblastic fibro-odontoma (AFO) is an uncommon odontogenic tumor occurring in childhood with limited reported data on recurrence. EPS00251 Methods Plexiform Ameloblastoma: A Case Report Based on a world-wide literature survey of published cases of ‘‘mixed odontogenic tumours’’. Results Dr Shruthi TM/Dr. Akshay Shetty/Dr Adil Shafath Some investigators have hypothesized that Ameloblastic Fibroma (AF), Ameloblastic Fibro dentinoma (AFD) and AFO could represent Sri Rajiv Gandhi College of Dental Science and Hospital a single entity in different stages of development: AF or AFD would evolve to AFO as they mature and the latter could differentiate into Abstract odontoma. However, when clinical characteristics of these lesions are Background/Introduction analyzed, AFO is more frequent in a younger age group with mean Robinson (1937) defined ameloblastoma as a benign tumor that is age of 9.6 years, than AF, which affects individuals with a mean age ‘usually unicentric, nonfunctional, intermittent in growth, anatomi- of 14.8 years, thereby in disagreement to the continuous differentia- cally benign and clinically persistent.’ It most commonly occur tion hypothesis. between the age of 20 - 40 years. It accounts for 1% of all tumors of Conclusions the maxilla and mandible and 11% of all odontogenic tumors. 70% of AFOs are hamartomatous in nature, representing a stage preceding the ameloblastomas develop in molar-ramus region of the mandible. complex odontoma. Radiographically it appears as unilocular or multilocular radiolucent lesion with a honeycomb or soap bubble appearance. Objectives Plexiform ameloblastoma is one of the variant of ameloblastoma, where plexiform’’ refers to the appearance of anastomosing islands of odontogenic epithelium in contrast to a follicular pattern. It is less aggressive and has a significantly lower recurrence rate.

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Methods EPS00290 A case Report of plexiform ameloblastoma of mandible in a 23 yr old Odontogenic Keratocyst or Keratocystic Odontogenic male patient who sought complete removal of the lesion but chose to undergo delayed reconstruction. It involved entire right ramus and Tumor: What’s in a Name? body of mandible with lesion extending till the base of mandible Radiographically, it appeared as an expansile radiolucent, with thin- Dr Shikhar Aich, Dr Akshay Shetty ned and perforated cortices. Results Sri Rajiv Gandhi College of Dental Science, Bangalore It was surgically resected and followed by placement of reconstruction plate. Abstract Conclusions Background/Introduction Treatment of mandibular ameloblastoma continues to be controver- An odontogenic keratocyst (reclassified as keratocystic odontogenic sial. Because of their neoplastic nature, surgical treatments differ tumour (KCOT) from 2005 to 2017) is a rare and benign but locally from those of other cystic lesions. Prior to choosing a treatment the aggressive developmental cyst. It is categorized as one of the clinico radiologic variant anatomic location, clinical behavior and developmental epithelial cyst which accounts for 11% of all cystic size of the tumor, and age of the patient should be assessed. jaw lesions. It most often affects the posterior mandible and commonly presents in the third decade of life. The most peculiar clinical feature of OKC tumor is its tendency to recur frequently, the reason EPS00289 behind variety of treatment modalities for this cyst. Objectives Case report on Case of Odontogenic Keratocyst To discuss the surgical management of OKC. Methods Dr Karan Panchal, Guided by Dr Navin Shah surgical approach in managing a 62 year old male patient with a large OKC of the mandible is reported. K M SHAH Dental College Results The treatment included surgical excision of the lesion with a wide Abstract margin of 1 cm, and Carnoy’s solution applied after excision. Background/Introduction Reconstruction was done using Free Fibula osteocutaneous flap. An Compared to other odontogenic and non-odontogenic cysts. Odon- OPG was taken postoperatively. togenic keratocyst (OKC) is most common, aggressive and likely to Conclusions reoccur. Diagnosing the lesion before it involves more bone reduces The present case of OKC was noticed in a 62-year old male patient on the likelihood of recurrence after treatment. However the radiologic the left mandible showing the clinical and radiographic presentations, and clinical characteristics of OKC are common to many other diagnosis, treatment and follow up. pathologic processes making the early diagnosis difficult. OKC can be confused with ameloblastoma, giant cell granuloma, dentigerous cyst radiographically. A 50 year old female patient came with EPS00293 complain of swelling and discharge from lower left back tooth region. Aspiration followed by incisional biopsy was done which Treatment Modalities for Parotid Fistula confirmed odontogenic keratocyst which was then operated under GA. Dr. Kunal Gajendragadkar, Dr. Kalyani Bhate Objectives to evaluate and treat preoperative paraesthesia present in left portion At Dr. D Y Patil Dental College and Hospital of chin region. Methods Abstract Enucleation was performed. Background/Introduction Results A parotid fistula is a rare, extremely unpleasant complication, both for When evaluated post-operative neurosensory responses were gradu- the patient as well as the treating surgeon. It consists of a commu- ally increasing. nication duct in between the salivary gland or between duct and the Conclusions skin, through which saliva is discharged. Various treatment modalities In this case, cystic lesion though sized large it was well encapsulated. have been used to treat this complication, viz; (1) Surgical procedures Performing enucleation also prevented secondary surgically site like, the use of drains graft tube, advanced dressing with AllodermTM, which would have been necessary if resection was planned with anastomosis of the proximal stump of the parotid duct, use of a autogenic bone graft. Lower border of mandible had adequate bone as saphenous vein graft to reconstruct the salivary duct; tympanic seen from CT hence enucleation was planned. neurectomy, temporalis fascia pedicle flap to isolate the parotid fistula, partial or total parotidectomy, etc. (2) Conservative management like local radiation and anticholinergic antisialogogues such as scopolamine, atropine, glycopyrolate, etc. (3) Alternate treatments transdermal injections of botulinium toxin A & scopolamine, warm hypertonic saline irrigations, etc. Objectives To evaluate the different treatment modalites for parotid fistula. To classify all the modalities into surgical, medicinal and alternate methods. To present the treatment modalities in a poster format.

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Methods EPS00332 Search engines used were Pubmed, google search, institutional library Central Bone Tumors of Jaws in Children: A Clinical and email to authors. Keywords used were Parotid fistula, Salivary gland fistula, Onabotulinium toxin, partotidectomy. Experience Results All the studies found were divided into surgical treatments, conser- Dr Ankit Sharma, Dr Snehal N Ingole, Dr Mohan D Deshpande, Dr vative approaches and alternative approaches. The articles were Pallavi Ranadive, Dr Noaman Kazi, Dr Deepak Burungale critically evaluated to conclude the best treatment outcome. Conclusions Abstract On the basis of the results obtained, newer treatment approaches were Background/Introduction found to attain better results with fewer complications. However, Children though less but do experience central bone tumors of jaw. more research need to be carried out to evaluate the long term efficacy These lesion can cause alteration in facial growth and development of these studies. results in physical, aesthetic and psychological disturbances. The histopathological origin of these lesions are variable at times their local behaviour is aggressive and sometime not matching there benign EPS00300 histological behaviour hence predicting their biological behaviour as well as their treatment is a challenge. Odontogenic Myxoma: An Archetypal Presentation Objectives of a Rare Entity The aim is to give insight to the Clinical and Radiographical appearance of various paediatric tumors of jaws and discuss our Dr. Pankhuri Tiwari experience in their management. Methods Patients age group from 8 to 15 reported to OPD with tumors of either V.Y.W.S Dental College and Hospital, Amravati of the maxilla or mandible. Their clinical presentation, imaging, pathology, treatment outcomes are reviewed. Abstract Results Background/Introduction All the patients are diagnosed having central bone tumors of jaw by Odontogenic Myxoma is uncommon locally aggressive benign their clinical and radiographic presentation and their benign nature odontogenic tumour arising from embryonic connective tissue asso- was confirmed with incisional biopsy. All these patient were treated ciated with tooth formation. WHO in 2003 classified Odontogenic surgically and are under follow up. myxoma as benign neoplasm arising from odontogenic ectomes- Conclusions enchyme with or without odontogenic epithelium. However, some To eliminate pathology and achieving function and aesthetic and studies have found that cells in the matrix of odontogenic myxoma are favourable growth of jaw effected with such central bone tumors of different from ectomesenchymal tissues of developing tooth. In jaw is always a challenge in children. In order to achieve the accurate addition though it is rare this tumour does occur in extragnathic diagnosis it is important to be familiar with clinical and radiographic bones. Thus, some pathologists consider it to have osteogenic origin. features as well as histopathological characteristics of such lesions. At present, there is no universally accepted theory about its histogenesis. Since local infiltration accounts for its aggressive nature and high recurrence rate, it is mandatory that patients be carefully followed after surgery. EPS00353 Objectives Immediate Primary Reconstruction of Hemi Mandible Objective is to evaluate surgical management of odontogenic myx- after Resection For Aggressive Odontogenic Keratocyst oma and report the outcome of a case managed by using surgical approach. (A Case Report) Methods We managed a rare case of odontogenic myxoma occurring in the Dr. Panat Sushmita Sunil maxilla of a 64-year-old male patient by wide surgical excision. Radiological investigations helped us to arrive at diagnosis which was Institute of Dental Sciences, Bareilly verified later by pre and post-operative histopathological examination. Results Abstract The case is successfully managed adopting a wide surgical approach. Background/Introduction Conclusions The Odontogenic Keratocyst is derived from the enamel organ or Due to the nonspecific and rare nature of these lesions along with from the dental lamina. p53 tumor suppressor gene has been associ- diagnostic and operative dilemmas related to myxomatous tumors, ated with it. It is also formed by degeneration of cyclic D1 and p53 proper histopathological diagnosis is required for its management. protein. In 2005, the WHO established a classification in which it was termed as Keratocystic Odontogenic Tumor. In January 2017, WHO reclassified it as Odontogenic Keratocyst. It is considered to be one of the most aggressive type of cyst due to its invasion ability in the bone and also due to its high recurrence rate. Objectives The aim of this poster presentation is to discuss a case on OKC with primary reconstruction. Methods Resection of the involved bone followed by Primary Reconstruction with stainless steel Recon plate was done.

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Results EPS00384 Patient is on 6 months followup and the result is good on the basis of Idiopathic Orofacial Granulomatosis: A Case Report no recurrence and minimal scar. Conclusions The treatment choice must take into account factors such as size Dr. Shripal R. Jani, 3rd year resident and location of the tumor, as well as invasion of the surrounding tissues and previous treatments. A variety of different treatment Faculty of Dental Science, Dharmsinh Desai University modalities have been proposed in the literature, ranging from conservative methods such as marsupialization to more aggressive Abstract ones such as resection. However, there appears to be a consensus Background/Introduction among most authors, according to which an association of tech- Orofacial granulomatosis is an uncommon disease, usually presenting niques seems to be the best choice, for instance, decompression & as recurrent or persistent swelling of the soft tissues, predominantly enucleation, marsupialization & curettage, or enucleation & Car- lips - termed as Cheilitis Granulomatosa. Though various aetiological noy’s solution. factors like foreign body reactions, infections, Crohn’s disease and Sarcoidosis have been implicated in the disease process. Delayed Hypersensitivity reaction with a predominant Th1-mediated immune response provides further evidence to the etiopathogenesis in Orofa- EPS00373 cial granulomatosis. The term Idiopathic Orofacial Granulomatosis is Ameloblastomatous Calcifying Odontogenic Cyst used in cases with unknown aetiology. A 13 years old male patient presented persistent and painless swelling on upper and lower lip and Dr. Enosh Steward, III Year Jr Resident swelling on gums since last 2 years. On examination, both lips were swollen, everted, soft, edematous, non-pulsatile and non-tender. Dharmsinh Desai University Intraorally, generalized gingival enlargement covering one half of the clinical crown. Objectives Abstract The objective of this poster is to present a case of Idiopathic orofacial Background/Introduction granulomatosis- a diagnostic and treatment challenge along with its Since Gorlin’s first discussion of Calcifying Odontogenic Cyst clinical features. (COC) in 1962, the lesion has been now included in group of Methods odontogenic tumors wherein there is odontogenic epithelium with After scrutinising all investigations, possible pathologies were ruled odontogenic ectomesenchyme with/without dental hard tissues for- out and diagnosis of Idiopathic Orofacial Granulomatosis was made. mation. Majority of authors have categorized COC under two basic The treatment was initiated with intralesional steroid injections for lip groups of cysts and tumors. The cystic variant of COC is charac- followed by gingivectomy & gingival contouring. terized by a unicystic lesion associated with or without odontoma Results and are in majority. They may also show ameloblastomatous pro- Uneventful healing took place and patient is asymptomatic after 6 liferative activity intraluminally or intramurally. Ameloblastomatous months follow up. COC resembles unicystic ameloblastoma except for ghost cells and Conclusions calcifications within the proliferative epithelium and the fact that it The diagnosis of Idiopathic Orofacial Granulomatosis is by exclusion occurs only intraosseously. supported by the histopathological evidence of chronic granulomatous Objectives inflammation. Barium meal and intestinal biopsy are not recom- The objective of this poster is to present a case of ameloblastomatous mended to rule out Intralesional corticosteroids are beneficial and a calcifying odontogenic cyst - a rare lesion alongwith its clinical regular follow up and review is essential. features, radiographic picture, most common site of lesion, recurrence rate and histological picture. Methods Enucleation of the lesion was done and carnoy’s solution was padded EPS00392 for 5 minutes and removed. Dermoid Cyst of the Floor of the Mouth Results Uneventful healing had occurred with no post operative recurrence even after 6 years of follow up. Dr. Ziaur Rahman Conclusions Ameloblastomatous COC, a cystic variant of COC occurs in the Himachal Pradesh Government Dental College and Hospital, Shimla mandible with a higher propensity towards the posterior region. As conservative treatment in the form of enucleation has proven to be Abstract effective, it needs to be differentiated from Ameloblastoma ex COC Background/Introduction since it requires more aggressive form of treatment. Dermoid cyst is a cyst filled with sebum like material with evidence of specialized skin derivatives. In head and neck region it accounted for 6.9% with floor of mouth comprising of 1.6%. Highest incidence in second and third decade of life with equal gender distribution. Most common site is lateral eyebrow while intraorally mostly occurs in the floor of mouth. Objectives Overview of dermoid cyst in the maxillo-facial region. Methods A case report of a female patient with submental swelling of size approx 6x5 cm.

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Results Methods Intoto excision of the cyst was done extraorally. Acceptable aesthetic Aspiration was done which yielded straw coloured fluid. An OPG and results achieved. In a 2 year followup no recurrence is seen. CBCT was taken which revealed unicystic lesion of mandible Conclusions extending mesiodistally from 36 to 46 with erosion of buccal and Dermoid cysts are infrequent in head and neck region but when it is lingual cortical wall. Surgical resection of mandible and reconstruc- present it is commonly located in lateral eyebrow extra-orally and tion was done. floor of the mouth intra-orally. Its diagnosis is based on usg, mri and Results histopathological examination with clinical correlation. Definitive Surgical resection was done from 36 to 46 and reconstruction was treatment is the complete excision of the cyst alongwith capsule. done with titanium reconstruction plate. No postoperative complica- Malignant transformation is exceptional. tions were noticed. Conclusions Ameloblastoma has a high rate of local recurrence if it is not adequately removed. So radical resection is the treatment of choice for EPS00394 ameloblastoma. Recurrent Ameloblastoma: Reconstruction with NVBG

Dr. Jaseena AK ABS00453 A Three Year Clinical Audit of Benign Masseteric Pushpagiri College of Dental Sciences. Tiruvalla Hypertrophy Abstract Background/Introduction Dr Ashish Garg Ameloblastoma is a rare odontogenic neoplasm of the mandible and maxilla with multiple histologic variants and high recurrence rates if Department of Oral & Maxillofacial Surgery, PGIDS, Rohtak improperly treated. The adequate therapy of ameloblastoma may require a compromise between the least destructive treatment possible Abstract of a benign tumor and sufficiently radical method to prevent recur- Background/Introduction rences. A case of recurrent ameloblastoma in a 55 year old female Benign Masseteric is associated with the enlargement of masseter patient is hereby presented. muscle with or without the bony overgrowth at the angle of mandible. Objectives It can occur unilaterally or bilaterally. If present bilaterally, it pro- Marginal resection and reconstruction of recurrent ameloblastoma duces a characteristic square/quadrangular face appearance. Patient is with ileac crest graft. mainly concerned for cosmetic reasons. This case series involves 8 Methods cases who reported to the department of OMFS, PGIDS, Rohtak The case was treated with resection and reconstruction with ileac crest between the period of june 2014 to july 2017. graft and stabilized with reconstruction plate. Objectives Results To correct the facial asymmetry of the patients surgically by No post operative morbidity in two months follow up. Patient is being debulking of the enlarged masseter muscle and removal of the bony followed up. overgrowth at the angle of mandible, if any. Conclusions Methods Recurrent meloblastoma requires more extensive method of All the patients were treated surgically under general anaesthesia after treatment. taking informed and written consent by extra oral or intra oral approach. Extra oral approach was used in 4 patients through Ris- don’s incision whereas intraoral approach was used through the EPS00404 vesibular incision extending to anterior border of ramus in same number of patients. In all the cases, the enlarged masseter muscle was Recurrent Ameloblastoma: A Case Report removed and angle osteotomy was done if needed. Angle osteotomy was done with the help of surgical template made intraoperatively. Dr. Anju P.R, Post Graduate Student Results All the patients were successfully treated surgically by both the Government Dental College, Trivandrum approaches with satisfactory results when facial symmetry is concerned. All the patients were satisfied with their post operative facial appearance. Abstract Conclusions Background/Introduction Surgical correction of benign masseteric hypertrophy by both Ameloblastoma is benign, slow growing locally aggressive odonto- extraoral and intraoral approach produce satisfactory results. genic tumor of oral cavity with local recurrence of upto 50 to 75% Extraoral approach provides good accessibility to masseter muscle cases. A 21 year old female presented with complaint of swelling in and the angle of mandible but it has a disadvantage of extraoral lower front teeth region. scarring and risk of damage to marginal mandibular branch of facial Objectives nerve. Intraoral approach avoids these complications but has difficult Aim is to report a case of recurrent ameloblastoma in mandible which access to the operated site. was presented as swelling in symphyseal region of mandible 8 years back. She was diagnosed with unicystic ameloblastoma and was treated by marsupialisation at that time.

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EPS00502 swelling with noticeable facial asymmetry. Several treatment Fibro-Osseous Lesions of Maxillofacial Region: modalities for CGCG corticosteroid therapy is also a treatment modality. In this case surgical excision of the lesion along with the An Institutional Experience extraction of involved tooth is preferred for better prognosis.

Dr. Jasmine, Dr. Pallavi Ranadive, Dr. Mohan D. Deshpande, Dr. Snehal Ingole EPS00524 Dr. Noaman Kazi Nair Hospital Dental College, Mumbai An atypical Presentation of Pindborg Tumor in Posterior Maxilla: A Case Report Abstract Background/Introduction Dr. Ashish Tripathi Maxillofacial fibro-osseous lesion is a generalized pathological diagnosis for lesions showing replacement of bone by a benign con- Career Postgraduate Institute of Dental Sciences & Hospital nective tissue matrix. Most lesions occur in younger age group around the growth spurt age. Although they do not cause any functional Abstract disability, they do cause cosmetic deformity and therefore emotional Background/Introduction distress to the patients. Their treatment may range from only observation to active surgical intervention. Diagnosis, long-term follow up CEOT also known as Pindborg tumour- is a rare benign odontogenic and timely intervention based upon clinical behaviour of lesion neoplasm, accounts for 0.4% - 3% of all odontogenic tumours. CEOT remains the mainstay of treatment. Cases seen in our institute are mostly involves posterior mandible and only few cases involves presented herewith. Patients reported with fibro-osseous lesions maxilla. belonged to 16-60 years of age group and the mean age was 30. Two Objectives patients had a long history of presence of the lesion. Treatment for the Surgical excision of lesion along with the removal of impacted tooth fibro-osseous lesion at our institute ranged from just keeping the lying at the left infra-orbital rim region followed by placement of patient under observation to cosmetic contouring to surgical inter- iodo-form dressing of the obtained surgical defect. vention at various intervals. Methods Complete surgical removal of the lesion and the impacted tooth was planned under general anaesthesia followed by placement of iodoform dressing. EPS00523 Results Treatment Modality of Central Giant Cell Granuloma Following post-operative dressings over a period of 6 months primary closure was done. With the patient on regular follow up for 1 year, there was no clinical and radiographical evidence of re-occurence of Mohd. Zeeshan lesion. Conclusions Career Institute of Dental Sciences and Hospital This case is one of the rare aspect of CEOT involving the maxillary sinus. The treatment modalities varied with the dependence of size Abstract and anatomic location of the lesion. According to Franklin and Background/Introduction Pindborg, they advised to remove a rim of normal tissue as safe The central giant cell granuloma (CGCG) is considered a benign, margins together with complete local resection. nonneoplastic lesion of bone found in a younger age group who are usually less than 30 years of age. The more aggressive type may cause root divergence and destruction of the surrounding bone that expand the cortical plateCentral giant cell granuloma (CGCG) is an EPS00527 intraosseous lesion consisting of cellular fibrous tissue that contains Follicular Ameloblastoma: A Case Report multiple foci of hemorrhage, aggregations of multinucleated giant cells and occasionally trabeculae of woven bone. CGCG, as described Dr. Asmita Gupta by Jaffe in 1953 is an idiopathic non-neoplastic proliferative lesion. Trauma has been considered as an important etiologic factor in the Career Postgraduate Institute of Dental Sciences & Hospital initiation of this lesion. The lesions increase by accumulation of tissue which is produced by slow, minute, continuous hemorrhages of Abstract multicentric nature due to trauma and some defect in the capillaries. Objectives Background/Introduction Evaluation of clinical presentation of central giant cell granuloma and Ameloblastoma is a true neoplasm which is described as benign treatment of the lesion. tumor of odontogenic epithelial origin which is usually unicentric, Methods non – functional, intermittent in growth, anatomically benign and suggestive treatment was surgical excision of the lesion along with clinically persistent. It was first described by Falkson in 1879, later extraction of involved tooth. Churchill has given the term ameloblastoma in 1933. It is slow Results growing painless tumor occurs mainly in mandible most often in the Patient were on the regular follow up and free of any ailment. molar ascending ramus area, while only 10% is seen in the Conclusions mandibular anterior region. Commonly seen in second and third It occurs most commonly in the mandible than in the maxilla. The decade of life with no sex discrimination. Incidence of follicular clinical behavior of CGCG is variable. It ranges from slow-growing, ameloblastoma are most common with incidence rate of 27.7%. asymptomatic swelling to an aggressive lesion which manifests with Radiographically it appears as radiolucent lesion usually with well pain. The most common presenting sign of CGCG is a painless circumscribed borders. 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S199

Objectives EPS00538 A case of anterior mandibular ameloblastoma arising from anterior Non Ossifying Masticatory Myositis: A Rare Case mandible treated by surgical excision of the lesion along with chemical cauterization (Carnoy’s solution) and preserving the lower Report border from mandibular fracture by immediate reconstruction to span and support the segment. Dr. Anjali Sudhakaran (MDS trainee), Dr. Ravi Veeraragavan (Prof. Methods and HOD), Dr. Shyamsunder, Dr. Jaeson Mohanan, Dr. Giri Sanker Treatment of amelobalstoma included surgical saucerisation with adjuvant chemical cauterisation. Post operative surgical dressing Department of Oral and Maxillofacial Surgery, Amrita Institute of inclusive of ribbon gauze soaked in iodoform and glycerine Medical Sciences, Kochi, Kerala medicament. Results Abstract Patient is on routine follow up and is currently free of ailment. Background/Introduction Occlusion rehabilitation has been done. Myositis ossificans is a rare disease in which ossification develops in Conclusions the muscle or soft tissue. It is divided broadly into Myositis Ossificans The present deserves emphasis because of its unfamiliar appearance, Progressive (MOP) and Myositis Ossificans Traumatica (MOT). In potential aggressive nature and deceptive radiologic appearance MOP multiple, heterotopic ossifications develop in the systemic maximising the chance of mal-diagnosis. muscles, fascia, tendons and ligaments. In many cases, MOP occurs in childhood, and the range of motion of the joints gradually becomes restricted, leading to ankylosis. MOT is also called traumatic myositis EPS00528 ossificans, is a disease in which muscles are ossified after trauma or inflammation. Surgical Management of Odontogenic Myxoma Objectives Treatment of MOP and MOT usually includes surgical excision of the Dr. Alok Kumar calcification and the surrounding muscles. Patients with MO of the temporalis or masseter area often undergo a coronoidectomy and the Career Post Graduates Institute of Dental Sciences and Hospital, excision of the involved calcified muscles; whereas MO of the Lucknow pterygoid muscle is more debilitating and the management of these patients are more complicated than that of the patients exhibiting MO Abstract of other masticatory muscles. Background/Introduction Methods Myxomas of the jaws are believed to arise from odontogenic ecto- This case report presents a rare case of Myositis of the pterygoid mesenchyme as it bears close resemblance to the mesenchymal por- muscles were the patient reported with restricted mouth opening. MRI tion of a developing tooth. It was probably first described by Rudolf was indicative of myositis of the pterygoid muscles, temporalis and Virchow as myxofibroma in 1863. In 1992, WHO defined OM as a superior constrictor. After clinical and radiological examination, the locally invasive neoplasm consisting of rounded and angular cells patient underwent coronoidectomy with muscle biopsy. lying in an abundant mucoid stroma. These tumors are rare, benign Results does not show metastasis but they are locally aggressive involving the The patient was diagnosed with masticatory muscle myositis, which is maxilla and mandible. rare in humans. Following surgical management patient was thor- Objectives oughly followed up and Hyaluronidase and Triamcinolone injections To diagnose a case of odontogenic myxoma with clinical and radio- were locally administered to maintain mouth opening. logical finding and make a treatment plan, needful treatment of Conclusions patient. MMM is rare and has not been extensively documented in humans Methods and easily misinterpreted as a neoplasm. After confirmative diagnosis through biopsy, patient was treated surgically followed by endodontically, first involve tooth preserved by endodontic treatment then lesion was surgically excised under ABS00539 general anesthesia. Results Clinical Audit of Haemangioma of Orofacial Region The patient was under follow-up and he is asymptomatic. Conclusions Dr. Manish Garg It is difficult to diagnose OM based on clinical and radiographic finding. Diagnosis can be made by biopsy. Differential diagnosis has Department of Oral and maxillofacial Surgery, PGIDS Rohtak great importance for all tumors involving the maxillo-facial region. Recurrence rates are high and a long follow-up period over years is Abstract essential after treatment for patients with these tumors. Due to Background/Introduction aggressive behavior of these tumors regular follow up is absolutely Hemangiomas are the most common benign vascular tumour in necessary in the cases of odontogenic myxomas. infancy and childhood, composed of an increased number of endothelial cells that line blood vessels. Hemangioma can appear anywhere on body. Approximately 60% occur in head and neck region, 25% on the trunk and 15% in arms or legs. Various treatment modalities have been advocated for haemangioma. Objectives To access the clinical features, treatment modalities and outcome of Orofacial Hemangioma. 123 S200 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

Methods EPS00569 Between year 2014-2017, a total of 10 patients of orofacial heman- OSMF: A Tale of Twists and Turns—A Case Report gioma reported to the department of oral and maxillofacial surgery, PGIDS, Rohtak. Out of which 5 patients were treated by surgical excision, 2 patients by medical management using Inj. Sodium Dr. C. Ravindran, Professor Head of Department, OMFS; Dr. tetradecyl sulphate 60 mg (setrol) and 3 patients by cryotherapy. J. Naveen Kumar, Professor OMFS; Dr. Vinay Sundar, Post Results Graduate, OMFS; All treatment methods gave satisfactory results. Mild soft tissue necrosis was reported in cases treated with inj. Sodium tetradecyl Sri Ramachandra University sulphate. No complications were reported in other two groups. No recurrence was reported till latest follow up. Abstract Conclusions Background/Introduction Treatment for orofacial haemangioma should be decided depending Oral sub mucous fibrosis is a chronic, complex, premalignant (1% upon the age of patient, site and extension of lesion. Small lesions can transformation risk) lesion of the oral cavity, characterized by juxta- be surgically excised. For larger lesion, medical treatment can be epithelial inflammatory reaction and progressive fibrosis of the sub- given followed by surgical excision, if needed. Cryotherapy is also a mucosal tissues. Micro trauma produced by friction of coarse fibres of good option to treat orofacial haemangioma. areca nut facilitates diffusion of the alkaloids into the sub epithelial connective tissue resulting in juxta-epithelial inflammatory cell infiltrate. Objectives EPS00556 The Objective of this e poster is to explain a case report of a patient Trigeminal Neurofibroma: A Case Report with oral Sub mucous fibrosis. Methods Fathima Hafila M.I (IIIyr Post Graduate), Dr. Karthik MDS (Reader), The patient underwent two surgeries in a span of three months Dr. Saravanan. C FDSRCS (Prof), Dr Vivek. N MDS (Prof & Dean) including bilateral fiberotomy, condylectomy and coronoidectomy. Results SRM Kattankulathur Dental College The poster will talk about the net result of the patient’s mouth opening status and further prognosis after both the surgeries. Conclusions Abstract OSMF disease is of benign pathology and needs to take a lot of Background/Introduction factors into consideration before taking the patient to the table and A neurofibroma is a benign nerve sheath tumor in the peripheral also the results are not always predictable. nervous system. In 90% of cases they’re isolated tumors, while the rest are found in persons with neurofibromatosis type I (NF1), an autosomal dominant genetically inherited disease. Neurofibromas have been reported to occur with varying frequency in the head and EPS00574 neck region. Trigeminal nerve tumors are rare, comprising 0.2%. To Infantile Capillary Hemangioma our knowledge, a trigeminal nerve neurofibroma of the main trunk has been reported in trace in the oral and maxillofacial surgery literature. The histology of a neurofibroma shows a well delineated, non-en- Dr. Sneha Singh, PG Student capsulated neoplasm composed of a proliferation of spindle cells within a myxoid or collagen stroma. Govt. College of Dentistry, Indore Objectives The purpose of this poster is to report a case of a trigeminal nerve Abstract neurofibroma, its different clinical presentation. Background/Introduction Methods Infantile haemangioma are the most common tumors of infancy that A 33 year old male patient came with a complaint chronic pain in the affect 10% children. Most infantile hemangiomas involve the head right lower posterior teeth region. Various investigations were taken and neck. As many as 30% of lesions may be evident at the time of to narrow down the source of the pain. Dental factors were ruled out. birth, usually as relatively inconspicuous so-called precursor lesions, CT facial bones were taken which revealed bony expansion in relation proliferate during the first year of life and later on involute. The to the inferior alveolar nerve canal. Incisional biopsy in the posterior hemangiomas which do not involute naturally may require surgical, region suggested as Neurofibroma of Inferior alveolar nerve. Under non surgical treatment modalities or combination of both. GA the tumor was excised. Patient recovered uneventfully. However Objectives patient reported back with pain in the right side of the face following To assess the treatment outcome of infantile capillary hemangioma which MRI was taken. MRI reports revealed Neurofibroma of the with a combination of surgical and non surgical management. Trigeminal Nerve. Methods Conclusions Under general anaesthesia total excision of lesion present on upper lip The anatomic complexity of the tumor lent itself to a multidisci- was performed. Intra-orally Collagen sheet was placed to facilitate plinary surgical effort and appropriate planning for successful closure. Intralesional sclerosing agent (sodium tetra decyl sulphate) management. was injected on upper lid and lateral border of the nose as the lesion at these sites were irregular and diffuse in nature. Results Surgical excision resulted in functional and esthetic resolution. After 8 months of surgical excision and 3 sessions of sclerotherapy the patient has no clinical signs of recurrence or any other condition associated with tumor.

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Conclusions Results Thus we may conclude that surgical excision along with intralesional The microscopic description of the lesion showed granular material injections of sclerosing agent provide excellent results while treating with occasional benign squamous cells & a few lymphocytes. There infantile capillary hemangioma. was no evidence of granuloma or malignancy in the smear. The diagnosis was cervical paramedian cyst. Conclusions Dermoid cyst are usually seen in the sublingual, submental & sub- EPS00580 mandibular region. It’s occurrence in cervical paramedian region is Ameloblastoma and Reconstruction of Mandible Using very rare. Iliac Crest Graft: A Case Series

Dr. Ajinkya Deshpande, PG Student EPS00634 Trends in Paediatric Ameloblastoma Management: Govt. College of Dentistry Indore An 47 Years Institutional Experience

Abstract Background/Introduction Dr. Shibani A Nerurkar, Dr. Neelam N Andrade, Dr. Paul Mathai, Dr. Ameloblastoma has been described as benign and locally invasive Harsh Desai tumour of odontogenic origin with a strong tendency to recur. Objectives Nair Dental College and Hospital To analyse the treatment outcome with resection of tumour and immediate reconstruction with reconstruction plate and iliac crest Abstract graft. Background/Introduction Methods Ameloblastoma is an aggressive, benign, odontogenic tumor com- Two patients with ameloblastma of mandible were treated with prising of 10 % of the total odontogenic tumors. It is most commonly tumour resection and immediate reconstruction with a 2.7mm recon seen in the 3rd- 4th decade of life and is considered a rarity in the plate and iliac crest bone graft. younger age group. Results Objectives A 6 months follow up showed satisfactory esthetic and functional Ameloblastoma is an aggressive, benign, odontogenic tumor com- results. prising of 10 % of the total odontogenic tumors. It is most commonly Conclusions seen in the 3rd- 4th decade of life and is considered a rarity in the Complete resection of ameloblastoma and affected part of mandible younger age group. permits immediate reconstruction with good post operative results. Methods A retrospective study was carried out in the paediatric group of 18 years and below, diagnosed with Ameloblastoma, at our institution over the past 47 years. The relevant data was collected by reviewing EPS00582 patient’s case notes, radiographs, histopathology reports and treat- Cervical Paramedian Dermoid Cyst: A Rare Case ment charts. Ameloblastomas were either enucleated with mechanical curettage or resected followed by primary reconstruction with either a Dr. Anagha Assissi reconstruction plate or free fibula flap. Results Of the total 273 paediatric tumours, Ameloblastoma was the most Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, common (15.2%). It occurred commonly in the age group of 12-18 Nagpur years with male predilection and there was no significant difference found between the occurrence of solid ameloblastoma (51.3%) and Abstract unicystic ameloblastoma (48.7%). Ten ameloblastomas which Background/Introduction appeared as unilocular radiolucency were diagnosed as solid type. 34 Intra orally dermoid cysts present as non-tender, slow growing mass were benign and one was a rare malignancy (Ameloblastic carci- in the sublingual, submental & submandibular region. The case of a nosarcoma). Only two recurrences were noted over 47 years. 31-year-old man with a cystic lesion in the paramedian region on the Conclusions left side of anterior triangle of neck is reported. The cyst was excised We conclude that ameloblastomas are not uncommon in the Indian & was confirmed histopathologically as dermoid cyst. Clinical pro- paediatric population. Unicystic ameloblastomas in the paediatric age gress was uneventful & post-operative recovery was excellent without group can be successfully treated conservatively owing to their recurrence. growth potential with emphasis on long-term follow-up. Solid, uni- Objectives cystic ameloblastomas must be treated radically. Pre-operative To report rare case of dermoid cyst. incisional biopsy from more than one area of the tumour should be Methods emphasized. Excision of the cyst was done through incision in the crease of the neck placed 1 cm below the cystic swelling. Dissection was done through skin, subcutaneous tissue, platysma, superficial & deep fascia to identify the cystic lining. Sharp & blunt dissection was carried for enucleation of the cyst. Thorough irrigation was done followed by wound closure with subcutaneous sutures with 3-0 vicryl & skin closure with 5-0 prolene suture by subcutaneous suture for better cosmetic results.

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ABS00636 lingual gland predominantly. The line of treatment was surgical Dentigerous Cyst Involving Maxillary Sinus in Relation excision of the ranula with the involved sublingual gland. The postoperative complications such as recurrence, infection and injury to to Impacted Maxillary Third Molar: A Case Report Wharton’s duct was nil, but 2 (8%) patients reported back with lingual nerve paraesthesia and 2 (8%) patients with restricted tongue move- Dr. Sameena Shamsudeen ments which improved with time and exercises to improve mobility. Conclusions Kannur Dental College Although marsupialization is a popular technique but it has greater than 90% recurrence rate. Careful surgical excision of ranula along Abstract with removal of sublingual gland offers excellent result with minimal Background/Introduction or nil morbidity. Common developmental benign odontogenic cyst of the oral cavity which accounts for the second most common cyst of the jaws EPS00690 Pathogenesis involves the accumulation of fluid between the unerupted or impacted tooth crown and surrounding follicle, giving rise to Marsupialization Followed by Enucleation; the characteristic clinical and radiographic finding of a cystic lesion Conservative Approach for Management surrounding the neck of the tooth. of Ameloblastoma: A Case with 8 Years Follow Up Objectives enucleation of dentigerous cyst in maxillary sinus aalong with removal of impacted maxillary third molar. Dr. Annadi Sreevaishnavi Methods investigations done PNS view, CT VIEW. Enucleation of cyst with Meghna Institute of Dental Sciences surgical removal of impacted teeth under general anaesthesia planned. Vestibular incision placed in r/t 23 - 28 Mucoperiosteal flap raised. Abstract Tooth identified – bone toughing done. Cystic lesion enucleated along Background/Introduction with tooth. Specimen sent for histopathological examination. Ameloblastoma is the most common odontogenic tumor of the jaws, Results with clinical and histological variants. Although it has been accounted Enucleation of cyst with surgical removal of impacted teeth under as a benign neoplasm, aggressive behaviour, local invasion potential general anaesthesia. and tendency to recur make it difficult to manage. Removal of jaw Conclusions cysts that reach large sizes, result in facial deformity, injuring to the Occurrence of ectopic tooth in maxillary sinus and association of a neurovascular bundle or jaw fractures. Marsupialisation followed with dentigerous cyst with it is a rare phenomenon. Its presence may be subsequent enucleation can be considered as an alternative clinical asymptomatic initially with clinical manifestations, later on as adja- conservative approach. cent structures are affected. Enucleation of the cyst along with Objectives removal of the tooth is the treatment of choice. To achieve normal architecture of Mandible To avoid complications with resection and reconstruction of Mandible. Methods Marsupialization & Enucleation. EPS00689 Results Incidence and Management of Ranula Good Prognosis with no recurrence. Conclusions Dr. Divyashree R, Dr. Ventakesh Anehosur Considering the age of the patient despite following aggressive methods like resection Ameloblastoma can also be managed by conservative methods with regular periodic follow up. SDM College of Dental Sciences and Hospital

Abstract EPS00691 Background/Introduction Ameloblastoma: Can It Recur? Ranula is defined as a mucus filled cavity in relation to sublingual gland present in the floor of mouth. Ranula resembles a frog’s translucent underbelly or air sacs. Ranulas are characterized by large Dr, Drub T. Sharma, Dr Kiran Radder, Dr. Venkatesh Anehosur cystic cavities and appear as a tense fluctuant dome-shaped vesicles, Objectives Oral and Maxillofacial Surgery S.D.M Dental College and Hospital The aim of this study is to evaluate the incidence, management and complications of ranula. Abstract Methods Background/Introduction A retrospective analysis of patients reporting with salivary gland Ameloblastoma is a rare, benign, slowly-growing odontogenic tumour pathology in teaching hospital during the period of 2007 to 2017 was accounting for about 1% of all tumours of the jaws and 11% of all done, from which 25 cases with final diagnosis of ranula were odontogenic tumours arising from epithelial and/or ectomesenchymal selected. The Medical records were evaluated for principal demo- tissue. Ameloblastomas are characterized by an aggressive potential graphic, clinical, diagnostic and therapeutic data. Percentage analysis for local invasion and a high recurrence rate (ranging between 55% was done on the evaluated data. and 90%) requiring a precise histological diagnosis and surgical Results treatment. Among the total of 25 patients diagnosed with ranula, 18 were males Objectives and 7 were females. 8, 9 and 8 patients were of 21-30 years, 31-40 The aim of this study is to assess the recurrence rate in operated cases years and 41-50 years age group respectively involving the left sub of ameloblastoma over a period 10 years (2006-2016) in our unit. 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S203

Methods findings. The histopathological features suggested ossifying fibroma Histopathologically proven cases of ameloblastoma between 2006 based on biopsy specimen taken from periphery of the lesion. Deeper and 2016 were retrospectively assessed for recurrence post-surgery. tissue/excision biopsy gave the impression of aggressive cemento- The surgical procedure carried out involved enucleation of the ossifying fibroma. Since the time elapsed for the surgery was short, pathology and chemical cauterization using carnoys solution. In the patient is on regular follow up and radiological monitoring. few recurred cases radical procedure of resection of the involved bone Conclusions was carried out. Fibro-osseous lesions of maxillofacial region represents a diverse Results group of conditions in which the diagnosis is difficult to establish. Out of 52 patients operated for ameloblastoma (biopsy proven) in the Lack of standardised terminology and classification of central or period of 10 years, 34 were male and 18 were female. This signifies intraosseous cement-osseous lesions of the jaws have long posed a the male predilection of ameloblastoma. The age of patients were dilemma for clinicians. Until 1948 it was believed that fibrous dys- ranging from 30-58 years with the mean age of 38. In 82% of the plasia and ossifying fibroma were the same entity. Distinguishing the patients the lesion was in posterior mandibular region. For all the fibro-osseous lesions was an irksome task. Therefore, the case pre- patients who were diagnosed with ameloblastoma wide excision, sented in this review had a multi-disciplinary approach; a team of oral curettage and chemical cauterization was carried out. We had a pathology and oral radiology apart from the maxillofacial team were minimal recurrence of 23%. involved in the proposition for the final diagnosis and treatment of the Conclusions lesion. Achieving an accurate final diagnosis is of primordial concern The results of this study appear to show a higher prediction of since it will command appropriate therapeutic action. Correlation ameloblastoma in male population, site predilection in the posterior between the biologic behaviour of the lesion and clinical, radiologic mandibular region and middle age predilection which is in summation and histopathologic data is essential in reaching an accurate diagnosis. with the literature. Treatment of a patient with an ameloblastoma should be based on accurate clinical details, radiographs, special imaging, and a representative biopsy. EPS00732 A Rare Case of Palatal Neurofibroma of Spindle Cell Origin A Case Report EPS00694 Maxillofacial Fibro-Osseous Lesions: Diagnostic Dr C R Sobhana Dr Deepthi S Dr Vivek V Dr Ansari Fakruddin Conundrum Govt Dental College Trivandrum Dr Pallavi Priyadarshini, Guided by Dr Soumi Samuel Abstract A B Shetty Memorial Institute of Dental Sciences Background/Introduction Neurofibromas arise from a mixture of cell types including Schwann Abstract cells and perineural fibroblasts. They may occur as solitary lesions or Background/Introduction in association with neurofibromatosis. Although most commonly Fibro-osseous lesions are the commonest entities reported in the head reported in soft tissues, Neurofibromas do occur in bone. Intra-oss- and neck region. These lesions constitute rare benign pathology with a eous lesions may produce a well demarcated or poorly defined non-odontogenic lineage that affects the craniofacial area. Benign unilocular or multilocular radiolucency. Adjacent soft tissue neu- tumours of bone such as, the ossifying fibromas cannot be accurately rofibromas may produce cortical erosion. Solitary neurofibromas and distinguished from several fibro-osseous lesions through any one type those found in association with neurofibromatosis share the same of investigatory method. Until 1948, lack of standardised terminolo- microscopic features. The tumor is composed of spindle-shaped cells gies and classification used to pose a dilemma for clinicians, to with fusiform or wavy nuclei in a delicate connective tissue matrix. It diagnose it as ossifying fibroma or fibrous dysplasia. That year, is not encapsulated and may blend with the adjacent connective tis- Sherman and Sternberg published a detailed description of the char- sues. The normally recommended treatment of solitary lesions acteristics of ossifying fibroma, and since then most researchers following biopsy is localized excision. coincide in considering the two lesions to be different entities. Objectives Therefore, accurate clinical, historical, histopathological and radio- A 17 year old female reported to Govt dental college Trivandrum graphical data are important in the final diagnosis of fibro-osseous complaining of swelling inside oral cavity for 2 months. On exami- lesions. nation a well defined solitary pink swelling of size 2x2 cm with Objectives reddish surface mucosal changes on mid palate at the junction of soft To review some of the pertinent studies related to diagnosis and and hard palate. On palpation was firm and non tender. Uvula normal treatment of fibroosseous lesions. no nasal regurgitation no paresthesia or numbness was noted. No ear Methods discharge. The review is based on a case report that describes a case of ossifying Methods fibroma arising in the maxilla of a 19 year old female. The relevant FNAC yielded RBC’s and inflammatory cells and repeat FNAC was articles and investigation procedures by which we arrived at a diag- also inconclusive. Was posted for wide excision biopsy under GA. nosis and differentiated it from other fibro-osseous lesions has been Results discussed. HPR - Palatal neurofibroma of spindle cell origin. Results Conclusions Studies and case reports related to diagnosis and treatment of fibro- Neurofibroma of spindle cell origin in rare in oral cavity especially osseous lesions were analysed. Radiographic investigations like OPG, palate area where initial suspicion always points toward a minor CBCT, 3D-CT face was done. The radiology report suggested an salivary gland neoplasm. A wide excision is usually preferred with expansile lytic lesion with a lobulated outline and well defined mar- sufficient margin clearance. The patient is under regular followup and gins. Incisional biopsy reports correlated with the radiographic the healing post operatively has been satisfactory.

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EPS00773 Results Intramasseteric AVM Resembles As Parotid Swelling One case in this series was diagnosed as OKC and later on after the management final histopathological report came out to be of unicystic ameloblastoma. In second case preoperative histopathological diag- Dr Moumita Sheikh nosis of ossifying fibroma changed postoperatively to central giant cell lesion. Third case of AOT was reported on post-treatment Rama Dental College & Hospital histopathology as ameloblastoma. Fourth and fifth cases were of osteoma according to initial histopathological diagnosis and after the Abstract management one diagnosed as aggressive osteoblastoma while other Background/Introduction as osteosarcoma. Keywords: Intramasseteric, AVM, Ultrasound, CT scan, Parotid Conclusions swelling. AVM of head and neck region is one of the rare vascular If the diagnosis of a known confusing lesion is suspected the surgeon anomalies. AVM tend to develop in superficial areas of head and neck and the pathologist should work together evaluating all the clinical region such as lip, tongue, buccal mucosa and rarely in intramuscular and histopathological features exhaustively and not sticking to one of location. The masseter muscle is the most frequent site and accounts the prominent feature. for approximately 5% of all intramuscular AVM in the head and neck region. Objectives An intra masseteric location may be mistaken for a parotid swelling EPS00829 and also may pose problems in term of proximity to facial nerve. Changing Trends in the Treatment Intramuscular malformation often have a delayed presentation due to of Osteoradionecrosis of Jaws: A Recent Review lack of obvious skin involvement or deformity. In this case report an intramuscular AVM occurring in a 20 years old male with an unusual Dr. T. Bharath, 2nd yr Resident clinical presentation is being presented. Methods The patient complained of a swelling in the preauricular region since Army College of Dental Sciences one year. The swelling increases during chewing movement. There is no discoloration of overlying skin & no local rise in temperature. Abstract Results Background/Introduction Ultrasound and CT scan revealed opacity into the parotid gland. Osteonecrosis of jaws is painful and debilitating condition which can Based on this clinical and radiological findings we performed be caused as a complication of treatment of surgery or radiotherapy superficial parotidectomy. Intraoperatively after completion of used in malignant tumours or medications used for bone modulations superficial parotidectomy we found a purple colour mass into the and anti- angiogenesis such as bisphosphonates Risk factors include masseteric resembling AVM. Excisional biopsy of the mass was total radiation dose, modality of treatment, fraction size, dose rate, carried out with proper ligation of the feeder vessel and the final oral hygiene timing of tooth extractions, as well as continued tobacco histopathology came as intramasseteric AVM. & alcohol since there is no specific treatment which acts isolated and Conclusions decidedly, management of those patients requires attention, different An intra masseteric location may be mistaken for a parotid swelling. treatment modalities employed in an appropriated manner to control The diagnosis of intramasseteric AVM is challenging Proper surgical and stabilize lesions, lastly a new –early management protocol is resection can be reliably attempted. proposed based on the current clinical criteria relating to osteonecrosis together with adoption of new therapies supported by increased levels of evidence. Objectives EPS00800 To present current knowledge of literature on management of Diagnostic Dilemmas in Maxillofacial Pathology: Our osteonecrosis of jaws, both radio-induced and medication related. Experience Methods Literature review in pubmed as well as manual search for relevant publications in references of selected articles, articles in English Dr. Ravirajsinh A. Gohil, Dr. Sajjad Abdur Rahman, Dr. Ghulam ranging from 2010-2017, which assessed osteonecrosis of jaws as Sarwar Hashmi, Dr. Tabishur Rahman main objective, were analysed and selected. Results Aligarh Muslim University, Aligarh Current understanding of the pathophysiology of ORN based on radiation-induced fibrosis has introduced the use of drugs such as Abstract pentoxifylline, tocopherol, and clodronate. 11–13 In animal studies Background/Introduction none of these alone could reverse reactive oxygen species, so their In maxillofacial pathology, it is not uncommon to come across lesions combined use is important. 18 In a clinical trial, Delanian et al. which share histopathological similarities. Such diagnostically con- reported striking regression and reversal of chronic radiation changes fusing lesions put the pathologists as well as surgeons in a dilemma after their combined use. 12 In a phase II trial, Delanian et al. 23 regarding correct diagnosis and treatment. showed that mucosal and bony healing occurred over a median period Objectives of 6 months. The objective of this study is to discuss various pathologies with Conclusions clinically and histopathologically confusing features. Current understanding of etiopathology changes the mode of treat- Methods ment more towards medical and makes pentoclo therapy as an Five cases of maxillofacial pathologies were taken and their pre- adjuvant therapy in osteoradionecrosis. treatment as well as post-treatment histopathological reports were analyzed. 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S205

Section: Oral Pathology—Malignant mesothelioma’’ because it was thought to be of mesothelial origin. However, recent studies indicate that pleural SFT appears to be derived from submesothelial mesenchymal cells. Recently, SFT has been described in extrapleural sites. SFT has also been reported to EPS00188 occur in such sites as the sinonasal tract, nasopharynx, oral cavity, A Wolf in Sheep’s Skin salivary gland, and thyroid. Until now very few cases of solitary fibrous has been documented in the literature. This is a case solitary Dr. Shekinah Grace Divya Philip - Post-graduate fibrous tumour which arose from the soft tissue of the floor of mouth. Objectives To report a rare case of solitary fibrous tumour. Sri Ramachandra Dental College Sri Ramachandra University, Methods Chennai A 48-year-old male presented with a 3-month history of a gradually enlarging, painless mass in the right side of the floor of the mouth. On Abstract oral examination, there was a mass of elastic hardness, measuring Background/Introduction 4x5cm, covered by normal mucosa. Contrast-enhanced CT scan Adenoid cystic carcinoma is a rare malignant tumor that affects major revealed an enhancing mass with a low attenuation at right side of the and minor salivary glands. It most commonly occurs in the maxilla. It is floor of the mouth. There was no evidence of bony involvement. A a tumor with a deceptively benign histologic appearance. Three prog- differential diagnosis was made as ranula or benign sublingual gland nostically significant histologic patterns are seen: cribriform, tubular tumor with cystic change. The tumour was surgically excised under and solid. It has relatively painless locally invasive growth and a high general anesthesia. The specimen was sent for biopsy. The biopsy probability of local recurrence. Adenoid cystic carcinoma is known for specimen revealed a solitary fibrous tumour with high proliferative its prolonged clinical course and its propensity for delayed onset of index. distant metastases. Some adenoid cystic carcinomas undergo dedif- Results ferentiation into high grade. Surgery is the treatment of choice of Biposy report revealed solitary fibrous tumour with high proliferative adenoid cystic carcinoma and microscopically free surgical lines of index. resection must be obtained. Positive lymph nodes, solid histological Conclusions features, positive margins at surgery and perineural invasion of major In the present case, the patient is well without recurrence and signs of nerves were associated with increased treatment failures and mortality. metastasis 3 months after the surgery; however careful, long-term Objectives clinical follow up may be required for the determination of the bio- To discuss a rare case of a 27 year old female who reported to the logical behavior of SFT. SFT has been recognized only recently, department of Oral and Maxillofacial Surgery, Sri Ramachandra tumors with histological features of malignancy should be regarded as Dental Hospital with the chief complaint of right ear ache and pain on potentially malignant and should be followed up closely even after a tongue movements, the further investigations done, the differential complete resection. diagnosis, the unique surgical management, arrival at the final diagnosis and the post-operative treatment plan. Methods Pre - operative work up and investigations: case history, clinical EPS00294 examination, MRI (brain, head and neck), CT angiogram (neck and Rare Malignant Tumours of the Mandible intracranial vessels), USG guided FNAB, Biopsy, Immunohisto- chemistry. Surgical management: Excision of tumor in relation to posterior tongue using tongue split technique under general anesthe- Dr. Mohan Baliga sia. Post-operative treatment plan: Radiotherapy, regular follow up. Results Abstract Post-operative final histopathology report revealed - High grade Background/Introduction adenoid cystic carcinoma. Margins free of tumor. Cancer is a disease involving complex multiple sequential irreversible Conclusions dysregulated processes showing metastasis that results in morbidity Adenoid cystic carcinomas’ occurrence in the tongue is relatively and mortality. Metastasis is a complex biological course that begins rare. The combination of surgery and post-operative radiotherapy to with detachment of tumor cells from the primary tumor, spreading treat adenoid cystic carcinoma has been seen to improve locoregional into the distant tissues and/or organs, invading through the lympho- control of the disease. Radiation therapy has been seen to promote vascular structures followed by their survival in the circulation. tumor regression and pain relief. Metastatic tumors to the oro-facial region are uncommon and may occur in the oral soft tissues or jawbones mainly the mandible. Objectives EPS00197 To highlight three rare malignant tumours of the mandible to be kept Solitary Fibrous Tumour with High Proliferative in mind whenever clinicians deal with malignant tumours of the mandible. Index: A Case Report Methods From the archives of the department for a period of 20 years. Dr. George Jacob, Dr. Gaurav Singh, Dr. Amit Gaur Results The interdisciplinary management including surgery and chemoradi- Sardar Patel Post Graduate Institute of Dental and Medical Science ation in the prognosis and the survival rate. Conclusions The clinical presentation of metastatic tumors can be variable, which Abstract may lead to erroneous diagnosis or may create diagnostic dilemma. Background/Introduction Therefore, they should be considered in the differential diagnosis of Solitary fibrous tumor (SFT) is a rare spindle cell neoplasm that inflammatory and reactive lesions that are common to the oral region. typically arises in the pleura. It was once referred to as a ‘‘localized

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This poster highlights three rare malignant tumours such as Malignant which carries high mortality and morbidity. An appropriate early ﬁbrous histiocytoma, Non Hodgkins lymphoma and Adenoid Cystic diagnosis and treatment can improve the prognosis and survival of carcinoma. These cases are frequently missed due to their less doc- patients. umentation in literature. Hence this present poster is an attempt to Conclusions bring into showcase these three rare malignant tumours to aid in its Synovial sarcoma is a rare malignant tumor of which treatment is proper diagnosis and diligent management. essentially surgical resection with high rates of recurrence. A head and neck surgeon should be familiar with this aggressive tumor, which carries high mortality and morbidity. An appropriate early diagnosis and treatment can improve the prognosis and survival of EPS00312 patients. Ameloblastic Carcinoma: A Case Report

Dr. Debashish Borkotoky EPS00510 Diagnostic Markers in the Head and Neck Malignancy Yenepoya Dental College

Abstract Dr Gopal Lahudas Nagargoje Background/Introduction Ameloblastic carcinoma is a rare malignant odontogenic carcinoma Maharashtra Institute of Dental Sciences and Research, Latur that has metastatic potential. Due to its rare incidence, there are few studies focusing on its radiological characteristics. When ameloblastic Abstract carcinoma demonstrates an aggressive appearance, it may be diag- Background/Introduction nosed as a malignant tumor; however, in cases showing a non- Oral cancer, the largest subset of head and neck cancer, has become aggressive appearance, it is difficult to distinguish ameloblastic car- one of the most lethal malignancies during the last two decades. cinoma from ameloblastoma. Clinically, ameloblastic carcinoma is Although several diagnostic tools have been applied for the early more aggressive than most typical ameloblastomas with extensive detection of oral malignancies, it is still important to identify novel local destruction, perforation of the cortical plate, extension into tumor markers. Early detection would significantly decrease the surrounding soft tissues, numerous recurrent lesions, and metastasis, mortality rate of oral cancer. Advances in understanding of the usually to cervical lymph nodes. The radiographic appearance of molecular mechanisms underlying oral squamous cell carcinoma ameloblastic carcinoma is consistent with that of ameloblastoma (OSCC) have resulted in an increasing number of biomarkers that can except for occasional presence of some focal radiopacities, apparently be used to predict the behavior of this disease. reflecting dystrophic calcification. Histologically, the tumor cells Objectives resemble cells seen in ameloblastoma but show cytologic atypia, Objective of this poster is to review the role of biomarkers in pre- cellular pleomorphism, nuclear hyperchromatism, mitoses, and vas- dicting the outcome of Head & Neck malignancies. cular and neural invasion. We report a case of a 44-year old male patient, with a history of swelling over the right mandibular ramus region two years back for which surgical excision was performed and histopathological examination was suggestive of Ameloblastic Car- EPS00541 cinoma. Later, the same patient reported two months back with a Treatment Modalities of Keratocystic Odontogenic recurrence of the swelling over the same region, for which wide Tumor excision was performed through extraoral approach. Dr. Shivika Choudhary

EPS00406 School of Dental Sciences Sharda University Synovial Sarcoma of Submandibular Region Abstract Dr. Nitesh Mishra Background/Introduction Management of keratocystic odontogenic tumor by conservative management and radical management. Faculty of Dental Sciences, IMS, BHU Objectives Various treatment modalities for curing odontogenic tumor. Abstract Methods Background/Introduction By conservative management like enucleation, curettage By radical Synovial sarcoma is a malignant tumor of pluripotent mesenchymal management like segmental resection, hemimandibulectomy. cells. This timour commonly found in periarticular tissues, with few Results cases occurring in the head and neck region. Keratocyystic odontogenic tumor can be cure by these procedures. Objectives Conclusions To present a case of synovial sarcoma of submandibular region. Its rare but it can be cured by conservative procedures as wwll as Methods radical management. Case report. Results Synovial sarcoma is a rare malignant tumor of which treatment is essentially surgical resection with high rates of recurrence. A head and neck surgeon should be familiar with this aggressive tumor,

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EPS00642 EPS00688 Spindle Cell Tumor of Neural Origin in Palate: A Rare Management of Oral Cancer with N0 Neck Cases: Our Entity Protocol and Controversies

Ananth. C Dr. Abhay T. Kamath, Dr. Adarsh Kudva

Govt Dental College Thiruvanthapuram Manipal College of Dental Sciences

Abstract Abstract Background/Introduction Background/Introduction Spindle cell carcinoma rarely occurs in the oral mucosa. In a series of The treatment of patients with N0 squamous cell carcinoma (SCCA) 307 oral spindle neoplasms observed over a 20-year period, only two of the head and neck remains controversial. The presence of lymph (0.7%) constituted spindle cell variant of the squamous cell carci- node metastases is the most important prognostic factor for survival in noma. The World Health Organization (WHO) defines this tumor as a head and neck. Histologically proven lymph node metastasis increa- ‘carcinoma within which there are some elements resembling a ses the stage to 3 and may decrease survival by 50%. squamous cell carcinoma that are associated with a spindle cell Objectives component’. Watchful waiting until a patient with an N0 neck develops Objectives detectable neck disease has been shown to significantly decrease Management of spindle cell carcinoma of palate. survival. Elective or prophylactic neck dissection improves regional Methods control, and the results of salvage surgery for N0 neck, which were Wide excision with safety margins under GA. observed and have progressed to N? neck, are poor. Therefore, the Results challenge of caring for patients with an N0 neck lies in identifying Continuos followup shows complete healing with no residual defect. which patients are at risk for developing lymph node metastases in Conclusions order to treat those patients prophylactically and to decrease the risk Wide excision with safety margin will be the treatment of choice for of neck failure in the neck. spindle cell carcinoma of palate. Methods Thus, the protocol followed at our institution is ipsilateral supraomohyoid neck dissection for oral carcinoma with N0 neck and it has shown promising results with great patient outcome. EPS00646 Results Prognostic Benefits of Use Touch Imprint Cytology Elective neck dissection resulted in higher rates of overall and dis- of Bone Resection Margins in Patients with Oral ease-free survival than did therapeutic neck dissection. Squamous Cell Carcinoma Conclusions This poster would give an insight into the diversity of oral cancer cases that have been treated by the above-mentioned method at our Dr. Monisha Fernandes institution and their outcomes.

AB Shetty Memorial Institute of Dental Sciences ABS00697 Abstract Background/Introduction Ewing’s Sarcoma of Mandible: A Rare Presentation A 5-mm margin of histopathologically uninvolved tissue surrounding the resected squamous cell carcinoma is widely accepted as a negative Dr Gauri Gupta, Prof. Rinku George margin however use of frozen sections is limited to soft tissue assessment introperatively. Limitations in methods to assess the Saveetha Dental College and Hospital involvement of the bone margin at the time of surgery can negatively affect prognosis. Imprint cytology is an intra- and peri-operative tis- Abstract sue assessment technique that offers sensitivity and specificity that is Background/Introduction equivalent to that of frozen sections, hence could prove to be a potent ‘Ewing’s Sarcoma (ES) is a rare malignancy primarily affecting tool for obtaining tumour free margins. skeletal system and it is commonly diagnosed in children and young Objectives adults. It seldom occurs in head and neck region. ES has poor prog- Intraoperative assessment of bone margins in oral squamous cell nosis because of uncontrolled metastatic potential making early carcinomas. diagnosis and intervention critical for survival of the patient. This Methods paper reports a rare case of ES involving mandible in an 9 year with Review of literature. clinical, radiological, histopathological and surgical modality. Results Objectives Touch imprint cytology is an accurate, simple, rapid and cost-effec- ES is an aggressive tumour showing rapid growth and metastasis. It is tive method that aids in intraoperative assessment of margins in a part of ES family of tumours (ESFT), which also includes peripheral diagnosing surgical specimens of thyroid, parathyroid, breast cancer neuroectodermal tumour (PNET), neuroepithilioma and Askin’s margins, sentinel lymph nodes prostate and also oral squamous cell tumour. This has made diagnosis even more complex. ES has the carcinoma. most unfavourable prognosis of all primary musculoskeletal tumours. Conclusions Even with early intervention, patient with metastasis have 20% of Thus touch imprint cytology has justified the need for further study survival rate. Here we report a case of ES involving mandible in an 9 and implementation in oral squamous cell carcinoma resections. year old girl with pertinent review of Indian literature to make the 123 S208 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 clinicians aware of the clinical as well surgical modality of the rare Section: Oral Surgery tumour. Methods ‘‘We report a case of 9 year old girl with a rapidly expanding mass on the right side of her face treated by complete surgical excision fol- EPS0027 lowed by reconstruction with fibula graft. Oro Antral Communication Closure by Buccal Fat Pad Results Results are satisfactory; and the patient is completely cured of Saloni Bharti & Bidsh disease. Conclusions Abstract Less than 70% cases of ES of mandible has been reported. It generally Background/Introduction requires multimodal approach. It’s a radio responsive tumour and It is a well documented post operative complications associated with local therapy includes combination of surgery and radiotherapy; the extraction of molars and premolars teeth. Surgery when feasible is the treatment of choice. Refinements in Objectives diagnostic imaging, along with newer techniques, ensure a long term Aim of present study was evaluate the use of buccal fat for the closure survival rates. of oroantral communication. Methods All defects were closed by application of buccal fat pad. ABS00702 Results Transmandibular Resection with or Without Lip The buccal fat pad for closure of an OAC was successfully used in patients at our department. Excluding all severe complicating cases Splitting: A Prospective Analysis of 30 Cases such as tumour related defects or previously treated cases, the overall success rate for closure of OAC was nearly 98 percent. No late Shoeb Ullahtalib Ansari, Vrinda Kolte, S.R. Shenoi, Anup Garg, complications occur. Kshitij Bang, Pranav Ingole, Neelima Budraja Conclusions According to the recommendations and anatomiclimitatuons reported VSPM DCRC Nagpur in published studies and discussed in the present report, the application of buccal fat pad is a safe and reliable procedure for closure of Abstract oroantral communication. Background/Introduction A lower lip-splitting incision is being used for transmandibular resections since the olden times for obtaining wide access to oral EPS0029 cancers regardless of its unfavorable aesthetic results. Here, we have Evolution of Diclofenac Products described a new modification of the traditional approach for transmandibular resection without lip splitting to improve the cosmetic results. Dr Jaismeen Kaur, PG 2nd Year Student Objectives To evaluate transmandibular resection with or without lip splitting. BRS Dental College and Hospital, Panchkula Methods Patients of oral cancer involving mandible and retromandibular tri- Abstract gone who underwent transmandibular resection were reviewed from Background/Introduction January 2016 to June 2016. Of 30 patients who underwent mandibular Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) of the resection for cancer, 15 had been operated without lower lip splitting phenylacetic acid class with anti-inflammatory, analgesic and anti- and 15 with conventional lip split approach. Each case was assessed pyretic properties. Since its introduction in 1973, a number of for TNM staging, status of resection margins, perioperative and different diclofenac containing drug products have been developed postoperative complications and aesthetic and functional results of with the goal of improving efficacy, tolerability and patient lower lip. convenience. Results Objectives All the tumors were successfully removed in-toto by means of This poster aims to illustrate how pharmaceutical technology has been modified non ‘‘lip-splitting and the traditional lip split approach. The used to modify the pharmaco-kinetic properties of diclofenac, leading cosmetic results have been analysed in these cases. to the creation of novel drug products with improved clinical utility. Conclusions Methods This new modified non-lip-splitting mandibulectomy approach could Analysis of literature was carried out and earlier articles about edvant certainly replace the traditional mandibulectomy approach for atleast of diclofenac products were studied. Market survey was carried out. some selected malignant lesions, with excellent cosmetic as well as Results functional results of the lower lip. The enhanced dissolution and absorption kinetics of diclofenac potassium led to the development of several diclofenac potassium- containing drug products, with the ultimate goal of shortening the time to clinically meaningful analgesia. Conclusions Continuous improvements in biopharmaceutical properties of diclofenac have led to the creation of a broad array of drug products designed to treat multiple inflammatory and painful conditions.

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EPS0030 pain control comparing these with earlier used ones on basis of Adult Stem Cells and Tissue Engineering Strategies research and clinical studies available to improve patients experience at dentist and thereby provide dentist with more cooperative patient for Salivary Gland Regeneration resulting in optimised dental care. Conclusions Dr Aakanksha Sharma, PG 2nd Year Hereby, I conclude that research showing CCLAD systems to be very promising in achieving painless injections especially with AMSA, BRS Dental College and Gen Hospital, Panchkula (Haryana) PASA, PDL injections. Vibrotactile devices are also useful in achieving patient satisfaction during injection. Jet injectors are not Abstract very useful when compared to other devices. Intraosseous systems are Background/Introduction very useful tools to achieve profound anesthesia, as an alternative to Tissue engineering is the application of life sciences and materials conventional injections. Safety syringes prevent accidental needle engineering towards the development of tissue substitutes that are stick injuries and it is advisable to use them in future. capable of mimicking the structure and function of their natural analogues within the body. The underlying strategy behind the development of tissue engineered organ substitutes is the combination EPS0068 of cells, biomaterials and biochemical cues intended to recreate the natural organ environment. Comparative Study of OPG & CBCT as Pre-operative Objectives Diagnostic Tools for removal of Impacted Mandibular This poster aims to highlight current bioengineering approaches for 3rd Molar salivary gland tissue engineering and adult stem cell sources used for this purpose. Dr. Vimal Joseph Devadoss Methods Analysis of literature was carried out and earlier articles about edvant of tissue engineering strategies for salivary gland regeneration were Rajas Dental College & Hospital,Tiunelveli studied, Results Abstract It has been demonstrated that tissue engineering approaches utilizing Background/Introduction stem cells and biomaterials have a capability to become a viable Extraction of the mandibular third molars is a routine procedure in means to achieve meaningful salivary gland regeneration. maxillofacial surgery, whether for prophylactic or for orthodontic Conclusions reasons. Third molars have a high incidence of impaction, associated Adult stem cells and tissue engineering is a step toward the devel- with many conditions such as pericoronitis, caries on the distal sur- opment of tissue substitutes that are capable of mimicking the face of the second molar, pain, external root resorption and structure and function of their natural analogues within body. odontogenic cysts and tumors. Imaging examination is undoubtedly an essential tool for diagnosis and surgical management because it provides valuable information about the tooth position, the number/morphology of the roots and relationship of the tooth to adjacent ABS0055 structures. Advancements in Local Anaesthetic Devices Objectives To evaluate the correlation of OPG ﬁndings & CBCT in the evaluation of relationship of impacted mandibular third molars to the Dr. Dharmika Jagani, B mandibular canal. Methods Divya Jyothi College of Dental Sciences and Research Institute 25 patients who reported to the department of OMFS, Rajas Dental College and Hospital, Tirunelveli, Tamilnadu. 25 patients with 40 Abstract impacted mandibular third molars showed 38 radiographic signs of Background/Introduction proximity of mandibular third molar to inferior alveolar canal on Pain and its successful management is one of the corner stones of digital panoramic radiographs for which CBCT was done. dentistry worldwide since time immemorial. ‘‘DREADED INJEC- Results TION FROM DENTIST’’ can be one of the primary reasons for 25 patients with 40 impacted mandibular third molars showed 38 potential patients not seeking timely treatment for their dental radiographic signs of proximity of mandibular third molar to inferior problems. alveolar canal on OPG for which CBCT was done, only 28 CBCT Objectives revealed the proximity of mandibular third molar to inferior alveolar It is imperative to update our knowledge and skills in using newer canal. alternatives in pain control and management and ways of adminis- Conclusions tering them to increase comfort level of our patients and resolve the Due to the recent development of CBCT, three dimensional images cliched paradigm of ‘‘PAIN AND DENTISTRY ARE are becoming more easily available. On comparison with OPG and INSEPERABLE’’. CBCT, the golden standard is CBCT but on dosage calculation Methods between OPG and CBCT, CBCT dosage is high but when the area of This poster is prepared by referring to 18 articles from journals of exposure is limited the radiation dosage between OPG and CBCT, is Dental clinics of north America, National journal of maxillofacial slightly more or the same. Thus using OPG and CBCT for diagnostic surgery, California state journal of medicine, IOSR journals and purpose for impacted third molar, CBCT plays a vital role in 3 textbooks of local anesthesia-Monheims, Stanley. F. Malamed. dimensional view, lower radiation and cost effective. Results This poster overview will enlighten the practising dentists regarding newer innovations in drug delivery system and methods of rendering 123 S210 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

EPS0072 A review was done of the current methods of 3D printing, applica- Versatility of Socket Shield Technique: A Case Study tions within oral and maxillofacial surgery and to look at their merits and pitfalls. Results Dr. Packiyaraj MDS, Prof and HOD, Dr. Sherin A. Khalam MDS, Dr. The overall easy access to 3D printers makes it possible to produce Chandoorya. C, PG First Year sufficient hardcopy templates as tools for reconstruction of bones in Maxillofacial surgery, within few hours at a reasonable price level, Rajas Dental College & Hospital which can greatly improve the quality of bone reconstruction. Conclusions Abstract This technology remains in its infancy at present however, it remains Background/Introduction clear that 3D printing technology is here to further develop and has a Extraction of teeth is inevitably associated with distinctive changes in successful role to play in oral and maxillofacial surgery. the surrounding hard tissue and soft tissue. Healing of extraction socket is characterized by the formation of bone within the socket and the loss of width, height of the alveolar ridge compromising the implant placement especially in the aesthetically important areas. EPS00108 Socket shield technique, introduced by Hurzeler in 2010, is the one Comparison Between the Clinical Results of Buccal Fat which prevents the resorption and achieves the alveolar ridge Pad with Collagen Sheet Over Buccal Fat Pad Alone preservation. in Reconstruction of Mucosal Defect Following Surgery Objectives To identify whether socket shield technique is a viable alternative to for Oral Sub Mucous Fibrosis bone substitutes and guided bone regeneration. Methods Dr. Utsav Singh Gurung With the socket shield technique the submucosal portion of the buccal root fragment of 1 to 2 mm is retained as a shield 1 mm coronal to the Sardar Patel Post Graduate Institute of Dental and Medical Sciences buccal alveolar plate, followed by an immediate implant placement. (SPPGIDMS) Results Socket shield technique reduces resorption, achieves osseointegration Abstract and minimizes buccal contour changes after tooth extraction. Background/Introduction Conclusions Oral submucous fibrosis (OSMF) is a potentially malignant condition It is an ideal method, which is cost effective and minimally invasive characterized exclusively by the formation of vesicles along with in preserving the ridge without the use of biomaterials like Guided juxta epithelial inflammatory reaction and fibroelastic changes in the bone regeneration and bone substitutes. lamina propria with atrophy leading to stiffness of oral mucosa. This leads to formation of fibrotic bands that ultimately results in restricted mouth opening (trismus). Burning sensation of the oral mucosa while EPS0096 taking hot or spicy food is the other clinical feature. It primarily affects the buccal mucosa but may involve various parts of the oral Application of 3D Printing in Oral and Maxillofacial cavity and often extends to the pharynx. The disease is predominently Surgery found in Indian subcontinents, due to deleterious tobacco chewing habits present in the inhabitants. OSMF can be managed by conser- Dr. Peyush Pratap Singh vative (intralesional corticosteroids plus oral supplements) or surgical means. However, the conservative management is limited only for mild cases of OSMF. Surgery is indicated for patients with marked Maharana Pratap College of Dentistry & Research Centre, Gwalior limitation of mouth opening. Various surgical modalities include: (MP) release of fibrous bands (fibrotomy), temporalis myotomy and coronoidectomy followed by reconstruction of mucosal defect using flaps, Abstract grafts and collagen membranes. Background/Introduction Objectives Three-dimensional printing, also known as rapid prototyping, additive The aim of this study was to evaluate the clinical results of Buccal fat manufacturing, or solid-freeform technology, is a precise computer- pad with Collagen sheet over Buccal fat pad alone for reconstruction directed process whereby models are fabricated via successive lay- of mucosal defects following surgery for oral sub mucous fibrosis. ering of material. 3D printing refers to the production of a three Methods dimensional object from a digital file. From aerospace technology, A 12 months prospective study was conducted on 20 patients diag- clothing to firearms this technology is being developed in most fields nosed with OSMF Group III or Group IV A (Khanna JN and Andrade and can even be applied to Oral and Maxillofacial surgery (OMFS) NN classification, 1995). They were divided into two groups. Patients Three-dimensional printed haptic models allow surgeons, students to in group 1 were treated by Buccal fat pad alone and in Group 2 by develop a superior understanding of anatomical features, through Buccal fat pad with collagen sheet. tactile and visual spatial feedback. The ability to interact directly with Results a custom model of patient-specific anatomy and pathology is expected The mean preoperative mouth opening was 13.55mm in group I and to improve preoperative planning. 13.06mm in group II. The mean postoperative mouth opening after 1 Objectives year was 35.48mm in group I and 36.51 in group II. Infection was The aim of this poster is to describe the applications and limitations of evident in 4 patients of group I whereas none in group II. The wound 3-dimensional (3D) printing in advanced oral and maxillofacial sur- dehiscence was noted in two patients after 1 week follow up in group gery (OMFS) and to discuss the benefits of this modality in surgical I and none in group II. Time taken for complete epithelialization of planning, student and resident training, and client education. mucosal defect in both groups was 2-3 weeks. Mean pain score was 4 Methods

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S211 and 2 on VAS scale after 1 week followup in group I and II disintegrated blood clot within the alveolar socket, with or without respectively. halitosis. Conclusions Objectives Collagen membrane can be used as an adjunct for reconstruction of To assess the efficacy of Platelet Rich Fibrin (PRF) on the pain and mucosal defect following surgery for OSMF as pain score, physical healing of the extraction socket associated with Alveolar Osteitis (Dry trauma, food lodgement and consequent infection at surgical site is Socket, AO) after removal of maxillary and mandibular molars. reduced. It further helps in maintaining structural integrity of BFP Methods during healing phase. 100 adult patients with age group ranging from 18 to 40 years along with established dry socket after maxillary and mandibular molar extractions who have not received any treatment for the same were included in the study. PRF was placed in the maxillary and EPS00112 mandibular molar extraction sockets after adequate irrigation of the A Novel Method of Local Drug Delivery System in Oral socket. All the patients evaluated for the various study variables Surgery which include pain, degree of inflammation, and healthy granulation tissue formation at 1st, 3rd, 7th, and 14th post operative day. Data were analyzed using Shapirowilk’s test, chi square test and/or student- Dr. Beena Sivakumar test, Friedman’s test, Wilcoxson’s signed rank test, and Bonferroni test, with the significance level set at P \ 0.05. People’s College of Dental Science and Research Center, Bhopal Results There was significant reduction in pain associated with AO at the 3rd Abstract and 7th postoperative day along with better wound healing by the end Background/Introduction of 2nd week. Post-operative pain management is one of the important aspects after Conclusions any procedures in Oral Surgery. Platelet rich fibrin (PRF) is an Use of PRF in this study illustrates the promising results in terms of autologous fibrin sealant enriched with platelet concentrate, which reduced pain and better healing in the patients with Alveolar Osteitits. can be produced chair side at the time of surgical procedure and can be utilized to enhance wound healing. Addition of medicaments to PRF is a novel method of local and systemic drug delivery. Objectives EPS00127 The objective of this study was to use Platelet rich fibrin (PRF) as a A Case Report of Chronic Osteomyelitis Associated method of local drug delivery following trans-alveolar extraction of with Extra-Oral Draining Sinus 3rd molar tooth. Methods Randomized clinical trial was conducted among patients undergoing Dr Ramandeep Grewal (PG-3rd Year) Dr S.P.S Sodhi (H.O.D) trans-alveolar extraction of 3rd molar tooth. Patient’s blood was collected before the initiation of the procedure for the preparation of Department of Oral & Maxillofacial Surgery, Dasmesh Institute of PRF. Then an opioid analgesic was incorporated into it following Research and Dental Sciences, Faridkot which the PRF was placed in the socket. Results Abstract Patient who received PRF with opioid analgesic in the extraction Background/Introduction socket was analyzed for occurrence and intensity of post-surgical pain A cutaneous draining sinus of dental origin is often a diagnostic when compared to the control group. Time and dosage of rescue challenge because of its common occurence and absence of dental analgesia was also recorded the study group. symptoms. Proper diagnostic treatment and the elimination of the Conclusions source of infection are must. Otherwise it can result in ineffective and PRF incorporated with an analgesic drug is an effective method to inappropriate outcome of treatment because of wider use of antibi- enhance wound healing and in post-operative pain management. In otics and greater awareness among the population. It is still not third molar extraction. uncommon to find suppurative orofacial infections in day to day practice in developing countries like India. Such an inflammatory process may take one of the three courses’’‘‘ acute, subacute and chronic, depending upon factors such as virulence of the micro-or- EPS00125 ganisms, resistance of the host and local conditions. We present a case Role of Plasma Rich Fibrin in Alveolar Osteitis of chronic suppurative osteomyelitis associated with a draining extraoral sinus, which has been successfully treated with surgical Tushar Dubey debridement and antibiotic therapy. Objectives The purpose of this study is to evaluate the efficacy of antibiotic Kothiwal Dental College therapy through the extra-oral drain. And also to evaluate post-operative healing of the sinus tract. Abstract Methods Background/Introduction Under Local anesthesia sinus tract was excised and sequestrectomy Dry socket or acute alveolar osteitis is a quite painful and debilitating and currettage was done along with the placement of the extra oral condition for the patients who underwent extractions. It can be drain for instillation of local antibiotics. Healing was evaluated at defined as the presence of ‘‘postoperative pain’’ in and around the site, regular post operative follow-ups. which extraction increases in severity at any time between 1 and 3 Results days after the extraction, accompanied by a partially or totally Healing of the sinus tract was satisfactory and the lesion healed completely one month post-operatively with no reocurrence.

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Conclusions stage, the only presenting symptom may be odontalgia, which may be The present case shows that antibiotic therapy and surgical debride- diagnostic challenge for the dentist. Postherpetic neuralgia, development is a deﬁnitive method of treating chronic suppurative mental anomalies, osteonecrosis of jaw bone and facial scarring are osteomyelitis of mandible with favourable clinical results. Patient the other complication associated with it. should be kept on regular follow ups post -operatively. Objectives Early diagnosis and prompt treatment of the disease in the prodromal phase by the use of antiviral agents should be the mainstay of it’s management. EPS00138 Methods Use of CBCT in Oral and Maxillofacial Surgery Conservative management (Medicinal treamtent). Results Dr. Deepak Kumar (PG 2nd Year) Dr. Gursimrat Brar (Sr. Lecturer) After the 14 day follow up there was a signiﬁcant difference in general systemic condition as well as oral lesion of HZV. Conclusions Dept. of Oral and Maxillofacial Surgery, Dasmesh Institute of Herpes zoster infection may be infrequently encountered in general Research and Dental Sciences, Faridkot dental practice. Diagnosing these complications of herpes zoster could pose a challenge to an dental surgeon due to their varied presentation Abstract ranging from post herpetic neuralgia, external root resorption, Background/Introduction osteonecrosis and tooth exfoliation. There is burning sensation, pain, The use of cone-beam computed tomography (CBCT) allows a vesiculation, ulceration along the course of the Trigeminal nerve 3-dimensional evaluation of the jaws; thus, surgeons can obtain more should be treated promptly with HZV infection in mind. detailed and accurate information about the quality and quantity of the bone, helping them to identify anatomical features. Cone beam computed tomography (CBCT) is an alternative modality to CT or MRI that should be performed in all cases of suspected pathology of EPS00157 the maxillofacial region. Prior to a surgical procedure, a careful Osteoradionecrosis preoperative examination is necessary to avoid complications and to take the appropriate precautions. CBCT is cost-effective as compared to CT and associated with lesser radiation exposure with patient Dr Priya Kumari; Dr Numair Farhan convenience. CBCT allows 3-D vision of normal anatomy and different pathologies of jaw bones and is a good tool for differential Chandra Dental College, Barabanki diagnosis and treatment planning. This poster gives an insight into the uses of CBCT in relation to oral and maxillofacial surgery. Abstract Objectives Background/Introduction Role of CBCT in 3-D visualization of normal anatomy and different Osteoradionecrosis (ORN) is a condition of nonvital bone in a site of pathologies of jaw bones with respect to differential diagnosis and radiation injury. ORN can be spontaneous, but it most commonly treatment planning. results from tissue injury. The absence of reserve reparative capacity Methods is a result of the prior radiation injury. Even apparently innocuous Not applicable. It is a review articles. forms of trauma such as denture-related injury, ulcers, or tooth Results extraction can overwhelm the reparative capacity of the radiation- CBCT hugely expand diagnostic and treatment possibilities for the injured bone. Traditionally, 3 grades of disease (I, II, III) are recog- patients. Three-dimensional imaging of cysts and tumors of the max- nized. Grade I ORN is the most common presentation. Exposed illofacial region and can give the surgeon the vital information necessary alveolar bone is observed. Grade II designates ORN that does not for planning surgery with volumetric analysis, this can help anticipate respond to hyperbaric oxygen (HBO) therapy and requires the need for and volume of a potential graft for reconstruction. sequestrectomy/saucerization. Grade III is demonstrated by full- Conclusions thickness involvement and/or pathologic fracture. Therefore, patients CBCT is cost-effective and associated with lesser radiation exposure can demonstrate grade I or grade III ORN at initial presentation. with patient convenience. It allows 3-D vision of normal anatomy and Objectives different pathologies of jaw bones and is a good tool for differential To review the current knowledge on etiology and management of diagnosis and treatment planning. osteonecrosis of the jaws, both radio-induced and medication-related, aiming to improve knowledge of professionals seeking to improve the quality of life of their patients. Methods EPS00142 Literature review in PubMed as well as manual search for relevant Case Report: Herpes Zoster as a Sequelae of Traumatic publications in reference list of selected articles. Articles in English Extraction ranging from 1983 to 2017, which assessed osteradioonecrosis of the jaws as main objective, were selected and analyzed. Results Kumar Abhishek Infections, traumas and decreased vascularity have a triggering role for osteonecrosis of the jaws. Prophylactic and/or stabilizing mea- Institute of Dental Sciences Bareilly sures can be employed in association with therapeutic modalities to properly manage osteonecrosis of the jaws patients. Abstract Conclusions Background/Introduction Selecting an appropriate therapy for osteradioonecrosis of the jaws Herpes-zoster or ‘shingles’ is an acute viral infection caused by re- management based on current literature is a rational decision that can activation of the VARICELLA-ZOSTER virus during prodromal help lead to a proper treatment plan.

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EPS00192 Methods A Case Report of of Angiofibroma A- Prf was obtained by collecting venous blood in 10 ml red color- coded vacutainer test tube and was centrifuged in Choukroun’s Centrifugal Machine at 1300 rpm for 7 minutes. After the process Dr. Gagandeep Singh (PG 3 Year) completes, it is rest for 5 minutes after which it separates into three layers. Another PRF derivative used is I- PRF which is prepared by Dasmesh Institute of Dental Science, Faridkot collecting venous blood in 10ml orange color- coded test tube and is centrifuged at 700 rpm for 3 minutes. After the completion of the Abstract process, an orange color liquid is separated from the underlying RBCs Background/Introduction layer. This liquid is collected with the syringe and can be used as such Juvenile angiofibroma is an unusual, destructive but essentially or in combination with bone graft and PRF membrane. T- PRF is a benign tumor, mostly seen in the nasopharynx of adolescent males. Its PRF derivative that is obtained by using titanium test tubes instead of occurrence within the maxillary sinus as a primary tumor is rare. glass test tubes. It is prepared by same procedure as that of standard Although histologically benign, the tumor has a tendency to be locally PRF i.e. 3000 rpm for 10 minutes. aggressive, and may extend into the sphenoid sinus, infratemporal Results fossa, orbit, cheek, or intracranial fossae. It is a relatively rare tumor All the PRF derivatives show promising results. It results in decreased with an incidence of between 1:6,000 and 1:55,000 of the population. post-operative pain and inflammation, rapid healing of the tissue and It is important to recognize this entity in order to avoid misdiagnosis also acts as filler material. If used along with the bone graft it also with other fibrous and vascular tumours A presentating a case report helps in rapid bone healing. of angiofibroma. Conclusions Objectives PRF and its derivatives has various promising applications in Oral The purpose of this study to check treatment modalities. and Maxillofacial Surgery. It is an autologous healing biomaterial that Methods accelerates and enhances soft tissue healing. It uses autologous blood Under GA. tumor was excised and healing was evaluated at regular hence, reduces the risk of cross contamination and also reduces the post operative follow ups. risk of allergic response by the patient. Results Successful tumor excise and healing satisfactory no recurrence. Conclusions This present case show surgical treatment of angiofibroma with ABS00202 favourable clincal results. Patient should be regular follow ups. Assessment of Position of Inferior Alveolar Canal in Relation to Impacted Mandibular Third Molars Using OPG and CBCT: A Comparative Study EPS00198 Super PRFs: A Healing Aid in Future Dr. Rachit Lochan Srivastava, Dr. Gopinath Thilak, Dr. Vidya Ajila

A.B. Shetty Memorial Institute of Dental Sciences, Mangalore Dr. Palak Goel (2nd Year Post Graduate—Ist Author), Dr. S.P.S 575018. Ph No. 08242204963, Email: [email protected], Sodhi (Prof and Head—Department of Oral and Maxillofacial Mobile: 9611757720 Surgery—2nd Author)

Abstract Dasmesh Institute of Research and Dental Sciences, Faridkot Background/Introduction The inferior alveolar neurovascular bundle containing the inferior Abstract alveolar nerve is present in variable anatomic relationship with Background/Introduction respect to impacted mandibular third molars. The surgical removal of In recent years, there has been a growing interest in the use of pla- mandibular third molar may result in inadvertent Inferior alveolar telet-rich products in regenerative medicine. Platelet-rich fibrin was nerve injury because of close proximity of the root to mandibular first developed in 2001 by Choukroun. But despite of its good clinical canal. The risk can be reduced by preoperative radiographic assess- success certain disadvantages including possible health hazards with ment of the anatomical relationship of third molar root and silica activators in glass tubes, amount of growth factors incorporated mandibular canal by Panoramic radiography (OPG) and Cone beam in the fibrin clot etc. led to development of newer techniques. T-PRF computed tomography (CBCT). is a newer generation of PRF, developed by Tunali et al, where more Objectives biocompatible class IV titanium is used. Titanium tubes may be more 1. To compare the accuracy of OPG and CBCT in predicting the risk effective at activating platelets than the glass tubes used by Chouk- of IAN injury pre-operatively. 2. To find out the distance between the roun in his platelet-rich fibrin (PRF) method. Another recent anatomic locations of mandibular third molar roots in relation with development is advanced PRF (A-PRF), developed by Choukroun mandibular canal in OPG and CBCT. et al, which is prepared by lowering the centrifugation speed and time, Methods due to which leukocytes are incorporated more in the fibrin clot and This was a prospective study of consecutive patients who consulted hence, fasten the speed of wound healing. Also, the use of platelet the department of Oral and Maxillofacial Surgery, A.B. Shetty concentrates in ‘‘liquid’’ form, remained an important indication in Institute of dental sciences for Mandibular third molar removal. various applications leading to the development of i-PRF (injectable). Radiographic assessment was performed to assess the relationship Objectives between the mandibular canal and impacted third molars additional Use of various variety of PRF and its derivatives in various Oral CBCT imaging was performed after confirming the proximity of the Surgical Procedures. canal to the tooth.

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Results Objectives Statistical significant changes were present in the study in relationship To test the hypothesis and validate our invitro study that the local to accuracy in predicting the relationship of the canal and the tooth anesthetic solution with neutral pH is likely to improve the efficacy of thus helping in diagnosing and adopting better treatment option prior local anesthetic solution in adverse local conditions as in the presence to the procedure. of infection. Conclusions Methods CBCT is recommended for preoperative radiographic evaluation of Based on the result of our invitro study, the pH of multidose vials of complicated mandibular third molars. lignocaine currently available in the market ranges from 3.3 to 3.6. The multidose vial is fortified with sterile sodium bicarbonate to bring the pH to near neutral value before administration. EPS00207 Results Tooth Banking The clinical efficacy of the fortified local anesthetic agent will be evaluated and tabulated. Conclusions Dr. Kedarnath N.S, Dr. Madhumati Singh, Dr. Nadira Khan, This study explains the role of pH and the efficacy of fortified local anesthetic agent particularly in the presence of infection. Rajarajeswari Dental College and Hospital

Abstract EPS00224 Background/Introduction Recent Methods of Dry Socket Management and Their Teeth are the most natural, non-invasive source of stem cells which Efficacy are easy, convenient and affordable to collect, isolate and preserve with promising therapeutic approach to restore structural defects. Banking ones own tooth derived stem cells is reasonable and simple Presented By Dr, C Satya Kinnera (MDS Ist Year PG) Guided By Dr, alternative to harvest stem cells with little or no trauma. Every child G Harsha MDS, MOMSRCPS (Glasg) HOD and Prof loses primary teeth, which creates perfect opportunity to recover and it is best time to harvest when child is young and healthy. MNR Dental College and Hospital, Sangareddy-502294 Objectives To discuss the history, different types relevant for dentistry, their Abstract isolation approaches, collection and preservation of dental stem cells Background/Introduction along with current status of dental and medical application. Alveolar osteitis ‘‘dry socket’’, is most commonly encountered Methods complications followed by extraction of permanent teeth. This article The retrospective analysis of relevant articles and dental journals is a comprehensive review of efficacy of different treatment methods explaining about Dental stem cell banking, regenerative capacity of used in management of dry socket, various new agents in the market dental stem cells and stem cells from human exfoliative teeth with can accelerate the healing of socket such as plasma rich in growth relevant updates. factor. Results Objectives Dental stem cells have the potential to be utilized for medical to asses efficacy of various methods used for dry socket management. applications like Heart therapies, regenerating brain tissue, for mus- Methods cular dystrophy, bone regeneration, to regenerate cartilage, adipose A cochrane and pub med-medline database search was conducted tissue and bone grafting with therapeutic results. with search terms ‘‘dry socket’’, post extraction complications, and’’ Conclusions fibrinolytic alveolitis’’, individually. Dental stem cells have multiple applications of restoring structural Results defects which can be improved with simple harvesting methods and final review includes collection of articles from cochrane database promising therapeutic and functional regenerative capacity. The system, pubmed publications, international journal of oral and max- oncogenic potential is still to be determined with minimal limitations. illofacial surgery. Conclusions all the treatments in the review have the aim to relieve patients pain EPS00214 and promote alveolar mucosa healing and dry socket as well as to review the efficacy of various recent treatment modalities. Role of Ph in Local Anesthetic Agent: An Invivo Study EPS00229 Dr. Indu, Dr. Karthik, Dr. Saravanan, Dr. Vivek (HOD) Implant Site Preparation using Autogenous SRM Kattankulathur Dental College and Hospital, SRM University Mandibular Symphysis Graft

Abstract Dr. Prateek Tripathy Background/Introduction Lignocaine is the most commonly used local anesthetic agent. Kalinga Institute of Dental Sciences, Bhubaneswar Although effective anesthesia is one of the most important prereq- uisites for successful minor oral surgical procedures, there are Abstract incidences of failure of anesthesia. The failure rate of local anesthesia Background/Introduction is estimated to be 5 to 15 % by American Dental Association. This After tooth loss, alveolar ridge resorption is a common phenomenon failure an be attributed to various factors including infection, which alters the size and shape of host bone available for dental anatomical variations, technical mistakes and anxiety of the patient. implant placement. In clinical practice, though patients often demand

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S215 osseointegrated implants to replace their missing teeth, the deficiency EPS00244 of bone volume causes the biggest hinderance in such treatment A Prospective Randomised Control Study to Compare option. The solution to such problem is reestablishing to ridge height and width using autogenous bone graft which is considered gold the Effiacacy of Concentrated Growth Factor Following standard. Surgical Removal of Impacted Mandibular 3rd Molar Objectives To prove that mandibular symphysis is a favourable donor site for Dr. R. Muralidharan autogenous bone grafts as it has an excellent risk benefit ratio. Methods Adhiparasakthi Dental and College Surgical placement of autogenous mandibular symphysis bone graft in the implant site where ridge augmentation is desired. The procedure is performed in patients reporting to the Oral Surgery OPD of Abstract Kalinga Institute of Dental Sciences, Bhubaneswar. Background/Introduction Results Growth factors are protein, which regulates the complex processes of There are documented evidences of increased alveolar ridge volume wound healing, main role on Cell migration, Cell proliferation and both laterally and vertically to prepare the ridge for correct implant Angiogenesis in tissue regeneration phase. As first generation of placement. platelet concentrate, platelet rich plasma (PRP) and Platelet rich in Conclusions growth factor (PRGF) was well known. As second generation of Hence it is concluded that implant site preparation using autogenous platelet aggregation, Platelet rich fibrin (PRF) but the PRF protocol mandibular symphysis graft is considered gold standard. doesn’t need biochemical additives like bovine thrombin and chemical additives as Calcium Chloride to make gel condition, So PRF is free from the concern of cross-contamination. Third generation Early accelerated tissue healing using adult blood derived stem cells (CGF ABS00230 Compared to PRF, CGF is attained by single centrifugation using Effects of Botulinum Toxin for Contralateral special centrifuge, results in fibrin rich blocks that are much larger, denser and richer in CGF than common PRF, So better regenerative Hyperkinesis and Asymmetry in Facial Palsy. The capacity and higher versatility. In addition CGF doesn’t require any Poison that Helps to Heal chemical or allergenic additives, such as bovine thrombin or antico- agulants, so is free from viral transmission disease. Dr Pritee Pandey Objectives The purpose of this study is to evaluate and compare utility and Divya Jyoti College of Dental Sciences and Research efficacy of concentrated growth factor on soft tissue healing and bone healing following surgical removal of mandibular impacted 3rd molar in mandible with control group. Abstract Methods Background/Introduction Blood Sample Centrifugation 1. The patient will be seated comfort- Use of botox therapy for facial sequele prompted the idea that botox ably in the dental chair in semi supine position, In patient’s fore arm might be useful in facial palsy leading to improve facial asymmetry tourniquet would be applied after Dabbing with anti septic swab 2. 9 and contralateral hyperkinesis. The application of Botox to healthy mL of blood will be drawn from the anticubital region and collected side of face in patients with facial palsy has shown to be minimally in sterilised Vacuette tubes (Greiner Bio-One, GmbH, Kremsmunster, invasive technique that improves facial symmetry at rest and during Austria) without anticoagulant solutions. 3. This tube will be imme- facial motion. diately centrifuged in special machine (Medifuge MF200, Silfradent, Objectives Forli, Italy) using a program with the following characteristics: 30’’ In cases in which medical or surgical treatment options are limited acceleration, 2’ 2,700 rpm, 4’ 2,400 rpm, 4’ 2,700 rpm, 3’ 3,000 rpm, because of existing medical problems or advanced age, most patients and 36’’ deceleration and stop. 4. At the end of the process there with facial palsy are advised to await spontaneous recovery or are would be three blood fractions: (1) the upper platelet poor plasma informed that no effective intervention exists. The purpose of this (PPP) layer; (2) the middle fibrin rich gel with aggregated platelets poster is to evaluate effect of botox treatment for facial asymmetry and concentrated growth factors (CGF); (3) the lower red blood cell and contralateral hyperkinesis in facial palsy that could not be opti- (RBC) layer. 5. Middle fibrin rich layer along with the few mm of mally treated by use of medical or surgical management because of RBC layer would be cut and kept in the extraction socket and wound severe medical or other problems. would be closed with 3-0 silk material. If required a plier would be Methods used to create aS membrane which will be placed in the socket. This poster is review of collection of 27 articles. Results Results On Clinical and Radiographic evaluation better results were observed After administration of botox on the nonparalysed side of patients in CGF group with respect to Pain, Edema, Wound dehiscence, Soft with facial palsy, marked relief was observed. Decreased facial and Hard tissue formation. asymmetry and strengthened facial function on paralysed side helps to Conclusions increase confidence in patients. CGF is an innovative method for producing a fibrin matrix with Conclusions concentrated growth factors and its clinical applications are presently It is concluded that such innovative therapy is of great value that being investigated. CGF was reported to have a good regenerative decreases the relative hyperkinesis contralateral to the paralysis capacity and a high versatility on sinus and alveolar ridge augmen- leading to greater symmetric function. Especially in patients with tation (Sohn et al., 2009). Similarly to PRF (Dohan Ehrenfest et al., medical problems that limit the medical or surgical treatment options, 2009, 2010; Dohan et al., 2006a, b; Mosesson, 2005), CGF has a in such cases Botox therapy represents a useful alternative. complex tridimensional architecture which makes it a real platelet, leukocyte and growth factor-rich fibrin biomaterial. In particular, the platelets and the dense fibrin network make large clusters of

123 S216 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 coagulation in the initial millimetres of the membrane beyond the red destrcutive necriosis and gas formnation in the subcutaneous tissue blood cell base, as confirmed by SEM analysis. The presence of and fascia. growth factors, such as TGF-b1 and VEGF, is important for stimu- Objectives lating cell proliferation, matrix remodeling, and angiogenesis during The purpose of this report is to understanding of necrotizing fasciitis healing processes (Grainger et al., 2000, Intini, 2009; Rodella et al., through a case study, that emphasizes the silent features and man- 2010). Our data confirmed the presence of TGF-b1 and VEGF in CGF agement of this dreaded disease as it affected the head and neck and demonstrate a similar pattern of expression also in RBC layer. In region of adult male patient through the dental infection. conclusion, our study demonstrates the presence of TGF-b1 and Methods VEGF in CGF and RBC layers, suggesting that improved CGF pro- Medical management followed by Surgical management. cedure could optimize the amount of growth factors in the CGF layer Results or, alternatively, a possible use of RBC layer in clinical applications. This case also outlines and appropriate sucessfull management Moreover, the presence of CD34 positive cells within the CGF net- strategy for the treatment of those patients. work could lead to investigate their clinical implications. Conclusions Misdiagnosis and delayed treatment can results in severe systemic toxicity, carotid artery erosion, jugular vein thrombophlebitis, aspiration pneumonia, meningitis, mediastinitis and even death. EPS00254 A Predictable Intra-Oral Approach to Ectopically Positioned Teeth EPS00280 Ludwig’s Angina: An Emergency 1. Dr. Gandhali Limaye (PG Student), 2. Dr. Pranav Sathe (PG Student) Dr. Nilanshu Singh Dr. D.Y. Patil Dental College & Hospital, Pimpri Pune-18 Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow Abstract Background/Introduction Deep seated third molars always pose difficulty to the most skilled of Abstract surgeons. On rare occasions, teeth are in ectopic positions like con- Background/Introduction dyle, ramus and the inferior border of mandible. An extra oral Ludwig’s Angina is a firm, acute, toxic cellulitis of the sub- approach in such cases is not only unaesthetic, but also laden against mandibular, submental and sublingual spaces bilaterally. Many the risk benefit ratio. clinicians are unfamiliar with these conditions as these conditions Objectives have become less common in post antibiotic era. Its tendency to cause The objective of this poster is to propagate an intra oral approach by oedema, distortion and obstruction of airway pose a great challenge use of certain optical and surgical instruments. for treating physicians and anesthesiologists and can even be life Methods threatening. Early recognition of potential cases, discussion with A total of 3 teeth in 2 patients were removed successfully by an intra patient and relatives, appropriate referral, aggressive antibiotic and oral approach under General Anaesthesia. The surgical aids used were timely surgical intervention are very much important to reduce a 2 mm long drill bit, illuminating spectacle mounted light morbidity and mortality of Ludwig’s angina. (ERGOPTICS) and magnifying loupes. A pre operative assessment Objectives with CBCT helps to locate the accurate position of the tooth. To evaluate the treatment outcomes, associated morbidity and sur- Hypotensive anaesthesia maintains a clean surgical field. vivability following Ludwig’s angina. Results Methods The procedures were successfully carried out intra orally without Our experience with review of literature in management of patient leaving a visible scar. suffering from Ludwig’s angina. Conclusions Results The author believes that if these methods are used, a predictable intra Treatment should involve high dose of broad spectrum parentral oral removal of deep seated teeth is possible with minimal surgical antibiotics, immediate surgical drainage under local and general risk. anesthesia in 75% and single patients respectively. This was in addition to extraction of offending tooth/teeth where applicable. The complications recorded were septicaemia, necrotising fascitis, laryngeal spasm and renal failure. ABS00259 Conclusions Cervical Necrotizing Fasciitis of Odontogenic Origin Ludwig’s angina is a life threatening, soft tissue infection of the submandibular, submental and sublingual fascial spaces bilaterally. If vigilant for its clinical presentation and aware of its potential for rapid Presented by Dr. Sampath Kumar, Guided by Dr. G. Harsha compromise of the patients airway, clinicians can intervene early in order to prevent its most dire consequences. The classic manifesta- MNR Dental College and Hospitals tions of these infections, such as high fever, systemic toxicity, and local signs may be absent due to widespread use of antibiotics and/or Abstract profound immune suppression. Their tendency to cause oedema, Background/Introduction distortion of fascial spaces and obstruction of airway pose a great Necrotizing fasciities of head and neck is uncommon, potentially challenge for treating physicians and anesthesiologists; airway control fatal, soft tissue infection charactarized by rapidly progessive and is of paramount importance, and attention to this consideration, combined with antibiotic therapy, surgical drainage, and modern

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S217 intensive care, have all contributed to a declining mortality. Early and mouth opening exercise from the next postoperative day while in liberal consultation with otolaryngology and anesthesiology services group B (n = 110), patients underwent physiotherapy 7th day post- will assure the greatest hope for speedy airway control, prompt operatively. Pain and discomfort, mucosalization, infection, flap institution of intravenous antibiotic therapy, and an uncomplicated dehiscence and necrosis were noted. Patients were followed for 1 year recovery from this rare and dreaded condition. on a regular interval basis. Results At the end of 1-year follow up, the postoperative mean mouth opening in group A was 38.63 mm and 34.19 mm in group B. In group A, the EPS00299 immediate physiotherapy results in mild to moderate pain and dis- C-Reactive Protein: A Diagonostic Marker comfort to the patients as compared to no apparent pain in the group B. The mean mucosalization time in group A and group B was 4.2 and Dr. Harisankar. S 5.1 weeks, respectively. Postoperatively, all patients achieve satisfactory mouth opening. Conclusions Yenepoya Dental College and Hospital Immediate aggressive physiotherapy yields a comparatively superior result than delayed physiotherapy with respect to mouth opening in 1 Abstract year of follow-up. Background/Introduction C-reactive protein (CRP) was discovered by Tillet and Francis in 1930 as a substance in the serum of patients with acute inflammation that reacted with the C polysaccharide of pneumococcus. The serum EPS00383 levels of CRP raises with infection making it a positive acute phase Cyberknife: A New Archetype in Radiotherapy reactant. This review mainly highlights the role of CRP in the field of Oral and maxillofacial surgery, It provides a knowledge based framework for interpretation and analysis of clinical observations of Dr. Esther. P. Pathi CRP in relation to infection, inflammation and other pathologies in orofacial region. The conventional measures to estimate infections Army College of Dental Sciences such as evaluation of WBC count and ESR are valuable in determining state of patient at testing time. However, the predictability of Abstract these is limited. A better knowledge of the inflammatory cascade has Background/Introduction given new insights and provided several mediators that in conjunction It is a high precision, non invasive robot guided frameless steriotactic with the clinical manifestations can be useful as markers of infection. radiosurgery system. One such mediator is C-reactive protein (CRP) and is probably the Objectives most widely used marker. The serum levels of CRP raises with It is the first and only radiosurgery system designed for treatment infection and also in inflammation making it a positive acute phase anywhere in the body. reactant with a very short half-life of 5–7 h. Thus, advantage of Methods having short half lives makes serum CRP levels as sensitive indicators It uses continual x-ray image guidance technology and computer of oral and maxillofacial pathologies. controlled robotic mobility to automatically track, detect and correct for patient movements. Results It is used for vascular anomalies, head and neck tumours, nasal and EPS00346 orbital tumours. Immediate Versus Delayed Aggressive Physical Conclusions Therapy Following Buccal Fat Pad Interposition It improves the quality of life. in Oral Submucous Fibrosis: A Prospective Study in Central India EPS00403 Dr. Vijay N. Rode, MDS-III Preoperative Intravenous Tramadol Versus Ketorolac for Preventing Postoperative Pain After Third Molar Swargiya Dadasaheb Kalmegh Smruti Dental College & Hospital, Surgery Nagpur Dr. Gaurav Verma, Reader Abstract Background/Introduction Institute of Dental Sciences, Sehora, Jammu & Kashmir, India. Phone Oral submucous fibrosis is a disease of an Indian subcontinent with Number- ?919736565635 E Mail- [email protected] obscure aetiology and poorly treated with varying signs and symptom. Objectives To find out role of immediate and delayed aggressive physical therapy Abstract postoperative on oral submucous fibrosis patient. Background/Introduction Methods The aim of preemptive analgesia is to prevent postoperative pain by In this study, 220 patients were randomly divided into two groups administration of various therapeutic agents prior to surgery. with mouth opening less than 16 mm and evaluated with immediate Preemptive analgesia concept is based on the principle of prevention and delayed aggressive physiotherapy with buccal fat pad interposi- of peripheral and central sensitization of pain pathways by nocicep- tion after fibrotomy. Group A (n = 110) patients underwent aggressive tive impulses. Pain is a predictable outcome after surgery. Preemptive

123 S218 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 analgesia may prove to be a valuable tool in preventing postoperative EPS00425 pain. Feasibility of Using I-PRF and Assessment of Clinical Objectives The objective of this study was to evaluate & compare the preemptive Healing After Its Use in Extraction Sockets: A Pilot analgesia efficacy of intravenous ketorolac and intravenous tramadol Study in prevention of postoperative pain after surgical extractions of mandibular third molars. Dr Samarth Vajpayee Methods Forty patients who required surgical extraction of mandibular third Rishiraj College Dental College, Bhopal molars were divided randomly into two groups. Group- I [Tramadol Group (n=20)] patients were given 50 mg tramadol intravenously preoperatively. Group- II [Ketorolac Group (n=20)] patients were Abstract given 30 mg ketorolac intravenously preoperatively. Surgical Background/Introduction extractions were performed under local anesthesia. The parameters The monocytes play an essential role on bone growth, vascularization under evaluation were postoperative pain intensity measurement, and production of vascular endothelial growth factor (VEGF) which mean time after which rescue analgesic was taken, total analgesic leads to more and earlier vascularization, faster soft tissue growth, consumption over 5 day recovery period, and patient’s assessment of release of BMPs and more cytokines. IPRF is a concept to get the the surgical procedure. whole amount of cells from the blood, white cells, platelets, along Results with circulating stem cells and endothelial cells essentially terming The result of the study revealed that, there was no statistically sig- A-PRF & I-PRF as ‘‘blood concentrates’’. nificant difference between the two groups in relation to the clinical Objectives parameters under investigations except patient’s assessment of the To assess the feasibility of using IPRF and to compare the hemostasis, surgical procedure. Greater percentage of patients in ketorolac group soft tissue healing and incidence of dry Socket of mandibular rated the procedure relatively better and less painful by giving higher extraction wounds with and without the use of autologous IPRF. scores. Methods Conclusions Group A consisted of 30 patients where IPRF was placed in the Although both ketorolac and tramadol were equally efficacious as extraction socket of mandibular teeth. Group B consisted of 30 preemptive analgesics on statistical backgrounds but ketorolac seems patients as the control group where the extraction sockets were to be more efficacious on clinical grounds. evaluated without any intra socket medicaments. Postoperative hemostasis, healing and incidence of dry socket were evaluated using predetermined criteria immediately after extraction and on the first, third, seventh and fourteenth post-operative days and statistical ABS00419 analysis was done. Oral Manifestation of Wegener’’s Granulomatosis: Two Results The result shows rapid hemostasis in the extraction socket treated Case Report with IPRF when compared with the socket without IPRF. Soft tissue healing was better in study site as compared to control site. Incidence Dr Vijaykumar of dry socket also appeared to be less than that of control group. Conclusions Pt. B.D. Sharma Uhs, Pgims, Rohtak, Haryana Autologous IPRF is biocompatible and has significantly improved hemostasis, soft tissue healing, and decreased incidence of dry socket. Abstract Time to prepare IPRF is lesser, easy and economical. It proves to be a Background/Introduction promising next generation PRF derivative in this short pilot study. It is a rare multisystem Autoimmune disease of unknown etiology. Its hallmark feature include Necrotizing Granulomatous inflammation & pauci immune vasculitis in small & medium size blood vessels. With EPS00426 classical WG there is initial involvement of respiratory tract if condition remain untreated renal involvement often develop known as Treatment Modalities for Oro-Antral Fistula Closure generalised WG. Oral lesion as a presenting feature are only in 2% of these cases. So recognition of this feature importance for timely Dr Shubham Dubey, Guided by Dr. Ananth Kumar G. B. diagnosis & management of this potentially fatal disease. Objectives K M Shah Dental College and Hospital, Vadodara To share our experience of a rare WG in the aspect of oral manifestation, Histologic behaviour, differential diagnosis with prognosis Abstract & Treatment modalities. Background/Introduction Methods Communication or fistula tract between oral cavity and maxillary here 2 case report, both were female with oral lesion in different in antrum mainly shows nasal regurgitation, loss of resonance, foul location that demonstrate the disease spectrum and current status of smelling pus discharge, post nasal drip etc. This might be the result of WG with respect to diagnosis, laboratory findings and treatment. iatrogenic complications or from dental infections, osteomyelitis, Results radiation therapy or trauma. The management of fistula or oro-antral After 3 month of follow up both patient was quiet normal and relieved communication depends on the duration, size of the defects, location of all symptoms. No any mortaltity. Patient is on regular follow up. and associated sinus infection and inflammation. Various treatment Conclusions modalities have been suggested based on the above mentioned Clinician should be aware with the broad spectrum of oral and sys- criteria. temic component of WG as well as disease recognition and provide oral health to these patients.

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Objectives EPS00442 The main objective of the surgery is to close the defect, prevent nasal A Demon Hiding in Plain Sight: Parotid Fistula—A regurgitation and sinus inflammation. Methods Case Report In this poster we would like to share our experience of managing oroantral fistula using buccal advancement flap, buccal fat pad with Dr Afshan Qureshi buccal advancement flap and Facial Artery Musculomucosal Flap. Results Abstract All the technique shows good results and there is no gapping of Background/Introduction closure seen. Trauma is the most common etiology for a parotid fistula. Other Conclusions causes include post parotidectomy, infections and malignancy. We Buccal advancement flap is the most commonly use technique for report two cases of a chronic parotid fistula. Diagnosis was confirmed closure of oro-antral fistula with small defects. Disadvantages, is the by fistulography and ultrasonography of the local part. One patient risk of reduction of the buccal sulcus depth. Buccal fat pad flap has underwent superficial parotidectomy and the other patient showed been widely used to reconstruct OAF with moderate defects because favourable outcomes with warm saline injections and pressure of its physical and biological properties like anatomical location dressing of the fistulous tract and closure of the cutaneous opening of closest to the recipient bed, vascularization, etc. The facial artery fistula. No recurrence of the fistula has been reported in these two musculomucosal flap, technically a combination of the nasolabial flap pateints over a period of 6 months. and the buccal mucosal flap which use in closure of large defects of Objectives oro-antral fistula. Early diagnosis and judicious treatment planning in patients with trauma in the pre-auricular region. Methods EPS00436 1. Warm saline injections intralesionally followed by pressure Evaluation of Technique of Coronectomy dressing. 2. Superficial parotidectomy. Results of Mandibular 3rd Molars Situated in Close Proximity Both the procedures gave favourable results, with no sign of re- to the IAN occurrence with a follow up of 6 months on both the patients. Conclusions Dr. Kamil Rajpari (3rd PG), Dr. Neelam. N. Andrade (Professor & Treatment modalities differ from patient to patient, early diagnosis & HOD), Dr. Tejas Mhatre judicious treatment planning does happen to give favourable outcomes. Nair Hospital & Dental College

Abstract EPS00459 Background/Introduction Recent Imaging Modalities in Oral & Maxillofacial The mandibular third molar remains the tooth most prone to impac- Surgery tion. Problems which may arise due to tooth impaction include pericoronitis, cheek biting, pressure on adjacent teeth resulting in pain, food impaction, association with pathological lesions such as Giriraj Sandeep cysts and tumours. Thus, the surgical removal of impacted wisdom teeth remains a common procedure in dental practice. Paraesthesia, Raja Rajeswari Dental College & Hospital, Bangalore anaesthesia of the inferior alveolar nerve are unwanted complications of third molar surgery that are frequently disturbing to both the patient Abstract and the practitioner. Background/Introduction Objectives Radiographic Imaging is one of the greatest investigative tools used in 1. To evaluate the beneﬁts of coronectomy of mandibular 3rd molar medical sciences since ages. In the early ages, there were no imaging situated in close proximity to the neurovascular bundle. 2. To evaluate tools that are required to assess the disease severity later on the change in position of the remaining root stumps in association with invention of radiographs brought little use in the clinical assessment the neurovascular bundle. of a disease and its severity. Various advancements like Ultrasound Methods (US), Computerized Tomography (CT), Magnetic Resonance Imag- A total of 50 cases were included in the study. Co-relation of the ing (MRI), Positron Emission Tomography (PET), Single Photon anatomic relationship between the tooth apices and the nerve as per Emission Computed Tomography (SPECT) came into existence to the criteria given by JP Rood [1992] were followed as the basis for overcome the disadvantages of each. performing coronectomy. Teeth that had an active peri-apical infec- Objectives tion and mobile teeth were excluded. The parameters included in the To review current advances in imaging technology and their uses in study were neurological evaluation, post-operative trismus, bone different disciplines of oral and maxillofacial surgery. formation, soft tissue healing and change in the position in the roots. Methods Results A retrospective analysis describing the history of advancements in Results showed that the technique of coronectomy in third molars imaging of maxillofacial injuries, joint pathologies and evaluation of does not lead to excessive complications and has a far lower incidence neoplasms and infections. of complications than would be predicted in cases where the radio- Results graphic signs indicate a high risk of nerve damage. Imaging plays a key role in dental implantation, management of Conclusions maxillofacial trauma, facial reconstruction, TMJ pathology, and Coronectomy can be suggested for teeth that are very close to inferior evaluation and treatment of neoplasms and infections. In addition to alveolar nerve with the risk of a secondary operation.

123 S220 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 traditional conventional radiography, recent advances in CT, MRI, Objectives and PET/CT fusion technology have made radiology an even more To ascertain whether during the extraction of permanent maxillary vital Combined PET and CT (PET/CT). teeth a single buccal injection results in a more painful experience Conclusions than the routine use of bilateral injections, and to compare the pain Advances in head and neck imaging can be divided into three broad resulting from 2 types of injection. categories: biologic imaging, high (spatial or contrast) resolution Methods imaging and new Magnetic Resonance findings, associated with 100 patients to be studied will be selected from patients visiting the pervasive clinical diagnosis. The significance of the information opd department of oral and maxillofacial surgery, school of dental obtained through these applications is a matter of active research. sciences, sharda university, who needs maxillary tooth extraction. Results According to the VAS scores, the pain of injection between buccal infiltration without a separate palatal injection and routine adminis- EPS00474 tration with additional palatal injection was statistically significant. Endoscopy: A Boon in Maxillofacail Surgery All patients described both extractions as ‘‘acceptable’’ and no patient requested an additional palatal injection to ensure Dr. T. Vignesh Prabhu comfortable extraction. Conclusions The routine use of a palatal injection for the removal of permanent A.E.C.S Maaruti College of Dental Sciences and Research Centre, maxillary teeth may not be required when articaine/HCl is used as the Bangalore-76 local anesthetic.

Abstract Background/Introduction The advanced surgical trend is to enhance the variety of minimally EPS00481 invasive approaches and, in particular, the possible applications of Efficacy of Low Level Laser Therapy Following endoscopy in head and neck surgery. Many procedures of maxillo- Surgical Removal of Impacted Lower Third Molars facial surgery like TMJ disorders, jaw pathologies, trauma and facial aesthetic surgeries can be diagnosed and treated with lesser rate of complications using endoscopic techniques. Recent technological Dr. Manodh, Dr Sailesh Kumar, Dr Arjun Raj advances in field of endoscopy resulted in substantial improvement in techniques of endoscope- controlled oral and maxillofacial Meenakshi Ammal Dental College and Hospital, Chennai procedures. Objectives Abstract Importance of endoscopy in maxillofacial surgery. Background/Introduction Methods To evaluate the effectiveness of Low-Level Laser Therapy (LLLT) in Described In Detail In E-Poster. the control of postoperative pain, swelling, and trismus associated Results with the surgical removal of impacted mandibular third molars. It Is An Overview Of Endoscopy Applications In Maxillofacial Sur- Objectives gery And Should Be Considered For Further Research And This prospective study was done to control postoperative pain, Development In Maxillofacial Surgery. swelling and trismus using Low Level Laser therapy and to compare Conclusions the efficacy of Low Level Laser therapy over analgesics and antibi- This Poster Presents Endoscopy Is A Minimally Invasive Procedures. otics given after surgical removal of impacted third molars. The Oral And Maxillofacial Surgeons Are Applying Endoscopy In Methods Various Procedures With Different Functions, Increased Success, 2 groups with a sample size of each 25 patients who had undergone Decreased Complications, Enhances Afficiency. prophylactic surgical removal of impacted lower third molars under LA, following which one group received LLLT and other was prescribed analgesics and antibiotics. A diode laser device with a EPS00475 continuous wavelength of 940 nm was used in LLLT. The assessment was carried out with the help of Visual Analog Scale for pain and Can a Single Buccal Infiltration of 4% Articaine measurement done for the size of swelling and mouth opening. All Provide Equivalent Local Anesthesia as Compared patients included in the study were followed up on the 1st, 3rd and 7th to Buccal and Palatal Infiltration of 2% Lignocaine postoperative day. in Maxillary Tooth Extraction? Results Intensity of pain, swelling and extent of mouth opening was lower in the laser group than in the control group using analgesic and antibiotic Dr. Suchismita Tripathi and Dr. Indrajeet Singh medications in all evaluations. Conclusions Abstract Patients treated with LLLT experienced larger clinical reductions in Background/Introduction the intensities of pain, swelling, and trismus postoperatively. This The aim of the study is to demostrate whether articaine administered avoids use of medications and discomfort after third molar surgery alone as a single buccal infiltration in a maxillary tooth removal and complications of the same. provided favorable palatal anaesthesia as compared to buccal and palatal injection, for a surgical procedure.

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EPS00492 EPS00493 Recent Advances in Wound Healing Plasma Cell Lesion a Rare Case

Dr. Aashi Gupta, Post-Graduate Student, Dr. Amit Bali, Professor Dr. Amit Patange/Dr. Ramdas Balakrishna/Dr. Suhas Prabhakar

Dept. of Oral and Maxillofacial Surgery, MMCDSR, Maharishi KLE Societys Institute of Dental Sciences, Bangalore Markandeshwar University, Mullana Abstract Abstract Background/Introduction Background/Introduction A Rare case of plasma cell tumor was referred to our institution with a Successful wound care involves local and systemic factors of a patient complaint of nasal discharge and pain over cheek and perialar region. in an ideal wound healing environment. The importance of wound Objectives care cannot be underestimated, as poorly managed acute wound can A Case report. result in a chronic wound, which in many cases have eventually Methods resulted in the failure of treatment. In the past, wound healing was Patient name Akash 21 yr old male went to ENT surgeon with a related to dry environment as it supported the fact that dry environ- complaint of nasal discharge since 1 month and pain on left cheek and ment would prevent bacterial growth. However, as supported by perialar region since 15days. PNS view revealed hazyness in the left recent evidences, current practices emphasise on moist wound closure maxillary sinus. The patient was then referred to our institution for the to prevent cell dehydration; stimulate cell migration, collagen syn- further management. CT scan revealed a cystic lesion in the left thesis and angiogenesis. maxillary sinus with erosion of anterior wall of maxillary sinus and Objectives with expansion of anterior and posterior aspect of the hard palate. This presentation aims to discuss recent updates in wound closure Aspiration of the lesion revealed a mucous exudate. Biopsy shows techniques and products. non specific inflammatory lesion. Enucleation of the cystic lesion was Methods done under General Anaesthesia. Study of PeriAcryl90 Oral Tissue Adhesive (GluStitch), OpSite Results (Smith &Nephew, London, England), Derma Gel (Medline Industries Histopathology revealed that the connective tissue stroma was found Inc, Mundelein, IL), DuoDERM (Convatec, Skillman, NJ), Tegaderm to be rich in plasma cells arranged in sheets and nodules along with alginate silver (3M, St Paul, MN), Lyofoam (Molnlycke Health care, Russell bodies suggestive of a plasma rich lesion. IHC studies for USA, LLC, Norcoss, GA) and Biobrane (Smith &Nephew, London, Kappa and Lamda were advised to obtain a definitive diagnosis. England) on wound healing. Conclusions Results Role of Immunohistochemistry, diagnosis and management will be Closure methodologies for surgical or traumatic wounds include discussed. suture, staples, adhesives and glues. Sutures have been the popular aid in wound closure from the past. Tissue adhesives are a new entry to limit the use of sutures as they cause less trauma to the investing tissues, fall in the rate of needle stick injuries, less technique sensitive EPS00495 and no more follow-up appointments for suture removal. Update in Parotidectomy (Retrograde Facial Nerve Dissection) wound dressing methods promote the moist environment required for wound healing. It’s observed that films give an effective barrier to Dr Hemanth Cr external contamination and are transparent. However, hydrogels are comfortable wound dressing containing desloughing agents. In many College of Dental Sciences, Davangere cases, wound dressing should have been waterproof. Hydrocolloids are waterproof, with a mixture of pectins, gelatins, sodium car- boxymethylcellulose and elastomers. They showed promotion of Abstract granulation tissue and were found cost-effective. In few cases Background/Introduction haemostatic properties of alginates came to use. They have proved Tumors of salivary gland are relatively uncommon and represent 2% exceptional utility in sinuses. Foam dressings conform to body con- of all head and neck neoplasms. Parotid gland comprises to 85% of tours. However, superficial wound closure was best done by laminates salivary gland tumors of which 80% are benign with pleomorphic in most subjects. adenoma parotidectomy is a common surgical procedure for the Conclusions treatment of benign and malignant lesions of parotid gland. Many clinicians stick to the old school methods for wound care while Objectives new products and technologies have been launched in wound care Analysing the efficacy of retrograde facial nerve disection compared armamentarium. The field of wound care is expanding with ever to antegrade facial nerve dissection in treating the parotid gland advancing technology and concepts. It is required that clinicians tumors. practice and adapt to the products in order to deliver better and speedy Methods healing of wounds. Review of literature. Results Retrograde facial nerve dissection is an easy technique with low complication and without compromising surgical outcome when compared to antegrade facial nerve dissection. Conclusions Superficial parotidectomy is the most preferred in treating lesions of the parotid gland tumors. Retrograde facial nerve dissection is an easy technique with low complication and without compromising surgical outcome.

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EPS00503 postoperative complications, the use of corticosteroids has gained Efficacy of Hydroxyapatite and Platelet Rich Plasma wide acceptance. Objectives in Bilateral Mandibular Impaction This study was conducted at the Department of Oral and Maxillofa- cial Surgery, ITS Dental College, Greater Noida and included 60 Dr. Ravi Ganeshwar patients in 30 each group of whom required removal of a single impacted mandibular third molar under local anesthesia. Measure- Sree Balaji Dental College ments of facial swelling, trismus and pain were made preoperatively and on the first, third, and seventh postoperative days. Abstract Methods Background/Introduction The study includes 60 patients 30 in group A and 30 in group B each Healing of bone is a complex process which involves participation of of whom required removal of a single impacted mandibular third many cell types and growth factors. The healing of fracture or wound molar under local anaesthesia, were randomly allocated to one of 2 is accomplished by the interaction of osteoblasts and extracellular groups of 30 each. The 2 groups were given dexamethasone 4 mg matrix under the influence of various growth factors of which some submucosally and intramuscularly. are secreted by platelets. These factors can activate the proliferation Results and differentiation of the local osteoprogenitor cells into bone Both dexamethasone groups A & B were associated with a significant forming cells leading to the formation of new bone matrix and reduction in the amounts of swelling and pain, but group A submu- mineralization. cosal dexamethasone had a significant effect on swelling and trismus. Objectives The comparable results obtained shows that submucosal dexametha- After surgically removed identical mesioangular mandibular impac- sone is an effective alternative to dexamethasone given systemically. tion and placing bone graft. By combining with calcium chloride, Conclusions PRP releases these growth factors. Soft tissue healing is also sub- Submucosal dexamethasone, is quite simple, less invasive, painless, stantially improved through the application of PRP, by increasing convenient for the surgeon and the patient, and offers a low-cost collagen content, promoting angiogenesis and increasing early wound solution for the typical discomfort associated with the extraction of strength. impacted lower third molars. Methods The extraction socket of the study group was packed with PRP and hydroxyapatite granules and that of control group was sutured without EPS00529 PRP and hydroxyapatite. The bone density of both extraction sockets were evaluated radiographically using gray level histogram and Uses of Autologous Fat in Maxillofacial Surgery compared periodically on immediate postoperative day, 1st and 3rd month postoperatively and postoperative sequelae of both the control Ashish Shukla group and study group in terms of oedema & pain or any other adverse reactions were also assessed. Raja Rajeswari Dental College & Hospital, Bengalore Results Data suggested evidence of early bone formation and maturation Abstract radiographically in study group as compared to control group. The Background/Introduction percentage of facial swelling was numerically greater on the control Autologous fat filling can be considered as valid alternative in various side as compared to the study side, procedures for both functional and aesthetic purposes. The use of Conclusions adipose tissue transfer for the correction of maxillo-facial defects was This study clearly indicated a definitive improvement in the wound first reported at the end of the 19th century by Neuber and has since healing, increase in bone density, which signifies and highlights the been subject of numerous research projects and studies. use of PRP and hydroxyapatite granules, certainly as a valid method Objectives in inducing and accelerating bone regeneration. To review the uses of autologous fat in the field of maxillofacial surgery and its outcomes. Methods ABS00519 Clinical applications include soft tissue augmentation to improve contour irregularities, interpositional material in TMJ surgery, malar A Comparative Study on Effects of Dexamethasone augmentation and treatment of post parotidectomy defects. Buccal fat Sodium Phosphate Given Submucosally pad- derived stem cells in combination with autogenous illiac bone and Intramuscularly on Postoperative Complications graft is used in the treatment of maxillofacial atrophy. after Removal of Impacted Lower Third Molars Results This poster reviews the basic principles underlying fat injection and overview of their use in maxillofacial regions. Dr. Sonal, Dr. Amit Kumar Conclusions This autologous fat is completely biocompatible, in most patients ITS Dental College & Hospital, Greater Noida, UP available in sufficient quantities naturally integrated into the host tissue, removable if necessary, cost effective and potentially Abstract permanent. Background/Introduction The removal of lower 3rd molars is the most common surgical procedure and is often associated with swelling, pain, and trismus as a result of the postoperative inflammatory response. To reduce

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ABS00530 extraction was performed under local anesthesia by different opera- A Novel Therapeutic Regenaration in Periapical tors and surgical difficulty was assessed by the total intervention time. Results Surgery: Case Series ANOVA test was performed and increased surgical difficulty was associated with gender and tongue encroachment. It was also asso- Keerthi R ciated with the occlusal level of impaction, retromolar space, bone content, and angulation of the impaction (P\ 0.05). Sri Sai Collage of Dental Surgery, Vikarabad, Telangana Conclusions Both clinical and radiological factors are essential in predicting sur- Abstract gical difficulty in impacted mandibular third molar removal and in Background/Introduction order minimize postoperative complications. Apical surgery is considered a standard oral surgical procedure. It is often a last resort to surgically maintain a tooth with a periapical lesion that cannot be managed with conventional endodontic (re- EPS00545 )treatment. Objectives A Comparative Study to Evaluate Efficacy of 0.5% To assess the potential benefits of a combination of bone graft, pla- Centbucridine to 2% Lignocaine (with Adrenaline) telet-rich fibrin (PRF) and amnion membrane in terms of reduced as Local Anesthetics in Dental Extractions post-operative discomfort, Radiographic evidence of accelerated periapical bone healing and present a novel therapeutic option in the Dr. Dipak B, Dr. Dhanshree J, Dr. Snehal I, Dr. Deepshree M, Dr. management of large periapical lesions. Aanand N, Dr. Ankit S Methods Two cases of radicular cysts were treated through a combined regenerative approach of Bio-Gen mixÒ, PRF and amnion membrane. Nair Hospital Dental College, Mumbai 40008 The patients were assessed for discomfort immediate post-operatively and after a week. The patients were recalled every month for the next Abstract 6 months for radiographic assessment of the periapical healing. Background/Introduction Results 2% Lignocaine is the most commonly used local anesthetic (LA) Amnion membrane combined with bone graft and PRF have enhanced agent has a vasodilative effect and needs to be combined with adre- the radiographic healing outcome and reduced the post-operative naline. O.5% Centbucridine is a non-ester, non-amide group Of LA discomfort. with an inherent vasoconstructive property. Because of encouraging Conclusions results of earlier trials, we decided to undertake a study between 0.5% The results of this case series substantiates the credibility of using a Centbucridine & 2% lignocaine with epinephrine in dental procedure, combination of amnion membrane with a bone graft and PRF to which is considered as reference standard. enhance radiographic healing outcome with decreased post-operative Objectives discomfort and present a viable regenerative treatment modality in 1. To study Onset of action, Depth, Duration of anesthesia & Vaso- periapical surgery. constriction ability 2. To study and compare the systemic changes. 3. To observe any signs of toxicity & allergic reaction after administration. Methods EPS00542 The study group comprised of fifty patients, male and female, of Morphological Factors in Determining the Difficulty consenting age which required extraction of bilateral mandibular non Index in Impacted Mandibular Third Molar Surgery impacted molars, by Pterygomandibular block. Results 1. 2%Lignocaine with epinephrine shows longer duration and greater Kalangi Raja Harsha depth of anesthesia. 2. 0.5% Centbucridine shows better cardiovascular stability & onset of aneasthesia. Abstract Conclusions Background/Introduction A total 50 patient were included & there were no significant differ- Surgical removal of mandibular impacted third molars is one of the ences with LA’S. Centbucridine can be used for dental procedure in most common surgical procedures carried out in oral and maxillofa- patients who cannot tolerate lignocaine or where adrenaline is cial surgery. Our study mainly focuses on predicting the local factors contraindicated. based on clinical and radiological information is essential in the safeguard of the surgeon, the preparation of the patient for the procedure, minimizing operative time and also to minimizing the risk of postoperative complications. EPS00546 Objectives Malignant Otitis Externa Associated with Osteomyelitis The objective of this study was to investigate morphological factors of Condyle and radiological factors associated in the removal of impacted mandibular third molars and also to correlate with the total surgical intervention time. CH. Mohan Vamsikrishna Guided by Dr. P. Srinivas Chakravarthy Methods A total of 50 patients who were diagnosed with 50 impacted Abstract mandibular third molars, were involved in the study. All the radio- Background/Introduction logical and clinical data were taken preoperatively. Surgical Malignant otitis externa refers to invasive infection in external auditory canal and skull base caused by pseudomonas aeruginosa,

123 S224 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 staphylococcus aureus, klebsiella, proteus and some fungus such as EPS00562 aspergillus, fumigatus. A Comparitive Study to Evaluate the Benefits Objectives Objective of this presentation elucidates the specific features of of Dexmedetomidine Injected in Combination clinical course of malignant otitis externa and its treatment by com- with Lignocaine Verses Only Lignocaine During bination of pharmacological and surgical treatment. Surgical Extraction of Impacted Mandibular Third Methods Molar Patient underwent antimicrobial regimen with no improvement with in 10days then patient underwent antifungal therapy and finally underwent surgical procedure by pre auricular appraoch condylec- Dr. Parijat Singh tomy and post auricular approach mastoidectomy and debridement of inflammatory changes in auditory canal. Kothiwal Dental College and Research Centre Moradabad Results By this ccombination of pharmacological and surgical approach Abstract Infection is cleared without any postoperative complications and also Background/Introduction no recurrence is observed. Dexmedetomidine, a selective a-2 adrenoceptor agonist, is intra- Conclusions venously administered to patients as a sedative. However, attention Several therapies are described for MOE and osteomyelitis treatment. has recently been paid to dexmedetomidine as a possible additive for They range from simple antibiotic treatment up to wide resections, local anesthesia. Acomparative study was conducted to evaluate the and combination of both. We hereby conclude that timely treatment benefits of adding dexmedetomidine to local anesthesia during of this disease is paramount and this must be based upon specific mandibular third molar impaction surgery with mandibular third diagnosis and pharmacological and surgical treatment so as to guar- molar impaction surgery when local anesthesia is used alone. antee total removal of the lesion. Objectives To assess the overall comfort during the surgery o To assess the perioperative pain control o To assess the sedative effect on the patient o To evaluate the cardio-vascular status of the patient. ABS00561 Methods Comparison of Physics Forceps V/S Conventional 30 healthy patients of mandibular impacted third molar were taken. Forceps in Extraction of Grossly Decayed and RCT The patients were randomly selected for choice of local anesthetic Failed Mandibular Molar Tooth: A Triple Blinded solution viz. local anesthetic ? dexmedetomidine (12.5 microgram) or local anesthesia alone with vasoconstrictor. Group 1: consists of 15 Randomized Control Trial patients who will be undergoing surgical extraction of mandibular third molar under 2 ml of lignocaine without vasoconstrictor plus Dr. Vandana Singh, Prof Dr. Uma Maheswari, Prof. Dr. Muthusekar 0.125 ml dexmedetomedine (12.5 microgram) Group 2: consists of 15 patients who will be undergoing surgical extraction of mandibular Saveetha Dental College, Chennai third molar under 2 ml of lignocaine with vasoconstrictor. Results Abstract In the group 1 the onset of action of local anesthesia was reduced and Background/Introduction the duration of action was increased. Sedative score 2 was seen in the The Physics forceps were developed by Golden Dental Solutions, group 1. Michigan which is based on the biomechanical principles of a first- Conclusions class lever, creep and stress distribution without the squeezing, Addition of dexmedetomidine to lidocaine enhances the potency of grasping, twisting and pulling forces to perform atrumatic extraction. lidocaine without any major influences on the cardiovascular system Conventional forceps work by forces placed equally on the facial and when locally injected. lingual portion of the tooth and elevating it out of the socket by movement of the operator’s arm and wrist. This pulling force technique invites unnecessary complications including fracture of roots, EPS00589 bone and loss of tissue. Objectives A Common Tumor in an Uncommon Location 1. To reduce postoperative pain and swelling. 2. To reduce Gingival Laceration. 3. To avoid fracture of cortical plate for future prosthetic 1. Dr Rahul Kumar Sanklecha, 2. Dr. Abdulla Kirash placement. Methods Sri Hasanamba Dental College and Hospital 62 patients took part in this Triple blinded Randomized control trial. To compare the outcomes of two groups. Patients where randomized Abstract and equally divided in two groups, Background/Introduction Results Keratocystic Odontogenic Tumor (KCOT) is an aggressive tumor of Pysics forceps had statistically significant reduction in operating time, odontogenic epithelium. It comprises 3% to 11% of all oral tumors It significant lesser fracture of buccal bone and there was not much is uncommon in the maxilla, with 20 % of cases occurring in the difference in postoperative pain. posterior maxillary region and only 13 % in the anterior region. Conclusions Hence, finding a KCOT in the maxilla is rare and more so in the According to the study, physics forceps was more effficient in anterior region. extraction of grossly decayed and RCT Failed tooth compare to Objectives conventional forceps. To evaluate swellings in the anterior maxilla.

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Methods and project through restoration of known horizontal, vertical and We hereby present you a 39 year old male patient who presented to sagittal buttresses. our unit with the chief complaint of swelling in the upper front teeth Objectives region since 6 months. He gave history of trauma to the teeth 2 years The aim is to aid in assessing the intra-operative position, projection ago. He was a chronic smoker and alcoholic. The swelling was and symmetry of repositioned or deformed skeletal anatong, visual- intermittently increasing and decreasing in size and it was also ization of deep skeletal contours involving the orbit, mandibular associated with pain. The treatment was done by surgical excision and condyle and skull base, variation in head position and craniofacial chemical cauterization of the tumour. development. Results Methods There was no recurrence of tumour noted after the patient was fol- CAD/CAM software enables the clinician to import 2-D CT data in lowed up for 1.5 years. DICOM format and generate an accurate 3-D representation of Conclusions skeletal and soft tissue anatomy. The swellings occurring in the jaw bones are not always common Results cysts. So keeping in mind all the possible diagnosis we have to make There are several factors that contribute to poor outcomes, including all the required investigations and plan the treatment accordingly. surgeons. Reliance on 2-D imaging for treatment planning on a 3-D problem have been overcome by the application of the above mentioned system in oral and maxillofacial surgeries. Conclusions EPS00592 Computer aided navigation surgeries has shown great potential for Acinic Cell Carcinoma: An Incidental Finding (A Case clinical application particularly when precise location of any instru- Report) ment or bony anatomic landmark is required.

Amruta ABS00614 Vokkaligara Sangha Dental College ‘‘Scalpel Versus Diathermy’’: The Better Wand?

Abstract Dr. Abdul Wahab, Dr. Madhulaxmi, Dr. Abhinav Prabhu, Dr. Manay Background/Introduction Roshini Acinic cell carcinoma is a malignant tumour representing 2% of all salivary tumours. It arises more frequently in parotid gland. Previ- Saveetha Dental College, Chennai ously malignant nature of this carcinoma was disputed and it was termed as acinic cell tumour or benign adenoma considering its potential to recur and metastatize. Abstract Objectives Background/Introduction The objective of this study was to report a case of 35 year old female Literature has innumerable studies to support or contradict the use of patient who presented with the history of swelling in the right side of scalpel and diathermy in skin incisions and neck dissections. How- cheek since 3 years. ever, there has not been any study to validate the best means in the Methods oral mucosa. Therefore, with our original research work, we hoped to Through Intraoral approach the lesion was surgically excised under solve the dilemma between the use of scalpel and diathermy among local anesthesia. oral and maxillofacial surgeons. Results Objectives The excised lesion was then confirmed histopathologically as Acinic The purpose of the study was to compare the wound healing of cell Carcinoma of parotid gland. mucosal incisions made by scalpel and diathermy. Conclusions Methods Therefore we conclude that acinic cell carcinoma can be successfully A prospective, split mouth study was designed on patients undergoing treated with superficial or total parotidectomy with sparing of facial anterior maxillary osteotomy, Le fort 1 osteotomy or both, during the nerve. time period from January 2015 to April 2017. In group A, the incision was made by scalpel and in group B, the incision was made by diathermy. Southampton scoring system was used to assess the wound healing on the first, third, seventh and tenth postoperative days. EPS00594 Student’s t-test was used to compare continuous variables, and the¨ Ià2 Computer Aided Navigation Surgeries test was used to compare proportions among groups. P \ 0.05 was considered significant. Results Diganth A total of 113 participants were enrolled in the study. 77 patients in group A and 87 patients in group B had postoperative complications Vokkaligara Sangha Dental College of wound healing. The difference in wound healing between the two groups was statistically significant (p). Abstract Conclusions Background/Introduction We observed that wound healing was better in the scalpel incisions Requiring functional and esthetic considerations, surgery in the oral when compared to the incisions made with diathermy. and maxillofacial region remains intellectually and technically challenging for even the most experienced surgeons. Complex congenital, developmental and acquired deformities of craniomaxilofacial skeleton are currently managed by re-establishing facial symmetry

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EPS00615 touch), but studies on chemogustatory changes are minimal or less A Prospective Study to Compare and Evaluate documented. Objectives the Synergistic Effect of Platelet Rich Fibrin (PRF) 1. To evaluate changes in gustatory sensations with Claussen’s and Alendronate in Post Extraction Sockets 5-Komponent-Chemo-Gustometry. 2. To establish a statistical co- relation between type of impaction, Pederson’s difficulty index score Dr. Yama N. Patel and incidence of suprathreshold taste change. Methods A total of 60 subjects were included in the study. Chemogustatory Karnavati School of Dentistry, Uvarsad, Gandhinagar, Gujarat evaluation was perfomed pre and postoperatively by dividing the subjects into group 1 (difficulty index score 3-4), group 2 (difficulty Abstract index score 5-6) and group 3 (difficulty index score 7-8). The con- Background/Introduction tralateral side of the included patient was considered as control. Five Maintenance of alveolar bone width and height following tooth loss is variant chemical stimuli with three differential concentrations were essential with regard to the restoration of missing teeth with used: - Sweet- glucose in solution - Salty-sodium chloride solutions - endosseous dental implants or prosthodontic approach. A various Sour-citric acid - Bitter- quinine solution - Bitter-phenylthiourea. amount of alveolar ridge resorption is likely to occur after tooth Results extraction at buccal and lingual alveolar bone plates. Alendronate is Group 3 subjects showed higher incidence of increase in taste well known for its potent inhibition of osteoclast-mediated bone threshold with statistical significant P value of 0.001. - Salty and sour resorption. Platelet rich fibrin (PRF) could serve as a resorbable taste have more predilection for increased taste threshold. membrane for guided bone regeneration (GBR), that allows the Conclusions migration of osteogenic and angiogenic cells and permits the under- Suprathreshold taste changes occur after surgical removal of an lying blood clot to mineralize. impacted mandibular third molar with high difficulty index score. Objectives These deficits maybe the result of nerve compression, laceration or objective of this study is to compare and evaluate the synergistic stretch, but get resolved within three months. Increased awareness of effect of alendronate and PRF in to extraction socket. these complications will allow the practitioner to effectively com- Methods municate with patients prior to the surgical procedure. Twenty patients with age between 25 and 65 years were selected from the out patient department of Oral and maxillofacial department, Karnavati school of dentistry. The patients were divided into two groups: 10 patients in each group. In 1 group after the extraction of EPS00620 teeth from molars to midline the sockets were irrigated with saline Management of Complications of Lateral Window and sutured on right side, on left side PRF was placed and sutured. In the other group the right side was treated the same way after Approach Sinus Lift Procedure extraction as in first group where as in the left side sockets PRF soaked in 20mg/ml alendronate was placed and sutured. Patients were Dr. Sandeep Thadani, Dr. Swapna Nayan, Dr. Gokul Venkateshwar evaluated: clinically for any local irritation, socket closure, swelling and pain; Radiologically with orthopantomograph or IOPA X-rays D.Y Patil University School of Dentistry were taken immediately after the extraction, 1 month after extraction and 3 months after extraction to determine the amount of bone loss Abstract prevented. Background/Introduction Results Sinus lift procedure using lateral window approach is a commonly Clinical study is under progress. performed oral surgical procedure in oral and maxillofacial surgical Conclusions practice. Lateral window approach has its associated possible com- Clinical study is under progress. plications of post-operative bleeding, swelling, perforation of schneiderian membrane, displacement of implant, paresthesia and sinusitis which have a direct impact on the patient’s quality of life EPS00617 after the surgery. Objectives Short Term Evaluation of Gustatory Changes After To study the postoperative seqeulae after lateral window sinus lift and Surgical Removal of Mandibular Third Molar: methods of their management. A Prospective Randomized Control Trial Methods In a series of 5 patients, various complications such as bleeding, perforation of schneiderian membrane, implant displaced into the First Author: Dr. Rahul Anand (Former Postgraduate Student), sinus, paresthesia, acute sinusitis and graft infection and exposure Second Author: Dr. D. Prabhu Shankar Reader, Presenter: Dr. were encountered and managed successfully. Melita Juliet J (Postgraduate) Results Maxillary sinus elevation procedure using lateral window approach Meenakshi Ammal Dental College and Hospital may have various complications which if managed can make this procedure worthwhile to both the surgeon and the patient. Abstract Conclusions Background/Introduction Maxillary sinus elevation procedure using lateral window approach Nothing would be more tiresome than eating and drinking if God had may have various complications which if managed can make this not made taste as pleasure and food as necessity. Voltaire Peripheral procedure worthwhile to both the surgeon and the patient. nerve damage associated with third molar extraction is almost exclusively reported as a somatosensory change (primarily involving

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EPS00626 Objectives Efficacy of 7.5% Buffered Lignocaine Hydrochloride To radiographically assess the lamina dura, bone density and trabecular pattern at the extraction site. To compare the radiological During Surgical Removal of Impacted Mandibular parameters in GroupA (PRF) with GroupB (PRP). Third Molars: A Prospective Double Blinded Methods Randomized Control Trial 30 adult patients with age of 19-35 years undergoing bilateral 3rd molar extraction were selected. Out of 30 patients 15 were included in groupA (PRF) and groupB (PRP). PRF and PRP preparation was done Dr R S Neelakandan, Dr Prabhu Shankar, Dr Faiza M and placed in the sockets after extraction in respective groups and bone healing was assessed using RVG at 4th and 8th week. Meenakshi Ammal Dental College Results No statistical difference present between GroupA and GroupB at 4th Abstract week post-op. Statistical difference present between GroupA and Background/Introduction GroupB at 8th week post-op. Injection of local anaesthesia is often the only painful part of a dental Conclusions procedure. Many factors influence the pain on injection, including pH We concluded that PRF is a viable option to improve postoperative of the solution. Alkalinizing local anaesthetics has been attempted healing in extraction sockets. over the years to alleviate pain leading to the concept of buffering local anaesthetics. Objectives To determine the effect of 7.5% Sodium bicarbonate as a buffering EPS00647 agent to local anaesthetic on Pain, Onset & Duration. Aggressive Osteoblastoma: A Diagnostic Challenge? Methods Split-mouth study involving 50 patients. Control: 2% Lignocaine Dr K Raghunandan, Guided by Dr. Joyce P. Sequeira Hydrochloride with 1:80,000 conc. Adrenaline Study: 7.5% Buffered Lignocaine hydrochloride with 1:80,000 conc. Adrenaline. Parame- ters assessed: Pain using VAS Time of onset Duration of anaesthesia. Yenepoya Dental College and Hospital Results All patients had no pain with Buffered solution whereas majority had Abstract moderate to severe pain with Conventional Lignocaine Onset time Background/Introduction with Buffered Lignocaine was 0–30 secs and greater than 60 secs with Benign osteoblastoma is a rare primary bone tumor that constitutes conventional lignocaine. The anaesthetic effect stayed for over 5 approximately 1% of all primary bone tumors. Its occurrence in the hours with Buffered lignocaine and was less than 3 hours with con- craniomaxillofacial region is also rare and represents only 15% of all ventional lignocaine. osteoblastomas. The tumor shows a predilection for the male gender Conclusions and constitutes less than 1% of all tumors of the maxillofacial region. 2% lignocaine with 7.5% sodium bicarbonate significantly decreases In the maxillofacial region, the mandible is affected more frequently pain, provide rapid onset and prolongs duration of anaesthesia when than the maxilla. Few cases of osteoblastomas involving maxillofacial compared to Unbuffered 2% lignocaine during administration of region have been reported in the literature. IANB. Objectives This case report is regarding a 47-year-old female patient with a solitary swelling on the left palate involving alveolar ridge and buccal vestibule measuring 3*2cm and excision biopsy of the same was done EPS00629 under LA and extraction of 25 root stump was done. Biopsy report Assessment of Grafted Third Molar Extraction Socket: suggested CHRONIC NONSPECIFIC OSTEOMYELITIS Later A Comparative Study Between Autologous Platelet patient reported to Dept with a recurrence in the same region which was surgically excised under LA on 5/1/16 and the biopsy was sug- Rich Fibrin and Platelet Rich Plasma Grafts gestive of AGGRESSIVE OSSIFYING FIBROMA Again patient has reported with the recurrence of the lesion in the same region and Dr. Neelakandan, Dr. K. Siva Kumar, Dr. Karthik burning sensation since 4months on 28/5/16. The biopsy was suggestive of BENIGN OSTEOBLASTOMA. Again the patient had Meenakshi Ammal Dental College and Hospital, Chennai reported 1year later with the recurrence of the lesion over the same region with associated pain and burning sensation involving 11 21 22 Abstract region for which surgical resection (partial maxillectomy) was done Background/Introduction and histopathological examination was done and suggestive of Dental extractions are the most frequently performed procedure in AGGRESSIVE OSTEOBLASTOMA. oral and maxillofacial surgery. Attempts to improve and hasten bone Methods healing in sockets have been made with autografts and allografts. Not applicable. Disadvantages like donor site morbidity have urged clinicians to look Results for autologous materials like platelet rich plasma and platelet rich Not applicable. fibrin. In this study we are comparing the efficacy of PRF and PRP in Conclusions third molar socket regarding the healing aspect. Not applicable.

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EPS00648 Objectives Surgical Treatment Modalities of Obstructive Sleep The aim of the study is to find the incidence of oro antral communication and its treatment options. Apnea Methods A retrospective study was conducted of patients who reported to the Dr. Naveen Lalchandani Department of Oral and Maxillofacial Surgery from 2012 to 2017. The study was conducted to evaluate aetiology and the treatment Abstract modalities adopted at our Department. Background/Introduction Results Obstructive sleep apnoea (OSA) is a common chronic disorder Out of the 105000 extractions performed in the department, 10 cases affecting about 2–4% of the adult population, with the highest of oro antral communication were reported. The incidence was most prevalence reported among middle-aged men. The condition is common following extraction of first molar followed by second molar characterized by repetitive episodes of complete or partial collapse of and third molar. Most of the cases were closed by buccal fat pad with the upper airway (mainly the oropharyngeal tract) during sleep, with a buccal advancement flap after retrieval of the displaced root from the consequent cessation/reduction of the airflow. The obstructive events antrum through the socket. (apnoeas or hypopnoeas) cause a progressive asphyxia that increas- Conclusions ingly stimulates breathing efforts against the collapsed airway, Primary closure might be considered as a quick method for oro antral typically until the person is awakened. communication. However, in case primary closure of the flap does not Objectives provide adequate closure of the communication, buccal advancement The role of surgery in management of OSA has been widely explored flap or buccal fat pad with buccal advancement flap is the treatment of in an attempt to find a treatment option that could be definitive. choice. However, its role remains extremely controversial. The aim of the surgery is to remove the cause of upper airway obstruction and to widen the airway, after a precise detection of the site where the EPS00664 obstruction occurs. The most common sites of obstruction are the oropharyngeal tract (collapse of the retropalatal and retrolingual Incidence of Odontogenic Infection and Management regions due to macroglossia, low-lying soft palate or enlarged tonsils) Protocol and the nose (congestion, polyposis, chronic rhinitis. Methods Dr Priti Kumari, Dr Venkatesh Anehosur Adenoidectomy, tonsillectomy, uvulo palatopharyngoplasty, nasal surgery, lateral pharyngoplasty, uvulopalatoplasty, linguoplasty, lingual, mandibular advancement, genioglissus advancement, hyoid Department of Oral and Maxillofacial Surgery SDM CDS Dharwad myotomy, maxillomandibular advancement. Results Abstract In adult patient maxillomandibular advancement and tracheostomy Background/Introduction procedure shows more success rates. A retrospective study was conducted of patient who reported in SDM Conclusions CDS CFU with odontogenic infection from August 2012 to August The role of surgery remains controversial. Tonsillectomy and ade- 2017. A total 103 of patient were included in the study. noidectomy are useful in children and in adults with enlarged tonsils. Objectives Uvulopalatopharyngoplasty is a well established procedure to be The aim of the study was to find the incidence of odontogenic considered as a second-line option when PAP has failed. Maxillar infection and management protocol reported to SDM CDS last 5 year. mandibular surgery is extremely effective and can be suggested to Methods patients with craniofacial malformations. All patient in this study underwent surgical incision and drainage, received IV antibiotics, and had culture and sensitivity performed. Patient demographics reviewed were gender, age, involved facial spaces, microorganism identified and antibiotics resistance from EPS00663 culture and sensitivity testing.: The successful management of single Oro Antral Communication: Incidence and Treatment and multi space orofacial odontogenic infections involves identifica- Options tion of the source of the infection, then anatomical space encountered, the predominant microorganism that are found during the various stage of odontogenic facial space infection. Patient should be hospi- Dr. Sayali Desai, Dr. Venkatesh Anehosur talized, and administration of parenteral antibiotics and fluids, utilization of interpretation of laboratory and diagnostic imaging SDM College of Dental Sciences, Dharwad studies and control of possible surgical complication. Results Abstract there were 56 male (54%) and 47 (46%) female patient ranging in age Background/Introduction from 17 to 70 years, with a mean age of 24 years (SD=14.5). Forty Oro antral communication is a common complication following patient (38.8%) presented with a single facial space abcess. The removal of maxillary premolars and molars because of anatomic submandibular space was the most frequent location for a single space proximity of root apices of these teeth to the maxillary antrum. abcess (30%), followed by the buccal space (27.5%) and the lateral Various methods have been described in the literature for closure of pharyngeal space (12.5%). Sixty three (61.2%) patients presented these communications which vary from simple local methods like with multiple space involvement, totalling 142 space involved. The buccal advancement, buccal fat pad to complex regionals like tem- submandibular space (28.2%) was again the most frequent location, poralis flap. followed by the submental space (14.8%) and the lateral pharyngeal space (14.0%), ludwigs angina (2%).

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Conclusions cross bite, previous failure of other devices. Distalisation of molars Patient who underwent surgical incision and drainage in the operating and also distraction osteogenesis. In conclusion surgical assistance room had a tendency for involvement of multiple space abcess with provides better and faster results than only orthodontic treatment in submandibular space, submental and lateral pharyngeal space effected correction of skeletal deformities. most frequently. Gram positive cocci and gram negative rods had the greatest growth percentage in cultures. EPS00677 Minimally Invasive Treatment of Oral Ranuala EPS00667 with a ‘‘Mucosal Tunnel Technique ‘‘ Piezosurgery: A Promising Technical Modality for Osteotomy Dr. M Suresh, Kumar (HOD), Dr. Meraj Sultana

Dr. Mangal Anil More Meghna Institute of Dental Sciences

Y M T Dental College and Hospital, Kharghar, Navi Mumbai Abstract Background/Introduction Abstract A Ranula is a pseudocyst that is caused by extravasation of mucous Background/Introduction from sublingual gland. The term ranula is derived from latin word Piezosurgery is a promising meticulous and soft tissue sparing system ‘‘rana’’meaning frog, as these masses appear as a blue-hued swelling for bone cutting based on ultrasonic vibrations. It has therapeutic in the floor of mouth, reminiscent of a frogs underbelly.’’RANUwas features that include micrometric cut (precise and secure action), a first reported by Hippocrates Celsius. Oral ranulas are located above selective cut (affecting mineralised tissues, but not surrounding soft the mylohyoid and encompass the floor of mouth, whereas cer. Vical tissues) and clear surgical field (the result of cavitation effect created ranulas extend into the fascial spaces of the neck either through or by an irrigation or cooling solution and oscillating tip) The major around the mylohyoid muscle. advantage of piezosurgery are decreased blood loss, less vibration and Objectives noise, reduction in the impact on soft tissues (vessels and nerves) and The mucosal tunnel technique is a safe, effective, simple and mini- increased comfort for the patient. Compaired to traditional methods, it mally invasive treatment of oral ranula. enables optimal healing because it reduces post surgery swelling and Methods discomfort. The indications of piezosurgery in oral and maxillofacial Marsupilization, more often Excision of entire sublingual gland, surgery are sinus lift, bone graft harvesting, osteogenic distraction, Mucosal tunnel technique. ridge expansion, endodontic surgery, periodontal surgery, inferior Results nerve decompression, cyst removal, impacted tooth removal. In Because of the squamous mucosa embeded under the bottom of the conclusion, piezosurgery represents an innovative technical modality sub lingual gland, mucosal tunnel did not heal postoperatively, and for different aspects of bone surgery with a rapidly increasing number the natural channels allowed sufficient drainage of cystic fluid for the of indications in the filled of oral and maxillofacial surgery. ranula to disappear. Conclusions Regardless of the treatment that is used to treat ranulas, the best approach is to preserve the sublingual gland, which ensures that EPS00668 physiological functions are maintained. It is therefore important to Surgically Assisted Orthodontic Treatment find an eff, ective, easy, and minimally-invasive procedure that would allow a short course of treatment, reduce postoperative complication Dr. Priyanka C. Kokane and prevent recurrences.

YMT Dental College and Hospital, Kharghar, Navi Mumbai EPS00682 Abstract Primary Tuberculous Granuloma in Maxilla: A Rare Background/Introduction Case Report Orthodontic treatments are one of the most time consuming treatment. In order to overcome the inconvenience caused to the patient due to the prolonged treatment span, surgically assisted orthodontic treat- Mohammed Faisal ments are the most promising adjuvant to the conventional treatment. It helps in faster tooth movement, safer expansion of constricted Meghana Institute of Dental Sciences, Nizamabad arches, enhanced post-orthodontic treatment stability, retraction of canine, increase traction of impacted tooth and many more. These Abstract uses have lead to the wider acceptance of the procedure. Taking Background/Introduction aesthetic into consideration young adults, & children prefer it as the Tuberculosis is a chronic granulomatous disease caused by most convenient line of treatment. Various procedures which could be Mycobacterium tuberculosis. There are two forms namely primary carried out using the surgical method include: Corticotomy (linear and secondary tuberculosis. Pulmonary tuberculosis is the most cutting technique in the cortical plates surrounding the teeth to pro- common form of primary tuberculosis. Primary tuberculosis in duce mobilization of the teeth.) Surgically assisted rapid palatal extrapulmonary site though very uncommon can occur in any site, expansion (SARPE) Commonly done in adults whose palatal sutures such as skin, brain, bone, eye, genitourinary tract and oral cavity. have fused & cannot be expanded via other techniques. It can also be Objectives: Surgical management of the excision of lesion which is carried out in patients of maxillary hypoplasia, bilateral posterior diagnosed as primary tuberculous granuloma involving maxilla.

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Methods dexamethasonized solution of local anesthesia a freshly prepared A 43 year old male patient reported with chief complaint of swelling mixture of 1.8ml of 2% Lignocaine with adrenaline (1:200000) and 1 in right maxillary region since 1 month associated with pain which is ml (4mg) dexamethasone making 2.8 ml solution. The solution is intermittent, non continuous and relieved on medication. Intraorally deposited in pterygomandibular space. The advantage of such an diffuse swelling in buccal mucosa with mild tenderness without any administration includes ease of administration, single prick for dual secondary changes, histopathological report revealed langerhan’s drug delivery, lesser sting of local anaesthetic injection, prolonged cells suggestive of tuberculous granuloma. duration of the soft tissue anaesthesia and improved quality of life in Results the postoperative period after the surgical procedure. Surgical excision of the lesion followed by post operative treatment Objectives with anti tubercular drug therapy. 1. Evaluation of the latency and duration of Twin-mix vs LAand its Conclusions impact on postoperative sequelae 2. Anti-inflammatory effects of This case report emphasizes the fact that primary oral tuberculosis Twin mix- Local vs various routes of Dexamethasone administration. should be considered in the diagnosis of soft tissue swellings, as the 3. Assessing stability of active ingredients in the twin-mix solution. communicable nature of the disease demands early diagnosis and Methods treatment. A prospective, randomized, double blind trial was designed to validate the efficacy of Twin-mix and LA in the surgical removal of impacted mandibular third molars. Clinical parameters of anaesthetic latency, anaesthetic duration and post-operative patient discomfort EPS00684 were assessed. VAS was used to assess the overall pain and specific Glandular Odontogenic Cyst: A Case Report facial measurements recorded to assess postoperative swelling. The stability of active ingredients were also assessed using a double beam Dr. Bibhu Prasad Mishra, Dr Meghali Diwaker UV-visible spectrophotometery. Plasma dexamethasone determination was done in venous using high performance liquid chromatography. ITS Dental College Results Addition of dexamethasone to lignocaine, and its administration as an Abstract intra-space injection significantly shortens the latency and prolongs Background/Introduction the duration of the soft tissue anesthesia, with improved quality of life Glandular odontogenic cyst is a rare developmental cyst of the jaws. in the post-operative period after surgical extraction of mandibular The histological features of GOC strongly suggest an origin from the third molars. This phenomenon kept local dexamethasone concen- remains of dental lamina. Radiographically GOC presents as well trations high in the tissues surrounding the surgical wound initially defined radiolucencies with uni or multilocular appearance. A case of and higher plasma concentration at the late stages. The anaesthetic GOC in a 35 year old female is presented here. efficacy of the twin-mix admixture and the stability of the local Objectives anesthetic solution was found physically compatible with the solution the cyst was present in the mandibular parasymphyseal region of the of 2 %lignocaine with 1:200,000 epinephrine. The mixing of the two patient. The objective was to carry out decompression of the cyst. solutions did not show any significant variations in the individual Methods solution when subjected to double beam UV visible Clinical, histologic and imaging features were evaluated. Due to the spectrophotometery. high tendency of recurrence and the aggressive potential of GOC, Conclusions Careful clinical and radiological evaluation must be carried out. Dexamethasone, which is 20–30 times more potent than cortisol, Results exerts a strong anti-inflammatory action by inducing the synthesis of No recurrence till 3 months of follow up. endogenous proteins that block the enzymatic activation. Dexam- Conclusions ethasone has a half-life of 36–54h, which makes it a suitable drug for This poster demonstrates the clinical presentation and radiological a single-shot preoperative therapy controlling surgically induced appearance at 1st, 2nd and 3rd month along with etiology and his- inflammation in the maxillofacial region. The preoperative adminis- tological appearance of this rare entity. tration of 4mg dexamethasone in the pterygomandibular space along with local anesthetic solution demonstrated obvious clinical advantages when used for surgical removal of impacted mandibular third EPS00708 molars. This Poster highlights our experience with Twin mix which included a better clinical outcome with improved quality of life Twin Mix Formulation as a Superior Adjunctive postoperatively when compared to use of plain 2%Lignocaine. for Pain and Inflammatory Control in Minor Oral Surgery EPS00716 Dr. Darpan Bhargava, Dr. R.S. Neelakandan, Dr. Shreya Panwar Versatality of Pedicled Buccal Fat Pad in Closure (PG Trainee) of Oral Defects People’s College of Dental Sciences, Bhopal; Meenakshi Ammal Dental College, Chennai Dr. Saurabh Chalke, Dr. Yogesh Kini, Dr. Gokul

Abstract Abstract Background/Introduction Background/Introduction Glucocorticoids are potential suppressor agents of multiple signaling The use of buccal fat pad as a grafting source in the closure of pathways leading to decreased levels of inﬂammatory mediators at the intraoral defects has gained popularity in the last quarter of this site of surgery. This study highlights the use of Twin mix -

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S231 century. Because of the ease of access and rich blood supply, its use in reducing patient morbidity and mortality. Maxillofacial pathologies oral defects is an attractive concept. are often found masquerading as other conditions thus posing a Objectives diagnostic hurdle in patient management. Rare presentation of com- To find out versatality of pedicled buccal fat pad in closure of oral mon pathologies adds to the ambiguity. The purpose of this paper is to defects. present case series of different clinical patterns of odontogenic ker- Methods atocyst and their management. The study comprised of 3 patients with oral submucous fibrosis, 1 patient with oroantral fistula, 1 patient with TMJ ankylosis. The acquired oral defects following resection of pathology in the oral cavity, were reconstructed with pedicled buccal fat pad. The Post ABS00746 operative follow up at the intervals of 1st, 7th and 15th day, followed Antimicrobial Efficacy of Alveogyl vs Zonc Oxide by 1st month, 2nd month and 3rd month was done. Eugenol in Alveolar Ostitis Results The procedure was successful in all the patients. Healing was satisfactory with no breakdown or liquefaction necrosis post operatively. Nivethitha Mohan, Uma Maheshwari All the patients had definitive colour change at the end of 1st post operative month owing to the epithelialisation with uneventful Saveetha Dental College healing. Conclusions Abstract The results of this study support the view that the use of buccal fat pad Background/Introduction is a simple, convenient and reliable method for the reconstruction of This study was done in vitro to compare the antiomicrobial efficacy of small to medium sized intra oral defects. alveogyl vs zinc oxide eugenol in microbial load of alveolar ostitis. Objectives To compare the antiomicrobial efficacy of alveogyl vs zinc oxide eugenol in microbial load of alveolar ostitis. ABS00744 Methods Odontogenic Keratocyst: Our Experience Fresh strains of enterococcus, staphylococcus albus, pesudomonas with Diagnostic and Treatment Challenges aeruginosa were used. 5 round cavities were prepared on the muller’s agar plates. Each batcteria were spread on two agar plates and divided into two groups- group A alveogyl and group B zinc oxide eugenol. Dr. Samridhi Maheshwari, Ist Year Post Graduate, Dr. Pravesh Agar well diffusion method was performed in which in which the Mehra, HOD & Prof zone of inhibition was measured to compare the efficacy of alveogyl vs zinc oxide eugenol. LHMC, New Delhi Results Results Were Represented Diagramatically And Schematically. Abstract Conclusions Background/Introduction Sion Oxide Eugenol Has Better Anti Mibrobial Property As Com- Odontogenic keratocyst (OKC) is a unique cyst because of its locally pared To Alveogyl In Alveolar Osteitis. aggressive behaviour, high recurrence rate and characteristic histological appearance. It accounts for approximately 12% to14% of all odontogenic cysts of the jaws. It has a predilection for the posterior part of the mandible, with a peak incidence in patients between 10 and EPS00750 30 years of age and a slight male predominance. Radiographically, the Lingual Based Flap Incision for Mandibular Third lesion is most often unilocular or multilocular radiolucency, sur- Molar Disimpaction rounded by smooth or scalloped margins with sclerotic borders. OKC has presumably arisen from cell rests of the dental lamina or from offshoots of the basal cell layer of the oral epithelium. Dr. Axadevsinh Pargara, Dr. Anil managutti, Dr. Akash Prajapati Objectives To ascertain the challenges met en route while diagnosing each Narsinhbhai Patel Dental College and Hospital, Visnagar, Gujarat patient efiiciently, thus paving the way for a customised treatment approach. Abstract Methods Background/Introduction This paper attempts to present a case series of three such cases with Third molar can present themselves completely and or partially varied clinical presentations. retained and may be mucosal, submucosal, or completely retained Results within the jaw. The surgical techniques include an incision type, Varied clinical presentations of a similar pathology proved nothing playing a key role in wound healing, presenting a series of incisions short of a diagnostic challenge for us clinicians. However, a systemic described over time, by different researchers and authors, each of approach to clinical reasoning using every step of the diagnostic these has been given to ensure adequate access and decease the side ladder judiciously becomes an imperative tool in achieving the correct effect of the procedures such as pain, trismus, swelling, dry socket diagnosis. Also, tailoring the treatment modality in each case based and infection. on extent of the pathology also added to the complexity. Objectives Conclusions Comparison of post operative complications Pain, Trismus, swelling In management of a disease, diagnostic reasoning remains critical.A and wound dehiscence of conventional flap with lingually based tri- timely diagnosis enables the patient to have the best opportunity for a angular flap for impacted mandibular third molar surgery. positive health outcome because clinical decision making will be tailored to a correct understanding of the afflicting pathology, thus

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Methods EPS00778 A lingually based triangular flap was used to remove the impacted Clinico Radiological Assessment of Alveolar Socket mandibular third molar on the contralateral side of the patient. An incision was made adjacent to the distal surface of the mandibular Preservation Using Autogenous and Alloplastic Bone second molar, and extended along the sulcus to the distobuccal corner Graft of the mandibular second molar. An oblique vestibular incision was made and extended into the vestibular fornix of the mandible, aligned Dr Deepak Tanwar, Dr. Amit Kumar with the mesiobuccal cusp of the second molar. It was continued postero superiorly towards the anterior border of mandibular ramus. ITS Dental College and Hospital, Greater Noida Results Post operative complicatios like Pain, Trismus, swelling and wound dehiscence score is less with lingually based flap incision compared Abstract with other routinlely used triangular flap. Background/Introduction Conclusions To preserve bone at the future implant site we used socket preser- To conclude that this new flap design is preferable to the routinely vation technique. Which involved the placement of autogenous and used flap for impacted third molar surgery. alloplastic bone graft material in future implant site. Objectives To compare effect of autogenous and alloplast graft in 1. Healing EPS00758 Time 2. Bony architecture. Recent Advances of Intermaxillary Fixation Methods The present study was approved by the Institutional Ethical Com- mittee. A randomized, controlled, prospective, Clinical study was Dr Mohit Rathore designed to investigate the efficacy of Autogenous graft in alveolar ridge preservation as compared to nova bone putty. Patients having at BRS Dental College and General Hospital least two teeth indicated for extraction were selected. The two extraction sockets were allocated to one of the following groups using Abstract random number table: Socket grafted with Autogenous graft Socket Background/Introduction grafted with nova bone putty. Intermaxillary fixation (IMF) is commonly used in oral & maxillo- Results facial surgery. Most commonly used in maxillofacial trauma, to Of the 30 selected sites in 15 patients, 30 sites were grafted with ridge achieve stable occlusion for ease of function. preservation technique (15 grafted with Autogenous and 15 grafted Objectives with nova bone dental putty) Among 30 grafted sites, 18 were in the To study the recent advances of IMF such as screws, Thermoforming maxilla (10-Autogenous and nova bone putty) and 12 were in plates, modification of arch bars & using of adhesive cast splint etc. mandible (5-Autogenous and 7-nova bone putty). On the 7th day Methods follow-up visit, uneventful healing was observed in all the patients at Review of literature will be done for various new methods of IMF. all the sites. One patient reported with sign of infection graft rejection. Inference will be drawn on advantages and disadvantages of each At the end of 6 months, a satisfactory clinical healing was observed in technique acc. To literature, same will be presented in pictorial form. all the patients. Visually, Autogenous sites showed minimum alveolar Results ridge width shrinkage compared to sites grafted with nova bone putty. According to the literature different techniques are invented and Conclusions reviewed, all have merits and demerits. The clinical outcome of alveolar ridge preservation procedure is Conclusions satisfactory with no reported complications. The study is able to We belive that newer techniques of IMF are valuable tools in the validate the need of alveolar ridge preservation technique in main- hands of maxillofacial surgeons. taining height and width of residual alveolar ridge after extraction. Autogenous graft has shown more promising results as compared to nova bone dental putty in achieving minimum volumetric alveolar bone loss when it is grafted immediately in postextraction socket. EPS00763 Histologically, it has shown to facilitate new bone formation. Radiofrequency Ablation: A Treatment Modality of Trigeminal Neuralgia EPS00821 Kiran Shubha, Dr. Ravi Narula A Comparative Study of Effectiveness of Three Different Wound Closure Techniques ‘‘A Randomized Abstract Clinical Study’’ Background/Introduction TN is a nueropathic pain condition… Affecting the face… Likely etiology is vascular compression of trigeminal nerve leading to focal Dr. Jasmin Tamboli, Dr. Vrinda Kolte, Dr. Nilima Agrawal (Principal demylination and abberant nureal discharge. Carbamazepine remain Investigator) (Co-Investigator) (Co-Investigator) (P.G. Student) (Prof the drug of choice in the first line treatment of TN. Minimally And Guide) (Senior Lecturer) invasion interventional pain. Therapies and surgeries are possible option when drug therapy fails. Younger patients may benifit from Abstract microvascular decompression, elderly patients with poor surgical risk Background/Introduction may be more suitable for percutanous trigeminal nerve rhizolysis. Different problems that have been come across with the use of sutures KEY WORDS: interventional treatment, minimally invasive, pain encouraged the development of sutureless skin closures such as management, radiofrequency rhizolysis, trigeminal nueralgia. wound glues or more commonly surgical adhesive strips. Here we are

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S233 discussing the benefits and limits of 3 different wound closure EPS00828 techniques. Piezosurgery -Boon to Cranio Maxillofacial Surgery Objectives To evaluate & compare duration needed for the placement of suture with cyanoacrylate and steri strips. - To evaluate and compare wound Dr. Rohit N Rathod [FIRST YR PG OMFS] dehiscence after placement of suture with cyanoacrylate and steri strips. - To evaluate and compare postoperative scar formation after Rajarajeswari Dental College & Hospital, Bangalore, India placement of suture with cyanoacrylate and steri strips. - To evaluate and compare postoperative patient satisfaction after placement of Abstract suture with cyanoacrylate and steri strips. Background/Introduction Methods Piezoelectric device or piezo surgery device was originally developed To evaluate & compare duration needed for the placement of suture for the a traumatic cutting of bone by way of ultrasonic vibrations and with cyanoacrylate and steri strips. - To evaluate and compare wound as an alternative to the mechanical and electrical instruments that are dehiscence after placement of suture with cyanoacrylate and steri used in conventional oral surgery, recent research have also shown the strips. - To evaluate and compare postoperative scar formation after benefits of their use in craniofacial surgery, plastic and reconstructive placement of suture with cyanoacrylate and steri strips. To evaluate surgery, head and neck surgery, neurosurgery, traumatology. and compare postoperative patient satisfaction after placement of Objectives suture with cyanoacrylate and steri strips. 1. To discuss the advantages & disadvantages of piezosurgery. 2. To Results review the current concepts and application of piezosurgery in cran- Awaited. iomaxillofacial surgery. Conclusions Methods Awaited. We have studied piezosurgery over conventional bur method in many cases- 1. Impaction 2. Intraoral bone grafting like parasympsis, ramus, etc 3. Maxillary & mandibular osteotomies 4. Ridge expansion 5. Maxillary Sinus lift 6. Distraction osteogenesis,8 Implants. EPS00827 Results Sinus Lift Key features of piezosurgery include the selective cutting of bone without damaging the adjacent soft tissue (e.g. vessels, nerves or Dr Mohit B Shankar, 1st Year PG mucosa), providing a clear visibility in the operating field, and cutting with micron sensitivity without the generation of heat. Rajarajeshwari Dental College & Hospital Conclusions Piezoelectric device allows better results compared to a traditional surgical saw, intraoperative blood loss, postoperative swelling and Abstract nerve impairment. Background/Introduction The paired maxillary sinuses are air-filled spaces lying within bilateral maxillae, lateral to the nasal cavity, superior to the maxillary teeth, inferior to the orbital floors, and anterior to infratemporal fossa. EPS00836 These are the largest of the paranasal sinuses, measuring an average Determination of Efficacy of Lidocaine 2% of 12.5 mL in vol. The maxillary sinuses are lined with thin bilaminar with Adrenaline 1:200,000 and 0.5% Ropivacaine mucoperiosteal Schneiderian membrane. The primary indication for Without Adrenaline in Infra Orbital Nerve Block sinus graft surgery is planned implant reconstruction of edentulous posterior maxilla afflicted with postextraction alveolar bone loss and sinus pneumatization, resulting in bone too atrophic for implant Dr. Shruti Jain, Dr. S.R. Shenoi, Dr. Nilima Agrawal, Dr. Vrinda placement. Kolte Objectives To discuss the advantages - disadvantages & indications - con- Dr. Anup Garg VSPM’S Dental College Nagpur traindications of these different techniques. Methods Abstract There are currently two techniques widely used for maxillary sinus Background/Introduction augmentation, the lateral window technique & sinus intrusion Peripheral nerve block is a common regional anesthetic technique and osteotomy. These techniques use several types of bone graft material: is used for broad spectrum of surgical, interventional or diagnostic autogenous bone, allograft, xenograft & alloplastic. procedures. Various adjuvant to increase the duration of block are Results describe in literature. The aim of prolonging the duration of block to Newer advanced techniques are better as they are minimally invasive, treat post operative pain is a key issue in regional anesthesia. cause less post-operative trauma, less time consuming and give reli- Objectives able results for successful implant placement. To evaluate and compare the effect of 1.8ml ropivacaine 0.5% and Conclusions 1.8ml lidocaine 2% with adrenaline 1:200,000 in infra orbital nerve The goal of the sinus lift is to graft extra bone into the maxillary sinus, block on – 1. Onset of action 2. Duration of action. so more bone is available to support a dental implant. But the wish of Methods patients and dentists for minimalivasive methods lead to the devel- • 50 patients will be divided in 2 groups wherein, Group A –Lido- opment of new innovative techniques, comprehensive treatment caine group Group B- Ropivacaine group • Both the groups will be planning& reliable implant positioning. evaluated for pain based on VAS and VRS. • Onset- will be calculated from the point of retrieval of needle till the first sensation of numbness • Duration of action- From complete loss of sensation till response to prick of probe.

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Results Section: Miscellaneous Awaited. Conclusions Awaited. EPS0044 Dermal Fillers

EPS00838 Dr. Reethu. M.S Use of Endoscopy in Oral and Maxillofacial Surgery Rajarajeswari Dental College and Hospital Dr. Monisha Uday H Abstract Background/Introduction Rajarajeshwari Dental College and Hospital, Bangalore Dermal fillers plays important role in macro esthetic profile of patient that focuses on overall facial appearance of patient. Filling agents for Abstract soft tissue augmentation procedures are now widely available based Background/Introduction on the long standing successful track records it has wide applications The Endoscope has been described as an extra set of eyes and is the in facial deformities, lip enhancement, depressed scars, facial folds, it basis for innovation across multiple surgical disciplines and the fab- is injected into the skin to help fill in facial wrinkles, restoring a rication of a new class of instruments and surgical techniques. The smoother appearance and play an important role in soft tissue versatility of the endoscope enables the surgeon to deliver a better and augmentation. improved quality of treatment as a result of efficient evaluation of Objectives internal structures. Some surgical procedures may also be completed The ultimate goal of dermal fillers is to smooth out wrinkles and with less morbidity and, perhaps, with a greater margin of safety (i.e. folds, even out scars, volumize furrows and sunken valleys, contour avoiding technical error) with the use of and endoscope. Increasingly, unevenness and laxity, and sculpt skin into a rejuvenated look. more endoscopic procedures are being described in the craniomax- Methods illofacial region. Decreased complication rates, comparable success Dermal filler is an injectable cosmetic filler. Types of dermal fillers rates, diverse functionality, and efficiency make the endoscope a include tissue derived and synthetic derived. These materials have helpful instrument in a surgeon’s armamentarium. The aim of the included injectable Bovine collagen, autologous collagen, autologous poster is to discuss the use of endoscopic techniques for the treatment fat, hyaluronic acid derivatives, allogenic and synthetic Products, of craniomaxillofacial trauma, craniofacial deformities, obstructive recombinant human collagen. salivary gland disease, maxillary sinus disorders trigeminal nerve Results injury and temporomandibular joint (TMJ) disorders. Selection of dermal fillers include immunological safety long term Objectives benefits efficiency, cost practicality, fillers persists for long duration, To discuss the benefits, advantages and disadvantages of Endoscopy painless, non toxic, non carcinogenic. techniques. Conclusions Methods It has given the widespread popularity of soft tissue augmentation and Review of Articles of the past 20years on Endoscopy in Oral and the ever present need to develop safer fillers that last longer than the Maxillofacial Surgery. current products. Results The use of this unique tool has been described in a wide range of surgical treatments, including fractures and orbital, frontal sinus, and other maxillofacial injuries. It is also used in orthognathic procedures. EPS0049 The adjunctive include sialoendoscopy for obstructive salivary gland Transoral Robotic Surgery in Head and Neck Cancer diseases, arthroscopy, TMJ surgery and removal of foreign bodies. Conclusions Dr. Swati Sahu The oral and maxillofacial surgeons are finding advantages and new applications for endoscopically assisted maxillofacial surgical procedures. Decreased complication rates, comparable success rates, New Horizon Dental Collage & Research Institute; Bilaspur (CG) diverse functionality, and efficiency make the endoscope a helpful instrument in a surgeon’s armamentarium. Abstract Background/Introduction The evolution of surgical oncologic technology has moved toward reducing patient morbidity without compromising oncologic resection. In head and neck surgery, organ-preserving techniques have paved the way for the development of transoral techniques that remove tumors of the upper aerodigestive tract without external incisions and potentially spare the patient adjuvant treatment. Objectives To review the published clinical data in Telerobotic Head and Neck surgery, evaluate the benefit of existing clinical applications and identify areas for potential development. Methods A qualitative review was performed of publications in PubMed, Medline identified from the following keyword searches: Telerobotic/ Robotic ENT, Otorhinolaryngology, Head and Neck surgery.

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Results is the most common form and is caused by invasion of the root canal Clinical benefits include avoidance or dose reduction of adjuvant system by microorganisms. Pericoronitis is another common cause. chemoradiotherapy and improved swallow function. The primary Objectives clinical advantage of robotic-assisted neck surgery is the avoidance of The discoveries of antibiotics are encouraging trends towards con- a neck scar. quest of the microbial infection. Conclusions Methods The primary outcomes of robotic surgery in the head and neck region This study emphasizes the detection of pathogenic microorganisms by demonstrate good disease control, quick postoperative functional microbiological examination and culture of specimens representative recovery and low surgical morbidity. However, definitive recom- of the infection, importance of early and correct diagnosis of infec- mendations for the application of robotic surgical systems will require tions, prompt treatment and supportive care. more well-designed studies and technical modifications in current Results surgical robots and in the future. The age group most commonly involved was in the third and fourth decades of life. Extraction followed by incision and drainage was done. The most commonly involved space was submandibular followed by buccal space. EPS0071 Conclusions Obstructive Sleep Apnea–Assessment & Management Amoxicillin and Clavulanic acid combination performed better, as 100 % strains were sensitive to it. The results of this study saw a Dr. Soumendu Karak changing trend in terms of predominance of anaerobic bacteria over aerobic ones. Dental infections can be treated by elimination of the primary source of infection with antibiotics as adjunctive therapy. K.D. Dental College, Mathura

Abstract Background/Introduction EPS00114 Obstructive sleep apnoea (OSA) is caused by a complete or partial Access Osteotomy in Maxillofacial Skeleton obstruction of airway during sleep resulting in sleep disturbance & day time somnolence. Untreated OSA may excerbate diseases & has Maj S Jayanth Perumal been associated with diabetes, cardiovascular morbidity & mortality. Objectives Army Dental Centre (R&R) Knowledge of facial growth & development will provide successful treatment for patients with OSA. Once properly diagnose, several treatment modalities are available that leads to successful improve- Abstract ment in both patient subjective & objective assessment. Background/Introduction Methods Surgical management of malignancies and pathologies requires Depend upon situation continuous positive airway pressure (CPAP); resection of the primary lesion with a safe margins and adequate tongue stabilizing appliance; geroge gauze appliance; uvulopharyn- access poses a challenge to the operating team. Access to even the goplasty (UVPP); genial advancement with or without hyoid most inaccessible sites of craniomaxillofacial region can be achieved suspension;maxillomandibular advancement (MMA) are choice of by using techniques and combination of osteotomies. treatment according to American Association of Sleep Apnoea. Objectives Results To review the surgical accesses that aid in removal of inaccessible Though polysomnographic result is satisfactory, both the conservative tumors and treatment of various pathologies of head and neck region and surgical methods having some limitation & potential side effect with a series of 09 cases operated in the Department of Oral and like dental changes, skeletal changes, temporary and permanent Maxillofacial Surgery, Army Dental Centre (R&R) from Jun 2014- neurosensory changes etc. Jun 2017. Conclusions Methods Successful control of OSA by multidisciplinary clinical team not only Three cases of juvenile nasoangiofibroma were operated through improve patient life style but also it reduce subsequent risk factor for transfacial approach with maxillary swing and one case was operated diabetes, hypertension, heart attack, stroke, arrhythmia and premature through a transoral approach using a Le Fort I osteotomy. One case of death. orbital floor tumor was approached through transfacial approach with an osteotomy on the infraorbital rim only. One case of SCC of the base of the tongue, two cases of odontoidectomy and one case of SOL EPS00109 of posterior pharynx were approached with a lip-split mandibular Odontogenic Infections osteotomy and mandibular swing. Results Six out of nine cases developed paraesthesia along the distribution of Dr Dhwani Govindbhai Ranveria, Guided By-Dr Nimisha Desai sensory nerve. No occlusal discrepancy, neuromotor deficit or any other significant long term complications encountered. Karnavati School of Dentistry, Uvarsad, Gandhinagar Conclusions Surgical access is the primary difficulty in resection of inaccessible Abstract tumors and pathologies of craniofacial region. Multiple techniques and Background/Introduction combination of osteotomies have been employed to facilitate the access An odontogenic infection is caused by dental caries, deep fillings or but the appropriate surgical approach must be selected considering the failed root canal treatment, pericoronitis and periodontal disease. The size, location of the tumor and extension into adjacent structures. course of infection depends on the virulence of the bacteria, host resistance factors, and the regional anatomy. The periapical infection

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EPS00115 opening, range of lateral excursion, duration of subluxation episodes, Evaluation of Placement Accuracy and Angulation previous treatment taken, deleterious habits, psychological issues, OPG and MRI findings. of Dental Implant Using Indegenious Stent.: An In Vivo Results and Vitro Study All 16 patients had a successful outcome with reduction in average mouth opening of 14.4 mm and no further episodes of dislocation, G. Karthik Rajan reduction in pain of mean VAS 4, reduction in deviation in mandible of average 3 mm and absence of clicking sound, thus requiring no further treatment at their 1-year follow-up. Post treatment OPG Sri Ramakrishna Dental College and Hospital showed that condylar head was within normal relation to the glenoid fossa in its new position. Abstract Conclusions Background/Introduction Autologous blood injection along with Arthrocentesis is a safe, sim- Implant dentistry has evolved into the main stream of restorative ple, and effective treatment for patients with chronic recurrent TMJ practices all over the world. When performing an implant surgery it is Subluxation. crucial to place implants in optimal position as on prosthetic rehabilitation plan. A surgical stent is essential for correct placement of implant during surgery, even with surgical stent the implant placement is not always as intended as there are iatrogenic errors. To EPS00137 eliminate such discrepancies, an extra component with the surgical Mesenchymal Stem Cells: The Regenerative Medicine stent has been designed at the same time, an attempt is made to access the bone width using a Intraoral radiographic horizontal and vertical in Oral and Maxillofacial Surgery positioner. Objectives Dr Vishnuraj R, Dr A.K. Adhyapok, Dr Subhas Ch. Debnath To evaluate the guide drill accuracy on planned angulation (coronally and sagittally). Regional Dental College Assam Methods Alloplastic maxilla and mandible are going to be used to assess Abstract radiographic positioner and surgical stent for determination of bone Background/Introduction width and final implant position. The results are going to be compared Regenerative medicine is an emerging field of biotechnology that in patients with implant prosthetic rehabilitation. combine various aspects of medicine, cell and molecular biology, Results material science and bioengineering in order to regenerate, repair and The results acheived on the alloplastic models was the determined replace tissue. The oral and maxillofacial surgery have a role in the angulations, the results were clinical carried out on patients and the treatment of traumatic and degenerative diseases that leads to tissue finial outcome was acheived for the determined angulation. loss. To rehabilitate these minuses, techniques have been improved Conclusions over time. Since 1990 growth factors, platelet concentrates, bioma- Thus this study proves that not a much complicated stent is required terials, scaffolds and autologous tissues serve these purposes in oral for the placement of implant in the determined angulation. The and maxillofacial surgery. The frontier of regenerative medicine is placement of abutment can be a straight one. represented by the mesenchymal stem cells (MSCs). With increasingly sophisticated technology to support MSCs manipulation, they are undoubtedly the future of regenerative medicine and they are ABS00132 showing perceptives unimaginable just a few years ago. Oral cavity turned out to be an important source of MSCs with the advantage to Autologus Blood Injection in Chronic TMJ Subluxation be easily accessible to the surgeon thus avoiding to increase the morbidity of the patient. Dr. Sonal Anchlia, Dr Vikash, Dr Hardi, Dr Philip Objectives To investigate the role of MSCs in clinical practice for bone regen- Abstract eration, documenting the state of art and indentifying future research Background/Introduction directions. Temporomandibular joint (TMJ) Subluxation is excessive forward Methods movement of the condyle beyond the articular eminence with com- A search of the literature was performed using the key words ‘‘MSC plete separation of the articular surfaces. and bone regeneration’’ and data was collected based on the recent Objectives articles. This study was conducted to assess the role of Arthrocentesis fol- Results lowed by Autologous blood injection to the TMJ in the treatment of MSCs represent an exciting and promising stem cell population for chronic recurrent TMJ subluxation. regeneration of bone in skeletal diseases, especially when tissue Methods engineering or biomaterials are applied. Sixteen patients with bilateral/Unilateral Chronic recurrent Condylar Conclusions Subluxation were included in the study. Arthrocentesis using a single The future is the regeneration of whole organs or biological systems puncture was performed on each patient, followed by injection of 2 consisting of many different tissues, starting from an initial stems cell ml autologous blood into the superior joint compartment and 1 ml into line, perhaps using innovative scaffolds together with the nano- the joint capsule. Patients with MRI findings suggestive of articular engineering of biological tissues. disc degenerative changes were excluded. All patients were assessed in terms of total mouth opening, deviation while mouth opening, pain according to VAS scale, clicking and grinding sound while mouth

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EPS00141 participants were instructed not to discuss with one another to avoid Awareness of Organ Donation Among Dental the possibility of a bias or a confounding factor. Only questionnaires which were fully completed were included in the study. Once the and Medical Students and Practitioners in and Around questionnaires were completed the data was compiled into a Micro- Melmaruvathur soft Excel spreadsheet and the Statistical Analysis was carried out using IBM SPSS for Microsoft Windows version 23. Correlation Dr. S. Duraimurugan between knowledge, attitude and practice scores was calculated by Pearson’s correlation coefficient. A p value. Results Adhiparasakthi Dental College & Hospital A total of 750 questionnaires were handed out to the undergraduate students, postgraduate students and the staff members of Abstract Adhiparasakthi Dental College & Hospital and Melmaruvathur Background/Introduction Adhiparasakthi Institute of Medical Sciences. 619 questionnaires Transplantation is defined as the transfer (engraftment) of human were collected back after completion. The response rate was 82.53 %. cells, tissues or organs from a donor to recipient with an aim of The remaining questionnaires were either incomplete or the individ- restoring function(s) in the body. On December 23rd, 1954, the first uals were not willing to participate in the study due to varied reasons. organ transplantation was carried out in the history of surgery and it is Out of the 619 participants 68. 49 % belonged to Adhiparasakthi one of the most important findings in the field of transplantation. A Dental College & Hospital (n = 424) and 31. 51 % belonged to kidney was transplanted between two identical twin brothers Richard Melmaruvathur Adhiparasakthi Institute of Medical Sciences (n = & Ronald Herrick by Dr. Joseph Hume at Brighton, Birmingham for 195). In Adhiparasakthi Dental College & Hospital 86 participants which the operating surgeon received the noble prize. Since then we belonged to the first year, 94 belonged to the second year, 84 have come a long way to reach our present state. But in almost every belonged to the third year, 99 belonged to the fourth year and 61 were country the number of willing organ donors falls short of the number from the Compulsory Rotary Internship. In Melmaruvathur of people on the waiting list by many thousands. Asian countries in Adhiparasakthi Dental College & Hospital, 133 belonged to the first particular have significant disparity between the number of waiting year, 55 belonged to the final year and 7 were from the Compulsory organ recipients and willing organ donors. The main reason for this Rotary Internship. The study population comprised of 31. 3 % of disparity is the non-willingness of individuals for organ donation. males (n = 194) and 68.7 % of females (n = 425). The mean age was Many factors must be taken into account when studying the knowl- 19.3 years with a standard deviation of ±2.1 years. Out of the 619 edge and attitudes of people towards organ donation. A variety of individuals, 18. 9 % were 17 years of age (n = 117), 29. 4 % were 18 factors influence these attitudes towards organ donation and these years of age (n = 182), 9 % were 19 years of age (9.0 %), 12. 6 % factors vary greatly with geographic location, education level and were 20 years of age (n = 78), 16. 3 % were 21 years of age (n = 101), other factors. As health care personnel we remain one of the most 9. 9 % were 22 years of age (n = 61), 2. 6 % were 23 years of age (n = reliable sources for general population to get information about a 16) and 1. 4 % were 24 years of age and above (n = 8). relatively safe procedure. But, before we impart knowledge, we Conclusions ourselves must be thoroughly informed about organ donation. Basic The knowledge, attitudes and practices of the medical and dental information on procedures, pros and cons and the ethical issues students towards organ donation can be greatly improved by involving organ donation should be included in the dental and med- increasing the knowledge amongst the students. Education about ical undergraduate curriculum, so that future doctors can become organ donation is the first step whereas the other steps which must be informed advocates. taken are education about various government and private organiza- Objectives tions for organ donation. If these steps are implemented the disparity This study aims to determine the knowledge, attitude and practices between the donors and the recipients may be curbed. towards organ donation amongst the Students & Staff members of Adhiparasakthi Dental College & Hospital, Melmaruvathur & Mel- maruvathur Adhiparasakthi Institute of Medical Sciences & Research, Melmaruvathur and the variation amongst the study population and EPS00147 determination of the factors that cause the variation. Obstructive Sleep Apnea Methods A cross sectional questionnaire based study was conducted amongst the students and staff members of Adhiparasakthi Dental College & Prof. Dr. A. Thangavelu, Mds, Dnb, Dr. R. Amirthaa Varshini Hospital, Melmaruvathur & Melmaruvathur Adhiparasakthi Institute of Medical Sciences, Melmaruvathur. The study sample comprised of Rajah Muthiah Dental College and Hospital undergraduate & postgraduate dental students and the staff members from the dental college. From the medical college, samples were Abstract collected from the undergraduate students and the staff members. Background/Introduction Anonymity and confidentiality of respondents were maintained and Obese Patients Complaining Of Snoring And Disturbed Sleep. participation was voluntary. A 39 item self-administered question- Objectives naire was developed based on previous studies (2, 5, 7–10). The Reduction In Snoring And Apenic Episodes Affecting Sleep. questionnaire comprised of four sections. The first section of the Methods questionnaire gathered the demographic details from the students, Anterior Mandible Box Osteotomy With Debulking Of Tongue. which included age, gender, year of study, religion and parents edu- Results cation level. The remaining three sections consisted of questions to Improvement Clinically And With Regards To Ahi Index. judge the knowledge, attitude and practices of the individuals towards Conclusions organ donation. Some questions were based on the dichotomous scale Long Term Follow Up Under Progress At Present Patients Are whereas other questions were based on a four point likert scale. After Symptom Free. obtaining permission from the higher authorities the questionnaires were distributed to the students during lecture classes. The

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EPS00164 remnant roots, and concomitant regenerative therapy showed pre- Platelet Rich Plasma a Treatment Modality liminary favorable outcomes. However, wider application of this technique for longer following up periods is required for further for Androgenic Alopecia conclusive recommendations.

G. Satya Vani EPS00167 Government Dental College, Vjayawada Piezoelectric Surgery in Oral and Maxillofacial Surgery Abstract Background/Introduction Bhart Vashishat, Gaurav Singh, Amit Gaur Alopecia is a medical terminology which Is used for various types of hair loss like androgenic alopecia areata. Cicatrical alopecia, tri- Sardar Patel Post Graduate Institute of Dental and Medical Sciences, chotillomania, traction alopecia. PRP become a newer modality for Lucknow treatment of androgenic alopecia. The pivotal discovery of PDGF in promoting wound healing, angiogenesis and tissue remodelling threw Abstract light on this novel autologous therapeutic modality. PRP is a con- Background/Introduction centration of multiple Growth promoting factors by virtue Piezoelectric bone surgery is a minimally invasive technique, its platelet alone and plasma protein, fibrin and fibronectin. This PRP physical and mechanical properties have several clinical advantages: works in a multipronged manner serving as an elixir for hair growth precise cutting with micron sensitivity without the generation of and improving overall environment. PRP is a promising therapeutic heat, and it also lessens the risk of damage to surrounding soft modality. tissues and important structures such as nerves, vessels and mucosa Objectives by selective cutting of bone and better visualisation of the surgical To provide an overview of platelet-rich plasma (PRP) injected into field. This technique also reduces the damage to osteocytes and the scalp for the management of androgenic alopecia. permits good survival of bony cells during harvesting of bone and it Methods seems to be more efficient in the first phases of bony healing, it A literature review was performed to evaluate the benefits of PRP in induces an earlier increase in bone morphogenetic proteins, controls androgenic alopecia. the inflammatory process better, and stimulates remodelling of bone Results with greater pace. In general, PRP showed a benefit on patients with androgenic Objectives alopecia, including increased hair density and quality. To describe various applications of piezoelectric surgical device in Conclusions the field of oral and maxillofacial surgery. PRP injection is a simple, cost effective and feasible treatment option Methods for androgenic alopecia, with high overall patient satisfaction. Over the past two decades, an increasing amount of literature has shown that piezoelectric devices are innovative tools and that there is extensive indication of their use in oral and maxillofacial surgery. EPS00166 Specific oral surgery indications include - bone graft harvesting, corticotomy, bone biopsy, implant site preparation, sinus augmenta- Immediate Dental Implants tion surgery, distraction osteogenesis, ridge expansion, endodontic surgery, inferior alveolar nerve transposition, cyst removal and dental DR Deepak Sharma extraction-mainly impacted teeth, orthognathic and reconstructive surgery, surgically assisted rapid maxillary expansion, removal of MPCD&RC osteosynthetic materials. Results Abstract Piezosurgery produces micro-vibrations and reduced noise, in contrast to the conventional surgical saw or rotary bur. Micro-vibration and Background/Introduction TM Immediate implant insertion in extraction sockets raises a series of reduced noise minimise a patient s psychological stress and fear challenges for clinicians. during osteotomy under local anaesthesia. Objectives Conclusions This preliminary study demonstrates the use of a modified insertion Piezoelectric surgery is an innovative ultrasonic technique for safe technique of implant placement at the time of extraction. and effective osteotomy or osteoplasty compared with traditional Methods methods that use rotating or mechanical instruments. It provides a sulcular buccal incision with releasing periosteal incisions were extreme precision on micrometric cutting, safety as well as great made around the site to be replaced, and implant insertion into the control on the surgical site. Moreover, the device causes minimal interseptal/interradicular bone was performed. The remnants of roots bleeding during and after the operative procedure and the healing were atraumatically extracted, and the bony defects around the process is shorter. Limitations are- slightly longer operating implant were grafted with synthetic resorbable bone substituteˆ I2- time for osteotomies than with traditional saws and large initial Tricalcium phosphate, and the flap was sutured. costs. Results The modified insertion technique followed showed an implant survival rate of 100 %. Conclusions The combination of immediate implant placement with engagement of the interseptal/interradicular bone, atraumatic extraction of

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EPS00168 involvement. To assess the difference in outcomes of odontogenic Salivary Pacemakers: Neuroelectrical Stimulation space infections. To assess the differences in disease progression of odontogenic space infections between non-diabetic, controlled dia- of Salivary Gland in Xerostomia Patients betic and uncontrolled diabetic patients. Methods Dr. Mercy Kamatam Cross sectional study conducted over a period of 20 months, from January 2013 to August 2014. Inclusion criteria includes patients with Government Dental College and Hospital, Vijayawada maxillofacial space infections of odontogenic origin, patients with age group 14 years or above. Exclusion criteria includes maxillofacial Abstract space infections of non odontogenic origin. Eg; salivary gland Background/Introduction infections, malignancy, upper respiratory tract infection etc. Odon- Xerostomia is a symptom of oral dryness that occurs when salivary togenic infections without maxillofacial space involvement. Eg; flow is not sufficient to compensate the fluid loss from the oral cavity. apical periodontitis, periapical abscess etc. Patients with any other Objectives cause of immunosuppresion. Eg; HIV, steroid medication etc. The objective of this review is to present the advances of neuro- Results electrical stimulation for the treatment of xerostomia based on the Out of 175 patients 113 (64%)-non-diabetic 62 (46%)-diabetic. 26 accumulated knowledge of neurological control of salivary secretion. (15%)-controlled diabetes 36 (21%)-uncontrolled diabetes Primary Methods space involvement. Out of 175 patients, 26 patients (14.9%) had no Neuro-electrical stimulator or salivary pacemakers are miniature intra primary space involvement Secondary spaces 83 patients (47.4%) had oral device that increase the salivation by means of stimulating the secondary space involvement. Culture-sensitivity and gram staining salivary reflex arch. There are three generations of salivary pacemakers. 89 cultures showed sterile or no growth 86 positive cultures- 65 Results cultures were gram positive and 21 cultures were gram negative 59 Frst generation led to an immediate (direct) response (increase of patients had streptococci infection 21 had klebsiella infection. 5 salivation as a result of the stimulation) and a cumulative long-term patients were infected by other gram positive bacteria staphylococci (indirect) response (sustained increase of basal salivary flow rate) as and enterococci 1 patient showed candidial growth in the culture. well as subjective improvement in symptomatic xerostomia. Second Conclusions generation was effective during application and up to 10 min after its Within the limits of the study, the following conclusions are drawn removal and third generation results are the most convenient and safe from the study: The patients with odontogenic space infections means to treat xerostomia. belonging to diabetic groups (both controlled and uncontrolled) more Conclusions frequently have multiple teeth involvement, multiple primary space Neuro electrical stimulation offers a new non pharmacological involvement, multiple secondary space involvement as compared to method of treatment which overtakes the relevant role in therapeutic non-diabetic patients which can be attributed to old age and poor stimulation salivation for the patients requiring long term therapy. periodontal status in diabetic patients. Streptococci remain to be the most commonly associated microorganism with odontogenic space infection, both overall and in non-diabetic patients. But diabetic patients are more frequently have infection predominated by gram EPS00172 negative bacteria especially, Klebsiella sp. Comparison of Clinical Profile of Odontogenic Space Infection Between Diabetic and Non Diabetic Patients EPS00180 Sreejith S Ridge Augmentation with Symphysial Graft: A Case Report Government Dental College Kottayam Dr. Sanjana Sethi Abstract Background/Introduction Bharati Vidyapeeth Dental College and Hosptal, Pune Odontogenic infections are one of the most common diseases in the oral and maxillofacial region The infections generally spread via path of least resistance through connective tissue and along fascial plane. Abstract There are different types of spaces in and around oral and maxillo- Background/Introduction facial region classified based on anatomical landmarks and Alveolar ridge resorption after the tooth loss due to trauma in anterior boundaries. Primary spaces and Secondary spaces. Patients with region is a common phenomenon which alters the size and shape of systemic diseases like diabetes are more susceptible to infections- the ridge. The demand of osseointegrated implants to replace missing owing to compromised neutrophil adherence, chemotaxis, phagocy- teeth which is mostly avoided due to the deficiency of bone, despite of tosis, bactericidal activity and cell-mediated immunity. So this study many recent advances the use of autogenous bone graft is the solution was formulated to—Understand the differences in pattern of disease for the best outcome. The mandibular symphysis (chin graft) is a progression in diabetic and non-diabetic patients and to assess if a favourable donor site as it has an excellent risk benefit ratio. This more aggressive treatment approach is needed to treat diabetic prepares the alveolar bone volume both vertically and laterally for the patients with odontogenic space infections. implant to be placed. Bone harvested from the mandibular symphysis Objectives is mainly cortical in nature, allowing application of rigid fixation To compare the disease progression, space involvement, complica- in situ and thus providing good primary stability. These grafts can be tions and outcome of odontogenic space infections between non- easily carved to intimately fill in defects and provide good alveolar diabetic, controlled diabetic and uncontrolled diabetic patients. To contour. In our case we have used chin graft in the region of 11, 12 evaluate difference in pattern of the primary and secondary space and the result has been very good.

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Objectives EPS00189 To evaluate the bone changes after the rigde transformation post Treatment Options in Trigeminal Neuralgia grafting. Methods Osteotomies were performed in a monocortical fashion, 5 mm ante- Naveen Kumar rior to the mental foramen, cephalad to the inferior border of the mandible, caudal to the expected position of the apices of the anterior Jain Government Dental College, Trivandrum teeth, and at the midline. The size of the corticocancellous block was then measured. Abstract Results Background/Introduction Healed uneventfully without wound dehiscence, paresthesia, or lip Trigeminal neuralgia (TN) is defined by the International Headache droop. Sufficient bone was obtained for ridge augmentation with Society (IHS) as ‘‘unilateral disorder characterized by brief electric eventual implant placement. shock-like pains, abrupt in onset and termination, and limited to the Conclusions distribution of one or more divisions of the trigeminal nerve’’ [In- The thick cortical layer of the transplant prevents or reduces resorp- ternational Headache Society, 2004]. The IHS suggests a tion and the cancellous part help to fasten the regeneration. It does not classification of TN as either classic (essential or idiopathic) TN produce immune reactions and are incorporated by osteoclastic (CTN) or symptomatic TN (STN; pain indistinguishable from that of resorption with a shorter healing period compared with other methods CTN, but caused by a demonstrable structural lesion other than vas- of osseous repair. cular compression). The diagnosis of CTN requires the absence of a clinically evident neurological deficit. CTN starts in the second or third divisions, affecting the cheek or the chin [International Head- ache Society, 2004]. The ophthalmic division alone is involved in less EPS00183 than 5% of cases [De Simone et al. 2005]. The single attack generally Human Dentin as Novel Biomaterial for Bone lasts from less than a seconds, patient may clutch the hand over face Regeneration and experience severe lancinating pain associated with spasmodic contraction of facial muscles during attacks. Objectives Ritu K Patel Review of Treatment options for management of Trigeminal neuralgia. KSD Methods Review Of Literature. Abstract Results Background/Introduction Medical Management Superior To Surgical Management. Although autogenous bone is considered the gold standard among Conclusions graft materials, donor site morbidity may be an associated problem. It is advisable to treat first with medical management and if patient Structure and composition of dentin is similar to the bone. Dentin is not respond to it then only surgical options is opted. thought to have a high osteoconductivity and osteoinductivity. In some patients, tooth extraction is required before dental implant treatment. It would be beneficial if extracted teeth could be utilized as autogenous grafting material. EPS00200 Objectives Stem Cell Therapy ‘‘A New Revolt in Maxillofacial The aim of this study is to examine the efficacy and safety of Practice’’ Autogenous partially demineralized dentin matrix (APDDM) prepared onsite, for clinical application in bone regeneration procedures in oral and maxillofacial surgery. Naveen Nandagopal Methods APDDM is transplanted in bone regeneration procedures related to Govt Dental College Kottayam implant dentistry including socket preservation, alveolar ridge augmentation, and maxillary sinus floor augmentation. Abstract Results Background/Introduction There are no systemic or local complications in any of the cases, and Stem cells are unique type of cells having specialized capacity for oral rehabilitation using dental implants is successful in all cases for self-renewal and potency, can give rise to one and sometimes many at least 2 years after attachment of the suprastructure. different cell types. Stemcell therapy involves manipulation of the Conclusions cells in vitro and using for therapeutic purposes. The possible appli- APDDM, is an efficient, safe, and reasonable bone substitute. Con- cations of stem cells are replacement and repair of tissues and organs. sequently, this material has the potential to become one of the options Replacement of oromaxillofacialstructure is difficult, because func- as a bone substitute in implant dentistry. tions suchas facialexpression, articulation, chewing, and swallowing are delicate and made of a complex anatomical structure with soft and hard tissues. Stem cells, biomimetic materials, and growth factors are essential toform these three-dimensional structures. Regeneration of

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S241 oral and maxillofacial structures can be carried out using stem EPS00204 celltherapy that has gained momentum in future. Transoral Robotic Surgery (TORS) Objectives The poster shortly review the available literatures on stem cell regarding their properties, types and its advantages and also aims to Dr. Shivani Savarkar/Dr. Ramdas Balakrishna discuss the possibilities of stem cell therapy in oral and maxillofacial region and its recentadvances till today. K.L.E. Society’s Institute of Dental Sciences, Bangalore Methods Here we used relevant articles written in English from the basics of Abstract stem cells till its recent advances. Background/Introduction Results TORS is a recent biomedical engineering advancement that features Stem cells can be useful in the regeneration of bone, PDL, soft tissues use of a surgical robot. Currently, the ‘‘da Vinci system’’ is being used of oral and maxillofacial region and to correct large craniofacial that allows precise removal of tumors of oral cavity, pharynx, para- defects due to cyst enucleation, tumor resection, and trauma. Stem pharynx and larynx. cells in maxillofacial region can replace the common technique of Objectives transfer of tissue by not having its disadvantages. Literature review of Transoral Robotic Surgery (TORS). Conclusions Methods The future dentistry will be more of regenerative based, where Literature search and review including online published articles patients can use his own cells to treat diseases. Stem cell therapy has (Pubmed search). got a paramount role as a future treatment modality in maxillofacial Results region. Stem cells should be differentiated to the appropriate cell A minimally invasive technique can be employed, since a magniﬁed types before they can be used clinically, otherwise lead to deleterious image of the surgical site with improved surgical access are feasible. effects, so it should be very carefully analyzed. Longer patient fol- Complete eradication of primary tumor and involved lymph nodes is lowup is needed to study the life time of regenerated tissue. facilitated, along with postoperative preservation of airway and swallowing. Reduction in pain and infection along with rapid recovery can be expected. Few drawbacks include expensive equipment, lack of sensory tactile sensation, and longer operating times. EPS00203 Conclusions Knowledge, Attitude, and Practice of Needle Stick Better functional, cosmetic and oncological outcomes with lesser and Sharps Injuries Among Dental Professionals Of morbidity can be expected with TORS. This may obviate the need for Pimpri- Chinchwad radical procedures like mandibulotomy, suprahyoid or lateral pharyngotomy, chemoradiation etc., for otherwise inaccessible tumors. But, more prospective trials and long-term follow-ups are Dr. Sanyukta Sanjay Raut needed to justify this paradigm shift towards minimally invasive surgery. Dr. D.Y. Patil Dental College and Hospital, Pimpri, Pune

Abstract Background/Introduction EPS00208 Healthcare workers (HCWs) including dental professionals are at an PRP from Socket to Scalp: Our Experience occupational risk of exposure to blood-borne pathogens following needle stick injuries (NSIs) and sharps injuries (SIs). A thorough Dr Sanidhya Sreenivasa understanding of the safe practices while handling sharps is crucial for HCWs. KLE Institue of Dental Sciences Objectives The purpose of this study was to determine the prevalence of NSIs among the clinical dental practitioners. Abstract Methods Background/Introduction A cross-sectional survey was conducted in May 2014 using a struc- Platelet Rich Plasma (PRP) is a concentrate of platelets, with small tured questionnaire that was administered to 540 dental professionals amounts of blood and plasma. PRP is an autogenous source of fresh at Pimpri-Chinchwad to assess the knowledge, attitude, practices, and platelets and clotting factors; therefore, it contains multiple growth self-report information of NSIs. and tissue modulation factors produced by platelets or present in Results plasma. In the present study, 80% of dental professionals had knowledge Objectives about Universal Precaution Guidelines B. A total of 28.3% partici- To evaluate the uses of PRP in various procedures in oral and max- pants had an NSI during the previous 12 months. About 33.7% of illofacial surgery. NSIs occurred during device recapping. Most common reason for Methods failure to report the incidents of NSIs, as declared by 21.1% of the PRP is derived from the centrifugation of the patient’s own blood and participants, included the fear of being blamed or getting into trouble it contains growth factors that inﬂuence wound healing, thereby for having an NSI. playing an important role in tissue repairing mechanisms. We discuss Conclusions the cases treated with platelet-rich plasma at our unit since 2015 in The knowledge of dental professionals on NSIs and their preventive various cases like male androgenic alopecia, derma abrasion, socket measures are inadequate. Authors recommend thorough training on preservation, wound healing etc. Universal Precaution Guidelines, protocols regarding post-exposure prophylaxis, and safety devices to prevent such injuries.

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Results EPS00234 The use of PRP in surgical practice could have beneﬁcial outcomes, Suprazygomatic Maxillary Nerve Block for Isolated reducing bleeding and enhancing soft tissue healing and bone regeneration. Zygomatic Arch Fracture Reduction Conclusions PRP is a new approach to tissue regeneration and it is becoming a Dr Abin Ann Abraham valuable adjunct to promote healing in many procedures in dental and oral maxillofacial surgery. Government Dental College, Kottayam

Abstract EPS00228 Background/Introduction Pain control is an integral part of minor oral surgery and maxil- Awareness of Forensic Dentistry Among Dental lary/mandibular nerve blocks have proved promising in achieving the Students and Practitioners in and Around same. Numerous methods are illustrated in the literature to produce Kanchipuram District profound regional anaesthesia and selection of the specific technique is determined, in large part, by the nature of the treatment to be provided. Complete maxillary nerve block is not commonly required Dr. Veeramuthu because they are believed to be difficult and may be associated with complications. Literature review suggests that an extra oral technique Adhiparasakthi Dental College and Hospital to anesthetise the maxillary nerve via the suprazygomatic approach is more safe and efficacious. The aim of this study was to determine the Abstract effectiveness of extra oral maxillary nerve block through suprazy- Background/Introduction gomatic approach from frontozygomatic angle in patients undergoing Forensic dentistry is a challenging and fascinating branch of forensic isolated zygomatic arch fracture reduction. science that involves the application of dental sciences in the iden- Objectives tification of decreased individuals through the comparison of ante- 1. To assess the pain during zygomatic arch fracture reduction by mortem and post-mortem records. Today we consider forensic VAS scale. 2. To assess the time required for the onset of anesthesia odontology to be a specialized &reliable method of identification in (subjective symptoms). 3. To assess the time needed for the onset of multiple fatality individuals. The aim of this poster it to analyze the peak effect of anesthesia (objective symptoms). 4. To assess the inter awareness, knowledge and attitude of forensic odontology among incisal opening before and after the procedure. 5. To record the Dental students and practitioners. The important applicationof complications namely hematoma, visual disturbance or deviation of forensic odontology include identification of humans through dental the lower jaw immediately following the injections. 6. To record the records and assisting at the scene of crime. It is used in the deter- positive aspiration of blood during the injection. mination of age, gender of the living or deceased and to testify as an Methods expert witness in the court to present forensic evidence. Extra oral suprazygomatic maxillary nerve block was administered in Objectives 50 patients for reduction of isolated zygomatic arch fracture. Lido- The aim of the study is to evaluate the knowledge, attitude and caine 2% with 1:80000 adrenaline anesthetic solutions was used to practice of forensic dentistry among dental students practitioners in anesthetize maxillary nerve through a 21 gauge 45 mm long needle. and around kanchipuram district. The following parameters were evaluated: onset of anesthesia, peak Methods effect of anesthesia, outcome of treatment, complications and pain A cross-sectional study was conducted in a sample of 903 dental during arch elevation. students and practitioners in and around kanchipuram district and data Results was collected by means of a questionnaire. The blocks were effective with majority of the patients (80 %) who Results reported only mild pain during the elevation of zygomatic arch Our study shows 68% of knowledge is from internet and 41.4% is fracture thus favouring the efficacy of the frontozygomatic angle from book, 87.4% of people reported that it is important to know approach. The subjective symptoms were reported in 9.08 minutes about forensic dentistry, 83.7 % report that forensic is useful in (mean value) and objective symptoms were reported in 13.08 minutes identifying criminals, 80.6% reported that it is important to maintain (mean value). Out of 50 patients, 18% had positive aspiration during the clinical record of the patient, 81.5% reported that we can identify injection procedure, 10% developed hematoma, 2% had temporary the age from forensic odontology, 78.6% people reported that DNA, visual disturbance which resolved within 6 hours time and 4% finger prints and teeth can be used to identify the individuals, 50.2% developed transient facial nerve paralysis which resolved within 24 reported that fragmented bodies decently, the evidences and materials hours without any intervention. for toxicological analysis, dental records are used to identify the age Conclusions and gender of the person during the mass disaster, 25.4% reported The present study has favoured the frontozygomatic angle approach comparing post and antimortam dental data for identification of for the maxillary nerve block as a simple, safe, efficacious method individual, 50.8% reported that lip prints are study of chelioscopy, associated with minimum complications. 17% of people underwent formal training, evaluating and presenting dental evidence,60% reported lip prints are unique as finger prints. Conclusions the study revealed in adequate knowledge, poor attitude and lack of practice of forensic odontology prevailing among the dental students and practitioners in and around kanchipuram district.

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EPS00263 Objectives Mangement of Hemangiomas and Vascular to describe and evaluation of clinical presentation of trigeminal neuralgia and treatment planning, and patient needful treatment. Malformations with Percutaneous Injections of Sodium Methods Tetradecyl Sulfate the case with diagnosis of trigeminal neuralgia was selected and treated by cryotherapy with ablation nerve branch, and patient was Dr. Neelakamal Hallur, Dr. Aaisha Siddiqua, Dr. Syed Zakaullah, Dr. followed on regular interval. Ashwin Shah, Dr. Chaitanya K, Dr. Shereen Fatima Results the patient was followed for long period and was asymptomatic. Conclusions Al-Badar Dental College and Hospital Gulbarga cryotherapy is an important asset in treatment of trigeminal neuralgia. It is a very simple, reversible, reliable and repeatable procedure with Abstract no mortality and with a negligible and transient morbidity. Background/Introduction Hemangiomas are rarely occurring vascular tumours. These are most common tumours of infancy (10%) with F:M ratio of 3:1, 60% of these occur in head and neck. They can cause aesthetic and functional EPS00309 impairment, depending on location. The most common site is the Tooth Derived Bone Graft for Alveolar Ridge upper lip but can occur on tongue, buccal mucosa and palate. Objectives Preservation: A Case Series To Evaluate Use Of Percutaneous Injections Of Sodium Tetradecyl Sulfate In Management Of Hemangiomas And Vascular Dr Nirav Patel Malformations. Methods Narsinhbhai Patel Dental Collage and Hospital, Visnagar, Gujarat MRI, USG, CT Angiography techniques are used as diagnostic aids. The conservative modalities for hemangioma as well as vascular Abstract malformations, Sclerotherapy is an effective method which produces Background/Introduction endothelial damage that results in permanent endofibrosis and clinical Alveolar ridge resorption is inevitable in all post extraction cases. obliteration of the vessel. Various sclerosing agents used are osmotic Retaining its shape & size is needed for prosthetic rehabilitation in agents, hypertonic saline solution, detergent solutions like sodium aesthetic and functional position. It can be achieved by ridge morrhuate, ethanolamine oleate, sodium tetradecyl sulphate, polido- preservation through modified extraction technique and use of auto- canol & sclerosant foam. These agents induce sclerosis on venous genic or allogenic graft materials. Autogenous bone graft is still endothelium via interference with cell membrane lipids until either considered the gold standard, in spite of the need for harvesting bone diluted or inactivated by serum surfactants. and possible surgical morbidity. Results Objectives cases of Haemangioma’s and vascular malformations in aesthetic It is well-know that jawbones, alveolar bone, and teeth develop from zone of maxillofacial region were successfully managed with scle- cells of the neural crest and many proteins are common in formation rotherapy with sodium tetradecyl sulphate injections. of bone, dentin, and cementum. Dentin and bone having same bio- Conclusions chemical similarities led to the idea of using it as a bone regeneration Percutaneous injection of sodium tetradecyl sulphate can be use material. In this graft dentin, which comprises more than 85% of successfully in management of Haemangioma’s and vascular hydroxyapatite, can serve as native bone grafting material. Recently, malformations. several studies have reported that extracted teeth, which undergo a process of cleaning, grinding, demineralization, and sterilization, can be a very effective bone graft to fill alveolar bone defects. EPS00265 Methods A total of 4 graft sites in 2 patients were included in this study. A Management of Trigeminal Neuralgia alveolar bone augmentation immediately after dental extraction. with Cryotherapy Vertical dimension of bone was measured after extraction after grafting and one week and one month follow-up. Dr. Rifaquat Ali Results Infection of graft material or graft bed was not observed and graft sites healed without any notable complications. The vertical dimen- Career Post Graduate Institute of Dental Science and Hospital, sions of alveolar bone increased by 5.38 mm. Lucknow Conclusions Autogenous demineralized dentin matrix from extracted tooth grafted Abstract to extraction sockets for the augmentation of vertical dimension is Background/Introduction effective method. trigeminal neuralgia is also called as tic doulourex was first explained by ARATEUS. Trigeminal is the most common orofacial painful under neuralgia and is among the most painful conditions in orofacial pain. Females are more commonly affected than male. Lloyed et al.(1976) introduced cryotherapy of trigeminal neuralgia. Cryotherapy when performed leads to necrosis of the affected nerve branch.

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EPS00314 Results Cardiopulmonary Cerebral Resuscitation (CPCR) The effect of platelet-derived products is considered to be effective because of the high number of platelets which contain a wide range of growth factors. It has also been observed that PRP provides a safe and Shardul Malkani effective means of speeding alveolar bone repair. Conclusions Rajarajeshwari Dental College and Hospital Bangalore PRP is prepared from the patient’s own blood and contains growth factors that influences wound healing. Abstract Background/Introduction Cessation of blood flow and ventilation constitutes cardiopulmonary EPS00328 arrest (CPA) that leads to inadequate oxygen and nutrient delivery to Bilateral Variation in Anatomic Structures tissue, shock and ultimately death. Cardiopulmonary arrest is typi- of the Inferior Alveolar Neurovascular Bundle: cally associated with loss of consciousness, collapse, lack of a palpable pulse, pale or cyanotic mucous membranes, lack of effective A Cadaveric Study respirations, and lack of measurable blood pressure. Cardiopul- monary-cerebral resuscitation refers to re-establishing blood flow to 1) Dr Pratik Agrawal, 2) Dr Navin Shah, 3) Dr Neel Shah the cerebral and coronary systems in the event of CPA by performing manual cardiac and thoracic compressions and manual ventilation K.M. Shah Dental College & Hospital, Vadodara until spontaneous circulation and ventilation occurs. The decision to begin CPCR has to be based on clinical signs, consideration on Abstract potential outcome and underlying disease process. Background/Introduction Objectives Knowledge of the variations of the mandibular nerve, its branches and To review the current concepts and to evaluate the efficacy of Car- communications are clinically important especially for dental sur- diopulmonary cerebral Resuscitation. geons to understand the effectiveness of the nerve block and Methods complications following regional anesthesia. This study would give There three phases of CPCR: 1) Basic Life Support (BLS) 2) us a brief idea of the pattern and position of the neurovascular bundle Advanced life support (ALS) 3) Post- resuscitation care. and its implications in implantology, dentoalveolar surgeries, pre Results prosthetic surgeries, orthognathic surgery etc. The alternative CPCR demonstrated an improvement in the incidence Objectives of good recovery. To check variation in arrangement pattern of anatomic structures of Conclusions the inferior alveolar neurovascular bundle bilaterally. The ultimate goal of cardiopulmonary cerebral resuscitation (CPCR) Methods is to improve long-term outcome in patients who have suffered car- The study is being conducted in 10 hemi mandibles of 5 cadavers. diac arrest. Therefore a new protocol of CPCR has been described. Cadaveric dissection is carried out to carefully expose the mandibular canal and inferior alveolar neurovascular bundle bilaterally, histopathological evaluation is done and interpretation is carried out. EPS00318 Results Platelet Rich Plasma and its Application in Oral As it is an ongoing study results are being awaited. Conclusions Surgery No Definitive conclusion can be made at present as it is an ongoing study, but the study will surely help in knowing the anatomical Dr. Bhagyashree Jagtap, Dr. Kalyani Bhate variation of Inferior alveolar neurovascular bundle.

Dr. D. Y. Patil Dental College and Hospital, Pimpri EPS00330 Abstract Difficult Airway Intubation Techniques in Oral Background/Introduction and Maxillofacial Surgery Platelet-rich plasma (PRP) is a new approach in tissue regeneration and a developing area for clinicians and researchers. It is used in various surgical fields, including oral and maxillofacial surgery. It Apurva Vivek Vaidya contains growth factors that influence wound healing. Of these growth factors, platelet-derived growth factor, transforming growth factor, Terna Dental College and Hospital Navi Mumbai insulin-like growth factor, and epidermal growth factor play a pivotal role in tissue repair mechanisms. Abstract Objectives Background/Introduction To describe the different bioactive substances included in PRP and One of the most important issues and concerns of head and neck their participation in the healing process. To elucidate the different surgery is the airway problem. The anesthesiology practice manage- techniques and available technology for PRP preparation in human ment guidelines define a difficult airway as a clinical situation in studies, to clarify risks, and to provide guidance for future research. which a trained anesthesiologist experiences difficulty with face mask Methods ventilation of the upper airway, difficulty with tracheal intubation, or Search engines PubMed, Google Search and Institutional Library both. Myriad modalities of intubation techniques exists for manage- were used. Keywords used were Platelet rich Plasma, Third molar ment of difficult airway. Each of these techniques have their own extraction, Secondary alveolar bone graft, Sinus lift procedure, Cysts indications. Since oral and maxillofacial surgeons often face such in oral cavity. 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S245 situations of difficult airway, thorough knowledge of appropriate EPS00348 airway is extremely essential. This poster depicts difficult airway Computerised Planning and Intraoperative Navigation: intubation techniques in oral and maxillofacial surgery. An in Vogue in Cranio-Maxillofacial Surgery

EPS00343 Dr. Usha Epistaxis: The Dilemma and It’s Management New Horizon Dental College & Research Institute, Bilaspur (C.G.)

Dr Trishala B. Fernandes, Dr. Francis Akkara and Dr. Vikas Dhupar Abstract Background/Introduction Goa Dental College and Hospital The refinements in preoperative planning for craniomaxillofacial surgery procedures have lead to major improvements in clinical Abstract outcomes. Introduction of computer aided surgery (CAS) into cranio- Background/Introduction maxillofacial surgery provides the surgeon with a highly reliable, Epistaxis is one of the commonest emergencies presenting to the reconstructive tool. This technique not only provides safety in sur- casualty department, initially seen by both ENT physicians and Oral gical interventions, but also opens a broadened spectrum of possible Maxillofacial surgeons. Treatment strategies have been broadly surgical approaches. similar for decades. However recently, with the evolution of endo- Objectives scopic technology, new ways of actively managing epistaxis are now To enlighten about newer and technologically advanced computer available. aided surgery (CAS) which includes presurgical planning with Objectives stereolithographic models and intraoperative navigation in planning The objective of this poster is to review the different currently and implementation of complex cranio-maxillofacial surgeries. available treatment modalities for the management of epistaxis and to Methods propose a comprehensive yet simple and modern algorithm of its Computer aided presurgical planning with stereolithographic models, treatment. Treatment options will be divided into medical, non-sur- intraoperative navigation and intraoperative CT/MRI imaging are gical interventional, and interventional options and will be described engineered to assist in planning and implementation of complex along with their advantages, disadvantages, complications and suc- cranio-maxillofacial surgeries such as complex orbital reconstruction, cess/failure rates, maxillo-mandibular reconstruction, cranial reconstruction, head and Methods neck tumor resection, skull base surgery, craniofacial/orthognathic The traditional management of acute epistaxis includes identification of surgery, TMJ surgery, dental & craniofacial implantology. the bleeding point by using a head mirror or other light source. If a Results bleeding point is localised then chemical or electrocautery is performed. The additional precision provided by computer aided surgery (CAS) If unsuccessful further management takes a stepwise approach; initially makes it a useful tool and brought it to forefront of surgical tech- anterior packing with medicated gauze or sponge and if unsuccessful, niques and offers new opportunities in the field of cranio- more advanced techniques such as compressive balloons or posterior maxillofacial surgeries. nasal packing may be used. Finally, endoscopic arterial ligation or Conclusions embolisation can be used to stem intractable bleeds. Preoperative computer aided design and stereolithographic modeling Results combined with intraoperative navigation provides a useful guide for The management of epistaxis includes a wide range of strategies and and possibly more accurate reconstruction of a variety of complex treatment options. However, it is important to appreciate when to cranio-maxillofacial deformities. Although probably not necessary for correctly employ the different individual interventions. It is also routine use, computer aided surgery is indicated for complex post- important to involve an experienced endoscopist who can intervene traumatic or postablative reconstruction of orbits, cranium, maxilla with endoscopic control in he ER or ESPAL in the OR. Recent lit- and mandible; total TMJ replacement; orthognathic surgery; and erature advocates an earlier surgical intervention with ESPAL for complex dental/craniofacial implantology. these cases due to its simplicity, high success rate, low risks and cost effectiveness in comparison to other treatment modalities. Conclusions Over the past decade, there has been a significant increase in the EPS00352 options available for the management of epistaxis. Traditional Role of Botox-A in Temporomandibular Disorders strategies like nasal packing have been supplemented by modern technology using the latest optic and electrical devices. Treatment Dr. Abhishek Sharma should ideally use a systematic protocol, starting with simple procedures that can be undertaken in the clinic environment and proceeding Subharti Dental College, Meerut to endoscopic techniques for more difficult cases. Abstract Background/Introduction Temporomandibular disorders (TMD), musculoskeletal disorders of the masticatory system, are common clinical labels for pain in the orofacial area. Since myofascial pains and mouth opening limitation are the most frequent symptoms in masticatory muscle disorders, directing treatments at the muscular components of TMD could yield therapeutic gains.

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Objectives Conclusions The present study was conducted to evaluate the efficacy of This poster discusses the risks and benefits of social media and sug- Botulinium toxin type-A (BTX-A) therapy in patients with tem- gests that a better understanding of social media and its role in the poromandibular joint disorders refractory to the conservative development and practice of newly qualified maxillofacial surgeons management. To achieve this aim, the following objectives were could benefit both trainees and patients. followed in the study: 1. To clinically assess the pain in temporomandibular disorders with the help of Visual Analog Scale (VAS). 2. To clinically assess the range of mandibular motion, tenderness of the EPS00372 masticatory muscles, oro-facial function and facial harmony with Digital Planning: Unleashing the Anatomic Truth—’A photographic evaluation (Pre-op & Post-op). Methods Guide to Aid’ This short sample study included total of 5 patients with TMD’s reported to the Department Of Oral & Maxillofacial Surgery, Subharti Dr. Nambinayaki E.M., Prof. Dr. Veerabahu M. Dental College, Meerut. RDC/TMD (Research Diagnostic Criteria) Axis-I was used to diagnose the TMD’s. Patients who failed in non- Abstract invasive conservative therapies such as soft diet, NSAID’s, physio- Background/Introduction therapy, oral appliances, muscle relaxants and anti-depressants were The best part of dentistry at this level is transforming lives!! We live included in the study. In this procedure, patients were asked to clench in a digital era, the struggle of which is to display the ‘ANATOMIC their jaws to make the injection sites more prominent. Botox-A TRUTH’, to show the 3D anatomy both static and in function as it injections were given on the affected side with 25 units each to exists in nature. masseter and temporalis muscle region divided evenly over 5 sites in Objectives each region. Patients were followed-up for 6 months. The AIM is to prove the accuracy of treating patients digitally Results overcoming the flaws of conventional surgical planning. Out of 5 patients in the study, 4 were benefitted from the study. The Methods study showed a reduction in pain on Visual Analog Scale and the Standardized CBCT scanning protocol All data were stored and mouth opening was increased post Botox-A therapy. transferred in DICOM format Materialize software. Conclusions Results With the positive outcomes shown from the study, clinical injections The potential benefits and actual limits of an integrated 3D virtual of BTX-A in masticatory musculatures of TMD patients could be approach for the treatment of the patient with a maxillofacial defor- considered as useful supportive treatment options for controlling mity are discussed comprehensively from our experience using 3D complex TMDs. Although long term study with large sample size will virtual treatment planning clinically. be required to establish the role of Botox-A in TMD’s. Conclusions This purpose of 3D craniofacial imaging and reconstruction is to decipher the 3D anatomic truth and treat patients with more accuracy EPS00371 avoiding errors due to conventional model surgery. Social Media: Friend or Foe???

Dr. Vishnu. J, Junior Resident EPS00378 To Heal or Not to Heal: Incision Techniques Govt. Dental College, Kozhikode Dr. Deepa R Abstract Background/Introduction Government Dental College, Kozhikode Social media are part of the fabric of today’s world, from which health care is not excluded. The use of social media has greatly Abstract expanded in the last decade, with widespread use of smartphones, the Background/Introduction internet, and other multimedia to enhance learning. There is evidence Various devices have been introduced in recent years to achieve to suggest that social media has a place in healthcare education and hemostasis with minimal tissue injury during surgery; these tools dentistry. This poster explores the various ways social media can include the laser, electrosurgical devices (needle, scissor, or knife), help, as well as hinder, the practice of dental professionalism espe- radiofrequency needle ablation device. All of these devices use heat cially in oral and maxillofacial surgery. energy to denature protein, leading to vascular tamponade and Objectives eventual hemostasis. - Explores social media and its uses in oral and maxillofacial surgery - Objectives Discusses the advantages and disadvantages of social media, and how To find the least traumatic incision method. it could be used to improve learning in oral and maxillofacial surgery. Methods - Encourages safe use of social media for all maxillofacial surgeons Pub med and clinical key search. and dental care professional. Results Methods The disadvantage of using heat energy during surgery is lateral Literature review, article search and web media. heating of the surgical field, leading to damaged vital structures, Results delayed wound healing as a result of compromised blood circulation, This poster discusses the risks and benefits of social media and sug- and increased postoperative pain caused by sensory nerve injury. The gests that a better understanding of social media and its role in the ultrasonic scalpel denatures protein by mechanically breaking the development and practice of newly qualified maxillofacial surgeons hydrogen bonds in protein molecules. could benefit both trainees and patients.

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Conclusions belonging to group II–IV or group III–V. Compared with traditional Although all lasers cut tissue by the same process, lasers of different fluorescence markers, QDs have narrow emission spectrum, wide wavelengths have different penetration, absorption, scatter, and tissue excitation spectrum, high intensity of fluorescence, and good photo- effect based on the energy absorption by different elements within chemical stability due to the quantum size and dielectric confinement tissue. The CO2 laser, with a wavelength in the infrared region effects. In addition, any emission spectrum from ultraviolet to near- (10,600 nm), has the advantage of precisely cutting tissue with limited infrared (or from blue to red) under the same excitation wavelength of injury to the surrounding tissue. The limitations of laser include slow light can be obtained by changing the particle size of QDs. These dissection, inadequate hemostasis, and uncontrolled lateral dispersion optical characteristics of QDs are not possessed by any of the current of heat resulting in tissue damage. To obviate these problems, ultra- fluorescent probes, including a variety of organic fluorescent dyes and sonic energy has also been used in tissue dissection. Unlike the heat- fluorescent proteins. Particularly, the fluorescence of recently devel- producing devices, the ultrasonic scalpel generates much less heat oped QDs with an emission of near-infrared wavelength from 700 nm from tissue friction. to 900 nm has strong penetration in human tissues, which is extremely suitable for visible in-vivo medical imaging. Oral squamous cell carcinoma is one of the most common oral cancers. Because most oral cancers are diagnosed and treated at an advanced stage, the overall EPS00386 5-year survival rate is only 50–60% presently. It has been reported Salivary Biosensors that the 5-year survival rate for patients of oral cancers that are diagnosed and treated at an early stage is over 80%. Thus, early Nikhil Kaushal, Post Graduate Trainee diagnosis is vital to improve patient quality of life and survival rate. Recent research has demonstrated that surface-modified QDs conjugated with membrane-penetrating polypeptides can be used in Army College of Dental Sciences labelling various types of cells, not only rapidly and efficiently but also with no damage to the live cells. Fluorescent probes have been Abstract developed by conjugating QDs with target molecules (eg. antibodies Background/Introduction and peptides) and have been used for in-vivo visualization of cancer Saliva sampling is relatively simple and the presence of various cells and tumour angiogenesis, sentinel lymph node detection, and disease-signalling biomarkers in saliva has meant that it can accu- imaging of drug targeting studies. These studies have demonstrated rately reflect normal and disease states in humans. Biosensors are that excellent optical properties of QDs have promising prospects in small, self-contained analytical devices used for the detection and visualization of cancer development and personalized therapies. measurement of a particular substance. The most common salivary Objectives biomarkers and their biosensing mechanisms are discussed. To explore the competence of near-infrared luminescent quantum Objectives dots for visual in vivo imaging on oral squamous carcinoma cells with The significance of salivary biomarkers for clinical diagnosis and review of literatures. therapeutic applications has been reported with additional focus on Methods technologies and biosensing platforms for screening these biomarkers. Yang K, Cao YA, Shi C, et al. Quantum dot-based visual in vivo The poster aims to increase awareness about the same. imaging for oral squamous cell carcinoma in mice: The use of con- Methods jugate membrane-penetrating polypeptide-conjugated near-infrared Salivary Glucose, Lactate, Phosphate, Hormones, Antibodies, quantum dots to label oral squamous carcinoma BcaCD885 cells Enzymes are discussed briefly in the poster. through endocytosis (Qtracker QD800, Invitrogen, CA, USA). The Results maximum emission wavelength of the QDs is 800 nm, and a custom Salivary biosensors have reported excellent sensitivity, detection peptide is used to deliver QDs into the cytoplasm of live cells with no limit, and response time. cell-type specificity. Qtracker QD800-labelled BcaCD885 cells Conclusions (BcaCD885/QD800) were implanted into nude mice for in vivo Hand held salivary detectors allows portability, which in turn pro- imaging and the sensitivity and dynamic imaging conditions of vides rapid point-of-care diagnosis and reduces costs which is highly Qtracker QD800 were investigated as a visual in vivo detection beneficial characteristic especially for applications in developing modality for BcaCD885 cells. Yang K, Li Z, Cao Y, Yu X, Mei J, countries. et al. Effect of peptide-conjugated near-infrared fluorescent quantum dots (NIRF-QDs) on the invasion and metastasis of human tongue squamous cell carcinoma cell line Tca8113 in vitro: In this study, EPS00387 peptide-conjugated near-infrared fluorescent QD (QtrackerTM QD800) with a maximal emission of 800 nm are used to label human Quantum Dots (QD): A Boon in Early Diagnosis of Oral tongue squamous cell carcinoma cell line (Tca8113) through endo- Squamous Cell Carcinoma and Surgical Treatment cytosis. We then observed the proliferation, adherence and chemotaxis of the QD800-labeled Tca8003 cells. These results pro- Dr. Suhasis Mondal vided theoretical bases to reveal if the visualized tumour cells labelled by peptide-conjugated near-infrared fluorescent QDs reflected the actual genesis, development, infiltration and metastasis of tumours S.C.B Medical College & Hospital, Cuttack in vivo. Kai Yang, Fu-jun Zhang, Hong Tang, Cheng Zhao. In-vivo imaging of oral squamous cell carcinoma by EGFR monoclonal Abstract antibody conjugated near-infrared quantum dots in mice: Quantum Background/Introduction dots with an emission wavelength of 800 nm (QD800) were conju- Quantum dots (QDs) were developed on the interdisciplinary gated to monoclonal antibodies against EGFR, resulting in the probe advancement of nanotechnology, chemistry, and optics. The unique designated as QD800-EGFR Ab. OSCC cell line (BcaCD885) optical properties of QDs have shown promising prospects in the expressing high levels of EGFR was transplanted subcutaneously into personalized surgical treatment for cancer patients. QDs are nude mice cheeks to develop an OSCC animal model. QD800-EGFR nanocrystals (with a diameter of 2–10 nm) composed of elements Ab containing 100 pmol equivalent of QD800 was intravenously

123 S248 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 injected into the animal model and in-situ and in-vivo imaging of EPS00397 cheek squamous cell carcinoma was analyzed at 10 different time Medical Modelling: Revolutionizing Treatment points. Results Planning Yang K, Cao YA, Shi C, et al. Quantum dot-based visual in vivo imaging for oral squamous cell carcinoma in mice. The minimum Dr. Abhirup Chatterjee, Dr. Abhay T. Kamath (Guide) detectable counts of BcaCD885 cells for QD800-based in vivo imaging were 1—104 in the dorsum subcutaneous, back muscle and Manipal College of Dental Sciences, Manipal, Karnataka under the cheek oral mucosa. As tissue depth increased, the detectable fluorescence intensity dropped; as cell counts increased, Abstract the fluorescence intensity and the visual image duration also Background/Introduction increased, especially for the QD800-labeled BcaCD885 cells in which Medical modelling is a concept based on 3D medical imaging for counts of 1—106 were visual imaged in the dorsum subcutaneous, diagnosis, planning and treatment. The technology of 3D printing using back muscle and under the cheek oral mucosa for 16 days. Yang K, Li 2D and 3D C.T. imaging has been used for fabrication of surgical Z, Cao Y, Yu X, Mei J, et al. Effect of peptide-conjugated near- templates, and guides; for increasing the accuracy, saving OT time, and infrared fluorescent quantum dots (NIRF-QDs) on the invasion and obtaining highly satisfactory results. We at MCODS Manipal, present a metastasis of human tongue squamous cell carcinoma cell line plethora of cases, wherein medical modelling has been used. Tca8113 in vitro. The results showed that there was no significant Objectives difference between the results of Tca8113 cells labelled with NIRF- To demonstrate the effectiveness and utility of 3D medical modelling in QD800 and those of unlabeled Tca8113 cells, suggesting that the diagnosis, planning and treatment of oral and maxillofacial conditions. proliferation, invasion, adherence and chemotaxis of Tca8113 cells Methods were not affected by NIRF-QD800. These results provide a basis for Pictoral demonstration in form of poster depicting the various uses of the further utilization of NIRF-QDs in non-invasive imaging and 3D modelling in oral and Maxillofacial Surgery and Reconstruction. tracking of tumour cells in vivo. Kai Yang, Fu-jun Zhang, Hong Results Tang, Cheng Zhao. In-vivo imaging of oral squamous cell carcinoma All the cases showed satisfactory results and restoration of function by EGFR monoclonal antibody conjugated near-infrared quantum and aesthetics. dots in mice In-vivo imaging and immune-histochemical examination Conclusions of the tumours showed that intravenously injected QD800-EGFR Ab 3D Medical modeling has revolutionized surgical treatment planning probe could bind EGFR expressed on BcaCD885 cells. Fluorescence and its outcome with advantages like replication of complex signals of BcaCD885 cells labelled with QD800-EGFR Ab probe anatomical structures, anticipation of possible complications or could be clearly detected, and these fluorescence signals lasted for 24 prognosis, performing mock surgeries and patient education and hours. The most complete tumour images with maximal signal-to- motivation. noise ratio were observed from 15 minutes to 6 hours after injection of the probe. The authors conclude that the combination of near- infrared quantum dots that are highly penetrating for tissues with EPS00414 EGFR monoclonal antibody has promising prospects in in-vivo imaging of OSCC and development of personalized surgical Study to Evaluate Two Alternative Alloplastic therapies. Materials in OMFS: Chorion vs. Amnion Conclusions The early detection of cancer is one of the key factors for cancer Dr Adrineel Banerjee treatment. Currently, the methods with good sensitivity for early detection of cancer, such as CT and MRI, can only detect tumours consisting of millions of cells. As for BcaCD885/QD800 used by Saraswati Dental College Yang et al., injection points in the dorsum subcutaneous, dorsum muscle and under the cheek oral mucosa were fluorescently Abstract detectable with as little as 1—104 cells. This finding suggested that Background/Introduction QD800-based imaging, compared with traditional CT and MRI, Regeneration and reconstruction with alloplastic material is not a new increased the sensitivity of the early diagnosis of cancer by more than concept but its role in various field of Oral and maxillofacial surgery 100-fold. Gao et al. forecast that near-infrared QD-labeled cells is new. Amnion and chorion are the only two alloplastic material with would improve the sensitivity of detection to 10–100 cells with the the potential to heal a wound, act as a graft & has role in regeneration development of stronger tissue- penetrating near-infrared QDs. At the with no immune reaction. Amniotic membrane as a biological same time, the QD800- based imaging methods are simple, safe, low- dressing material is being used for last 100 years with excellent cost, easy-to-use and particularly suitable for direct visualization of results but no such study is done on chorion although studies have cancer cells in surgery. At present, clinicians lack the visual screening shown that chorion have more growth factors than amnion. method for the carcinoma edges during surgery and thus they can only Objectives define the tumour boundaries by palpation and experience, resulting To find, efficacy of Amnion vs. Chorion on the basis of graft dehis- in residual cancer cells around the carcinoma edges in up to 40% of cence, epithelisation and post-operative mouth opening (oral patients with head and neck cancers, which greatly affects the sur- submucous fibrosis). vival rate of patients. It’s believed that with the development of Methods quantum dot imaging technology, clinicians can make accurate visual Twenty five patients were randomly included for split mouth study. identification on the carcinoma edges, the residual cancer cells and 15 oral submucous fibrosis patients were treated with amniotic and the lymph node metastasis of cancer cells in operation, with the aids Chorionic membrane on either side of oral mucosa after fibrotic band of a conventional imaging device and a pocket sized near-infrared removal. 10 patients having bilateral leukoplakia where treated with excitation light source and receiver, so as to achieve a real treatment amnion on one side and chorion on other. Dried amnion and chorion tailored to the individual surgery. membrane were acquired from Tata Memorial tissue bank Bombay.

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Evaluation was done on the basis of pre-operative and post-operative EPS00424 7, 14 and 21 days of follow up. Awareness About Oral & Maxillofacial Surgery Results Epithelisation was better in Amnion than Chorion. Wound healing Specialty Among Medical and Dental Professional’s was faster & Mouth opening achieved was good in Oral Submucous Fibrosis cases. Rs. Barathvikraman Conclusions Amnion is more effective graft material than chorion. Adhiparasakthi Dental College and Hospital

Abstract EPS00418 Background/Introduction Scope of Oral & maxillofacial surgery occurred in Egypt in the so- Assessment of Self Medication Among Dental Students called Edwin smith papyrus (2700BC) [1]. The specialty of oral & and Dental Practitioners in and Around Kancheepuram maxillofacial surgery (OMS) is defined by the American Association District of Oral & maxillofacial surgery (1948) as the specialty of dentistry that includes the diagnosis, surgical and adjunctive treatment, injuries and defects involving both the functional and the aesthetic aspects of R. Chinnaiah the hard and soft of the Oral & maxillofacial region [2]. In mid1960’s OMFS is a specialty of dentistry recognized by Federal Dentistry Adhi Parasakthi Dental College And Hospital Broadis responsible for the diagnosis, and clinical and surgical treatment of traumatic, congenital, developmental and iatrogenic Abstract lesions in the maxillofacial complex [3]. Background/Introduction Objectives A non-doctor prescribing and self-medication of drugs is common in To access the Awareness about Oral & maxillofacial surgery among developing countries. People tend to act on their own for their health. Medical and Dental students and staff members of Adhiparasakthi Encouragement of self-care is seen as giving patients every oppor- Medical and Dental institutions at Melmaruvathur, Tamilnadu, India. tunity to take responsibility and build confidence in their ability to Methods manage their own health. A cross sectional questionnaire based study was conducted amongst Objectives the students and staff members of Adhiparasakthi dental and medical This poster aims to gather information about the awareness and institutions. Anonymity and confidentiality of respondents were prevalence of self-medication in the dental student fraternity and also maintained and participation was voluntary. A 51 questions in 9 to educate people to ensure safe practices. groups was prepared based on the previous studies. This questionnaire Methods gathered the demographic details from the students and staff mem- Study questionnaire was adapted from various similar studies con- bers, which included age, gender, year of study, stream, family ducted previously (17) Study site- the study was carried out in and monthly income, Parents education level. round Kancheepuram district. Study population- was conducted on Results 900 peoples. No study was earlier conducted here. Data collection & A Total of 900 questionnaire were handed out the Dental and Medical analysis Data was collected from to participation was totally volun- professional’s. Among that 800 questionnaire were collected back tary. Age, sex, year of study was noted. Ethical issue Operational after completion and incomplete questionnaire were excluded from definition-self medication is the selection and use of medicines by the study. Out of 800 participants 41% (n =329) belonged to Medical individuals to treat self recognized illness or symptoms. stream and 58.9% (n =471) belonged to Dental stream and this study Results comprises of 28.6% of males (n =229) and 71.4% of females (n = The study includes 900 dental students, faculty and practitioners in 571). Among 9 categories I belonged to Minor surgical procedures of our questioning study in the consistency of 38% males and 62% mouth from Medical 5.75% (n = 46) were marked has other dental females in that females majority in different age groups In this study specialist and 35.3 % has chosen OMFS where has in Dental only 3% 96% students and practitioners and faculty members are using self- (n = 24) has chosen other dental specialist and 55.8% (n = 447). (P medication. The prevalence shows the high members of self- value 0.00). medication. Conclusions Conclusions Awareness of OMFS among the medical professionals remain slow. Inevitable practice of self-medication’s merits and demerits is made Therefore OMFS practitioners should take it upon themselves to be aware through proper education and the channel or medium through active promoters while being guardians and ambassadors for this which self medication reaches the public should be inspected regu- specialty. larly and properly channelized. Thus a holistic method of legally issuing medicines as per (sold on prescription only) basis be put in reality (16).

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EPS00434 Objectives Sialendoscopy: A New Diagnostic and Therapeutic Tool Objective is to see the efficacy of submental intubation over other intubation technique in patients with panfacial trauma. Methods Karamjot Singh Ghotra 1.5-2.0 cm skin incision was made in the Submental region in the midline 2.0 cm behind the symphysis. Followed by blunt dissection Punjab Government Dental College and Hospital, Amritsar was done through the subcutaneous fat, platysma, investing layer of deep cervical fascia, anterior bellies of digastric, geniohyoid and Abstract genioglossus muscles. Mouth opening was maintained using a gag or Background/Introduction dental prop and the tongue was retracted, exposing the floor of the Sialendoscopy is one of the innovations introduced in the last few mouth. Pair of medium-sized artery forceps was introduced into the years in the field of oral surgery. It is a recently developed minimally submental incision, until the tip of the artery forceps tented the invasive diagnostic and therapeutic procedure for the management of mucosa of the floor of the mouth. Then tented oral mucosa was obstructive diseases of the salivary glands. Sialolithiasis and incised to see the tip of the artery forceps into the oral cavity taking sialadenitis are two of the most frequently presenting disorders of the care to avoid damage to the sublingual and submandibular duct and salivary glands. lingual nerve. Blades of the artery forceps were separated to a dis- Objectives tance equal to the diameter of the tube. Pilot tube was grasped by the Sialendoscopy allows for optical exploration of the salivary ductal artery forceps and pulled through the passage in the floor of the system and extraction of the stones by a basket under endoscopic mouth. Patient’s lungs were ventilated with 100% oxygen for five view. minutes. Then tip of the artery forceps was quickly re-inserted Methods through the submental incision. The tracheal tube was briefly dis- The orifice of the duct is progressively dilated with dilatation probes. connected from the breathing circuit and the universal connector was The endoscope is introduced within a fine diagnostic sheath with an removed. Then the end of tracheal tube was grasped and pulled out in operator channel connected to a foot controlled automatic irrigation the oral-to-skin direction. The connector was re-attached, the cuff re- system to dilate and wash out the gland. inflated and the tracheal tube reconnected to the breathing circuit. The Results position of the tracheal tube was checked using capnography and it is best in diagnosing and removing the stones within the duct. The chest auscultation. complications and recurrence is quite low as compared to other Results procedures making it unique and good. submental intubation is the best technique for intubation with least Conclusions complications as compare to other intubation technique in patients Sialendoscopy incorporates diagnostic with therapeutic procedures, as with panfacial trauma. dictated by the clinical findings. This technique can be performed in Conclusions most cases as an ambulatory, outpatient procedure under local The submento-submandibular intubation has proved effective in anaesthesia. comparison to the more morbid and manpower intense tracheostomy and other techniques. Though on the face of it, it appears to be complex, the submento-submandibular intubation technique is quite simple, easy to learn and produces wonderful results in good hands. EPS00439 Submental Intubation EPS00447 Dushyant Singh Janmeda Botulism to Botox Kamineni Institute of Dental Sciences Crupa Susan Mathews Abstract Background/Introduction Pushpagiri College of Dental Sciences, Thiruvalla, Kerala Securing an airway during the management of faciomaxillary injuries remains a challenge and is an important part of treatment. The sur- Abstract geon needs access to an unobstructed field and, in most instances, Background/Introduction maxillomandibular fixation is required intraoperatively for adequate Botulinum toxin is a neurotoxin derived from Clostridium botulinum, reconstruction of facial fractures. Presence of fracture of the base of which is used considerably across the globe due to its broadening the skull& Comminuted midfacial fractures cause physical obstruc- treatment options in rejuvenating aesthetics as well as function, tion to the passage of nasotracheal tube. Surgical reconstruction often developed from its property to cause flaccid muscle paralysis by Sir involves maxillo-mandibular fixation in the intraoperative period to Justinus Kerner. restore the patient’s dental occlusion. This precludes the use of oral Objectives endotracheal intubation. Tracheostomy may involve a significant risk A transient, reversible, minimally invasive and relatively safe adju- of iatrogenic complications, such as tracheal stenosis, internal vant therapy for many medical and dental conditions which do not emphysema, damage to the laryngeal nerves, tracheoesophageal fis- have complete treatment modalities in conventional methods. TMJ tula and scarring A useful alternative method of managing the airway disorders, bruxism, oromandibular dystonia, gummy smile are a few intraoperatively is by submental endotracheal intubation, which to list. allows tracheal intubation by passing the tube through the floor of the Methods mouth. First reported by Francisco Hernandez Altemir in 1986 as a The drug is administrated as subcutaneous and intramuscular injec- procedure that could avoid tracheostomy and allow for the con- tion to the hyperactive muscle in therapeutic doses. comitant restoration of occlusion and reduction of facial fractures in patients ineligible for nasoendotracheal intubation.

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Results To study 21 cases of oral cysticercosis reported to PGIDS, Rohtak - The drug causes transient and specific muscle paralysis. To discuss their clinical features and therapeutic considerations. Conclusions Methods The mechanism of action, indications, contraindications and the Records of 21 patients reporting to PGIDS, Rohtak in year 2012-2017 application of this miraculous toxin in oral and maxillofacial surgery diagnosed as oral cysticercosis were taken. Clinical information i.e. will be listed in this poster. age, gender, size and site of lesion, treatment and follow up was taken. Ultrasonographic and histopathologic findings were the diagnostic criteria. Most of the cases presented as asymptomatic submucosal nodules. EPS00449 Results Diagnostic Dilemma in Anterior Mandibular Lesion Therapeutic management was done with Albendazole therapy in all patients. Mostly cases responded to the treatment. Treatment modality Dr. Abhishek Saraswat for the patients who did not respond to this therapy was surgical excision. Conclusions Dr. Abhishek Saraswat Though oral cysticercosis is a rare finding, it should be considered as a differential diagnosis of asymptomatic nodular swellings in the oral Abstract cavity so that early diagnosis is made and further systemic manifes- Background/Introduction tations may be avoided. Anterior mandibular lesion with unknown etiology creates dilemma in formulating the treatment protocol as well as unexpected treatment outcomes postoperatively. EPS00452 Objectives Human Amniotic Membrane: Scaffolding Material To know the importance of preoperative histopathological examination and its revaluation by one or more centers in lesions of unknown in Reconstructive Surgery etiology. Methods Dr. Rinsha Gireesh A 50 years male presented with a swelling which was asymptomatic and sessile gingival overgrowth extending from mesial of 43 to distal College of Dental Sciences of 33. Incisional Biopsy report revealed it to peripheral cemento- ossifying fibroma. Considering that patient had been planned for Abstract excision with extraction of teeth. Postoperative histopathology Background/Introduction revealed the different result, one diagnostic center shows it peripheral The amnion has been ascribed to function as its Greek name suggests. cemento-ossifying fibroma but another diagnostic center shows It has become an attractive biomaterial for all surgical disciplines. malignant mesenchymal tumor. Amniotic membrane is the inner most lining of the human placenta Results that is normally discarded after parturition. The membrane has Preoperative and postoperative diagnosis were totally different and numerous growth factors, proteins and stem cell reserves that help in there was development of excessive tissue at the site of excision accelerating wound healing with regeneration of the lost tissues. lesion suggestive to considered as a malignancies patient referred to Objectives higher center and biopsy revealed non-hodgkin lymphoma and patient This poster discusses the properties, mechanisms and the applications undergone chemotherapy still on follow up with us. of this neglected tissue that makes it a potential material for regen- Conclusions eration in the field of oral and maxillofacial surgery. It is advisable to have more than one histopathological examination Methods opinion of incisional biopsy tissue in case of unknown etiology. Amniotic membrane is the inner most lining of the human placenta that is normally discarded after parturition; collected and preserved. Results ABS00450 Amniotic membrane has gained an acceptable position in the surgical armamentarium of maxillofacial surgery as it ensures a reliable and Oral Cysticercosis: A Collaborative Study affordable option for surgeons and patients. Conclusions Dr Dolly Due to its innate property of re-epithelialization and vascularization. Human amniotic membrane has proven to be a good dressing material PGIDS, Rohtak for management of wounds in various regions of oral cavity.

Abstract EPS00456 Background/Introduction Cysticercosis is a potentially fatal parasitic infection caused by Taenia Efﬁcacy of Temporalis Muscle Flap in Reconstruction solium. Taenia eggs may be ingested through undercooked/ raw pork, of Maxillary Defects vegetables, contaminated water or by autoinfection in patients infected with adult T. solium. Frequently affected tissues are brain, Dr. Kunal Marwah muscles, liver, heart, lungs and subcutaneous tissues. Though oral cavity involvement is rare, it can appear as asymtomatic swelling in Subharti Dental College, Meerut tongue, labial mucosa, buccal mucosa or ﬂoor of mouth. Objectives Abstract Background/Introduction 123 S252 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

The temporalis muscle flap, has been used as donor tissue for the repair Objectives of various head and neck defects because of its anatomic location. Objectives of this case report are to discuss a case of oral myiasis and Objectives to understand the occurence, presentation, treatment of this condition. The present study was conducted to evaluate the efficacy of tempo- Methods ralis muscle flap in reconstruction of maxillary defects. In this report, a case of oral myiasis in 55 year female patient with Methods rural background and poor oral hygiene has been described and also The short sample study includes 3 patients with maxillary defects that its clinical features, management and treatment are discussed. The reported to the department of oral & maxillofacial surgery Subharti treatment given was tablet Ivermectin 6mg OD. Cotton swab dental college Meerut. In which we compared nasolabial, radial impregnated with turpentine was placed near the defect area for 5- 10 forearm flap and temporalis muscle flap in reconstruction of maxillary minutes and Maggots were removed with the help of forceps. Wound defects. was debrided and slough was removed. Results Results Temporalis muscle flap is more desirable in reconstruction of max- The condition of the patient’s oral health improved after one month of illary defects upto the midline as it provides large surface to cover. the treatment. Patient is further recalled after 5 months for the six Conclusions month follow up. The temporalis muscle is an attractive option for maxillary recon- Conclusions struction for several reasons: (1) the donor site and the defect are To conclude, myiasis affects low socioeconomic level individuals within the same operative field and therefore the need for more with poor hygiene habits and unhealthy patients with psychiatric complex free tissue transfers can be avoided; (2) there is considerable disorders, diabetics, and immunocompromised patients. Undoubtedly, tissue available; (3) the flap remains well vascularized; (4) cosmetic preventive approach measures, including basic health care, hygiene, deformity is limited and (5) the flap can be used to correct defects access to primary health service, and safe water and drainage, are upto the midline. fundamental to prevent cases such as this one.

EPS00458 EPS00494 Submental Intubation in OMFS Follicular Unit Extraction Presentation Hair Transplant Dr. Mukhallat Qazi, Dr. Gunachandra Rai Dr. Ashok Kumar Abstract Background/Introduction Jaipur Dental College Yenepoya Dental College. Objectives Abstract In any surgical procedure under general anesthesia, the choice of Background/Introduction intubation technique requires a thorough assessment and multidisci- For androgenic alopecia, the only permanent available solution is plinary approach, especially in case of craniomaxillofacial trauma. surgical hair restoration. Techniques have evolved dramatically, with Nasotracheal intubation, which is the mainstay in various maxillo- FUE as the most recent advancement in minimally invasive surgical facial surgeries is contraindicated in fractures involving the middle hair restoration. third of the face, especially the median structures. Similarly orotra- Objectives cheal intubation becomes obsolete when we require the occlusion in Restoration and transplantation of hair. maxillomandibular fixation as a guide to optimally reduce and fix the Methods skeletal structures. This necessitates the need for knowledge of sub- IN FUE, individual units are removed from the scalp and prepared for mental intubation technique. The maxillofacial surgeon needs to be direct transplantation into recipient scalp. confident and well-versed with this method of intubation, as well as Results any associated complications. This process leaves little scar, and thus creates a natural, aesthetically pleasing result and patients experience minimal downtime before returning to normal activity. EPS00473 Conclusions Oral Myiasis: A Case Report Follicular Unit Extraction is the preferred option in many patients seeking surgical hair restoration. FUE is usually practiced in patients with androgenic alopecia, but has successfully restored a natural hair Dr. Anurag Agarwal appearance in patients with a number of other alopecia types. Cur- rently available methods include manual and automated systems, Institute of Dental Sciences, Bareilly offering the benefit of increased efficiency without the noticeable occipital line scar implicated in traditional surgical techniques. Abstract Background/Introduction Myiasis is the infestation of tissues and organs of animals and humans by certain Dipteran fly larvae or maggots. Oral myiasis is a rare condition occurring more frequently in underdeveloped countries or hot climate regions and is associated with poor oral hygiene, suppurative oral lesions.

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EPS00496 they feel ligaments, manipulating fracture segments, contouring bone Use of Autogenous Dentin Graft in Extraction Sockets grafts as if working directly on the patient. Haptic technology simulate operations and allow surgeons for precise preoperative planning especially in maxillofacial trauma, oncosurgery, orthognathic surg- Dr. Akhilesh Kumar Pandey eries, palpating myofacial trigger points and also helps to simulate surgery for training purposes for surgical students to practice and train Goa Dental College & Hospital more.

Abstract Background/Introduction Extracted teeth are still considered a clinical waste therefore dis- EPS00509 carded. It is evident that chemical composition of dentin is similar to Medico-Legal Cases Prospective in Oral bone. Following tooth replantation the tooth is replaced by bone and Maxillofacial Surgery Practice: A Conundrum followed by root resorption, ankylosis and ﬁnally integrated in sur- Resolved rounding alveolar bone. Objectives To present novel procedure in clinical setting that employs freshly Dr. Priyanka M. Tapsale extracted teeth that are processed into bacteria free particulate dentin, and grafted immediately in extraction site. Maharashtra Institute of Dental Sciences & Research, Latur Methods The process consists of reducing any restorations, caries or debris Methods after extraction. The clean, dry tooth is grinded using ‘Smart Dentin An Oral and Maxillofacial surgeon (OMFS) is highly likely to face Grinder’ The dentin particulate of 300-1200 um is sieved through plethora of medico legal cases (MLC) in day to day practice. How- special sorting system, and immersed in basic alcohol cleanser to ever there are vast lacunae in recording, analysing and understanding dissolve organic debris, bacteria Particulate is washed by sterile sal- of the correct method of dealing with such cases. Medical jurispru- ine, and is ready for immediate grafting into extraction socket. dence is interesting and serious. Correct interpretation of an injury in Results MLC needs utmost level of objectivity, observation skill, analytical Autogenous dentin graft helps in preservation of alveolar bone. It has ability and integrity. The OMFS should have an understanding of the been observed implant insertion has been possible in 2-3 months post law and legal system and can be a good witness in deciding true grafting. On X-rays & biopsy of grafting site a dense dentin-bone justice. However practitioners get anxious and apprehensive as they composite is found. have to interact with individuals and systems outside the normal Conclusions realm of practice. In today’s arena, it is of utmost importance to be Autogenous mineralized dentin particulate grafted immediately after aware of legal system and law of particular country. The OMFS needs extraction should be considered as gold standard for socket to have thorough understanding in recording and maintenance of the preservation. details of all MLCs and should have through knowledge of presenting the same in court. Professional guidelines for expert witness are often not well recognised as those relating to the clinical practice. This presentation provides a bird’s eye view into the details of registration EPS00506 of MLC, examination and recording of injuries, collecting medico- Advanced Virtual Reality: Haptics A True 3D legal evidences and writing a medico legal report. Also it highlights Experience for Maxillofacial Surgeons the court proceedings and possible questions that may be faced by the surgeon in the court. Dr. Ashish S. Satpute

Maharashtra Institute of Dental Sciences & Research, Latur EPS00511 Recent Advances in Local Anesthesia Abstract Background/Introduction Chetna Yadav Haptics, a term that was derived from the Greek word ‘‘haptesthai’’ meaning ‘‘pertaining to the sense of touch’’ which is added to present virtual reality technology which provides a true 3D experience for Rungta College of Dental Sciences Bhilai Chattisgarh maxillofacial surgeons. Methods Abstract ‘‘In virtual reality surgeons interacts with two dimensional sensory Background/Introduction modalities that is visual and auditory but in advanced virtual reality of Pain and its successful management have been one of the corner- haptic technology adds third dimension by recreating the sense of stones of Dentistry worldwide since time immemorial. The successful touch through applying forces, vibrations or motions to the user along use of local anesthetic solutions and their diligent administration have with visual and audio aids. Since 2013 research focused on tactile helped patients overcome their fears and displeasure towards den- interaction with holograms and distant objects by adding haptic tistry. Although local anesthesia remains the backbone of pain control feedback, which is successfully applied in advancements in medical, in dentistry, researches are going to seek new and better means of surgical, educational and other industries. Haptic technology provides managing the pain. Most of the researches are focused on improve- tactile and resistance feedback to surgeons, as they makes an incision ment in the area of anesthetic agents, delivery devices and technique involved. Newer technologies have been developed that can assist the

123 S254 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 dentist in providing enhanced pain relief with reduced injection pain EPS00531 and fewer adverse effects. This poster gives an overview and will Dilemma in Treating Oral Ulcer enlighten the practicing dentists regarding newer devices and methods of rendering pain control comparing these with the earlier used ones on the basis of research and clinical study available. Dr Shifa Objectives This review focuses on the most recent developments in dental LA Yenepoya Dental College techniques and devices. Methods Abstract This section will discuss vibrotactile devices, computer-controlled Background/Introduction local anesthetic delivery (CCLAD) systems, jet injectors, safety Oral ulcers are generally painful lesions that are related to various dental syringes and devices for Intra-Osseous (IO) anesthesia. conditions developing within the oral cavity. They can be classified Results into acute or chronic according to their presentation and progression. Conflict of Interest: None declared. Acute oral ulcers can be associated with conditions such as trauma, Conclusions recurrent aphthous stomatitis, behcets disease, bacterial and viral Local anesthetics have made a great advancement in dentistry and infections, allergic reactions and adverse drug reactions. Chronic oral have changed patients’ perspectives of dental procedures to a great ulcers are associated with conditions such as oral lichen planus, extent. There is still room for the improvement of painless techniques pemphigus vulgaris, mucosal pemphigoid, lupus erythematosus, in administrating local anesthetics. It is important for clinicians to be mycosis and some bacterial and parasitic diseases. familiar with all the local anesthesia devices and techniques available Objectives for dental procedures to best exploit them. The correct differential diagnosis is necessary to establish the appropriate treatment, taking into account all the possible causes of ulcers in oral cavity. EPS00526 Odontology: Bite Mark Analysis EPS00554 Dr. Supriya Dombre Fabrication of Customized Tongue-Displacing Stents: Considerations for Use in Patients Receiving Head Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, and Neck Radiotherapy Nagpur Dr Abhinav Neog Abstract Background/Introduction Abstract An objective analysis which can withstand vigorous cross-examina- Background/Introduction tion in High Courts is essential if perpetrators are to be matched to Conformal or intensity-modulated radiation therapy can be improved bite marks. The comparison of bite marks with dentitions of possible by using a customized tongue-displacing (CTD) stent. These stents perpetrators must be regarded as a scientific analysis in which a are designed to either move healthy oral tissues out of the path of the degree of concordance is either demonstrated or rejected. The mini- radiation beam or stabilize mobile tissues to allow more precise field mum requirements for any analysis are the recognition of individual control. dental features, quality of the bite mark registration in the skin or in Objectives animate object bitten and the quantity of evidence available for This poster presents a review of the current applications of cus- analysis. tomized intraoral stents which can help to prevent the unnecessary Objectives irradiation of surrounding normal tissues, thus reducing the severity To rule-out bit mark assessment in crime investigation. of the reaction and also throws Light on the various types of stents Methods that can be fabricated, their uses and its importance. 1. Photograph the bite mark. 2. DNA swabs of the bite marks along Methods with Impressions of the marks. 3. Silicone impressions of the bite The authors describe CTD stent construction for both tongue-devi- mark should be taken 4. Documentation of all actions related to the ating and tongue-depressing applications. collection of bite mark evidence. Results Results CTD stents enable clinicians to achieve more predictable and con- A determining role in the scientific analysis of the bite marks as the sistent radiation dosimetry planning while sparing greater volumes of pool of suspects may have only one suspect who would fit the pattern. healthy tissue from damage. They have been well tolerated by Conclusions patients. Bite mark analysis is a multi-faceted approach to the matching of Conclusions tooth marks left at the crime scene with the dentition of a suspect in Use of CTD stents results in increased oral mucosal sparing, ensures which the quality, quantity, presence or absence of dental features, reproducible immobilization and is incorporated readily into the warping, shrinkage and distortion in open and closed populations are clinical practice of radiation oncology. examined and reported on.

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EPS00557 ative patients suffering from congenital bleeding disorders The Adipose Stem Cells Used to Reconstruct Cranio- common bleeding disorders like hemophilia and von willebrand’s disease and their effects on the delivery of oral health care are also Maxillofacial Hard Tissue Defects included in this poster. Various lab test used for diagnosing such disorders are also discussed in poster. Dr Sanchaynee Pathak Objectives objective of this poster is to make people aware of recent advances in Abstract management of patients suffering from congenital bleeding disorders. Background/Introduction Methods Cranio-maxillofacial skeletal defects arise as a consequence of con- objective of this poster is to make people aware of recent advances in genital malformations such as cleft lip and palate, are due to traumatic management of patients suffering from congenital bleeding disorders. avulsion, result from tumor resection, or follow severe infection. The Results use of autogenous bone is still considered to be the gold standard for Objective of this poster is to make people aware of recent advances in the reconstruction of cranio-maxillofacial skeletal defects. An alter- management of patients suffering from congenital bleeding disorders. native approach is that of tissue engineering vital bone-forming cells, Conclusions growth factors, and a scaffold to promote the formation of new bone Objective of this poster is to make people aware of recent advances in in a desired location and with particular precise dimensions and management of patients suffering from congenital bleeding disorders. shape. Objectives The aim of this poster is to review consecutive cases of cranio- EPS00571 maxillofacial hard-tissue defects reconstructed with a variety of scaffolds seeded with adipose-derived stem cells (ASCs) and in some Surgical Management of Elongated Styloid Process: cases with the addition of the growth factor. A Review of Cases Methods The authors describe the use and efficiency of Adipose Stem Cells in Dr. Shruti Sunil Patil treatment of Cranio- maxillofacial deformities. Even in some cases the combination of adipose stem cells and biomaterials is been used and is been considered to be an advanced therapy. Abstract Results Background/Introduction The success criterion for the grafts at the four different sites, frontal Pain is the most frequent cause of suffering and disability. The eti- sinus, cranium, mandible, and nasal septum healed hard-tissue grafts ology of orofacial pain is still elusive. However, the etiology has to be in their recipient bed, functioning according to the demands of their ascertained for definitive treatment. Only after a systematic and new native sites during the follow-up period show good results cor- careful evaluation can a treating surgeon be aware of the underlying responding to bone growth. cause. Though dental causes predominate in the diagnosis of orofacial Conclusions pain, the rare cause of facial pain have to be excluded, which would The use of adipose-derived stem cells (ASCs) along with other prevent unnecessary and fruitless dental treatment. Pain is the most combinations has proven to be very useful for cranio maxillofacial frequent cause of suffering and disability. Misdiagnosis and multiple reconstruction. failed treatments are common in some patient population. Patients with orofacial pain frequently undergo numerous dental procedures that fail to eliminate symptoms, and are often referred to the oral and maxillofacial surgeon for evaluation and treatment. Facial pain can be EPS00559 the presenting, and sometimes the only, complaint of many disorders Management of Patients with Congenital Bleeding that originate from cranial structures. Patients with pharyngodynia, Disorders in Dental Clinic neck, and facial pain can lead to an extensive differential diagnosis. Vague orofacial pain associated with elongation of the styloid process or calcification of the stylohyoid ligament has been known as Eagle Dr Dipesh Gawri syndrome may be taken in account. American otorhinolaryngologist Watt Weems Eagle in 1937 defined ‘‘stylalgia’’ as an autonomous Rungta College of Dental Science entity related to abnormal length of the styloid process or to mineralization of the stylohyoid ligament complex. Eagle described two Abstract possible clinical expressions attributable to elongated styloid process Background/Introduction as follows: 1. Classic styloid syndrome 2. Styloid carotid syndrome. Oral and maxillofacial surgeons must be aware of the impact of Objectives bleeding disorders in the management of such patients. Initial To demonstrate cases of elongated styloid process can be managed recognition of a bleeding disorder, which may indicate the presence intraorally without tonsillectomy. of a systemic pathologic process, may occur in dental practice. Fur- Methods thermore, prophylactic, restorative and surgical dental care of patients Cases operated in the department of oral and maxillofacial surgery with bleeding disorders is best accomplished by practitioners who are with an intraoral approach for elongated styloid process. knowledgeable about the pathology, complications and treatment Results options associated with these conditions. The purpose of this poster is Cases of elongated styloid process can be managed intraorally with- to review the recent advances in management of pre and post-oper- out tonsillectomy. Conclusions Surgery was uneventful, Follow ups revealed that the patients had remained symptom free after surgery.

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EPS00575 Objectives Socket Shielding Technique: Boon to Implant Dentistry To provide an overview of modern nuclear medicine and exemplify its application in the diagnosis and treatment of oral and maxillofacial diseases. Dr. Rupam Methods Bone Scanning Bone scan uses a radiopharmaceutical technetium- BRS Dental College & Hospital, Distt Panchkula 99m labeled with diphosphonates having half-life of six hours and emission of 140kev gamma energy. Since the adsorption of diphos- Abstract phonates to hydroxyapaptite is 40 times more than organic matrix its Background/Introduction uptake correlates with degree of mineralization. Areas of increase Extraction of a tooth inevitably brings the loss of alveolar bone width uptake is called ‘hot spot’ whereas areas of decrease uptake is called and height, impeding the esthetic outcome of immediate implants. A ‘cold spot’. Lesions resulting from radiation treatment, local vascular clinical technique was developed where the buccal portion of the root compromise, prosthetic joint, early osteomyelitis, multiple myeloma, is retained to preserve the periodontal ligament and bundle bone. and avascular necrosis which causes area of decrease uptake or cold Objectives spot is also seen on bone scan. Positron Emission Tomography (PET) To evaluate the potential of socket shielding technique in preserving 18F-fluorodeoxyglucose (FDG) is the radiopharmaceutical most tissue and bone loss at extraction site for immediate implant commonly used in PET scanning. FDG is a glucose analog that is placement. transported into cells and phosphorylated like glucose, but the Methods: A Medline (Pubmed) search was performed using the metabolism stops at this point and the phosphorylated FDG becomes terms; ‘‘socket shielding technique’’, ‘‘partial extraction’’, ‘‘socket trapped in the cell and starts to accumulate. Most tumors, with a more preservation for immediate implants’’,: case reports for socket rapid growth rate, have an increased rate of glucose use due to an shielding technique ‘‘from 2000 to 2017. increased rate of glycolysis compared to normal tissue or scar tissue. Results Consequently, FDG preferentially accumulates in tumor cells and Various authors confirmed the reduced bone loss. Preservation of demonstrates an increased uptake especially in poorly differentiated buccal bone contour after healing in case of socket shielding tech- tumors. The accumulated FDG is detectable to the PET camera. nique in comparison when implants were placed without using this Lymphoscintigraphy Technetium 99m sulfur-colloid is injected in technique. four to six subcutaneous sites around the neoplastic lesion. The Conclusions radioactive colloid will be carried away in the lymphatic channels to Socket shield technique meets the demands of minimal invasion, the first echelon lymph node draining that area, the so-called sentinel tissue preservation, and no need of bone substitute materials. Thus, it node. The sentinel node is felt to be the best predictor of nodal spread is a viable and safer method for preserving alveolar bone and can be of the tumor. The pattern of lymphatic spread and the sentinel node employed for successful immediate implant placement. can then be imaged using a gamma camera. One to two hours later, in the operating room, the surgeon using a hand held gamma counter is able to localize the node and remove it. Salivary Gland Studies The major salivary glands with a functioning parenchyma have the ability EPS00588 to take up technetium 99m pertechnetate in sufficient quantities to be Role of Nuclear Medicine in Diagnosis of Oral imaged, since the Te99 mimics chloride influx into the acinar cells. and Maxillofacial Diseases Scintigraphy involves administering a radioactive tracer with an affinity for the organ or tissue of interest; the distribution of the radioactivity is then recorded with a scintillation camera. SPECT It is Dr. Dibya Falgoon Sarkar an extension of conventional bone scan as it utilizes tomographic technology to provide 3-dimensional images (axial, coronal and Abstract sagittal) which thereby facilitates more accurate interpretation and Background/Introduction better localization of bone pathology, Medical healthcare has been using nuclear medicine for a long time Results now but the use of it in dentistry is poorly understood, underutilized, Bone scanning (Dale, Baur et al.) Bone scans can be used to diagnose underexplored. In recent time procedures like PET, SPECT, lymph and differentiate osteomyelitis from cellulitis, as well as detect pri- node scintigraphy /sentinel lymph node has made nuclear medicine as mary and metastatic malignant disease. They can also be used to adjunct in modern diagnostic arena and justifies its use in dental assess the vascularity of bone grafts and contribute to the diagnosis of disease as well. Nuclear medicine utilizes the accumulating action of various metabolic bone diseases such as fibrous dysplasia, Paget’s radioisotopes in cells and so after injecting them, with a help of a disease, TMJ osteoarthritis, and rheumatoid arthritis (RA). It is specialized gamma camera images are taken at a certain time interval important to keep in mind a bone scan can detect 10-15% mineral to detect distribution and quantification of isotopes and hence meta- loss, while standard radiographs will only visualize a bony defect bolic activity. Head and neck tumors, salivary gland disease, and after 35-50% mineral loss. Overall the scan has a high sensitivity but various metabolic as well as infectious processes of the head and neck low specificity, Positron Emission Tomography (PET) (Dale, Baur region are the areas where radio isotopic scanning can be used in oral et al.) PET can be used to assess the response of a tumor to treatment, and maxillofacial disorders. Plain films radiographs, CT scan and diagnose recurrence, detect residual disease, or detect distant MRI scan are able to provide good soft and hard tissue imaging only unknown metastases. PET scanning is helpful in evaluating a neck when morphological change have occurred but nuclear scanning mass or evaluating a neck without palpable adenopathy (staged as a precede them in diagnosis by detecting metabolic changes earlier than N0 neck) in oral squamous cell carcinoma. PET is especially useful to be seen as morphological changes. With all these observations a when trying to localize an occult primary tumor. PET has not shown dentist must be aware of this specialty and discussion and emphasis any usefulness in pre-operative evaluation of salivary gland neo- should be laid on this for a successful diagnostic and therapeutic plasms. In OSCCA, there has been a great deal of interest in using implications. PET to evaluate the clinically N0 neck for occult or micrometastasis

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S257 before any changes are visible on CT or MRI. False positives can also functional sequels affecting phonation, deglutition and mastication. occur in conditions such as tuberculosis and sarcoidosis. Overall, Therefore, approach for cancer patients is not only based on control of while the sensitivity can be lacking, the specificity is high. Lym- the disease, but also the rehabilitation and reinsertion in society. phoscintigraphy (Goyal, Khanna, et al.) Sentinel node mapping is a Objectives technique which uses the property of carcinomas to spread via lym- Surgery is first choice for early cancers and for cancers that do not phatics. Sentinel node is first draining node of a particular anatomical respond to radiation and chemotherapy in the form of salvage. Sur- area. In carcinomas, sentinel node is primary node carrying metastatic gery can result in cosmetic, functional and psychological impairment cells via lymphatics which further drain into subsequent nodes. If greatly affecting the patient’s quality of life. Presently the thrust in sentinel node is diagnosed to be involved then chances of lymphatic cancer care is not simply on survival but on rehabilitation, which aims spread to other nodes is present. It prevents unnecessary surgical to improve multiple impairments and Quality of Life (QOL). intervention if sentinel node is found to be negative for metastases. Conclusions Salivary Gland Studies (Dale, Baur et al.) Scintigraphy of these Health related QOL refers to a multidimensional concept, which glands is used for functional evaluation and evaluating mass lesions. encompasses perception of both negative and positive aspects of four Mass lesions in a gland usually present as areas of decreased uptake, dimensions of physical, emotional, social and cognitive function. The with the notable exception of Wharthin’s tumor and oncocytomas team of rehabilitation usually comprises of otorhinolaryngologist, which demonstrate increased uptake and decreased washout time. radiation oncologist, medical oncologist, maxillofacial prosthodontist, Patients with Sjogren’s Syndrome may have poor uptake of the speech therapist, psychologist, and nursing staff amongst the other radiopharmaceutical and poor response to stimulation. Acute disciplines for specific problems of the cancer patient. As a critical inflammation of the glands usually demonstrates increased uptake and member of the team the maxillofacial prosthodontist co-ordinates the increased washout, whereas chronic inflammation shows decreased effort in many facets of patient care. Rehabilitation goals are focused uptake. SPECT Various uses of SPECT includes assess the on the restorative, supportive and palliative aspects of treatment. The mandibular invasion of squamous cell carcinoma (SCC) determining primary objective of this poster is to showcase various post-operative in the therapeutic course in patients with asymmetrical mandibular prosthesis following oncology surgery of head and neck cancers that condylar hyperplasia and to assess the osseous integration process of rehabilitate to preserve and restore the function of speech, swallow dental implants. Bone grafting (Goyal, Khanna t al.) Use of bone and esthetics. scans/PET scans to determine viability of bone graft is useful in predicting graft failure. Since clinical monitoring of these vascularized grafts is difficult bone scans are useful studies done by Karcher et al (35), Harbert et al (34), Schimming (36) have shown significant EPS00672 role of nuclear medicine in deterring success/failure of bone grafts. The Cutting-Edge in Oral and Maxillofacial Surgery Conclusions Radionuclide imaging is a patient-friendly, non-invasive technique Dr Amol Dubey for detecting various disease processes in dentistry. It includes techniques which are sensitive and specific for imaging inflammation, YMT Dental College Kharghar, Navi Mumbai infection, and malignancies. It is able to deliver objective measurements before and after intervention, surgery or any other treatment modalities so that outcome analysis can be performed quantitatively. Abstract Interpretation of the scan results, as well as the pitfalls involved is Background/Introduction important to understand, as they may be required at times to be done Abstract The vision for the future with advanced technology and by the dental surgeons. Bone scan, SPECT imaging and PET scans science for easy and better treatments outcome motivating the clini- are the techniques that help in diagnosing oral/dental pathologies and cians to look forward the cutting edge tactics in the oral and tumors. In the present era, since nuclear diagnostic techniques are maxillofacial surgery. The results will be providing patients with first being used commonly in dental practice, it is important for the den- class medical services with the reduction of treatment morbidity. tists to be familiar with these scans in nuclear medicine and also to be Greater progress has been made in the field of oral and maxillofacial well versed with the various indications for nuclear imaging tech- surgery. In the last decades the researchers were concentered for the niques in oral/dental pathologies. improvement of the preoperative planning as it plays vital role in success rate of the surgical procedures. Now as the result of the advanced computer technology, the researches extend beyond the scope of planning and moving toward the surgical procedures itself EPS00606 Evolution over the last decades focused towards the improvement of Maxillofacial Prosthetic Rehabilitation After Oncology preoperative planning, minimally invasive approaches and minimiz- Surgery ing the operation time. All aiming to decrease surgical complications and post operative pain and rapid return to normal life style activities. As a result; remarkable recent advances in surgical and computer Dr. Swati Jadhav technology are evolving every day. Innovation in oral and maxillofacial surgery have allowed the professions to progress at very fast MIDSR Dental College Latur rate for more every day. The increased accuracy and speed of treatment along with reduced discomfort, and decreased the complications Abstract will always be the actual advantage to our patients. The of our current Background/Introduction review is to give an insight about the cutting edge in the field of oral Tumor processes compromising the head and neck region can par- and maxillofacial surgery to provide a more detailed physical mani- ticularly affect the identity of the human being. There are different festation of your mental picture and new dimension of insight into the therapeutic alternatives to treat this cancers, which generate clinical situations you encounter every day:

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EPS00680 determined. Statistical Analysis: For correlation of age between Demineralised Dentin Matrix for Alveolar Bone estimated age and actual age, using cemental lines Pearson’s correlation coefficient was applied. Engineering Results A strong positive correlation was found between the estimated age Dr. Akansha Kandoi and actual age. Blood groups obtained from the pulp were compared with those obtained from the study subjects. Sinhgad Dental College, Pune Conclusions The evaluations of fingerprints, lip prints, and palatal rugae showed Abstract fractal dimensions, occurring variations in dimensions according to Background/Introduction the complexity of each structure. Even though a minute self-repetition Autogenous bone graft is considered the gold standard for the repair in the patterns of lip, thumb, and palate among the three consequent of alveolar bone defects, but it is associated with donor complications generations in a family was observed considering the sample size, and morbidity and also suffers from a limited supply. To avoid and these results need to be confirmed in a larger sample, either to overcome these disadvantages, bone substitutes are under develop- establish the role of chaos theory in forensic science or identifying a ment as an alternative to autogenous bone. Dentin and bone having particular pattern of the individual in his family hierarchy. same biochemical similarities led to the idea of using it as a bone regenerative material. Objectives EPS00721 This poster discusses the development and clinical use of demineralized dentin matrix (DDM) produced from the patient’s own Cyberknife: A Stereotactic Radiosurgery for Head n extracted teeth, to repair alveolar bone defects. Neck Tumors & Trigeminal Neuralgia Methods Both vital and non vital extracted teeth after removal of soft tissue Dr. Mehta Payal (Trainee) Guided By: Dr. Nimisha Desai and callus, where rinsed twice in phosphate buffered saline. The teeth was then crushed in a dentin grinder, the resultant particle were Karnavati School of Dentistry, Uvarsad, Gandhinagar washed in 1. oM sodium chloride and partially demineralised for sometime. This was then mixed with PRF and used as grafts. Results Abstract Background/Introduction Appreciable amount of bone regeneration was seen in the patients. Conclusions The CyberKnife System is a non-invasive alternative to surgery for A tooth is the simplest thing one could think of to be used as a bone the treatment of a number of cancerous and non-cancerous tumors. It substitution material. The easy availability makes the job even easier. focuses on minimizing and eliminating tumors within the body. DDM with larger particle size induced prominent bone regeneration CyberKnife cancer treatment does not require any cutting, needles, or and can be easily used as a bone substitute. anesthesia. Instead, the system sends concentrated doses of radiation directly to the tumor. This means the CyberKnife cancer treatment option minimizes exposure to healthy tissue and reduces side effects because of the beam’s increased accuracy. It has become the leading EPS00712 radiosurgery system. Current Trends O Forensic Odontology Objectives To report outcomes of stereotactic radiosurgery CyberKnife for head & neck tumors, trigeminal neuralgia and to evaluate them. Dr. Patel Mamta Methods Stereotactic radiosurgery is delivered with the CyberKnife an X-band Rungta College of Dental Sciences and Research linear accelerator with an overall system targeting error of less than 1 mm. The lightweight linear accelerator is capable of irradiating the Abstract target from 120 different directions using image-guidance based on a Background/Introduction treatment plan created using a CT volume. Treatment is administered Forensic odontology is currently defined as forensic dentistry which is depending upon the configuration and volume of the tumor as a branch in dentistry dealing with proper handling, examination, and determined by the treating radiation oncologist, neurosurgeon and evaluation of dental evidence, which will be then presented in the oral and maxillofacial surgeon. Dose constraints are applied to nearby interest of justice. The current scenario of forensic dentistry is that critical structures based upon the total dose and fractionation scheme. though there are many researchers working on various aspects of Results forensic odontology, applications of dental findings in personal Show the benefit of CyberKnife salvage treatment for advanced, identification still lack significant practical applications. recurrent lesions, without lymph node metastases in previously irra- Objectives diated head and neck cancer and trigeminal neuralgia. The purpose of this study was to determine age, sex, and ABO blood Conclusions group of individual from a single tooth, to determine the effect of Demonstrates the effectiveness of CyberKnife stereotactic surgery in different environmental conditions, and to extract maximum infor- providing safe and effective pain relief as an alternative to invasive mation also at the same time preserving some tissue for the further surgical procedures in cases of head n neck tumors and trigeminal investigation whenever needed. neuralgia. It focuses on providing the most comfortable experience in Methods the outpatient center. Treatment with it is completed within 5 days, The teeth were sectioned longitudinally in the buccolingual plane allowing the patient to carry on with their everyday lives. along the midline. Longitudinal ground sections of each tooth were prepared for age determination from cemental lines. Pulp removed was divided into two halves thereafter sex and blood group was 123 J. 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EPS00726 Results Different Treatment Modalities for Oro Antral Significant long-term relief was observed in the patients with no reported morbidity. Communication Conclusions Glycerol injection has been used as one of the treatment options for Dr. Rayan Malick the management of trigeminal neuralgia due to simplicity of procedure and long-term results with minimal complications. Abstract Background/Introduction Oro-antral communication and fistula can occur as a result of inade- ABS00739 quate and improper treatment. Inadvertent communication with the maxillary sinus can occur during certain surgical procedures in the Efficacy of Polidocanol Sclerotherapy maxillary posterior region. Though, spontaneous healing may occur in for the Management of Venous Malformation defects which are smaller than 2 mm but larger communications require in Maxillofacial Region immediate attention and should be treated without delay, in order to avoid sinusitis and further complications leading to patient discomfort. Objectives Dr. Arun Kumar Mehta Oro-antral communications and fistulas (OACs & OAFs) are complications frequently encountered by oral and maxillofacial surgeons. Rama Dental College Hospital and Research Centre, Kanpur Other causes of OAC/OAF include tuberosity fracture, dentoalveolar/ periapical infections of molars, implant dislodgement into maxillary Abstract sinus, trauma (7.5%), presence of maxillary cysts or tumors (18.5%), Background/Introduction osteoradionecrosis, flap necrosis, dehiscence following implant fail- Venous malformations in maxillofacial region are common and need ure and sometimes as a complication of the Caldwell-Luc procedure. to be treated conservatively in smaller low-flow superficial lesions. Methods Sclerotherapy with Polidocanol provides better results with minimal A presentation on management of cases of oroantral communication/ complications. Fistula with different surgical and nonsurgical modalities. Objectives Results To evaluate the efficacy of polidocanol sclerotherapy in the man- A wide range of techniques has been proposed for the management of agement of venous malformation in maxillofacial region. oroantral communication but the surgical closure of oroantral com- Methods munication remains the better treatment of choice. 25 patients were selected with symptoms of pain, swelling, discol- Conclusions oration functional limitations and discoloration in maxillofacial Oro antral fistula/communication should be managed promptly by region. They were treated with polidocanol sclerotherapy. The out- creating a barrier between oral cavity and maxillary sinus. Different come were evaluated on the basis of color, swelling, ongoing growth, treatment modalities should be offered to the patient considering both and assessment by parents and physician. Serial photographic records surgical and non surgical options. were maintained. The response were graded as excellent, good, poor, or nil. Results All patients reported ‘‘good response’’ in pain 60% (3/5), swelling ABS00734 (87%; 20/23), functional limitation (81%; 17/21), and cosmetic dis- Management of Trigeminal Neuralgia figurement (73%; 11/15). None of the patients responded to ‘‘No change’’ or ‘‘worse’’ for any symptoms. In addition, 17 of 25 patients Dr. Neelam Yadav, 1st Year Post Graduate, Dr. Pravesh Mehra, (68%) reported being ‘‘very satisfied’’ with the treatment; these HOD & Prof patients were defined as the ‘‘satisfaction’’ group. Conclusions Efficacy of polidocanol sclerotherapy for the treatment of low flow LHMC, New Delhi venous malformations in maxillofacial region produces excellent results with minimal complications. Abstract Background/Introduction Trigeminal neuralgia is a paroxysmal and severely disabling facial pain. The diagnosis is usually made on the basis of a typical history ABS00747 and the exclusion of secondary causes. Initial management of the pain Role of Sialoendoscopy in Management of Non Stone is medical. Carbamazepine is the drug of choice although some Disorders of Salivary Gland patients respond to other drugs including phenytoin, baclofen, sodium valproate and clonazepam. Invasive therapy (Nerve block and surgical excision of nerve) should be considered if medical treatment fails Dr Chirag Chamria, Dr Gokul Venkateshwar or cannot be tolerated. Objectives Dept. of OMFS, D Y Patil University, School of Dentistry, Navi To review the efficacy and safety of Glycerol Injection as an invasive Mumbai treatment option in the management of Trigeminal Neuralgia. Methods Abstract A series of 50 cases diagnosed with trigeminal neuralgia and treated Background/Introduction with glycerol injection in the peripheral branches of the nerve were Eligible articles that reported on the use of sialendoscopy in the reviewed. The patients were followed up for at least 1 year and treatment of non-stone disorders were identified using Pubmed, intensity of pain was assessed.

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Science Direct, NCBI, & Google Scholar. The search used key words was 24.2 Months and the 4 year and 7 year OS rates were 42% and sialendoscopy, salivary endoscopy, salivary scope, salivary duct 36% respectively. 3) Survival times following BNCT ranged from 1 stenosis, salivary duct stricture, salivary duct obstruction, sialadenitis, to 95 month 4) BNCT improved quality of time and survival time. 5) chronic sialadenitis, juvenile recurrent parotitis, parotitis. The primary adverse events were brain necrosis, osteomyelitis and Objectives transient mucositis and alopecia. Review the current literature on the use of sialendoscopy in the Conclusions treatment of non-stone disorders of the major salivary glands. All cases were advanced and 17 of 35 (49%) had regional lymph node Methods metastases and 10 Out of 35 (29%) had distant metastases. Boron Full-length prospective and retrospective original articles; systemic concentration rations of tumor/normal tissue as determined by reviews; and meta-analysis, including adults and children with ade- 18FBPA- PET imaging were 1.8-7.0 for SCC, 2.5-4.0 for sarcomas quate data for evaluating the sialendoscopy for non-stone disorders, and 2.5-7 for parotid tumor. were included. Results There is an increasing trend for the use of sialendoscopy for salivary obstruction caused by a wide variety of non-stone disorders world- EPS00776 wide. The studies of sialendoscopy for non-stone disorders are often Evolution of Dressing Materials: Then and Now retrospective, of smaller sample size, and more subjective in measurement of patient outcome. The most common indications currently Dr. Nitesh Chhikara for the procedure are scars, juvenile recurrent parotitis, radioiodine sialadenitis, and Sjogren syndrome, respectively. Bapuji Dental College & Hospital, Davangere, Karnataka Conclusions Although the initial evidence for the use of sialendoscopy for non- stone disorders is not as established as that for stones, it remains a Abstract promising gland-preserving tool in the management of non-stone Background/Introduction disorders of major salivary glands. Throughout history, from the ridiculous to the ingenious, various interventions have been utilized to enhance healing in acute wounds and to overcome the unique challenges posed by chronic wounds. Objectives EPS00748 This presentation discusses the evolution of the types of dressing Boron Neutron Capture Therapy !!!!!!!!!!! materials and methods from the past to the most advanced technologies of the present that are used in order to enhance wound healing and stave off infections. Dr. Rubi Gupta Methods PolyMem polymeric membrane range of dressings is multifunctional RCDSR Bhilai and comprises a hydrophilic polyurethane matrix that contains a mild, non-toxic wound cleanser (F-68 surfactant), soothing moisturizer Abstract (glycerin), a superabsorbent starch co-polymer and a semi-permeable Background/Introduction backing film and lead to a giant evolution in dressing materials his- BNCT, a kind of radiotherapy, is a revolutionary treatment method tory. Another key feature is their ability to combine wound cleansing, which enables to kill only the cancer cells selectively by generating a debridement and fluid handling (absorption and retention of fluid) nuclear reaction. The target substance, the boron compound, which is which makes them highly suitable for a wide variety of wounds and absorbed into cancer cells and exposed to irradiation from a neutron, cost-effective approach to healing and pain relief. which is harmless to the human body. The Boron reacts to this Results exposure and kills the cancer cells. Combination of dressings with drugs or active agents was done to Objectives prevent or treat infection, stimulate the healing process, or control the As alternative to conventional radiation therapy for malignant brain production of scar tissue and favorable results were obtained. tumors, recurrent head and neck cancer, and recurrent sarcomas. To Conclusions estimate safety and effectiveness of BNCT for patient with recurrent The development of newer materials like polymer dressings along head and neck cancer for which there were no other treatment option. with nano-crystalline technology and advancement of the existing Methods methods can result in better outcomes and improve concordance with From December 2001 to February 2013, total of 35 patient with the care plan and simplifying the dressing choice. recurrent HNC by means Of 52 applications of BNCT. Histopatho- logically, there were 24 patients with squamous cell carcinomas. 7 with salivary gland carcinomas and 4 with sarcomas. All of them had received standard therapy and subsequently developed recurrent dis- EPS00781 ease for which there were no other treatment options. All of the Augmented PRF in the Management of Cystic Lesions patient received intravenously either a combination of two boron containing drugs, sodium borocaptate (BSH, 5g) and borophenylala- Dr. Shreepriya Miskin nine (BPA, 250mg/kg) or BPA (500mg) alone. In this report, the clinical results and outcomes of 35 patients with HNC who had Abstract received BNCT at either the Kyoto University research reactor Background/Introduction institute (KURI) or Japan Atomic Energy Agency (JAEA) nuclear platelet rich fibrin is a autologous biomaterial, which is second gen- reactor. eration platelet concentrate which possesses favourable biological Results properties like inducement of new blood vessels, support of immune Regression rates were CR:18 Cases (51%), PR:13 (37%), PD:3 (9), response, helps in hemostasis, wound coverage and accelerate both NE:1. 1) The overall response rate 88%. 2) The mean Survival Time

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S261 soft tissue and bone healing. Bone grafts have excellent bone con- EPS00818 ductive properties and permit outgrowth of osteogenic cells from Effectiveness of 4% Articaine for Maxillary Posterior existing bone surface into the adjacent bone structure. Objectives Tooth Extraction To evaluate the outcome with use of PRF in isolation or in combination with bone graft material in the management of peri apical Dr. Mohd Athar Iqbal, Dr. Shefali Ghodeswar, Dr. Vrinda Kolte, Dr. lesion. S.R. Shenoi, Dr. Anoop Garg Methods In the patients who diagnosed with cystic lesion, after enucleation, VSPM Dental College bony defect filled with PRF in isolation and in combination with graft material to evaluate the healing and bone formation post operatively. Abstract Results Background/Introduction PRF in combination with graft gives better healing. Research shows that most of the population may avoid dental care Conclusions because of fear of injection. 1 Palatal injection are most painful and PRF in combination with graft, will improve handling properties, known to be poorly tolerated. The posterior buccal maxilla is thin and graft stabilization, hemostasis, promote wound healing, bone growth porous, and facilitates the diffusion of local anesthetic, especially and maturation. articaine, a local anesthetic agent, which is known to be highly diffusible. Objectives EPS00788 To demonstrate effectiveness of articaine as an anesthetic agent used on buccal side only. Stem Cells: The Future of Dentistry Methods The data will be collected from 180 sites. - In the experimental side Dr. Ankita Mutha 1.7ml 4% articaine hydrochloride with epinephrine was given buccal. - On the control side an identical protocol was applied for buccal ACPM Dental College, Dhule injection; and palatal infiltration - Pain will be assessed with VAS and VRS scale. Abstract Results Background/Introduction In the experimental side 71/80 patients (88.7%) indicated that the pain Stem cells have become a mainstay in future research in dentistry. In was ‘‘less than expected’’, 8 patient indicated that the pain was ‘‘as humans, dental stem cells are relatively easily obtainable and exhibit expected’’ and 1 patient rated it as ‘‘greater than expected’’. On the high plasticity and multipotential capabilities. This will be a bench- control side, 74/80 patients (92.5%) indicated that the pain was ‘‘less mark in the future Oral and Maxillofacial Surgery. than expected’’, 4 patients indicated that the pain was ‘‘as expected’’ Objectives and 2 patients rated it as ‘‘greater than expected’’. The objective of this poster is to highlight the types of stem cells, Conclusions methods of harvesting stem cells and its uses in Oral and Maxillo- Articaine hydrochloride 4% demonstrated relatively good buccal facial Surgery. palatal diffusion and hence to provide analgesia owing to high dif- Methods fusing property of articaine hydrochloride; thus discomfort associated Mechanically dissociate the pulp tissue and filter through a 70um with injection can be avoided. strainer and culture in alpha-minimal essential medium (MEM) with 20% FBS and medium changed twice a week. At day 21 cells were detached and analyzed at Fluorescence Activated Cell Sorter (FACS) EPS00822 for stem/progenitor antigen expression in good manufacturing practice (GMP) conditions. Cells will be detached using 0.02% EDTA Oral and Maxillofacial Surgery: Perception & Referral solution, centrifuged and incubated with 1ll of antibody in 100llof Patterns of Various Medical and Dental Health Care phosphate buffered saline (PBS) solution for 1hour at 4°C. Antibodies Professionals in Nagpur City: An Observational Cross were anti CD34 and anti-flk-1. Sectional Study Conclusions Stem cells of dental origin have multiple applications, nevertheless, there are certain limitations as well. Like other powerful technologies, Dr. Nilima Surve, Dr. S.R. Shenoi, Dr. Vrinda Kolte, Dr. Nikhil dental stem cell research poses challenges as well as risks. If we are to Moriwal, Dr. Sapna Vadera realize the benefits, meet the challenges, and avoid the risks, stem cell research must be conducted under effective, accountable systems of VSPM’s Dental College and Research Centre, Nagpur social-responsible oversight and control, at both the national and international levels. Abstract Background/Introduction People in today’s world are more health conscious and are aware of the different medical specialties. Despite the tremendous advancements in the field of dentistry, there seems to be a limited knowledge among the general public and also among medical professionals regarding the areas of specialization in dentistry. Oral and maxillofacial surgery (OMFS) receives referrals from dental and medical professionals and also from emergency services. This remains the only specialty in dentistry to be closely associated with other medical departments. 1 Patients regularly present to their dentists or

123 S262 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 emergency departments with abnormalities that require the expertise Conclusions of specialists in OMFS. Our medical and dental colleagues need to The efficacy of PRP in improving wound healing makes it a useful have the necessary knowledge to make informed decisions about their adjunct in Oral and Maxillo-Facial surgery. PRP can be used in a wide patient’s management. 3 It has been found that very few studies have variety of surgeries and its versatility can make it a helpful addition. collected data concerning the dental knowledge of medical practitioners. Objectives Section: Scientific Innovations To main objective of the study is to evaluate the referral pattern in OMFS by various medical and dental health care professionals. - To ascertain how knowledgeable the medical and dental health care professionals are about the diverse scope of surgical procedures that INV001 the oral and maxillofacial surgeon performs. Intermaxillary Fixation Technique Methods An observational cross sectional study was conducted in 2 months duration. Medical Health Care Professionals and Dental Health Care Dr. Abdul Ahad Khan Professionals in the institution and various private practitioners in Nagpur city were included in the study. MBBS: 50 MS: 50 BDS: 50 Intermaxillary fixation [tying/alignment of upper and lower teeth MDS: 50 Data was collected using printed pre tested, semi-structured together in a prespecified position (satisfactory dental occlu- questionnaire. The data collected is to be analyzed using the Statis- sion/maximum intercuspation)] is one of the treatment modalities tical Package for the Social Sciences statistical software (SPSS employed in the management of facial jaw fractures since times version 16.0). immemorial. It has also been used to orient the upper (maxilla) and Results lower jaw (mandible) in various other surgical procedures such as Results are awaited as the study is under statistical evaluation. orthognathic surgery, tumor/cancer resection surgery etc. There are Conclusions various ways of achieving intermaxillary fixation (IMF) mentioned in The term ‘oral and maxillofacial surgery’ (OMFS) evolves from the the literature viz., Gilmer’s wiring, Risdon’s wiring, arch bar wiring, anatomical region with which it deals. Contrary to common belief, the Ivy eyelet wiring, intermaxillary fixation screws, orthodontic work performed by an oral and maxillofacial surgeon (OMS) does not brackets, bracket bars bonded to the teeth, adhesive cast and ther- start and end with teeth. It expands to incorporate procedures that are moforming splints, buttons or beads and wires, Dimac wires, Rapid life saving, as well as those that enhance the quality of life by pro- IMF etc. The technique mentioned here is novel, innovative and has viding better function and aesthetics. In the Indian scenario, OMFS as bare minimum disadvantages as compared to all the previous a specialty till date is far removed in the thoughts of medical pro- techniques. fessionals and the general public. Our medical and dental colleagues Technique: A pre-specified 26 gauge Stainless Steel wire of 6 inches/ need to have the necessary knowledge to make informed decisions 15cm length is stretched and straightened to release the inner stresses. about their patient’s management. Wiring involves one corresponding tooth on each side (right and left), in both upper and lower arches, say 2nd premolar and/or central incisor. For demonstration purposes, we use artificial dental models and consider 2nd premolar of left upper (maxillary) and lower EPS00825 (mandibular) arch. Both ends of the straightened wire are passed from PRP in Oral and Maxillo-Facial Surgery buccal (outer) to palatal (inner) side through the mesial and distal interdental spaces (as shown in photograph no. 1). Dr. Siddhant Pradhan/Dr. Mukul Padhye/Dr. Gokul V

Abstract Background/Introduction During the past several years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in Oral And Maxillofacial Surgery. PRP is now widely used in OMFS to augment wound healing in various situations. Objectives The objective of this presentation is to shed light on the various uses of PRP in Oral and Maxillo-Facial Surgery and its efﬁcacy in improving the post operative results. Methods A review of literature was conducted for PRP in Oral and maxillofacial surgery. A number of articles were reviewed and compared. Results The results of these studies demonstrate that PRP is effective in soft tissue healing and bone regeneration. There was no signiﬁcant Now the wire that was passed from the mesial interdental space of advantage to the use of PRP when combined with other materials with maxillary left 2nd premolar should be directed through the distal regards to sinus lifting but the results can vary depending on the interdental space of mandibular left 2nd premolar while coming out material used. from lingual (inside) to the buccal (outside) and the wire that was passed through the distal interdental space of maxillary left 2nd premolar was brought buccally (outside) from the lingual (inside) side through the mesial interdental space of mandibular left 2nd premolar (as shown in photograph no. 2).

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The length of the wires are adjusted suitably after achieving sat- The passage of the wires lingually/internally (towards the side of isfactory dental occlusion (as shown in photograph no. 3) and IMF the tongue) creates an ‘X’ shape because of crossing over (as shown (Intermaxillary ﬁxation) is done by tying both the buccal wires in photograph no. 6). together over the facial/buccal surface of mandibular left 2nd premolar (as shown in photograph no. 4).

One important point to mention here is that wires are to be placed on both right and left sides initially and IMF (intermaxillary ﬁxation) should be done simultaneously on both the sides. The end result is shown in photograph no. 7A, 7B and 7C (as seen from both sides and from behind) below.

Photograph no. 7A Photograph no. 7B Photograph no. 7C

Left IMF Right IMF As seen from the back (inside)

Advantages

1. It takes very less time for application and removal (an average of 5 minutes, each for doing IMF & removal). Excess wire will be cut and tucked interdentally (as shown in 2. It remains stable over a time span of 3–4 weeks if taken care photograph no. 5). of. (i.e. the patient should voluntarily bite the teeth into occlusion forcefully, while sneezing/ coughing, so that bare minimum pressure is transferred to the wires).

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Improper instrumentation due to the inadequacy of intraoral space 3. It reduces intra-operative surgery time (required for doing leads to the difﬁculty of anaesthetizing the region, inability to place IMF as compared to other techniques). the forcep etc. Any attempt to open the mouth forcefully during 4. No pre-operative preparation needed (i.e. arch bar/ ivy eyelet extraction may tear the buccal mucosa leading to excessive bleeding application). and further aggravating the ﬁbrosis in that region. 5. In addition to Maxillofacial trauma, it can be used in all To avoid and overcome these problems the following measures surgeries related to jaw reconstruction (orthognathic surgery, can be adopted so that the extraction of malposed third molar jaw resection/reconstruction surgery) wherever IMF is needed. becomes easier: 6. It permits better oral hygiene maintenance. 1. Vazironi Akinosi block should be used instead of inferior 7. It reduces possibility of glove perforation (as compared to alveolar nerve block for mandibular third molar. Posterior other prevalent techniques). superior alveolar nerve and greater palatine nerve block should 8. It reduces possibility of needle stick injury per se (as be used for maxillary third molar. compared to other prevalent techniques), thus less possibility of 2. The adjacent buccal mucosa is to be anaesthetized topically. transmission of infection. 3. 24-guage standard stainless steel wire is to be used. This wire is 9. It reduces iatrogenic trauma (due to less no. of wires used and to be cut obliquely and introduced through the interdental space less no. of teeth involved). of the second and third molar. The two ends of the wire are then 10. It is very economic and easy to master. twisted tightly around the crown to prevent them from slipping. 4. The tooth is elevated with the help of an elevator. While Disadvantages: elevating the tooth, precaution should be taken that the adjacent buccal mucosa is in a relaxed position. This can be accomplished 1. Its utility is questionable in cases where the teeth have open by asking the patient to close the mouth while elevating the tooth. inter-proximal contacts. 5. After elevating the tooth, it is pulled out of the socket with the 2. Its utility is limited when the involved teeth are also compro- help of a twisted wire instead of applying the forceps. mised (mobile/fractured). any one of the wires gives way 3. Even if (breaks), then we will Advantages have to repeat the wiring on both the sides. 1. It does not tear buccal mucosa as the mucosa is in relaxed position. 2. No space is required for placing the wire in the third molar INV002 region. Newer Technique of Third Molar Removal in Trismus 3. Patients experience relatively less pain. Due to Oral Submucous Fibrosis Disadvantages

Dr. Abhishek Akare 1. It is not used in stage 4 cases of OSMF because of the difficulty of access to the distal to the third molar. Hence placing the wire in that region can be difficult. Abstract 2. It is a time-consuming process as it takes a lot of time to place the In oral submucous fibrosis, to avoid chronic mechanical irritation in wire in the third molar region. posterior part of buccal mucosa adjacent to the malposed upper and 3. This technique is used only in completely erupted third molars. lower third molar, extraction of malposed third molar is necessary. Trismus caused by fibrosis makes it difficult for the removal of third molar. Any attempt to open the mouth forcefully during extraction Acknowledgements may tear the buccal mucosa leading to excessive bleeding and further Funding: No funding was required. aggravating the fibrosis in that region. To avoid and overcome these Conflict of interests: No conflict of interest. problems this technique can be adopted so that the extraction of Ethical approval: Not required. malposed third molar becomes easier. Patient consent: Informed consent has been obtained. Technical Note Oral Submucous Fibrosis (OSF) is characterized by chronic, insidious fibrotic change causing stiffening of oral mucosa, oropharynx and References trismus. In advanced cases thick fibrotic bands extend from subep- 1 1. Lai DR, Chen HR, Lin LM, Huang YL, Tsai CC: Clinical ithelial connective tissue to muscle layer. Chronic mechanical evaluation of different treatment methods for oral submucous trauma due to sharp remaining teeth, less than ideal fillings prosthesis fibrosis. A 10 year experience with 150 cases. J Oral Pathol Med and loose anchoring attachments have been report etiology for oral 2 24:402, 1995. squamous cell carcinoma in OSF patients. Trauma to mucosa acts as 2. Thumfart W, Weidenbecher M, Waller G, Pesch HJ: Chronic a promotional stimulus in inducing epithelial dysplasia or carcinoma 3 mechanical trauma in the aetiology of oropharyngeal carcinoma. initiated with carcino-gen like with betel nut, tobacco. J Maxillofac Surg 6: 217, 1978. In order to avoid chronic mechanical irritation in posterior part of 3. Bhonsle RB, Murti PR, Daftary DK, Gupta PC, Mehta FS, Sinor buccal mucosa adjacent to the malposed upper and lower third molar, PN, Irani RR, Pindborg JJ: Regional variations in oral submucous extraction of malposed third molar is necessary. Trismus caused by fibrosis in India. Community Dent Oral Epidemiol 15:225, 1987. fibrosis makes it difficult for the removal of third molar due to reduced mouth opening, limited access and reduced visibility.

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INV004 Posterior Belly of Digastric Muscle Flap for Contour Deformity Correction After Superﬁcial Parotidectomy

Anuj Jain & Anshul Rai

Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Reconstruction of the hollowing defect after parotidectomy becomes essential part of the surgery now days. The percentage of Frey’s syndrome (FS) postoperatively [1] was between 12.5 to 62%. FS and contour deformity (CD) significantly reduces a quality of life of the patient [2]. Many space filling techniques to prevent CD and FS have been documented in the literature after parotidectomy. They are Sternocleidomastoid (SCM) muscle flap, Platysma muscle flap (PMF), Temporoparietal fascia (TPF), Superficial musculoaponeu- rotic system (SMAS), Buccal fat pad (BFP). Non-vascularized tissues such as dermal fat graft, fat injections at subdermal layer, acellular dermal allograft and artificial material such as ethisorb or gore-tex [3]. SCM muscle flap creates a hollow deformity of the upper neck at Fig. 2 Photograph showing posterior belly of Digastric muscle the donor site, especially in thin and young patients. When large within the surgical site inferiorly based flap was raised and when the patient turns his or her head away from the donor side it becomes more obvious (Fig. 1) [4]. We have used this technique successfully in 5 patients without any PMF is very thin and required expertise. All other techniques required complications. After identification of facial nerve trunk, the conven- another incision or dissection which increases post-operative dis- tional anterograde nerve dissection was carried out carefully followed comfort of the patients. To eliminate all these complications, we by superficial parotidectomy. The digastric tendon was incised at the recommended posterior belly of digastric muscle (PBDM) flap greater cornu of the hyoid bone (Fig. 3) and the flap was reflected (Fig. 2) after superficial parotidectomy to prevent CD and FS. easily. The PBDM was sutured to the remaining dense fascia of the parotid bed and tendon was sutured in the pre auricular area just above the auriculotemporal nerve course to prevent FS post-operatively (Fig. 4).

Fig. 1 Postoperative photograph of the patient showing hollowing defect Fig. 3 PBDM ﬂap

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Fig. 4 Photograph represents sutured tendon of muscle at the pre auricular region just above Fig. 6 Bilateral symmetrical postoperative result Advantages of PBDM PBDM originates from the mastoid notch lies between the mastoid and styloid process, very close to the stylomastoid foramen and Disadvantage PBDM is short in comparison to other flaps but inserted on the digastric tendon. It is considered by many as a land- eliminates all the drawbacks of other flaps mentioned above. In mark to identify the facial nerve [5]. It is encountered during the conclusion, we present an innovative and simple method of PBDM surgery and that’s why easy to dissect. No extra incision or dissection transposition to eliminate the CD after superficial Parotidectomy. required. The branch of occipital artery which supplies the muscle References was preserved. It can be easily used without any complications in young patients and patients with thin neck. There was no donor site 11. Li C, Yang X, Pan J, Shi Z, Li L. Graft for prevention of Frey morbidity and no post-operative contour deformity was noticed. syndrome after parotidectomy: a systematic review and meta- Excellent postoperative results were noticed after reconstruction with analysis of randomized controlled trials. J Oral Maxillofac Surg. PBDM flap (Figs. 5, 6). 2013;71:419–27. 12. Arden RL, Miguel GS. Aesthetic parotid surgery: evolution of a technique. Laryngoscope. 2011;121:2581-5. 13. Hayashi A et al. Effectiveness of platysma muscle flap in preventing Frey syndrome and depressive deformities after parotidectomy. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2016;69:663–72. 14. Edward W. H. Sternomastoid muscle flap for parotidectomy: the pros and cons. British Journal of Plastic Surgery. 2002;55:88–93. 15. Kanatas AN, McCaul JA. Use of digastric branch of the facial nerve for identification of the facial nerve itself in parotidectomy: technical note. British Journal of Oral and Maxillofacial Surgery. 2011;49:493–494.

INV005 A Novel Approach to Treat Markowitz Type 1 and Type 2 Naso-Orbito-Ethmoidal Fractures- Minimally Invasivetranscutaneo-Periosteal Plates

Dr Arjun Shenoy, M.D.S Fig. 5 Excellent postoperative result after turning the head Fellow in CMF Trauma (AOMSI)

Introduction Displaced Fractures of the Naso-Orbito-Ethmoidal complex have always stood out as a challenge for surgeons owing to their complex articulation in the central midface from the anatomic, aesthetic and

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S267 functional perspective. In Maxillofacial Trauma, the evolving trends have shown a steady paradigm shift towards minimally invasive procedures when approaching facial fractures from the extra-oral approach. The aim of these minimally invasive procedures has been to achieve restoration of original form and function without compromising the aesthetic outcome. Conventional surgical approaches to the central midface describe incisions which allow for proper visualisation of the fracture fragments to aid in their reduction and fixation. The attachment of the medial canthal ligament to the NOE Complex and its disruption during the fracture play a vital role in the treatment planning and surgical intervention. Markowitz Type 1 and Type 2NOE fractures can be unilateral or bilateral and are characterized by the medial canthal ligament being attached to a bone fragment which may or may not have significant displacement. The innovative novel approach of transcutaneo-periosteal plates (TCPP system) was conceptualized by the authors as a minimalistic but effective design template to aid in anatomic reduction and dynamic fixation without the need for placing an incision in the treatment of Markowitz Type 1 & 2 fractures of the NOE complex fractures. The dynamic fixation refers to the fixation principle which allows for real time manipulation of the template by digital compression in the postoperative period allowing for the moulding of the NOE Complex into its desired form and function. A detailed clinical study of the versatility and viability of the TCCP System was undertaken as a one year fellowship scientific study by the author during his one year AOMSI fellowship in Cranio-Maxillofacial Trauma at a Tier 1 Trauma Centre. Materials and Methods To have an universal and appealing application, the TCCP System has been modelled on a template that was readily available and inexpensive. The 4 hole with gap stainless steel and titanium plates served as the basic rigid splint upon which the displaced NOE complex could be re-suspended both with antero-posterior traction and horizontal vector traction. After the plate was in flush mimicking the intended framework to be restored, sutures 4-0 vicryl or nylon is passed through the skin and negotiated through the periosteum of the NOE complex and suspended over the template with positive traction. The traction suspension allows for post-operative manipulation by digital compression to aid in dynamic remodelling to res tore the anteroposterior projection and disrupted intercanthal distance.

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Methodology of Research The clinical study was performed over a period of one year as a part of the fellowship project as instructed by the AOMSI from 2015–16. The sample size of cases were 20. The cases included both displaced Type 1 markowitz and type 2 Markowitz fractures of the NOE Complex.

NOE fracture type Patients

Markowitz type 1 with displacement 10 Markowitz type 2 10

Clinical Parameters

Antero-posterior projection Pre-op & post op Inter medial canthal distance Pre-op & post op Functional nasal airﬂow Post op only Subjective Patient satisfaction index Post op only Post operative radiographic measurements Pre-op and post op

Why this Study Fits in the Innovative Bracket Having stepped into a year of fellowship in Cranio-maxillofacial trauma at a tier 1 unit, there existed an urge to design a simple yet brutally efficient template which could minimise the time required to fix the Type 1 and 2 fractures which did not necessarily need can- thopexy. Since most of the patients who presented with these classification of fractures were usually the ones with pan-facial fractures, saving time using this radical yet simple design was a breath of fresh air. Clinically backed by a year long clinical original research study which confirmed the efficacy of the TCPP system in restoring the lost form and function, the author felt the need to advocate the simplicity and universal appeal of this innovation which could be beneficial to many units who deal exclusively in facial trauma surgery, hence saving time and increasing productivity of the unit. Patents None. Special Interests None.

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INV007 surgical technique which differs from that of E. C. KO et al on certain Transoral Gap Arthroplasty for Temporo Mandibular important aspect. Patients and Methods Joint Ankylosis Eight TMJA in a series of 5 patients were operated for gap arthroplasty transorally between February 2012 and August 2013. The Dr Dinesh Jhawar, Professor, Dr Ritesh Rajan, Professor and Head average age of the patient at the time of surgery was 14.4 yrs and none of them were recurrent cases. Two of the patients had Sawhney’s Dept of OMF Surgery, SVS Institute of Dental Sciences, class I type of ankylosis and three of them had type II ankylosis. The Mahabubnagar average mouth opening at the time of surgery was 8.6mm with the lowest being 4mm and the highest 14mm. All patients had history of Abstract trauma to the mandible with two of them reporting with history of This paper describes the technique of performing gap Arthroplasty in prolonged Maxillomandibular fixation. Follow up ranged from 3 Temporomandibular Joint Ankylosis (TMJA) by transoral access. months to 20 months with mean follow up of 9 months. No inter- Treatment of TMJA by creating an adequate gap is paramount in positioning material or substance was used in any of the cases. preventing any future recurrence and this can be achieved only when Physiotherapy and mouth opening exercises were started on 1st post good access is gained to this complex anatomical joint. Five patients operative day with increasing intensity towards the 7th day. Patients with eight TMJA were treated by gap arthroplasty using intraoral were generally discharged on 3rd post operative day and reviewed approach. The average mouth opening before surgery was 8.6mm and once a week for the first month and once a month for the rest of an average mouth opening achieved post surgery was 37.9mm. The follow up period. Condylar reconstruction is contemplated after one average follow up time was 9 months and none of the patient had any year of ankylosis free period and this is achieved using ramus dis- recurrence or significant complications during or after surgery. Our tractors. (Table 1). technique relies on using a stable landmark to trace the superior most Surgical Technique extent of the Ankylotic mass and thereby facilitate in removing the Nasotracheal intubation was done to administer anaesthesia on all five entire mass including the medial extent. We found that even though patients with the aid of blind awake technique. Following this, the transoral access is technically challenging and took an average time of incision site was infiltrated with 10 cc of lignocaine and adrenaline of 84 minutes, it has many advantages over conventional extra oral 1: 200000 concentrations. With adequate retraction, mucosal incision approaches in terms of facial scar or facial nerve injuries. Authors was made along the external oblique ridge beginning from also emphasise on the importance of good post operative physio- mandibular 1st molar, posteriorly along the anterior border of ramus. therapy and pre surgical patient counselling to prevent future Mucoperiosteal flap was raised on lateral and medial surface of recurrence. mandible down to the angle region and superiorly until the inserting Transoral Gap arthroplasty for Temporo Mandibular Joint fibers of temporalis muscle were visualized. They were incised and Ankylosis retracted upwards with the aid of forked ramus retractor almost till the Temporomandibular joint ankylosis (TMJA) is a common condition tip of coronoid. A malleable retractor is then placed at the inner aspect in India. In spite of attempts to prevent its incidence by timely and of the ramus to protect the internal maxillary artery that lies imme- appropriate management of mandibular condyle fractures in both diately deep to the condylar neck and the channel retractor moved pediatric and adult populations, it is still seen quite rampantly. upwards for better access to the ankylosed area. An osteotomy was Ankylosis of temporomandibular joint is an extremely debilitating performed at the base of coronoid process running obliquely upwards condition especially when it affects the joint in its growing stages. towards the sigmoid notch. The osteotomy was completed with the Apart from causing severe facial disfigurement, it also alters the aid of osteotomes and the coronoid was retrieved transorally after patients eating habits and speech ability. It aggravates psychological detaching the remaining fibers of temporalis. Once the coronoid was stress, prevents the patient from maintaining good oral hygiene out, an attempt was made to increase the mouth opening with the aid resulting in dental decay, loss of multiple teeth and hampers the of Hiesters mouth opener. In bilateral ankylosis, the same was quality of life 1. attempted after completing coronoidectomy on both the sides. It was Treatment of ankylosis is often challenging and many surgical observed that mouth opening improved by an average of 3 mm after techniques have been reported in the literature. Since the times of unilateral coronoidectomy and 5mm after bilateral resections. A Esmarch, 1851 who was credited with performing first ever osteot- mouth prop was placed interocclusally on the contra lateral side to omy for ankylosis to the times of Abbe (1880) and Risdon (1934), maintain the mouth opening. The dissection was carried out superi- who introduced the concepts of gap arthroplasty and interpositional orly towards the zygomatic arch and once it was identified, a arthroplasty respectively, to today’s times, the debate still rages on, periosteal incision was made at its inferior border and subperiosteal on the choice of ideal treatment 2, 3. Kaban and et al. 4 outlined the dissection was carried out along the arch posteriorly to trace the protocol for management of TMJA in 1990 which is universally anterior and superior extent of the ankylotic mass and glenoid fossa. followed and was later modified by the same author 5 in 2009. Once the superior extent of the ankylotic mass was delineated, an Accessing the temporomandibular apparatus or the ankylotic mass, by osteotome or surgical bur was used to separate it from the glenoid choosing from myriad of extra oral incisions and techniques so far fossa. Another osteotomy was initiated at about 1.5 cm below the reported, had always been an impending challenge to the surgeon in previous one to create an adequate gap. The entire ankylotic mass was terms of i) gaining adequate visibility, ii) minimizing facial scar, iii) removed in one piece or in piece meal pattern depending on the negotiating facial nerve and auriculotemporal nerves to prevent their medial extent of the exuberant mass. In bilateral cases, the similar injuries, iv) to reduce intra-operative and postoperative hemorrhage, procedure was repeated on the opposite side. After release the v) occasional anatomic deformity of the ear vi) surgical infection vii) mandible was vigorously opened and mobilized to release any left- salivary fistula and sialocele 6. Many authors tried to circumvent over fibrous union. Postoperative physiotherapy was begun on 1st these complications approaching the joint trans orally. However, E. post operative day with gradual increasing intensity by the end of first C. Ko and S. Lai 7 in 2009 were the first and only authors to report week. transoral access for the treatment of TMJA. In this article we report Results our experiences with transoral access to the TMJA and describe our The targeted minimum mouth opening at the end of surgery on table was 35 mm and we could achieve that mouth opening in all patients except one (Patient no:4). The mouth opening achieved

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ranged from 33.6mm to 42 mm with the mean mouth opening of 37.9mm. All the patients presented slight decrease in mouth opening during follow up periods but none of the patients had any recurrence or signiﬁcant decrease in post operative mouth opening. One patient 120 mins Surgery (patient no 4) had decrease of mouth opening by 7mm at 2 months follow up which was the maximum decrease among all the patients, and was subsequently maintained with active physiotherapy. The mean decrease in mouth opening at the last follow up as compared to that achieved at the time of surgery was 3.6mm. Apart from one patient showing signiﬁcant decrease in mouth opening, none of the patients had any intra operative or post operative complications. The superior most extent of the ankylotic mass was traceable in all the patients using this technique irrespective of the size and extent of the Op Mouth Opening

Complications Duration of mass. The duration of surgery ranged from 45 minutes to 120 minutes with a mean duration of 84 minutes. Discussion The ultimate goals of treating TMJA is to restore mouth opening to at least 35 mm, prevent any further recurrence and to restore as near normal ramal height as possible either by reconstruction or by distraction osteogenesis. To achieve these goals, the foremost important thing is to gain a good access to the joint area which helps in adequate Amount of Decrease In Mouth Opening resection of the ankylotic mass. The variety of incisions and techniques described in the published data on approaches to the condyle 8, reﬂects the complexity of the anatomy of this region and the importance of preservation of vital structures in the pathway. The classical pre auricular approach described by Blair 9, Dingman 10 and the modiﬁed versions of Al-Kayat, Bramley 11 and popowich 12 carry the risk of injuring peripheral branches of facial nerve and an

Mouth Opening of The Last Follow-Up unsightly scar on the face. The post auricular incision described by Alexander 13 gives the best cosmetic result as it is hidden in the post auricular crease. Injuries to the facial nerve are minimal with this approach but in cases of massive ankylosis, it might be difﬁcult to reach the anterior extent of the ankylotic mass and also could result in

Follow- up Period residual ear deformity or auricular stenosis. Vishal Bansal et al. 6 in comparing the pre auricular approach with post auricular in 30 joints with TMJA have outlined many beneﬁts of this approach but also suggested that this approach might lead to more intra operative hemorrhage and the prolonged time to expose the joint as chief disadvantages. Politi et al. 14 proposed a surgical technique called ‘‘deep subfascial approach’’, in which they claimed no transient or permanent facial nerve injury by developing an additional protective fascial Mouth Opening Immediate Post-Op layer when the dissection was performed deep to the deep temporalis fascia. The bicoronal approach ﬂap described by Pogrel et al.15,in bilateral ankylosis cases carries no special advantage over two separate bilateral preauricular incisions with temporal extensions. In our view it has additional burden of more blood loss, longer duration and

Pre-Op Mouth Opening has no advantage of wider exposure and access to the ankylosed mass as compared to the conventional pre auricular approach. Although many authors16,17 in the past have described intra oral approach to the condyles, to treat various problems related to it, it was E. C. Ko et al7 who first published this technique to treat TMJA. We (Sawhney) observed similar advantages and disadvantages with our technique as described by Ko et al which are, absence of facial scar, less possibility of injuring the facial nerve and the auriculotemporal nerves, no sialocele, simultaneous coronoidectomy via the same incision, ability to protect internal maxillary artery by placing a retractor on medial surface of ramus and thus reducing chances of hemorrhage. The disadvantages with this technique like, limited surgical field, the requirement to have a good sense of orientation and the limitations regarding the selection of interpositional material are also agreed upon. We differ from Ko et al in terms of surgical technique, in which they advocate retaining the superior part of the ankylotic mass Details and outcome of the patients treated Age Sex Ankylosis Etiology Type without any attempt at removing it to prevent possible risk of middle cranial fossa perforation. Salins3 clearly reiterated the importance of complete excision of ankylotic mass to prevent chances of reanky- Table 1 Patient No. 123 84 12 M M 24 Bilateral Unilateral F 16 Trauma Trauma II M Unilateral I Trauma Bilateral I Trauma II 8mm 14mm 12mm 5mm 35mm 38mm 42mm 33.6mm 20 Months 8 Months 32mm 8 Months 36mm 6months 38mm 26mm 3mm 2mm 4mm 7mm - - - Significant Decrease In Post 90 mins 45 mins 80 mins 5 12 M Bilateral Trauma II 4mmlosis. He 41mm stated that partial 3 Months excision 39mm of the ankylotic 2mm bone often - results 85 mins

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S271 in reorganization of the entire mass and complete encapsulation of 12. L. Popowich, R. M. Crane. Modified preauricular access to the materials used for interposition. The bridging ankylotic mass con- temporomandibular apparatus: Experience with twenty-eight tinues to grow without any signs of remodeling and is augmented on cases Oral Surgery, Oral Medicine, Oral Pathology 1982: 54: the medial side by tough fibrous scar which makes the second 257–262. intervention even more challenging. Similarly Kaban4 and Raveh 13. Alexander RW, James RB. Postauricular Approach for Surgery et al18 emphasized on complete excision of the ankylotic mass to of the Temporomandibular Articulation. J Oral Surg 1975: 33: prevent reankylosis. Our technique of complete removal of the 346–350. ankylotic mass relies on tracing the superior most extent of the mass 14. Massimo Politi, Corrado Toro, Roberto Cian, Fabio Costa, at its junction with the cranial base by using the inferior border of Massimo Robiony. Deep Subfascial Approach to the TMJ. zygomatic arch as a key anatomical landmark. J Oral Maxillofac Surg 2004. 62: 1097–1102. In our case series we did not use any interpositioning material, not 15. M.A. Pogrel, D.H. Perrott, L.B. Kaban. Bicoronal flap approach for the reason that it is technically more challenging by transoral to the temporomandibular joints. International Journal of Oral approach but for the reason that we believe aggressive post operative and Maxillofacial Surgery 1991: 20: 219–222 physiotherapy and proper counselling of the patient prior to surgery 16. Moose SM. Surgical correction of mandibular prognathism by are the most important factors in preventing reankylosis. Our views intra-oral subcondylar osteotomy. Br J Oral Surg 1964: 2: are shared by Katsnelson et al2 in a systematic review and Meta 172–176. analysis published by them in 2012. Similarly Ajoy Roy Choudary 17. Shevel E. Intra-oral condylotomy for the treatment of temporo- et al19 in their series of 50 cases of TMJA, emphasized the crucial role mandibular joint derangement. Int J Oral Maxillofac Surg 1991: of post operative physiotherapy over interpositioning. 20: 360–361. Application of endoscopic technique in transoral approach to 18. Joram Raveh, Thierry Vuillemin, Kurt La¨drach, Franz Sutter. TMJA is irrefutable as described by Sembronio et al20. It is easy to Temporomandibular joint ankylosis: Surgical treatment and check the medial aspect of the resection and intraoral endoscopic long-term results. Journal of Oral and Maxillofacial Surgery guidance may be useful to safely remove the ankylotic mass and 1989: 47: 900–906. anchor the temporalis muscle and fascia flap more accurately, 19. Ajoy Roychoudhury, Hari Parkash, Anjan, Trikha, DA. Func- reducing the risk of re-ankylosis. Though transoral approach cannot tional restoration by gap arthroplasty in temporomandibular be employed in every case of ankylosis, especially in massive and joint ankylosis: A report of 50 cases. Oral Surg Oral Med Oral recurrent cases, the option of using it should always be borne in mind Pathol Oral Radiol Endod 1999: 87: 166-9. whenever possible and should be augmented with an endoscope to 20. Salvatore Sembronio, Alberto Maria Albiero, Francesco Polini, improve the accuracy when available. Massimo Robiony, Massimo Politi. Intraoral endoscopically assisted treatment of temporomandibular joint ankylosis: pre- References liminary report. Oral Surg Oral Med Oral Pathol Oral Radiol 1. Keqian Zhi, Wenhao Ren, Hong Zhou, Ling Gao, Lu Zhao, Endod 2007: 104: e7–e10 Chengqun Hou, Yincheng Zhang. Management of temporo- Captions to Illustrations mandibular joint ankylosis: 11 years’ clinical experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009: 108: 1. Table 1: Details and outcome of the patients treated. 687–692. 2. Pic 1: Pre Operative OPG of left unilateral ankylosis 2. Alexander Katsnelson, Michael R. Markiewicz, David A. Keith, 3. Pic 2: Pre Operative 3-D Reconstructed Image of Let Unilateral Thomas B. Dodson Operative Management of Temporo- ankylosis mandibular Joint Ankylosis: A Systematic Review and Meta- 4. Pic 3: Intra Operative Picture of Tran oral Access and Gap Analysis. J Oral Maxillofac Surg 2012: 70:531–536 Arthroplasty 5. Pic 4: Picture Showing resected coronoid and ankylotic Mass. 3. Salins PC. New perspectives in the management of cran- 6. Pic 5: Post Operative OPG of the same patient at follow up. iomandibular ankylosis. Int J Oral Maxillofac Surg 2000: 29:337. 4. Kaban LB, Perrott DH, Fisher K. A protocol for management of temporomandibular joint ankylosis: J Oral Maxillofac Surg 1990 48: 1145. 5. Kaban, Bouchard, and Troulis. Management of Pediatric TMJ Ankylosis. J Oral Maxillofac Surg 2009: 67: 1966–1978. 6. Vishal Bansal, Sanjeev Kumar, Apoorva Mowar, Anurag Yadav, Gagan Khare. The post-auricular approach for gap arthroplasty - A clinical investigation. Journal of Cranio- Maxillo-Facial Surgery 2012 40: 500–505 7. E. C. Ko, M. Y. Chen, M. Hsu, E. Huang, S. Lai. Intraoral approach for arthroplasty for correction of TMJ ankylosis. Int. J. Oral Maxillofac. Surg 2009:38: 1256–1262. 8. G.J. Knepil, A.N. Kanatas b, R.J. Loukota. British Journal of Oral and Maxillofacial Surgery. 2011: 49: 664– 665. 9. Blair VP. Operative treatment of ankylosis of the mandible. Surg Gynec Obstet 1914: 19: 436 10. Dingman RO, Grabb WC. Intracapsular temporomandibular joint arthroplasty. Plast Reconstr Surg 1966: 38: 179–185. Pic 1 Pre Operative OPG of Left Unilateral Ankylosis 11. Al-Kayat A, Bramley P. A modified pre-auricular approach to the temporomandibular joint and malar arch. Br J Oral Surg 1979: 17: 91–103.

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Pic 4 Picture Showing Resected Coronoid and Ankylotic Mass

Pic 2 Pre Operative 3-D Reconstructed Image of Let Unilateral Ankylosis

Pic 5 Post Operative OPG of the same patient at follow up

INV008 An Innovative and Novel Tool for Maxillo-Mandibular Fixation: Orthodontic Brackets and Fiber-Reinforced Composite

Pic 3 Intra Operative Picture of Tran oral Access and Gap Dr. Gursimrat Brar Arthroplasty Abstract Introduction Maxillo-Mandibular Fixation (MMF) is used in a variety of clinical situations, including the management of mandible and midface fractures, maintenance of occlusion during mandible reconstruction and maintenance of occlusion after elective orthognathic surgery. Stabilisation, immobilization and maintenance of occlusion are the primary goals accomplished in placing the patient into maxillo-mandibular ﬁxation. Various methods for maxillomandibular ﬁxation are prevalent; wiring alone or wiring of archbar being the most commonly used method. But this exposes the operator to many communicable viral and bacterial infections by perforating injuries as well causes considerable insult to the periodontium and is painful and uncomfortable for the patient. As a safer alternative, orthodontic brackets and elastics or elastomeric chain has been reported in literature, however, it may cause extrusion of the teeth. But combining it with some splinting technique may provide a satisfactory solution. 123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S273

Purpose of the study Clinical and radiological evaluation of the Diagnosis and decision of the treatment method of maxillofacial results of using orthodontic brackets and Fiber-Reinforced Composite fractures was made on the basis of detailed history, clinical and for maxillo-mandibular fixation and also to evaluate the efficacy of radiological examination. Routine laboratory investigations which this method in preventing perforating injuries to the operator. include complete blood count, urine analysis, glycemic index and Methodology The present study included 30 patients who required viral markers were carried out to assess systemic condition of selected maxillo-mandibular fixation as a part of their treatment for maxillo- cases before the procedure. All the procedures were performed by the facial injuries. Maxillo-mandibular fixation using orthodontic same surgeon. brackets and fiber-reinforced composite was done and patients were The inclusion criteria for the study were: Patients of age 10 years followed up for 8 weeks. Occlusion, inter-incisal mouth opening, Loe and above with dentoalveolar fractures, mandibular fractures, both and Sillness gingival index, incidence of debonding, any perforating associated with unilateral or bilateral condylar fractures, midface injury to the operator were assessed during the study. fractures requiring maxillo-mandibular fixation, TMJ disorders Results Satisfactory occlusion was achieved in all the patients at 8 requiring maxillo-mandibular fixation or restricted mouth opening. weeks post-operatively, mean mouth opening achieved at the end The exclusion criteria were: Patients with a decreased level of of 2 months was 39.2 mm, mean gingival index was below 1, consciousness, learning difficulties or history of significant psychi- incidence of debonding was 23.33% and incidence of glove per- atric disease, with compromised respiratory status, with associated foration was 0. head injury, edentulous patients and those with multiple missing teeth Conclusion Application of fibre-reinforced composite and on either side of fracture line or in the opposing arch. orthodontic brackets behave more like a customized archbar where All the patients were evaluated for the cause requiring maxillo- the fibre-reinforced composite provides horizontal stability and mandibular fixation. Mouth opening was assessed by measuring the brackets act as cleats for application of elastics. From this study, we inter-incisal distance in millimeters between central incisors in each conclude that this method is highly beneficial in preventing perfo- arch. Assessment of gingival condition was made by Loe and Sillness rating injuries to the operator, especially in cases of patients with gingival index (GI). All the teeth were assessed. positive viral markers. The respect for periodontal tissues, bloodless Following pre-operative assessment, patient was admitted. Medi- application and removal and ease of oral hygiene maintenance are cations (antibiotics, anti-inflammatory drugs and analgesics) were other advantages of this technique. administered prior to the procedure, if required. Introduction Operative Procedure Trauma to the facial region frequently results in injuries to soft tissue, Step 1 teeth and major skeletal components of the face. One of the main Under complete aseptic conditions, patient was painted with challenges in the management of maxillofacial trauma is to consis- antiseptic solution and draped, exposing the area to be operated upon. tently restore patients back to their pre-injury form and function. In Local anaesthesia was administered using 2% Xylocaine with 1: the proper reduction of fractures of tooth-bearing bones, it is impor- 80,000 concentration adrenaline. Oral cavity was thoroughly irrigated tant to place the teeth into the pre-injury occlusal relationship. with saline and 0.02% chlorhexidine solution and all the loose debris Maxillo-mandibular fixation is used in a variety of clinical situa- and blood clots were removed, if present. Figs. 1, 2. tions, including the management of mandible and midface fractures, the maintenance of occlusion after elective orthognathic surgery. Stabilization, immobilization, and maintenance of occlusion are the primary goals accomplished in placing the patient into MMF. Cur- rently, rigid internal fixation techniques are widely used for the treatment of fractures. Even with rigid fixation, a proper occlusal relationship must be established before reduction, stabilization and fixation of the bony segments. Use of orthodontic brackets and elastics or elastomeric chain as an alternative technique for maxilla-mandibular fixation has been widely reported in literature. However, theoretically, bonding brackets on to the teeth alone and applying elastic traction may cause the extrusion of the teeth, so use of orthodontic brackets as a method for maxilla- mandibular fixation must be combined with some splinting technique. The development of fiber-reinforced composite (FRC) technology Fig. 1 Pre-operative photograph has brought a new material into the realm of metal-free, adhesive aesthetic dentistry. It has not only shown to have significant benefits in terms of mechanical properties, the possibility of direct chairside application and the ability to bond to the tooth structure make FRC an attractive choice for a variety of dental applications including splinting of the teeth. Orthodontic brackets bonding and intermaxillary elastics in combination with a splinting technique is a useful alternative method of maxilla-mandibular fixation in the management of maxillofacial trauma. Material and Methods The present study was undertaken in 30 patients who reported to the outpatient Department of Oral and Maxillofacial Surgery, Dasmesh Institute of Research and Dental Sciences, Faridkot and required maxillo-mandibular fixation as part of their treatment for maxillofacial injuries. The patients were selected irrespective of sex, caste, religion and socioeconomic status. Fig. 2 Pre-operative radiograph

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Step 2 Step 7 The teeth were cleaned with saline soaked gauze to remove superficial Occlusion was achieved with gentle manipulation of the fractured debris. Corresponding opposing teeth in both the arches were selec- segments and maxillo-mandibular fixation was done using short ted. After thorough drying with air spray, the selected teeth in one orthodontic elastic chain Figs. 5, 6. quadrant were etched with the application of 37% phosphoric acid etching gel for 15 seconds. Step 3 Selected teeth were thoroughly irrigated with copious amounts of distilled water to remove the etchant gel. Teeth in that quadrant were isolated with cotton rolls to prevent moisture contamination and dried with the help of air spray till frosted surface of the etched teeth became evident. Step 4 Bonding agent was applied on the frosted surface of the teeth with the help of applicator and light cured for 30 seconds. Step 5 Required length of bondable reinforcement ribbon was cut with scissors and wetted with bonding agent. Flowable composite was applied on the etched teeth and bondable reinforcement composite placed on the selected teeth with flowable composite and cured for 30 Fig. 5 MMF with orthodontic Elastic chain seconds with light cure unit. Step 6 Orthodontic brackets were held in a bracket holding forceps and bonded to the selected teeth over the bondable ribbon. Same procedure was repeated for each quadrant Figs. 3, 4.

Fig. 6 Immediate post-operative occlusion achieved

Patients with unfavourable fractures in which occlusion could not Fig. 3 Fibre-reinforced composite with orthodontic brackets bonded be achieved with manual manipulation, internal fixation was planned over teeth under general anaesthesia. After exposing the fractured segments, anatomical reduction was achieved by manual manipulation and point reduction forceps, maxillo-mandibular fixation was done with short orthodontic elastic chain and internal fixation was done. Patients treated with closed reduction were put on maxillomandibular fixation for 4 to 6 weeks and patients treated with open reduction and internal fixation were put on MMF for minimum of 7 days post-operatively. Patients with condylar fracture were put on MMF for 2 weeks followed by guiding elastics. Glove perforations and percutaneous injuries during the procedure were recorded. The same type of gloves (Surgicare) were used, double gloving technique was used but only perforations of the outer glove were noted. When it was noticed that gloves were perforated they were changed immediately. All skin perforations, even minor ones, were noted. Glove integrity was tested using the water-inflation technique described by Brough et al. Post-operative Care Fig. 4 Fibre-reinforced composite and orthodontic brackets placed in All patients were prescribed dispersible analgesic tablets and 0.02% all quadrants chlorhexidine mouth rinse. Antibiotics were prescribed post-operatively, if required. Orthodontic elastic chain was changed every week post-operatively during the period of MMF to maintain the elastic strength. All patients were encouraged to maintain good oral hygiene and brush their teeth daily. Patients were put on a liquid diet for the

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S275 period of maxillo-mandibular fixation. Patients were asked to avoid smoking and abstain from consuming alcohol at least for the period of maxillo-mandibular fixation. Post-operative Assessment Patients were followed for a minimum period of 8 weeks post-operatively and observations were made. 1. Interarch occlusal relationship of teeth was assessed every week for the period of follow-up. 2. Any incidence of debonding of brackets, time of debonding during the period of MMF was documented. 3. Loe and Sillness gingival index for assessing gingival health was Distribution of patients according to cause requiring MMF was as noted every week during the follow-up period. MMF was follows. Out of 30 patients, 20 patients were treated with closed released for assessing lingual surfaces of teeth for gingival index reduction and 10 patients were treated with open reduction and and MMF was done again with new orthodontic elastic chain. internal fixation followed by MMF for 7 days (Table 1). 4. Inter-incisal mouth-opening in millimetres following the release of MMF was assessed every week for the period of follow-up. 5. Any other complications like non-union, malunion, delayed Table 1 Distribution of patients according to cause requiring MMF union, need of an alternate method of MMF, breakage of elastic and method of treatment chain or elastics was also noted during the follow-up period. Cause requiring No. of Percentage Method of treatment Case – I MMF Patients Parasymphysis 9 30% Closed reduction in 6 Fracture patients & open reduction and fixation in 3 patients Body fracture with 1 3.33% Closed reduction Condylar fracture Parasymphysis 12 40% Closed reduction in 5 fracture with patients & open Concomitant other reduction in 7 patients Pre-operative Occlusion Pre-operative mouth opening fracture Condylar fracture 5 16.66% Closed reduction Maxillary dento- 3 10% Closed reduction alveolar component Total 30 100% Closed reduction in 20 patients and open Pre-operave OPG Post-operave OPG reduction in 10 patients

Satisfactory occlusion was achieved in all patients post-operatively; out of 30 patients, 26 patients (86.66%) had disturbed occlusion and in 4 patients (13.33%) occlusion was not disturbed preoperatively. Satisfactory mouth opening was achieved 2 months post-opera- Fibre-reinforced composite and MMF achieved with orthodontic elastic chain tively in all patients, with mean mouth opening of 28.83 mm one orthodontic brackets placed month post-operatively and 38.96 mm two months post-operatively. (Graph I)

2 months post-operative mouth opening 2 months post-operative occlusion Observations and Results In the present study, out of 30 patients, 24 were males (80%) and 6 were females (20%). Age of the patients ranged from 10 years to 52 years with the maximum number of patients (43.33%) in their third decade.

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Graph I Mean inter-incisal mouth opening in mm oral hygiene. Further their removal is painless and comfortable for the patient without any periodontal injury. Gingival index was recorded pre-operatively. i.e. baseline, 1 week, As there is little hardware in the oral cavity this appliance causes 2 weeks, 3 weeks, 1 month and 2 months post-operatively. Mean minimum, if any, irritation or injury to buccal and labial tissues which gingival index at baseline was 0.39, at 1st week post-operatively was is a continuous problem with archbars. In case of favourable fractures 0.51 and then decreased gradually over 8 weeks to 0.23. (Graph II) with minimal displacement this method can be used to achieve MMF with minimal use of local anaesthesia, without causing any pain, discomfort to the patient further it also reduces the chances of any needle stick injury to the operator. Avoiding penetrating injuries remains a vital aspect of protecting the surgeon against exposure to blood-borne diseases. The incidence of surgical glove perforation during the treatment of some maxillofacial fractures may be as high as 50%, with over 80% going unnoticed at the time of operation. Percutaneous injuries may also occur in upto 21% of operations. Needlestick injuries are a serious occupational hazard for surgeons, particularly during MMF. Avery and Johnson (1999)1 showed an incidence of glove perforation 50% when wiring techniques were employed. Ayoub And Rowson (2003)2 Studying different methods of maxillomandibular fixation found a rate of skin penetrating injuries of 27% when archbars were used. Outer glove perforation rate of 37.5% was reported by Gaujac et al (2007)4 during archbar placement. Graph II Mean Gingival Index of Patients A perforation rate of 1.5 per operation was reported by N. Pigadas et al (2008)6 during eyelet wiring. In the present study, out of 30 patients, 4 patients were HCV Incidence of needlestick injuries during MMF was 23% in a study positive and 2 patients were HBsAg positive and were treated suc- reported by Rishi Bali et al (2011)3. cessfully without any incidence of glove perforation or percutaneous During the present study, no glove perforation was noticed as injury. reported by several other studies during MMF. No glove perforation was observed in any of the 30 patients In our study, out of 30 patients, 4 patients were HCV positive and during the study. 2 patients were HBsAg positive. So, this technique is highly efficient Out of total 512 brackets bonded in 30 patients, 10 brackets debonded in preventing needle stick injuries and spread of blood-borne diseases during the period of MMF in 7 patients. Days of MMF ranged from 7 to the operator during MMF especially in light of present day high days to 28 days with mean of 17.96 days. prevalence of HCV and HBsAg positive cases in the area where this Discussion study was conducted. In the present study, satisfactory occlusion was achieved in all There was no evidence of any orthodontic movement or discrep- patients post-operatively which was assessed by asking the patient to ancy in occlusion observed in any patient during the study. occlude teeth in maximum intercuspation. Orthodontic movement of teeth was absent maybe, because forces Satisfactory mouth opening was achieved in all patients post-op- were applied for a short period of time as maximum intercuspation eratively in this study. Mean mouth opening of 38.96 mm was was achieved in all patients within 48 hours of application of elastic obtained 2 months post-operatively, which depicts recovery of chain and once intercuspation of teeth was achieved, chances of any mandibular function and is comparable with 38mm to 42mm at 6 orthodontic tooth movement became very minimal as discussed by P weeks post-operatively reported by Gaylord S. Throckmorton, Magennis et al (1990)5. Further teeth on which brackets were applied Edward Ellis III (2000)8 and other studies. were splinted together with fibre-reinforced composite. In the present study, mean gingival index of patients pre-opera- When conventional archbar wiring is done, maximum number of tively was 0.39. Initially, 1 week post-operatively, mean gingival teeth are involved with wiring, but in this method, only few teeth on index increased to 0.51 which may be due to difficulty in maintaining either side of fracture line are involved which makes this fixation oral hygiene in early post-operative period because of pain and dis- appliance more aesthetic, comfortable for the patient, improves the comfort, it gradually reduced to 0.25 one month post-operatively and social acceptability (early return to work). Aesthetic appearance of then to 0.23 two months post-operatively. Overall low scores of this appliance can further be increased by using ceramic brackets gingival index indicate healthy gingival tissues and good oral hygiene which are far less noticeable and can be used in patients with active maintenance. social life. It must be kept in mind that maxillo-mandibular fixation patients Conclusion are unique because of restricted access to all surfaces of the teeth for Application of fibre-reinforced composite and orthodontic oral hygiene measures. With the inherent difficulty of maintaining brackets behave more like a customized archbar where the fibre- proper oral hygiene and the necessity to penetrate the interdental reinforced composite provides horizontal stability and brackets papilla with the circumdental wire in tight interproximal embrasures, act as cleats for application of elastics. some degree of gingival inflammation and damage is always expected From the results of this study, we conclude that this method is highly with the use of wiring techniques and archbars. A Thor, L. Ander- beneficial in preventing perforating injuries to the operator, sson (2001)7 reported few deep pockets or severe marginal bone loss especially in cases of patients with positive viral markers. Due to from periodontitis in 5 patients in their study. They also reported painless application and removal, this method is highly advantageous gingivitis and bleeding from inflamed gingiva around the wired teeth in paediatric and adolescent patients as the armamentarium required at the time of removal of the wires. Bonded orthodontic brackets on and the appliance itself appear far less threatening. The respect for the other hand, are far more hygienic and are free from penetrating periodontal tissues, bloodless application and removal, and ease of injury to interdental papilla and thus lead to better maintenance of oral hygiene maintenance is another advantages of this technique as low mean gingival index was noticed in our study. Hence, this

123 J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 S277 technique could be a useful alternative to conventional wiring assessment from the neurosurgeon, maxillofacial surgeon as well as techniques. the anaesthetist. Nasal intubation after severe craniomaxillofacial may Though this technique is highly beneficial, it has its own set of result in meningitis or it can also lead to passage of tube intracranially limitations. It is technique sensitive, requires a good level of moisture in patients with frontobasilar fractures. To avoid this complication, control which is sometimes difficult to obtain in trauma patients, it is oral intubation may be preferred, but this may interfere with the expensive than the conventional wiring techniques and cannot be used placement of intermaxillary fixation (IMF) to establish the patient’s in patients with deep bite. Also it is difficult to use in patients with occlusion in the intraoperative period. To enable IMF to be placed, metal or porcelain crowns on teeth, patients with multiple missing tracheostomy may be indicated but this carries significant morbidity. teeth on either side of fracture line and it cannot incorporate single An alternative to tracheostomy i.e. submental intubation was first alone standing tooth. It is also difficult to achieve MMF with this described by Hernandez Altemir in 1986. The submental intubation technique in unfavourable and grossly displaced fractures as maxi- with conventional Altemir’s technique and few of its modification has mum incidence of debonding of brackets occurred in such cases been used largely in maxillofacial injury cases. This paper highlights during the study as discussed earlier. Furthermore, this technique a modification of submental intubation incision in patients with involves etching of teeth which causes small amount of demineral- panfacial injuries, to treat complex mandibular fractures. ization. In spite of the above listed limitations, advantages of this Modified Submental Intubation Technique technique are significant. In cases of panfacial trauma wherein open reduction and internal With the advent of better bonding and splinting methods, we can fixation was planned, in view of the surgical consideration and need further enhance the efficacy of this technique making the procedure for IMF, nasal intubation and orotracheal intubation was excluded. In less technique sensitive as well. cases of comminuted mandibular symphysis fractures subsequent modification of the conventional technique of submental intubation References was planned. Conventional oral intubation was carried out using 1. Avery CME, Taylor J, Johnson PA 1999, ‘Double gloving and flexo-metallic endotracheal tube. Using aseptic technique the skin of a system for identifying glove perforations in maxillofdacial the neck and submandibular area was scrubbed and prepared. The trauma surgery’, British Journal of Oral and Maxillofacial conventional incision of submental intubation was modified to gain Surgery; vol. 37, pp. 316–319.3 better access and to avoid a second intraoral surgical wound to reduce 2. Ayoub AF, Rowson J 2003, ‘ Comparative assessment of two and fix mandibular symphysis and parasymphysis fractures. The methods used for interdental immobilization’, Journal of Cranio- conventional submental incision was marked and bilaterally lateral Maxillofacial Surgery; vol. 31, pp. 159–161.6 extensions were marked at an obtuse angle from the conventional 3. Bali R, Sharma P, Garg A 2011, ‘ Incidence and patterns of incision, along the curvature of the mandible 2cm below the inferior needlestick injuries during intermaxillary fixation’, British Jour- border of mandible. Length of these horizontal lateral extensions were nal of Oral and Maxillofacial Surgery; vol. 49, pp. 221–224.4 modified depending on the fracture site and exposure needed. 4. Gaujac C, Coccheti MM, Yonezaki F, Garcia IR, Peres After local infiltration of LA, the incision was made using no 15 MPSM 2007, ‘Comparative Analysis of 2 Techniques of Double- surgical blade. Blunt dissection was carried upto the inferior border of Gloving Protection During Arch Bar Placement for Intermaxil- mandible. A curved hemostat was passed along the lingual surface of lary Fixation’, Journal of Oral and Maxillofacial Surgery; vol. mandible to reach the floor of the mouth, taking care to avoid injury to 65, pp. 1922–1925.5 submandibular gland duct, and an incision was taken in the floor of 5. Magennis P, Craven P 1990, ‘Modification of orthodontic the mouth to pass the hemostat in the oral cavity. ET tube was dis- brackets for use in intermaxillary fixation’, British Journal of connected and shifted along with the cuff from oral cavity to Oral and Maxillofacial Surgery; vol. 28, pp. 136–137. 8 submental region through the intraoral incision. After reconnecting 6. Pigadas N, Whitley SP, Roberts SA, McAlister K, Ameerally the ET Tube it was secured to the inferior flap with 1-0 mersilk for P, Avery CME 2008, ‘ A randomized controlled trial on cross- stabilization. infection control in maxillofacial trauma surgery: A comparison Full thickness skin flap was raised to expose the mandibular of intermaxillary fixation techniques’, Int. J. Oral Maxillofac. symphysis fracture. The fracture site was exposed, reduced and fixed Surg; vol. 37, pp. 716–722.7 with miniplates. 7. Thor A, Andersson L 2001, ‘Interdental wiring in jaw fractures: Discussion effects on teeth and surrounding tissues after a one-year follow- Airway management for patients afflicted with panfacial fractures is a up’, British Journal of Oral and Maxillofacial Surgery; vol. 39, challenge for the anaesthetic team. In addition, the maxillofacial pp. 398–401.2 surgeon requires intraoperative MMF to achieve satisfactory surgical 8. Throckmorton GS, Ellis III E 2000, ‘Recovery of mandibular outcomes. This necessitates modification of the standard anaesthesia motion after closed and open treatment of unilateral mandibular techniques. Submental intubation with midline incision is used fre- condylar process fractures’, International Journal of Oral and quently, but modifying the incision for treatment of mandibular Maxillofacial Surgery; vol. 29, pp. 421–427.1 fractures has been rarely mentioned. It has various advantages like a second intraoral incision is not required for management of mandibular fractures in symphysis, parasymphysis and body regions. It reduces surgical time. It provides an extraoral approach for fixation of the fracture, hence providing INV009 good accessibility, with minimal scar. In edentulous patients stripping Modified Submental Intubation: A Useful Adjunctive of periosteum intraorally compromises blood supply to mandible in Maxillofacial Trauma hence this extraoral approach is preferred. In case of comminuted fractures involving both the cortices, extraoral approach is preferred as managing lingual cortex is difficult intra orally and needs separa- Dr. Sharanbasappa tion of geniohyoid and genioglossus muscle which is avoided extraorally. Loss of sulcus depth and ptosis of mentalis muscle may Introduction: also be reduced. Airway management is a difficult task in complex craniomaxillofacial trauma. The choice of intubation technique depends on good

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Conclusion There are various bottles are recommended for feeding babies with The successful use of a same single extraoral incision made it possible clefts. Each feeding system has advantages with their disadvantages. to perform submental intubation as well as to reduce and fix the Some feeder bottles requires continuous involvement and close mandibular symphysis fracture in cases where oral and nasal intu- attention of the parent to maintain actuate flow at regular intervals. bations were either contraindicated or not possible. This technique has Another challenge that families encounter is the cost associated with great advantage and can be used with ease. specialty feeding systems. The associated cost can add additional stress to the families and caregivers of cleft children.2 Ultimately, parents of most cleft palate babies take to feeding with spoon. By this method, very small quantities of fluid are administered at a time hence it is time consuming and has potential for the baby to remain undernourished.3 To overcome these challenges, study was to design assistive devices of cleft palate and formulated the following objectives • Designing an affordable feeding bottle or add-ons for an existing bottle that allow adjustable flow control CT scan images showing displaced lingual and buccal cortex in mandibular symphysis fractures • Reducing dependence of flow rate of milk on intraoral negative pressure. It is to ensure that the patient with the most severe cleft deformity can consume fluid at the optimum flow rate without causing fatigue. Material and Methods A normal pigeon feeder was bought and the set of restriction orifice plates were fabricated from acrylic sheets using a laser cutting Marking Of Modi d Incision Placement Of An Incision EtTube Through Submental Region machine. A total of five plates were made with the only difference being in the number and position of holes in them. The diameter of the plates were decided such that they fit into the neck of the feeding bottle and the diameter of holes was decided by following calculations. In order to ensure smooth entry and removal of plates the inner diameter chosen was 3.15 mm. Five orifice plates having diameter of Stabilizing Et Tube Raising Of Skin Flap Fixaon With 3.15 mm and different hole profiles were fabricated by laser cutting of Miniplate 2mm thick acrylic sheets. Notches were given on diametrically opposite ends for securing the plates in the fixtures.

Post Operave Submental Scar By Modiﬁed Technique INV015 An Innovative Modiﬁcation of Feeding Bottle for Cleft Palate Babies

Dr. Surendra Daware, Assistant Professor, Dr. Abhay Datarkar, Professor and Head, Dr. Rashmi Uddanwadiker, Jugal Shah, Sukhada Joshi

Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Nagpur, India, Email- [email protected], Ph-9860207478, E-mail- These plates were fitted in the Pigeon Feeder one by one and the [email protected], Ph-9822698145; Department of volume of milk leaving the bottle in a minute was measured using a Mechanical Engineering, Visvesvaraya National Institute of vacuum machine as source of suction. It was observed that the flow Technology (VNIT), Nagpur; VNIT, Nagpur rate with all the plates was same inspite of using orifice plates due to leakage through the cut notches. Hence it was realised that a new Introduction method of fastening was to be used. Cleft lip and palate deformity is one of the most common deformities among Indian children. A majority of cleft births occur in rural India where poverty, illiteracy and misinformation are rampant and access to medical resources is scarce. Feeding challenges are among the biggest concerns that parents and caretakers have in the early stages of diagnosis.1

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The surgical vacuum pump was used to generate suction and the flow rate with use of each plate was recorded. Each plate was fixed in the bottle and the nipple was connected to the inlet pipe. The pump was switched on for one minute. The difference in volume was noted using the graduations already present on the bottle. Thus flow rate in ml/min was calculated. Fig. 3.4 Schematic for calculations Theoretical Calculation For milk as working fluid: An attempt has been made to analyze the proposed model using l= 3cP principles of fluid mechanics and some basic assumptions. q=1035kg/m3 A healthy baby is said to be capable of creating -50 to -197 mm On application of Bernoulli’s equation we get Hg suction while suckling for milk. Also the rate at which a healthy Patm?qgH=Pmouth?(0.5*q*V2) ?qghf baby consumes milk is observed to be between 10 to 25 ml/min.4 This 2 Formula for head loss is given as is subject to hunger, age and other physiological characteristics of the qghf= (128*l*L*Q)/pD4 individual baby. Thus the bottle (without restriction orifices) should From above two equations V can be calculated be designed to allow the baby who can create least vacuum (say 10 2 Q=A V mm Hg) to drink fluid up to a maximum of 25 ml/min. Then the flow 2 2 A = (p/4)*D2 rate can be stepped down with subsequent addition of orifice plates in 2 2 the path of flow of milk. The above two equations can be used to evaluate D2 which is the diameter of nipple hole. The hole size of the nipple should be increased to the calculated value in order to satisfy the baby capable of producing only 10 mm Hg of suction. Now use of an orifice plate to reduce the flow from 25ml/min to 15ml/min

Q=AiVi =A2V2 Hence V2 can be found Applying Bernoulli’s equation between orifice plate and tip of bottle; 2 2 Pi?qgh?(0.5*q*Vi )=Pmouth?(0.5*q*V2) Pressure drop across the orifice; DP = Patm?qg(H-h)-Pi …..(1) Formula for pressure drop across an orifice is given as 2 DP (across orifice)= (32*l*Vi*L)/D ……(2) Q=AiVi …..(3) Thus for a certain thickness of orifice plate (L) the above three equations give us two independent equations in Vi and D. On solving these two equations we obtain the effective diameter of holes in the plate. Discussion Oro-facial clefts, particularly cleft lip with (CLP) or without (CL) cleft palate and cleft palate alone (CP) are a major public health problem affecting 1 in every 500 to 1000 births worldwide.5 With the diagnosis of cleft palate/lip, feeding is a major concern for parents.

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Feeding difficulties appear at birth, due to impairment of the suction streams through the multiple holes and this reduces the noise which and swallowing mechanisms resulting from the alteration in the would be otherwise will be above the acceptable limit if a single hole anatomical structures. At this early stage, the priority is monitoring device is used. infant nutrition and weight gain.1 However, the suction machine did not maintain a constant vacuum Surgery is the initial treatment for CLP. Adequate nutrition is also reading during the testing hence the set up could not exactly replicate important for the child to be able to undergo the cleft repair surgery, the suction of a baby. Inspite of unsteady value of vacuum we can i.e., stable weight gain with no health alterations and the capability to render the experiment as fairly analogous to reality as exactly the safely receive anaesthetics.6 same pressure variation was observed for each experiment when the Several devices and methods have been tried in order to allow pump was turned on. The vacuum machine dial read suction pressures the infant to get nourishment. Prior art has produced a feeding plate from 10 mm Hg to 400 mm Hg, which was more than the range of which fits into the palate and seals off the cleft in both the lip and suction created by a baby. the palate. This enables the infant to generate intraoral negative Conclusion pressure to pull nourishment from conventional bottles.3 Next, it Keeping in mind that cleft with various variations, this study vali- has used long feeders on a bottle such that the milk is directly dated the hypothesis of flow control using orifice plates as the injected into the infant’s throat so that he may swallow the milk expected trend in flow rate was adhered to. This study when scaled without sucking. This method is an attempt to bypass the problem down to the suction range and suckling speed of a baby can help of the infant’s inability to suck and causes frequent choking and calculate area of holes corresponding to very high, high, medium, aspiration and prevents the child from developing the muscles of low, very low flow rate between 10ml/min and 30ml/min. It is also the mouth which are believed to aid in language articulation in later seen that higher flow rate is observed as number of holes increases life.7 Parents of such infants have to take extra care while feeding and when holes are located closer to the centre. the babies; the correct angle has to be maintained to prevent entry of food into the nasal passage. References There are three types of bottles that are recommended for feeding 1. Arts-Rodas D, Benoit D. Feeding problems in infancy and early babies with clefts: childhood: Identification and management. Paediatrics & Child 1. Haberman Feeder Health. 1998;3(1):21–27. 2. Pigeon Feeder 2. David G. Gailey Feeding Infants with Cleft and the Postoperative 3. Mead Johnson Nurser Cleft Management Oral and Maxillofacial Surgery Clinics of North America, Volume 28, Issue 2, Pages 153–159 The Pigeon Feeder and Mead Johnson Nurser, both need to be 3. Devi ES, Sai Sankar AJ, Manoj Kumar MG, Sujatha B. Maiden pressed in order to actuate flow at regular intervals. Hence it morsel - feeding in cleft lip and palate infants. Journal of requires continuous involvement and close attention of the parent. International Society of Preventive & Community Dentistry. The Haberman Bottle fits the bill when it comes to utility as it 2012;2(2):31–37. regulates flow without any intervention. The Haberman Feeder is 4. C. R. Prieto, H. Cardenas, A. M. Salvatierra, C. Boza, C. activated by tongue and gums. A one-way valve separates the nip- G. Montes, and H. B. Croxatto Sucking pressure and its ple from the bottle. Milk cannot flow back into the bottle and is relationship to milk transfer during breastfeeding in humans. replenished continuously as the baby feeds. A slit valve opening J Reprod Fertil 108 (1) 69–74. near the tip of the nipple shuts between jaw compressions, pre- 5. Reddy SG, Reddy RR, Bronkhorst EM, et al. Incidence of cleft venting the baby from being overwhelmed with milk. Stopping or Lip and palate in the state of Andhra Pradesh, South India. Indian reducing the flow of milk is controlled by rotation of the nipple in Journal of Plastic Surgery: Official Publication of the Association the baby’s mouth. However the cost of Haberman feeder is too of Plastic Surgeons of India. 2010;43(2):184–189. much in Indian Scenario. 6. Duarte GA, Ramos RB, Cardoso MC. Feeding methods for Several flow restricting mechanisms were considered in order to children with cleft lip and/or palate: a systematic review. Braz J design the modified feeding bottle. Ultimately it was decided to make Otorhinolaryngol. 2016;82:602–9. use of restrictive orifice plates for flow control. The mechanism employs multi-hole restrictive orifices for flow control. A choice can be made from a set of plates based on the extent to which flow rate has to be changed. The highest flow rate will be achieved when there INV016 is no orifice plate. As milk flows through orifice plates, the effective pressure head of the flowing milk is decreased, and flow rate at outlet Murva: A Biotic Strand for Biological Healing of orifice is controlled. The orifice plates can be inserted by the parent in the neck of any Dr Ashutosh Thorat & Dr Pravin Lambade conventional milk bottle based upon age, hunger and other characteristics of the patient. The choice of plates will majorly be a function Introduction of severity of the cleft. As are the variations in cleft formation, The success of any surgical procedure depends upon healthy healing, 2 feeding difficulties in patients with clefts are equally diverse. An which in turn depends upon the suture material used & the method insert and turn locking arrangement accounts for sturdy nature of the employed for the closure. Many synthetic materials have replaced the assembly and it is very convenient to remove, clean and reassemble at natural materials, which were once used for suturing in the ancient the time of feeding. times, and Murva is one of them. There are references of Murva Restriction orifice is mainly used to achieve controlled or (SansevieriaroxburghianaSchult. and Schult.f.) (Fig 1). at various restricted flow of process medium. The orifice offers a restriction to contexts of ‘‘SushrutaSamhita’’ where it has been used as a suture the process flow and the pressure head drops from the upstream to the material. It is a xerophytic herbaceous plant occurring abundantly in downstream. The area of the orifice determines the rate of flow at the the eastern coastal region of India. This study is carried out to com- outlet of a given process fluid for the specified pressure. pare the efficacy of murva fibre with Silk as suture material. A restriction orifice plate may be single hole or multi hole. In a multi hole orifice plate, the flow at the inlet is channelled into several

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Fig. 1 Murva plant Fig. 3 Silk suture Objective The objective of this study is to compare the efficacy of Murva fibers (Fig 2) with Silk (Fig 3) as a suture material in closure of intraoral Methods incision in third molar surgeries. Fifty incisions (Wards incision) placed for the surgical removal of mandibular third molar were sutured with Murva and fifty incisions with Silk. Patients were evaluated for pain, swelling, hemostasis, infection, wound dehiscence, local tissue irritation, and bacterial colonization. Follow-up were scheduled on postoperative 1st, 2nd, 3rd, and 7th day. Result On comparing these two suture materials, in terms of post-operative pain, swelling, hemostasis, infection, wound dehiscence, local tissue irritation and bacterial colonization, the results were in favour of Murva as compared to Silk. Conclusion This study indicates that Murva can be effectively used as an alternative suture material to Silk as it is natural, economical and biocompatible with an antimicrobial activity.

Fig. 2 Murva suture

Fig. 4 Surgical site post-op 7 day (murva suture)

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INV011 Modiﬁcation of Ryle’s Nasogastric Tube

Dr. Manay Roshini Srinivas

Abstract Anasogastric tube is a narrow bore tube passed into the stomach via the nose. It is used for short- or medium-term nutritional support in patients, young or old, who are not able to feed on their own either due to congenital defect in the oro-pharynx region or during the post-operative healing period. Although the current design of Ryle’s tube has been used over decades. One-third of the tube, which is seen externally can not only be a source of infection but also have a psychological impact on the patient’s well-being. Hence to overcome this, a modification of the current design is done where the external segment of the tube can be detached and attached only when feeding is required. Keywords Enteral Feeding catheter, Nutritional Support in Primary Care, Nutritional Support in Hospital, Nasogastric tube, Ryle’s Fig. 5 Surgical site post suture removal (murva suture) nasogastric tube I. Field of invention The invention is based on a modification of the design of eternal feeding tube used in the field of medicine II. Description of the prior art A nasogastric tube is a temporary tube placed through the nose into the stomach. It is be used to remove fluid from the stomach, or used for nutritional support in patients who are not able to feed on their own either due to congenital defect in the oro-pharynx region or during the post-operative healing period after a surgery or during radiation therapy in patients diagnosed with cancer. III. Drawback of the existing state of art The current design of Ryle’s nasogastric tube has been used over decades all over the world, especially in patients undergoing going oncology (cancer) treatment. One-third of the tube is left hanging from the patient’s nostrils through which liquid food/supplement is passed. This can harbour infection if not maintained well. And also have a psychological impact of being diseased on the patient. IV. Novelty Fig. 6 Surgical site post-op 7 day (silk suture) The proposed design is such that the external tube can be detached and easily snapped on to the internal tube which is inserted into the patient nostrils at the time of extubation by anaesthetist The internal tube is positioned at the level of the nostrils with semi-rigid support with the help of the two external nose clips which adhere to the alar and collumela respectively. External tube can be detached and attached only when required to the internal tube. This allows the patient to be free of an external tube hanging outside their nostrils (Fig. 1).

Fig. 1 A schematic representation of nasogastric tube in a human aero-digestive tract view Fig. 7 Surgical site post suture removal (silk suture)

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V. A detailed description D. A hollow flexible detachable external tube (Fig. 4) of predetermined length adapted to be inserted into the top end of the The proposed design is a user friendly, hygienic and aesthetically internal tube through the slit during feeding appealing nasogastric tube for feeding nutritional solution to patients who are unable to feed on their own. The tube is devoid of fixed external extension of the tube from the nostrils unlike the current design, thereby eliminating the problems of infection and psychological stigma. It comprises of the following. A. A hollow flexible internal tube of predetermined length comprises of two ends, closed top end and opened bottom end wherein plurality of tiny holes disposed on circumferential surface at predetermined length above the bottom end of the internal tube for easy discharge of nutritional solution into stomach and the closed top end is closed by means of thin layer with a slit. B. A hollow cylindrical rigid support of predetermined length disposed on outer circumferential surface on the top end side of the internal tube (Fig. 2). Fig. 4 External tube inserted

E. A storage container (Fig. 5) for storing the external tube when feeding is complete is provided along with the set

Fig. 2 Internal tube

C. An aesthetic nose clip (Fig. 3) comprises of a ring with pair of clips wherein the ring is disposed on outer circumferential surface on the top end of the internal tube in front of the rigid support.

Fig. 5 Storage box with 20 ml syringe

The internal tube is to be inserted into the patient nostrils at the time of extubation. The bottom end of the internal tube is positioned inside the stomach and the top end of the internal tube is positioned at the level of the nostrils with the rigid support with the help of the two clips that adhere to the alar and collumela region. The rigid support ensure the support of the internal tube to nostrils and comfortability to patient The slit on the top end of the internal tube opens when the external tube being inserted during feeding and the slit closes when the external tube is removed after feeding thereby preventing the infection to enter into the internal tube The nasogastric tube - internal tube and external tube is made of materials comprising of polyvinylchloride (PVC). The diameter of the external tube is lower than the diameter of the top end of the internal tube which aids in the easy-snap ﬁt insertion of the tube. Fig. 3 Internal tube inserted and positioned at the nostrils

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VI. Summary With the change in design, it is not only user friendly and hygienic,it also helps those who are on it for long term to re-integrate themselves into the society and carry forward their routine activities by demol- ishing the stigma the patients carry on themselves (Fig. 6). The simplicity of the proposed design will deﬁnitely bring about a change in the quality of lives of our patients.

Fig. 6 A comparison of the external appearance with the current (left) design and proposed (right) design

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