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Challenges and Opportunities in Maxillofacial Surgery

Challenges and Opportunities in Maxillofacial Surgery

Department of Oral and Maxillofacial Surgery, Karpaga vinayaga Institute of Dental Sciences, Chengalpattu, Tamilnadu, India

Department of Oral and Maxillofacial Surgery, Karpaga vinayaga Institute of Dental Sciences, Chengalpattu, Tamilnadu, India

Department of Oral and Maxillofacial Surgery, Karpaga vinayaga Institute of Dental Sciences, Chengalpattu, Tamilnadu, India

Department of Oral and Maxillofacial Surgery, Karpaga vinayaga Institute of Dental Sciences, Chengalpattu, Tamilnadu, India

Department of Oral and Maxillofacial Surgery, Karpaga vinayaga Institute of Dental Sciences, Chengalpattu, Tamilnadu, India

Department of Oral and Maxillofacial Surgery, Karpaga vinayaga Institute of Dental Sciences, Chengalpattu, Tamilnadu, India


The development of novel regenerative material to reduce inflammation and enhance healing process is one of the greatest task in clinical research. PRF ( platelet rich fibrin) is an second generation platelet concentrate which has gained popularity in recent years due to its unique regenerative process. Platelet Rich Fibrin is completely autologous material with extended growth factor release compared to other growth concentrates. The standard quality and quantity of the fibrin matrix , leukocytes, platelets, and growth factors of PRF demands a standard protocol for preparation. The use of Platelet Rich Fibrin treatment has shown increased cellular proliferation, osteogenesis and mineralisation thereby enhancing wound healing capacity. Due to its versatility Platelet Rich Fibrin serves as workhorse in wound healing. This Review article attempts to encapsulate the technique, it’s preparation and use of Platelet Rich Fibrin in the field of oral and maxillofacial surgery.

John R. Zuniga, DMD, MS, PhD
Robert V. Walker Endowed Chair in Oral and Maxillofacial Surgery; Professor, Departments of Surgery and Neurology, University of Texas Southwestern, Dallas, Texas, USA

Timothy W. Neal, DDS
Resident, Advanced Training Program in Oral and Maxillofacial Surgery, Parkland Hospital, Dallas, Texas, USA


Background and Aims: Neuropathic pain can occur following intentional or unintentional peripheral nerve injury. The purpose of this review was to determine in patients who have post-traumatic trigeminal neuropathic pain or required ablative mandibular operations with transection of the nerve, do those who undergo immediate or early surgical interventions, when compared to those whose nerves are not repaired or delayed, have a decreased or increased risk for resolving neuropathic pain?

Methods: Two single-site and one multi-site retrospective observatory studies of patients who had neuropathic pain prior to operative treatment of the injured nerve and in patients who underwent resection of the mandible for benign or malignant disease with either no repair or immediate repair were analyzed for the presence or absence of neuropathic pain at 6 months post-surgery. The primary predictor variable in the surgical treatment of neuropathic pain pre-existing surgery was the time from injury to repair and the preoperative pain intensity rated by Visual Analogue Scale (VAS). The primary predictor variable in the study of intentional transected nerve was the immediate repair or no repair of the nerve at the time of resection.

Results: There was statistically significant difference in the primary outcome based on time from injury to repair. When the time to surgery was less than 200 days, the percentage of patients with no neuropathic pain was greater than 60%. There was a significant difference in mean VAS between those who had no neuropathic pain (6.4,SD 2.68) and those with recurrence (7.75,SD 1.95). Following mandibular resection there was statistically significant difference between the immediate repair and no repair group. Post-hoc logistic regression modeling showed an inverse relationship between the immediate repair and the incidence of chronic postoperative pain and neuropathic pain with an odd ratio <1.

Conclusions: In patients with neuropathic pain, earlier diagnosis and treatment, including peripheral nerve surgery, should be considered with the best outcomes when operative interventions occur within 200 days of the injury and pain intensity are mild or moderate on VAS scales.

The immediate repair of an intentionally transected trigeminal nerve appears to reduce and possibly eliminate the development of neuropathic and chronic postoperative pain compared to avoiding nerve repair.

Dr. Sanjiv C Nair
Professor and Head of the Department, Maxillofacial Surgery Department, Bangalore Institute of Dental Sciences, Bangalore, India

Dr. Niveditha N
Assistant Professor, Maxillofacial Surgery Department, Vokkaligara Sangha Dental College and Hospital, Bangalore, India

Dr. Advaith Nair
Former Trainee, Vydehi Institute of Medical Sciences And Research Centre, Bangalore, India

Dr. Prashanth R
Associate Professor, Maxillofacial Department, Vokkaligara Sangha Dental College and Hospital, Bangalore, India


Head and neck vascular lesions management has been a great challenge to the surgeons due to catastrophic bleeding that obscures the visibility during the surgery. A proposed surgical technique called CORSET SUTURING for the treatment of non cutaneous low-flow vascular malformations in the head and neck region minimizes the blood loss and facial disfigurement. Corset sutures are placed to strangulate the lesion and restore the facial symmetry with the least amount of comorbidities. The aim of the present study is to describe the clinical characteristics of patients treated by corset suturing technique, material used and surgical morbidity, in order to contribute to a better understanding of this technique. Medical records and images of 15 patients treated by the same corset suturing protocol were retrieved and analysed. The indications, advantages and disadvantages, technique and complications observed are discussed. There was a significant reduction in the bulkiness of tumour mass noted and also a return of the regional facial outline was evident. In conclusion, corset suturing has an important role in management of diffuse low-flow vascular malformations of the head and neck as it is found to be a simple, cost-effective, less scarring and acceptable method, hence can be considered as an alternative to the other expensive methods such as embolization, with least surgical comorbidities.

Abdulhadi Alhelwani
DDS, MSc, PhD Researcher, Department of Oral Implantology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, Netherlands

Dr. Erik Blom
DDS, MSc, PhD Department of Oral Implantology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, Netherlands

Dr. Frank Leusink
DDS, MD ,PhD Maxillofacial Surgeon and Medical Director, KaakmeesterZ Hengelo, Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam,

Prof. Dr. Albert Joseph Feilzer
DDS, MSc , PhD Full Professor, Department of Oral Regenerative Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, Netherlands


Background: The comparative effectiveness of intraoral scanners (IOS) and conventional impression (CI) methods in full-arch implantology has been a topic of ongoing debate. This systematic review aimed to provide a comprehensive comparison of these methods across different applications and conditions. Methods: This systematic review was conducted in accordance with the PRISMA guidelines, with the search conducted across different online databases and the relevant studies were extracted, following which they underwent bias assessment and their relevance towards this review was examined. Results: Five in-vitro studies, encompassing various types of IOS and CI methods, were systematically reviewed. The review revealed that neither IOS nor CI could be deemed universally superior. Their relative effectiveness varied depending on several factors, including the specific application, the presence or absence of landmarks, and the type of dimensional analysis used. For instance, while digital techniques offered advantages in terms of minimal distortion for tilted implants, conventional methods demonstrated superior trueness in other scenarios. Conclusion: The findings underscored the importance of a context-specific approach in selecting between IOS and CI, thereby guiding clinical practice and informing future research. However, the transferability of the findings to clinical practice may be limited due to the in-vitro study design, the variety of IOS types, the unaccounted influence of operator skill, and the incomplete exploration of the role of landmarks. Future studies should address these limitations to further enhance our understanding of full-arch implantology.

Andreas Pfützner Marie Schaedlich

Peter Möller

Shipra Gupta
Oral Health Sciences Centre, Post Graduate Institute of Medical Education &amp; Research, Chandigarh, India

Tommi Pätilä
Department of Congenital Heart Surgery and Organ Transplantation, New Children’s Hospital, University of Helsinky, Finland

Ismo T. Räisänen
Department of Oral Diseases, Karolinska Institutet, Huddinge, Schweden

Timo A. Sorsa
Department of Oral Diseases, Karolinska Institutet, Huddinge, Schweden; Department of Oral and Maxillofacial Diseases, Helsinki University and University Hospital, Helsinki, Finnland


The SARS-CoV-2 virus leads to symptoms ranging from mild flu symptoms to severe COVID-19 pneumonia requiring mechanical ventilation and even death. According to epidemiological observations, diabetes mellitus is a major risk factor for severe outcome, next to older age, s, hypertension, and other serious chronic illnesses. Recent studies have determined that the oral cavity mucosa is the main entry portal for the SARS-CoV-2 virus into the body. The viruses accumulate in the mouth at locations where the main viral receptor is highly expressed. The oral pathway of the virus into the body and the contributing factors are described in this review. The immune system of people with diabetes is generally impaired. Diabetes induces chronic systemic inflammation, which regularly manifests as periodontitis in the oral cavity. Furthermore, frequent hyperglycemia leads to additional weakening of the mucosal immune barrier. These findings provide plausible explanations for the more frequent severe courses of respiratory viral infections in diabetes patients. An oral examination helps to identify patients at elevated  risk. Activated matrix metalloproteinase-8 (aMMP-8) is an established biomarker for measuring the degree of oral inflammation and is an indicator of the destruction of collagen and bone structures in the mouth. aMMP-8 point-of-care tests are readily available. We propose that the current recommendations for the prevention of SARS-CoV-2-associated severe COVID-19 disease should be extended to consider the aspects of measuring and sanitizing oral health, as well as to include preventive regular daily disinfection of the mouth and the pharynx.

Riddhi Jaiswal 
H S Malhotra 
D Himanshu


As a part of multi-disciplinary team of the institute in managing Covid positive patients as well as those admitted with its complications, Pathology department was reporting specimens of suspected fungal infection, received from clinical departments like neurosurgery, otorhinolaryngology, ophthalmology, oral and maxillofacial surgery, respiratory medicine, internal medicine etc. Simultaneous serology and various Covid associated blood parameters were being investigated during admission to hospital, as per the clinical scenario.

The aim of this paper is to discuss pathogenesis of fungal infections and bring out any significant pathological differences in Covid 19 positive cases afflicted subsequently by either mucor alone or mixed fungal infections.

Out of 274 tissue specimens received between April to November 2021, clinically suspected to be of Covid 19 associated mucormycosis, we found 14 cases of simultaneous co-infection with other species of fungi. 45 specimens were reported negative for fungal elements while 229 were confirmed by histo pathological examination.

Cases were grouped according to the presence of either only Mucormycosis on histology or mucor with co-infecting fungi.Various biochemical, hematological and histopathological parameters were compared and significance of difference analysed using student t test in the two groups.

Statistically significant differnce was observed in mean values of serum ferritin (p value 0.005); C-Reactive Protein/CRP (p value 0.003); serum creatinine, Random Blood Sugar/RBSHaemoglobin, Total Leuocyte Count/TLC and duration of hospital stay (p value of each being 0.00) while p value was insignificant in serum Lactate Dehydrogenase/LDH and InterLeukin 6/IL6 values between the two groups.

Platelet count of patients in both the groups were within normal range. (1-4.5 x1000/cu mm). None of the Histopathological parameters showed any statistically significant difference in the two groups (p value of each was more than 0.05).

Monal Karkar
Assistant Professor, Department of Oral and Maxillofacial Surgery, Rural Dental College, Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra. Pin code: 413736. India

Abhinav Lambe
Assistant Professor, Department of Anaesthesiology and Critical Care, Dr. Balasaheb Vikhe Patil Medical College, Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra. Pin code: 413736. India.


Introduction: Congenital heart disease (CHD) is a common birth defect that occurs in approximately 1% of live births worldwide. Cleft lip and palate (CLP), another common birth defect, affecting approximately 1 in 600- 800 live births in India. Several studies have reported an association between CHD and CLP, however, there is limited data on the prevalence and types of CHD in patients with CLP in rural areas of developing countries, including India. This study aimed to investigate the prevalence and types of CHD in patients with CLP at a rural hospital in central Maharashtra, India.

Methods: This retrospective study included medical records of patients with isolated Cleft lip, isolated cleft palate and patients with cleft lip and palate, between January 2018 and December 2020. The study was conducted at a rural hospital in central Maharashtra, India. The patients’ records were examined for any heart disease. Patients who had a diagnosis of CHD were identified through medical records and echocardiography reports. The prevalence and types of CHD were compared between the two groups using descriptive statistics and chi-square tests.

Results: A total of 291 patients were included in our study. 169 were males and 122 were females. Congenital heart diseases were found in 12.37% (n=36) patients.5 Cleft lip (13%), 12 Cleft lip and palate (48%), 19 Isolated cleft palate (39%) were diagnosed with Congenital heart diseases. The types of Congenital Heart Diseases reported in our study were atrial septal defect, Ventricular septal defect, Patent ductus arteriosus, Pulmonic Stenosis and Tetralogy of Fallot.  

Conclusion: The most common types of CHD in both groups were ASD and VSD, but the prevalence of these defects was significantly higher in the CLP group. These findings have important implications for the multidisciplinary Perioperative management of patients with CLP, as they may require close monitoring for CHD and appropriate intervention if necessary, especially in resource-limited settings.

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