Zygomatic Buttress Research Articles

The impact of zygomatic buttress bone graft on nasal floor augmentation in unilateral alveolar cleft patients with late referral: A case series

PurposeThis preliminary study aimed to assess the efficacy of zygomatic buttress bone grafting for nasal floor augmentation in patients with a unilateral alveolar cleft who were referred after the optimal timetable for this surgery had elapsed. Case seriesFive patients, aged 12–18 years, with unilateral alveolar clefts were treated at Qaem Hospital, Mashhad, Iran. Initially, a mucous layer was established on the side of the cleft nose, followed by forming a bony bridge between the defect's sides through a bone graft derived from the zygomatic buttress and xenograft bone powder. Subsequently, the grafted region was covered with an absorbable collagen membrane, and the oral-side flap was sealed. Post-operative follow-ups occurred at 1 week, 1 month, and 3 months, and cone beam computed tomography (CBCT) was performed 6 months post-treatment. Discrepancy between the anterior edge height of the pyriform aperture on the healthy and cleft sides post-grafting was assessed. The average disparity between the height of the anterior edge of the pyriform aperture on the healthy side and the peak height achieved post-grafting on the cleft side was 1.90 ± 2.82 mm. ConclusionWithin the limitations of the study, it seems that zygomatic buttress is applicable for late unilateral alveolar bone grafting as an intraoral source, and is helpful in symmetric bony nasal floor reconstruction, with a good success rate.

Quantitative Evaluation of Zygomatic Buttress, Ramal, and Symphysis Onlay Grafts in Ridge Augmentation Prior to Implant Placement

Quantitative Evaluation of Zygomatic Buttress, Ramal, and Symphysis Onlay Grafts in Ridge Augmentation Prior to Implant Placement

Failure rate of infra-zygomatic crest (IZC) bone screws in orthodontics: A Systematic review

The aim of this review is to provide a precise estimation of infra-zygomatic crest (IZC) bone screw failure rate during orthodontic treatment. Data were obtained using the Cochrane Central Register of Controlled Trails (central), PUBMED, EMBASE, google scholar, OVID, Wiley library till 1 January 2022. The titles and abstract of the electronic search were screened and evaluated by two observers according to the inclusion and exclusion criteria. This review was enrolled in PROSPERO (registration ID number CRD42020206610). There were 1725 records identified through electronic and 1 additional record identified through manual search. After 377 duplicate removal, 1349 studies were screened on the base of title and abstract the final sample included 9 studies that meet the primary inclusion criteria were selected. Each study was assessed using the evaluation method described in the Cochrane handbook for systematic reviews. All studier collectively included of the 1238 IZC miniscrews. Included studies ranged from 20 to 772 IZC miniscrews and the average number was approximate 137 IZC miniscrews per study. The diameter of inserted IZC miniscrews ranged from 1.2 to 2.3 mm and length ranged from 6 to 17 mm. The recorded failure rate ranged from 0% to 47.2%, and the average failure rate for IZC miniscrew was 9.45% (with 95% CI [58.91; 93.82]).IZC miniscrew has low failure rate which suggest that IZC miniscrew are clinically reliable. Miniscrew are a stable anchorage for orthodontic tooth movement and zygomatic buttress of maxilla is suitable region for skeletal anchorage device placement.

Maxillary sinus floor augmentation with autogenous bone graft compared with composite grafts: A one-year single-blinded randomized controlled trial.

The objective was to assess the one year implant treatment outcome and patient-related outcome measures (PROMs) following maxillary sinus floor augmentation (MSFA) with autogenous bone graft (ABG) from the zygomatic buttress (control) compared with 1:1 mixture of ABG and anorganic porcine bone mineral (APBM) (Test I) or biphasic bone graft material (BBGM) (Test II). Sixty healthy patients (34 females, 26 males) were randomly allocated to either control or test groups. Outcome measures included survival of suprastructures and implants, implant stability quotient, health status of peri-implant tissue, peri-implant marginal bone loss, frequency of complications, and PROMs using Oral Health Impact Profile-14 combined with questionnaire assessing patient perception of peri-implant soft tissue, prosthetic solution, implant function, and implant treatment outcome using visual analogue scale. Mean differences were expressed with standard deviation and 95% confidence interval. Level of significance was .05. All suprastructures and implants were well-functioning after one year of functional implant loading. There was no significant difference between control and test groups in any of the applied outcome measures. The implant stability significantly increased from implant placement to abutment connection within all groups (p < .001). High patient satisfaction and significant improvement in oral health-related quality of life was also reported within all groups. This study demonstrates that MSFA with composite grafts containing minimal amounts of ABG reveals comparable implant treatment outcomes as compared with ABG alone, after one year of functional implant loading. Extensive ABG harvesting in conjunction with MSFA therefore seems not to be needed.

The Accuracy of Intraoral Registration for Dynamic Surgical Navigation in the Edentulous Maxilla.

Despite the high clinical accuracy of dynamic navigation, inherent sources of error exist. The purpose of this study was to improve the accuracy of dynamic-navigated surgical procedures in the edentulous maxilla by identifying the optimal configuration of intraoral points that results in the lowest possible registration error for direct clinical implementation. Six different four-area configurations (left and right sides; n = 12) were tested by three operators against two negative controls (left and right sides) and one positive control (three-area and eight-area configurations, respectively) using a skull model. The two dynamic navigation systems (X-Guide and Navident) and the two registration methods (bone surface tracing and fiducial markers) produced four registration groups: XG tracing, ND tracing, XG fiducial, and ND fiducial. The accuracy of the registration was checked at the frontal process of the zygoma. Intra- and interoperator reliabilities were reported for each registration group. Multiple comparisons were conducted to find the best configuration with the minimum registration error. Ranking revealed one configuration in the tracing groups (Conf.3) and two configurations in the fiducial groups (Conf.3 and Conf.5) that had the best accuracy. When the inferior surfaces of the zygomatic buttress were excluded, fiducial registration produced better accuracy with both systems (P = .006 and < .0001). However, bilaterally tracing 1-cm areas at these surfaces resulted in similar registration accuracy to placing fiducial markers there (P = .430 and .237). Navident performed generally better (P = .049, .001, and .002), but the values had a wider margin of uncertainty. Changing the distribution of the four tracing areas or fiducial markers had a less pronounced effect with the X-Guide than with the Navident system. For surgery in the edentulous maxilla, four fiducial markers placed according to Conf.3 or Conf.5 resulted in the lowest registration error. Where implants are being placed bilaterally, an additional two sites may further reduce the error. For bilateral zygomatic implant placement, it is optimal to place two fiducial markers on the inferior surfaces of the maxillary tuberosities, two on their buccal surfaces, and another two on the anterior labial surface of the alveolar bone. Utilizing the inferior zygomatic buttress is recommended over the inferior maxillary tuberosities in other types of maxillary surgeries.

A 3D dynamic finite element analysis of biomechanical behaviour of maxilla and fixative appliances following advancement Le Fort I surgery applied in different lengths

ObjectivesDynamic analysis of chewing impact on the stability of rigid fixation techniques following Le Fort I osteotomy has not been investigated in the previous literature. The aim of the present study was to evaluate segmental displacement and von Mises (VM) stress values on the fixation devices following different amounts of Le Fort I advancements under dynamic loading conditions. Materials and methodsThe 3D finite element models simulating 3, 5 and 8 mm advancement of maxilla at the Le Fort I level were generated using CBCT scan data. The models included two anterior L plates and two posterior I plates fixations bilaterally. Dynamic finite element analysis was performed to evaluate their biomechanical behavior against chewing cornflakes bio. Von Mises stresses and displacement values on three points were calculated. ResultsCalculations were made in a time of 38, 40 and 40.5 ms for 3, 5 and 8 mm advancement models, respectively. As the advancement increased, stress values on the plates and displacement values in the D1 (intersection of the apex of the canine tooth with the osteotomy line), D2 (the most prominent point of zygomatic buttress on the osteotomy line), and D3 (intersection of the midline of the second molar tooth with the osteotomy line) points increased. The lowest stress and displacement values were found in the 3 mm advancement model. As advancement increased, the highest values were found in the I plates. The stress levels on the plates and screws remained within safe limits. ConclusionsThe von Mises stresses and displacement values tend to increase in according with the amount of advancement. More stress is transferred to posterior I plates and screws under dynamic forces.

Virtual Three-Dimensional Model Analysis in the Assessment of the Maxillary and Mandibular Donor Sites on Cone-Beam Computed Tomography Images.

Using the Mimics software to assess the maxillary and mandibular donor sites on cone-beam computed tomography (CBCT) images. This cross-sectional study was conducted on 80 CBCT scans. Data in DICOM format were transferred to the Mimics software version 21, and a maxillary and a mandibular mask according to cortical and cancellous bones were virtually created for each patient based on Hounsfield units (HUs). Three-dimensional models were reconstructed, and boundaries of donor sites, including mandibular symphysis, ramus, coronoid process, zygomatic buttress, and maxillary tuberosity, were defined. Virtual osteotomy was conducted on the 3D models to harvest bone. The volume, thickness, width, and length of harvestable bone from each site were quantified by the software. Data were analyzed by independent t-test, one-way ANOVA, and Tukey's test (alpha = 0.05). The greatest harvestable bone volume and length differences were observed between ramus and tuberosity (P < 0.001). The maximum and minimum harvestable bone volumes were found in symphysis (1753.54 mm3) and tuberosity (84.99 mm3). The greatest difference in width and thickness was noted between the coronoid process and tuberosity (P < 0.001) and symphysis and buttress (P < 0.001), respectively. Harvestable bone volume from tuberosity, length, width, volume from symphysis, and volume and thickness from the coronoid process was significantly greater in males (P < 0.05). The harvestable bone volume was the highest in symphysis, followed by ramus, coronoid, buttress, and tuberosity. The harvestable bone length and width were the highest in the symphysis and coronoid process, respectively. Maximum harvestable bone thickness was found in symphysis.

Facts to Consider in Developing Materials That Emulate the Upper Jawbone: A Microarchitecture Study Showing Unique Characteristics at Four Different Sites.

The maxilla is generally acknowledged as being more trabecular than the mandible. Allograft currently available for use in the maxillofacial region is harvested from the hip and long bones, irrespective of their local characteristics, and grafted onto the jawbones. Other alternative are autograft or commercially available bone substitutes. Due to their inherent differences, an in-depth understanding of the bone microarchitecture is important to develop the most compatible graft for use at the maxilla. This cross-sectional study aimed to determine the microstructures of bone harvested from different sites of the maxilla, to be used for standard setting. Forty-nine specimens from seven human cadavers were harvested from the zygomatic buttress, anterior maxillary sinus wall, anterior nasal spine and anterior palate. Each bone block, measuring of 10 mm × 5 mm, was harvested using rotary instruments. Bone analysis was performed following micro-computed tomography to obtain trabecular number (Tb.N), trabecular separation (Tb.Sp), trabecular thickness (Tb.Th), and bone volume fraction (BV/TV). There were site-related differences, with BV/TV that ranged between 37.38% and 85.83%. The Tb.N was the lowest at the palate (1.12 (mm-1)) and highest at the anterior maxillary sinus wall (1.41 (mm-1)) region. The palate, however, had the highest trabecular separation value (Tb.Sp) at 0.47 mm. The TB.Th was the lowest at the anterior nasal spine (0.34 mm) but both the zygoma and anterior maxillary sinus regions shared the highest Tb.Th (0.44 mm). Except for having the lowest Th.Sp (0.35 mm), the anterior maxillary sinus wall consistently showed higher values together with the zygomatic buttress in all other parameters. Concurring with current clinical practice of harvesting autograft from the zygomatic buttress and anterior maxillary sinus wall, their bony characteristic serve as the microarchitecture standard to adopt when developing new bone graft materials for use in the maxilla.

Stress distribution and displacement in the maxillofacial complex during intrusion and distalization of the maxillary arch using miniplates versus mini-implants: a 3-dimensional finite element study

ObjectivesTo three-dimensionally analyse the stress distribution and displacement pattern in the maxillofacial complex following intrusion and distalization of the maxillary arch using finite element analysis in skeletal class II malocclusion with prognathic maxilla and vertical maxillary excess using miniplates and mini-implants.Materials and methodsFinite Element models of a skull, Y-shaped stainless steel miniplate, mini-implant and a posted arch were generated. Three force levels (1) 200 g (2) 300 g and (3) 500 g per side were applied to the assembly. The models were pre-processed and the analysis was performed using ANSYS version 18.1 software. Alterations in von mises stress, principal maximum stress, principal minimum stress and compressive stress were analysed around the sutures and surface landmarks.ResultsWith miniplates, there was a maximum stress concentration at the zygomatic buttress with even stress distribution at the fronto-maxillary, zygomatico-temporal, zygomatico-frontal and pterygomaxillary sutures along with anatomical landmarks such as frontal process of maxilla, ANS, Point A, prosthion and maxillary process of zygoma. First molars experienced greater distalization effects with buccal flaring when miniplates were used. With mini-implants, canine and premolars also exhibited greater distalization effects. In the root apices, lateral incisors showed increased lingual root movement with mini-implants.ConclusionMiniplates provide a greater distalizing effect while mini-implants produce increased intrusive effect. The distalizing effect is greater when 500 g of force is applied using miniplates with significantly even stress distribution and displacement pattern.

Comparison study of the Le Fort I osteotomy using 2- and 4-plate fixation.

This study was conducted to evaluate the postsurgical stability of Le Fort I osteotomy using zygomatic buttress internal fixation alone with no piriform aperture internal fixation. Patients with maxillary retrognathia and mandibular prognathism underwent the Le Fort I osteotomy with a bilateral sagittal split ramus osteotomy. In group I, fixation was accomplished using titanium plate and screws placed at the piriform aperture and the zygomatic buttress (4 plates). In group II, fixation was accomplished using titanium plate and screws placed at the zygomatic buttress (2 plates). Lateral cephalometric radiographs were taken preoperatively (T1), immediately after surgery (T2), and at 6 months to 1 year (T3) to evaluate skeletal movement. In total, 32 patients were included in this study. None of the patients had wound infection, dehiscence, bone fragment instability, and long-term malocclusion. Regarding point A and the posterior nasal spine (PNS), vertical and horizontal relapse in groups I and II did not differ significantly. In most hospitals, the maxilla was fixed using four plates (piriform aperture and zygomatic buttress); however, within the limitations of the study, the choice of the number of plates for osteosynthesis following Le Fort I osteotomy and repositioning of the maxilla can be left to the discretion of the surgeon without putting the patients at risk for increased relapse by careful intraoperative management.

Adapting a simple surgical manual tool to a 3D printed implantology protocol: the use of a universal screwdriver for fixation of custom-made laser sintered titanium subperiosteal implants

PurposeCurrent paper aims to describe a simple technique used for the fixation of the screws of a customized implant via a universal screw driver (BoneTrust® Easy Screw according to Dr. Bayer, Medical Instinct®, GmbH, Germany) to simplify the surgical placement of the customized implants.MethodsThe insertion of the drilling screws for the retention of the implant with angulated handpiece into the palatinal region or zygomatic buttress were performed with universal screw driver.ResultsThe retention screws could be inserted with a proper angulation without interfering with the surrounding tissues. The technique described herein has significantly simplified the surgical intervention.ConclusionThe insertion of the drilling screws for the retention of the implant with angulated handpiece into the palatinal region or zygomatic buttress could be challenging, thus the anatomical structures and the insufficient length of the handpiece could interfere with the placement of the screw with a proper angulation. This problem could be easily managed with the use of universal screw driver.

ImplantsP-36666236-303Quantitative evaluation of zygomatic buttress, ramus and symphysis onlay grafts in ridge augmentation

<h3>Background</h3> Placement of endosseous dental implants requires adequate bone width for prosthetic support. In severe deficiency of bone width, implant placement is challenging. This study evaluates onlay grafts from zygomatic buttress, ramus and symphysis in ridge augmentation prior to implant placement. <h3>Method</h3> A comparative study comprising of 30 patients with maxillary and mandibular edentulous width of less than 3mm radiographically were selected. Patients were randomly divided into 3 groups- Group A (Zygomatic buttress), Group B (Ramus), Group C (Symphysis). They were evaluated in terms of pain, interincisal opening (IIO), postoperative complications, patient satisfaction score and width of the newly formed bone using CBCT immediate postoperative and then at 1 month, 3 months and 6 months. <h3>Findings</h3> All patients demonstrated an average bone width increase of 4.75mm. There was no significant difference in postop pain, and interincisal opening on later follow-up, at 1 month, 3 months and 6 months. However, the immediate postoperative IIO was less and swelling was more in Group B followed by Group C and Group A. The average increase in bone width was 4.4, 5.2 and 4.7mm for Group A, B and C respectively at 6 months. Grafts resorption was seen in two cases in Group A. <h3>Conclusion</h3> Ramal graft provides more bone volume compared to zygomatic buttress and symphysis. Symphysis graft leaves an aesthetic defect at the donor site. Therefore, ramal grafts may be considered the ideal intraoral bone grafts for implant surgery.

Volumetric and linear assessment of maxillary, mandibular and zygomatic bone as donor sites for alveolar ridge augmentation using CBCT

Objective: To analyze preoperative CBCT assessment of intraoral donor sites (symphysis, ramus buccal shelf of bone, zygomatic buttress and maxillary tuberosity) for purpose of autogenous block graft. Materials and Methods: Twenty (5 for each graft) participants were included in the study, (informed consent was signed by each participant) Participants were recruited according to certain eligibility criteria. Results: The measurements of the block grafts showed that there was a significant difference between different sites (p&lt;0.001). The highest value was found in mandibular symphysis (1.56±0.44), followed by mandibular ramus (0.99±0.19), then zygomatic buttress (0.49±0.06), while the lowest value was found in maxillary tuberosity (0.31±0.07). Post hoc pairwise comparisons showed value of mandibular symphysis to be significantly higher than other sites (p&lt;0.05). In addition, they showed mandibular ramus value to be significantly higher than values of zygomatic buttress and maxillary tuberosity (p&lt;0.05). Conclusion: According to this study, mandibular donor sites showed larger segmented pieces and larger volumes than their maxillary counterparts. For multiple missing teeth, the most appropriate block grafts will be the symphysis and ramus spanning the largest mesio-distal dimension. In terms of implant stability, the rami and maxillary tuberosities showed the largest thicknesses, which will ultimately help in implant stability.

CLINICAL APPLICATIONS OF SAFESCRAPER® IN MAXILLARY SINUS FLOOR ELEVATION AND RIDGE AUGMENTATION

Introduction. Although there is a wide variety of bone grafting materials for the augmentation of the deficient alveolar ridge, autogenous bone is still considered to be the gold standard. There are various methods for harvesting autologous bone grafts. Among these, Safescraper® is conveniently used as a harvesting device of autogenous cortical bone in oral Implantology and reconstructive surgery, ensuring high volumes of grafting material with a minimally invasive and predictable procedure. Purpose. The purpose of this presentation is to showcase the clinical applications of Safescraper® in various augmentation procedures and to review the existing literature for the evidence supporting its application in clinical practice. Materials and Methods. In the presented cases, Safescraper® provided surface-derived autogenous bone graft deriving from the maxillary tuberosity, the zygomatic buttress, the lateral sinus wall, the pyriform aperture of the nose, the external oblique ridge and the mandibular symphysis. The collected autogenous bone has been mixed either with xenograft, or autologous venous blood, or platelet-rich fibrin and used in procedures such as: Maxillary sinus floor elevation, Reconstruction of periimplant defects, Reconstruction of alveolar ridge defects with onlay autogenous blocks, or bone rings, Ridge augmentations using resorbable collagen membranes, titanium-reinforced non-resorbable membranes or titanium meshes, Ridge augmentations using the Khoury technique. Results. Satisfactory amounts of autogenous bone have been harvested in all cases. The bone harvesting procedure was swift, reliable and devoid of any complications. Conclusion. Safescraper® is an extremely useful, cost-effective and minimally invasive device for collecting bone to adequately cover the needs in autogenous grafts everyday clinical practice.

AUTOLOGOUS BONE GRAFTS – INDICATIONS AND RESTRICTIONS

INTRODUCTION : Autologous bone grafts and especially intraoral autografts have been used with increasing success for centuries and remain in common use today. They involve the transport of bone from an intraoral donor site to a different intraoral site, in the same patient. AIM AND METHOD: The aim of this poster is to introduce the intraoral autogenous bone grafts and evaluate the indications and restrictions of these techniques. MATERIAL AND METHOD: Autografts are commonly obtained from intraoral sites such as: symphysis mandible, ramus mandible, anterior sinus wall and lateral zygomatic buttress. Autograft bone harvested from mandibular ramus is used when the requiring augmentation is less than 4mm in thickness and span a maximum of four teeth. Although this graft presents a risk of damage to the inferior alveolar nerve, it is associated with secondary complications compared to other intraoral sites. Generally, indications for bone augmentation procedures are determined by means of the following parameters: a)Presence of severe alveolar ridge atrophy rated classes IV and V according to the Cawood and Howell classification b)Residual maxillary bone less than 5 mm from the alveolar crest to the sinus floor. RESULTS: Even when major augmentation procedures with autografts had to be carried out for severely resorbed jaws, success rates exceeding 95% have been achieved. CONCLUSION: Although, autolografts occasionally have significant drawbacks, such as increased postoperative morbidity, the need of secondary surgical visit and the lack of sufficient bone mass at the donor site, it is still regarded as the gold standard in alveolar reconstruction, due to its osteoconduction, osteoinduction and osteogenesis-inducing characteristics.

Surgically assisted rapid palatal expansion for transverse maxillary discrepancy in adults - Case report.

Introduction and importanceTransverse maxillary deficiency is one of the most detrimental problems to midfacial growth and the integrated dentoalveolar structures. Early diagnosis and proper treatment of such cases is most important to maintain the balance between the basal bones and stable occlusion.Case presentationIn our case, a 17-year-old male had irregular upper front teeth with an unpleasant smile. Detail examination revealed a symmetrical face with an orthognathic profile, mild malar deficiency, competent lips, asymmetrical arches, Class I molar and canine relationships bilaterally. Crowding was present in the upper anterior arch with 2 mm of anterior open bite and posterior cross bite present in the premolar region and molar region bilaterally. Lefort-1 osteotomy, midpalatal split, pterygomandibular disjunction without down fracture was done. The HYRAX appliance was cemented. Distraction started after four days of surgery. One mm distraction per day was done for 10 days. The patient was transferred to fixed orthodontic treatment to relive the anterior crowding. Records were taken after 1 year of follow up and analyzed. Skeletal relationships were in harmony. Dental crowding, anterior open bite and posterior crossbite were corrected.Clinical discussionThe zygomatic buttress and the pterygomaxillary junction are considered as the critical areas of resistance for maxillary expansion. Literature claims lefort-1 osteotomy in combination with palatal distraction results in more displacement and less stress in the maxilla.ConclusionSARPE has proved to be clinically effective and stable for the correction of transversely deficient maxilla after cessation of growth in adult patients.

Patient\u2019s perception of recovery after maxillary sinus floor augmentation with autogenous bone graft compared with composite grafts: a single-blinded randomized controlled trial

BackgroundAutogenous bone graft is considered as the preferred grafting material for maxillary sinus floor augmentation (MSFA). However, harvesting of extraoral or intraoral autogenous bone graft is associated with risk of donor site morbidity and supplementary surgery. From a clinical and patient perspective, it would therefore be an advantage, if postoperative discomfort could be minimized by diminishing the need for autogenous bone graft harvesting. The objective of the present study was to test the hypothesis of no difference in patient’s perception of recovery after MSFA with autogenous bone graft from the zygomatic buttress (control) compared with 1:1 mixture of autogenous bone graft and deproteinized porcine bone mineral (DPBM) (Test I) or biphasic bone graft material (BBGM) (Test II). Sixty healthy patients were randomly allocated to either control or test groups. Oral Health-related Quality of Life (OHRQoL) was evaluated by Oral Health Impact Profile-14 (OHIP-14) at enrollment. Recovery was estimated by self-administrated questionnaires and visual analog scale assessing pain, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment and discomfort after 1 week and 1 month. Descriptive statistics was expressed as mean with standard deviation (SD). Correlation between OHRQoL at enrollment and recovery were assessed by linear regression. p-value below 0.05 was considered significant.ResultsTreatment satisfaction and willingness to undergo similar surgery were high in all groups. Average numbers of days with pain and sick leave were 3.5 (SD 3.9) and 0.5 (SD 1.2), respectively, with no significant difference between groups. Moreover, no significant difference in eating and speaking ability, physical appearance, work performance and sleep impairment were seen between groups. Mean OHIP-14 score at enrollment was 9.30 (SD 9.25) (control), 9.95 (SD 7.96) (Test I) and 8.15 (SD 9.37) (Test II), with no significant differences between groups. Impaired OHRQoL, gender or age seems not to predispose for delayed recovery or increased postoperative discomfort.ConclusionsMSFA with diminutive autogenous bone graft harvesting is associated with high patient satisfaction, limited postoperative discomfort and willingness to undergo similar surgery. Presurgical OHRQoL, gender or age seems not to be associated with impaired patient’s perception of recovery.

Incidence of Plate Removal and its Correlation to the Site of Injury in Patients with Maxillofacial Trauma: A Retrospective Study

Background: Maxillofacial injuries can be classified according to its anatomical location of the involved bone and by the degree of involvement like simple, compound or comminuted. Regardless of the site of involvement and nature of trauma the fracture can be addressed by closed and open methods of reduction. Objective: The aim of this retrospective study was to record the incidence and factors associated with plate removal in patients with maxillofacial trauma. Materials and Methods: Records of 280 cases managed for maxillofacial trauma in the last (5 years) period from January 2010 to Dec 2014 by open reduction and internal fixation (ORIF) with osteosynthesis plates were analyzed at a tertiary health care facility. Logistic regression analysis was done to find an association between the variables studied and incidence of plate removal. Results: 32 cases (11.42%), 55 number of implants underwent removal of plates due to reasons ranging from infection(50%), Plate exposure(9.375%), treatment failure(15.625%), palpability(12.50%), and persistent pain(12.50%), Zygomatic buttress and Parasymphysis sites had highest incidence of plate removal compared to other sites. Being a female [OR 9.87(4.21–10.72)], age groups of 46-60 [OR 6.39(4.43-9.62)], 31-45 [OR 11.25(6.81-13.77)] and 15-30 [OR 10.01(5.74-12.22)], infra orbital rim among sites [OR 2.03 (1.48-4.67)] significantly increased the odds of incidence of plate removal. Conclusion: In our retrospective analysis, the overall incidence of plate removal was 11.42%. Maximum plate removals were from Zygomatico-Maxillary Buttress and Symphysis and Parasymphysis regions. Infection was found to be the most common cause of plate removal.

Extra Articular False Ankylosis Following Fusion of Mandible to Zygomatic Bone and Maxilla Due to Ossifying Fibroma-A Rare Case Report

Trismus is a disturbing condition with varied etiology, one of them is Extra articular ankylosis. The extra articular ankylosis has been reported in the literature as a fusion of the coronoid process to the zygomatic bone or to the skull base. However, there are a very few cases reported in the literature that highlights a pathologic tumor of mandible leading to extra-articular ankylosis and subsequently resulting in trismus. We hereby present a unique case of young adult having restricted mouth opening due to the bony fusion of the mandibular ramus to the zygomatic bone and zygomaticomaxillary buttress region due to a pathologic tumor diagnosed as Ossifying Fibroma.

Fixation of Ramus of the Mandible to the Zygomatic Buttress to Prevent Condylar Dislocation in a Case of Mandibular Reconstruction Using a Fibula-Free Flap: A Technical Note

Fixation of Ramus of the Mandible to the Zygomatic Buttress to Prevent Condylar Dislocation in a Case of Mandibular Reconstruction Using a Fibula-Free Flap: A Technical Note