The Traumaxilla

The zygomatic bone’s lateral prominence and convexity make it the most important bone to provide aesthetic facial appearance and set the face width, but at the same time, this prominence and convexity make this bone more susceptible to injury. Among facial injuries, zygomatic-complex fractures or tripod fractures are the second most common fractures after nasal fractures. This study has performed a comparative assessment of fixation of zygomatic buttress by L and Z shaped plate. Fourteen zygomatic-complex fracture patients were selected and split into two groups, further divided into two subgroups (A, B). Group A patients were treated with a titanium Z shaped plate and Group B with L shape plate. One point fixation was performed and was observed in terms of stability, aesthetics and prevention of vertical or horizontal axis of rotation of the fracture segment. Z-shaped plates showed some advantage over L-shaped plates so there use can be preferred in complex fractures where comminuted bone pieces are scattered.

Pediatric maxillofacial surgery airway management is difficult due to physiological and anatomical differences between children and adults. Pediatric patients have a bigger tongue, omega-shaped epiglottis, and cranially positioned larynx, which makes intubation and breathing difficult. For anesthesiologists, children with limited mouth opening can impair airway access and increase induction problems. Maxillofacial surgery includes oral, facial, ear, nose, and throat (ENT), plastic, neurosurgical, and base of skull operations. This article provides an overview of the various types of pediatric maxillofacial surgeries that are commonly performed. These surgeries include cleft lip and palate repair, mandibular distraction osteogenesis, orthognathic surgery, craniosynostosis surgery, and trauma treatment. Since pediatric maxillofacial surgery can significantly affect the airway, adequate airway management in these patients is a challenging task for anesthesiologists. This review article also discusses pediatric patients’ unique anesthesia and maxillofacial surgery challenges and specific anesthetic plans for each procedure. Anesthesiologists can improve pediatric maxillofacial surgery safety and outcomes by completely addressing these difficulties and personalizing anesthetic regimens for each patient.

Mucormycosis is a rare fatal fungal infection which has caused havoc in the present scenario of COVID-19 pandemic usually infecting post-COVID-19 recovered patients who were treated with corticosteroids or those who had ill regulated diabetes or immunocompromised states. The causative organism is a saprophytic fungus of the order mucorales and has a high affinity for blood vessels causing endothelial damage and thrombosis which results in necrosis of the affected tissues. Rhinocerebral mucormycosis is the most common infection being diagnosed in the current cases requiring the combined surgical approaches of an ENT Surgeon, a Maxillofacial surgeon and a Neurosurgeon. The disease may progress to involve the cranium thereby increasing the mortality rate. The first line of management in mucormycosis is antifungal therapy which may extend and also include surgical management by debridement/resection of the necrosed structures. In this article, we have reported a case series of 50 mucormycosis patients most of whom are post COVID, with the discussion of their demographics, affected structures, teeth mobility, blood sugar levels and neutrophil count with detailed description of the cases.

The zygomatic buttress is the functionally and structurally important vertical buttress. The strength and support of the midface are mainly by the buttresses. A study was done to evaluate and compare vertical with horizontal vestibular incision to reduce and plate fractures involving zygomatic buttress. Intraoperative evaluation and comparison of exposure time and time taken for surgery, herniation of the buccal fat pad and exposure of the fracture site were performed, followed by postoperative evaluation and comparison of pain, wound, sialocele formation and infection done on 7th, 14th and 21st days. Horizontal incision gives limited accessibility and visualization, with buccal fat interference and difficulty in suturing the distal part of the incision. It also, in some instances, caused injury to Stenson’s duct. An obliquely placed vertical incision eliminates the need to reflect all muscle attachments and provides a good amount of soft tissue for closure. Vertical incision shows no instances of injury to the duct of the parotid gland.

Oral submucous fibrosis (OSMF) is a potentially malignant condition of the oral cavity. Various surgical treatment modalities have been advocated in the management of OSMF with variable results. We are reporting a case of OSMF Group IVa where the post-fibrotomy defect was reconstructed using a platysma myocutaneous flap (PMF) in a young male patient. Postoperatively, patient was evaluated during a regular follow-up period for one year. The Preoperative interincisal opening of 2 mm gradually improved to 35 mm at the end of one year postoperatively with no postoperative complications. The facial aesthetic is not compromised as the incision is some way from the face and the scars are hidden underneath the collar. PMF can be considered a good reconstructive option for OSMF with aesthetically acceptable results, however, the technique is more demanding and must be mastered properly.

Schwannoma (neurilemmoma or neurinoma), is a benign tumor arising from Schwann cells that comprise the myelin sheaths surrounding peripheral nerve. They are encapsulated, usually solitary and slow-growing. Approximately 25%-45% of schwannoma occurs in the head and neck region. Intraoral incidence of schwannoma is 1%-12%. The most common intraoral site is tongue (1%) followed by palate, floor of the mouth, buccal mucosa, gingiva, lips and vestibular mucosa, retromolar region is the least common site. We describe a rare case of lingual schwannoma involving the left lateral part of tongue in a young male presented with a slow-growing, asymptomatic, painless mass on the left lateral part of tongue for several years. Magnetic resonance images demonstrated a well-defined almost oval-shaped isolated mass with uniform intensity on T2 weighted images relative to surrounding muscles. Patient was managed with complete surgical excision of the tumor and has not shown any recurrence in the follow-up period of 1 year. Schwannoma of tongue is a rare tumor of head and neck region. The diagnosis should be based on histopathological examination and in some cases after immunohistochemistry findings. Complete transoral resection allows removal of tumor to avoid recurrence and also avoids causing morbidity of tongue function.

Maxillofacial surgery encompasses a range of procedures on the head and neck, often presenting unique challenges for anesthetists due to the shared airway with surgeons and the common occurrence of difficult airways. This comprehensive overview addresses key aspects of anesthesia for maxillofacial surgery, including pre-assessment, airway management, anesthetic techniques, and postoperative care.