ObjectivesTo assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in cranio-maxillofacial trauma, along with an assessment of its morbidity and complications.Materials and MethodsSubmental intubation was performed in 17 patients who had maxillofacial panfacial trauma and management was done under general anesthesia during a period of one year from 2013 to 2014 at Departments of Oral and Maxillofacial Surgery and Dentistry, the Malankara Orthodox Syrian Church Medical College, Kochi, India.ResultsIn all 17 cases, the technique of submental intubation was found to be simple and reliable. Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient.ConclusionSubmental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications.
Benign fibrous histiocytoma (BFH) is a rare spindle cell tumor occurring in the jaw. It is a benign lesion composed of spindle shaped fibroblasts arranged in a storiform pattern. Literature shows that there are less than hundred reported cases of BFH worldwide and only six reported cases in the mandible. In this article, we are reporting a rare case of BFH in mandible and novel points of modification in reconstruction with nonvascularised iliac crest graft.
A 50-year-old female was referred to the Department of Prosthodontics, KMCT Dental College, Manassery, Kozhikode, Kerala, India for prosthetic rehabilitation of oral cavity. She had short stature, and was moderately built and nourishment for her age. The general clinical examination revealed multiple cutaneous nodules of different sizes ranging from 2mm to 6 cm unevenly distributed over the head and neck, trunk and upper arms [Table/ Fig-1a-c]. The nodules were soft, flesh coloured, non tender, with no signs of inflammation. A large number of both cutaneous and subcutaneous neurofibromas were scattered over the entire patient's skin. Lymph nodes were not enlarged. More than 10 café-au-lait spots were noted on the trunk and upper arms which were flat and brown pigmented. Freckles could be seen diffusely over the back and axillary region. The patient reported that some pigmented lesions were present at birth and the other ones appeared when she was a child, nodules began to develop in puberty and increased during the pregnancy. There was no family history of neurofibromatosis. Hers was a non consanguineous marriage, and her parents were also unrelated. Written consent was obtained from the patient to avoid ethical conflicts in documenting and publishing her case.Extraorally, she had mild prognathism of the mandible. Isolated nodules of few millimeter sizes were seen on the upper and the lower lip. Intraorally isolated nodule on the dorsum of tongue was noted [Table/ Fig-1a,2]. There were multiple bilaterally distributed nodules on edentulous alveolar ridges of maxilla and mandible which were non-ulcerated, non painful with normal color and firm on palpation [Table /Fig-3a]. The nodules were also present on the palate [Table / Fig-3b]. There were no symptoms associated with the nodules other The various oral manifestations of neurofibromatosis in dentulous patients have been documented in literature. Although most of the previous documents have discussed on common findings like a prominent lingual papillae, or solitary overgrowth of gingival soft tissue, this article focuses on a relatively rare occurrence of multiple nodular manifestations of Neurofibromatosis-1 on an edentulous alveolar ridge, tongue, palate and lips of an elderly female patient.
The combination has proved to be useful for the better neuromuscular control and psychological aspect, i.e., the fear of dislocation. Future of the technique combination lies in further prospective studies.
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