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This retrospective study analyzes the long-term results and complications of mandibular reconstruction with nonvascularized bone grafts (NVBGs) and suggests refinements. A total of 166 patients underwent mandibular ablation and primary reconstruction between June 1990 and August 2009, of which 101 were NVBGs, 27 were vascularized bone grafts, and 38 were with functional plate reconstruction. Eighty-seven of 101 patients undergoing NVBG, having all records and followed up for a minimum of 12 months, were included in this study. The analysis criteria included site of defect, surgical approach, method of graft fixation, bony continuity and stability, presence or absence of infection, aesthetic and functional prosthetic rehabilitation, donor-site morbidity, and clinical and radiological changes in the reconstructed area.The overall success with NVBGs in our study was 77 (88.5%) of 87. We used ilium in 68 cases (78.16%), fibula in 16 cases (18.39%), and rib in 3 cases (3.44%). Ten cases (11.5%) showed complete failure due to infection (7 cases) and resorption (3 cases).Nonvascularized bone grafts could be used judiciously for reconstruction of selective mandibular resection defects where there is not much of soft tissue loss, or where 2-layer watertight closure can be achieved intraorally and extraorally. Where only a single-layer intraoral closure is anticipated, either additional soft tissue should be brought submucosally or there should not be extraoral-intraoral communication even during surgery. Also precise patient selection, surgical planning, and execution with meticulous nursing care are keys to success.

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This study aims to retrospectively analyze the incidence and pattern of cranio-maxillofacial injuries in the developing world in a hope to emphasize on authorities the need of improvising infrastructural facilities, medical and other. Hospital medical records with available radiographs of 6,872 patients treated for cranio-maxillofacial injuries at major trauma centres in Pune, India over a 22 year period (from July 1989 to June 2010) were reviewed. Relevant data pertaining to patients' age, sex, cause of injury, sites of injury, associated injuries, anaesthesia, various treatment modalities and complications were recorded and analyzed statistically. A total of 6,872 patients sustained maxillofacial injuries of which 5,936 (86.4 %) were caused by road traffic accidents (RTA), followed by fall in 608 cases. Distribution pattern of sex revealed male predominance (M:F-2.5:1) and the third decade age group (2,416) sustained maximum cranio-maxillofacial injuries. Of 12,503 cranio-maxillofacial sites involved, mandible (6,456) predominated, while there was middle third involvement in 5,024 cases. Most of the patients (4,856) were treated with open reduction and internal fixation without maxillo-mandibular fixation and complications were noted in 320 patients. In comparison to similar recent studies reported in the literature, our findings show that RTA remains the most common cause of cranio-maxillofacial injuries with male preponderance. Also RTA remains the major preventable etiological factor of cranio-maxillofacial injuries, which should prompt authorities to take "Herculean effort" to implement rules and educate people.

Iatrogenic origin of neurosensory dysfunction is a distressing sequel to the surgical removal of impacted mandibular third molars, which is frequently overlooked. According to various surveys, the rate of neurologic complications related to the surgical removal of impacted mandibular third molars varies between 0.5% and 1% for permanent damage and 5% and 7% involving temporary damage. Prevention always stands as the best modality to avoid patient's discomfort and lawsuits by sophisticated consumerism.Preoperative assessment of the topographic relationship of the impacted mandibular third molar to the inferior alveolar canal has been performed by different imaging modalities. However, none of the imaging techniques give cent percent information. The best available imaging modality in time and resources should be adopted by the surgeon to avoid complications and lawsuits. Orthopantomography has often been cited as the imaging modality of choice before surgical removal of impacted mandibular third molar. However, it depicts a two-dimensional view of an intricate three-dimensional anatomic relationship and also fails to accurately project the buccolingual relation between the tooth and the inferior alveolar canal. The current study was designed to evaluate the potential advantages of spiral computed tomography and compare its efficacy as a presurgical planning tool with orthopantomography in patients with impacted mandibular third molars showing proximity to the inferior alveolar canal on an orthopantomogram.

Mucormycosis is a fulminant fungal infection that occurs most often in diabetic and immunocompromised individuals. Our patient, with uncontrolled diabetes mellitus and multiple systemic disorders, developed postextraction mucormycosis of mandible, an extremely rare complication. An initial clinical and radiographic diagnosis of mandibular osteomyelitis was made and the lesion was treated medically and surgically with curettage and saucerisation. The specimen was sent for histopathological evaluation, which showed necrotic area containing broad aseptate fungal hyphae with right angle branching consistent with mucormycosis. The patient succumbed to multipleorgan failure secondary to septicemia. The disease is usually fatal with a poor survival rate; there is still paucity of literature on the definitive management of this disease involving the mandible. This paper emphasizes the need for correction of underlying immunodeficiency and early diagnosis with aggressive multimodality treatment approach to offer the best chance of survival.

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