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EVALUATION OF THE EFFICACY OF LEUKOCYTE-PLATELET RICH FIBRIN VERSUS PLATELET RICH FIBRIN MATRIX ON BONE HEALING

Mohammad Hassan Nour – Reham Lotfy Aggour

Objective: The aim of this study was to compare the efficacy of leukocyte-platelet-rich fibrin (L-PRF) and platelet-rich fibrin matrix (PRFM) on bone healing.

Methods: Eight rabbits were included in this controlled, prospective, blinded study. Defects with a diameter of 3 mm and 2 mm depth were created in the bone of both tibias, filled with L-PRF (group II), PRFM (group III) or left empty (group I). The bone mineral density (BMD) was measured by dual energy absorptiometry (DXA) and histological examination was performed on the 10th and 21st days.

Results: According to Emery’s histopathological healing criteria, control group (group I) revealed score 0 and score 3 at 10 and 21 days respectively. Group II showed score 2 and score 5 at 10 and 21 days respectively. On the other side group III treated by PRFM showed score 3 and score 7 at 10 and 21 days respectively.

Conclusion: Both L-PRF and PRFM showed increased bone formation in surgically created bone defects in rabbits, however, the effect of PRFM was more pronounced. The use of PRFM and L-PRF may contribute to the success of bone regeneration.

KEYWORDS: Bone regeneration, L-platelet-rich fibrin, platelet-rich fibrin matrix.

Volume 64, No 1, January 2018, Page 1-6

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HERBERT CANNULATED BONE SCREW OSTEOSYNTHESIS VERSUS MINIPLATES OSTEOSYNTHESIS IN THE TREATMENT OF MANDIBULAR ANGLE FRACTURES

Haytham Al-Mahalawy

Purpose: Mandibular angle fractures are commonly encountered in the maxillofacial field, their surgical treatment includes a wide range of fixation techniques. Herbert cannulated bone screw is a successful minimally invasive mean of fracture fixation that is used routinely in orthopedic surgery. The aim of this study was to evaluate the clinical and radiographic performance of a solitary Her¬bert bone screw in the treatment of mandibular angle fractures and compare it with the commonly established treatment modality with double 2.0-mm miniplates.

Patients and methods: Twenty patients, 15 males and 5 females,with unilateral isolated fracture in the mandibular angle region were selected and randomly allocated into the following groups: group I (n=10) treated with a solitary Herbert Bone Screw and group II (n=10) treated with doubleminiplates. Patients were clinically and radiographically monitored for twelve weeks.

Results: The occlusal examination showed a normal occlusion in all of the cases in both groups. Both groups showed a statistically significant gain in the mean bone density across the follow-up period(P<0.001). The difference between groups was statistically insignificant (P=0.761).

Conclusions: The utilization of a solitary Herbert cannulated bone screw osteosynthesis provides a successful, more economic, minimally invasive and predictable treatment modality for the treatment of mandibular angle fractures.

Volume 64, No 1, January 2018, Page 95-101

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MEDIAN FOREHEAD FLAP IN RECONSTRUCTION OF THE CUTANEOUS MIDFACE DEFECTS FOLLOWING RESECTION OF BASAL CELL CARCINOMA

Reda A. Nofal – Ibrahim A. Abdelbar

Objective: The current work attempted to assess the median forehead flap (MFF) for reconstruction of mild and moderate defects of the midface after resection of basal cell carcinoma (BCC).

Patients and Methods: A total of 20 patients with T1-T2 midface basal cell carcinoma (BCC) were included in this study. Patient’s ages ranged from 60 to 70 years. According to the size of the postsurgical defects> At Tanta Tumor Institute, the patients were categorized into two groups: Group I (GI) included 10 patients with mild defects (2 cm or less) repair using median forehead flap(MFF) and Group II (GII), included 10 patients with moderate defects (more than 2 cm) repair using median forehead flap(MFF).The patients were prospectively evaluated by parameters such as; Flap viability (capillary refill time, bleeding on puncture with a needle and the color of the skin paddle) and esthetic results. Preparation of patients and planning of the surgical technique were necessary to determine the size of the defect were employed for reconstruction of all defects.

Results : On comparing the results of GI and GII, the flap viability, patient satisfaction and donor site morbidity were found to be 80%, 70% and 0% in GI compared to 60 %, 60% and 20% in GII respectively (the overall results were: 70%, 65% and 10%respectively). Postoperative infection and partial wound necrosis, were diagnosed in one patient of GI (20%) and was successfully treated with specific antibiotics and local measures; and in 2 (10%) patients of GII that failed to conventional treatment and lost most of the flap (the overall partial and complete flap necrosis was 30%). One patient (5%) of G II showed temporary fistula formation, which disappeared few weeks postoperatively. We conclude that, the median forehead flap insures skin coverage, muscle bulk and good blood supply therefore; it can remain viable additional it is a feasible and reliable technique.

KEY WORDS: Median forehead Flap (MFF), Reconstruction, Midface Defects, Resection, carcinoma

Volume 64, No 1, January 2018, Page 87-94

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RETROSPECTIVE ANALYSIS OF MAXILLOFACIAL TRAUMA IN MAKKAH CITY, SAUDI ARABIA

Asmaa T.Ashour – Samahir A. Bashraheel – Alaa Z.Makki – Mohamed.Foda

Objective: This study was aimed to analyze retrospectively the demographic data, incidence, etiology and different treatment modalities of maxillofacial fractures in patients managed at Al- Noor Hospital-Trauma Center, Makkah City, Saudi Arabia during a 2-year period.

Patients and Methods: A total of 223 patients with maxillofacial trauma referred to and diagnosed at the Maxillofacial Department, Al-Noor hospital, Makkah City between December 2010 and November 2012 were assessed in this retrospective study according to their age, sex, etiology, medical/dental history, chief complaint, site and distribution of facial fractures, in addition to the definitive diagnosis and treatment of the case. Data of each patient were collected on a sheet and then transferred to an SPSS (ver. 16.0; SPSS Inc., Chicago, IL, USA) spreadsheet for statistical analysis. The chi-square test was used to test the association between two categorical variables or factors

Results: In these 2-years retrospective study, the reported cases of the maxillofacial trauma were most frequent in males (84.8%) than females (15.2%), and the affected decay was 21-30 (37.2%). Motor Vehicle crashes were the most common etiology among all assessed cases, except in those with age < 10 years whereby fall was the most frequent cause. The majority of cases were mandible fractures (46.6%), particularly ramus followed by the angle and the body of the mandible. Extremities trauma (16.6%) and other associated traumas were also reported. Among the 223 referred patients, survival rate was 97.8%, and the most applied treatment was open reduction and internal fixation (59.3%) followed by closed reduction and internal fixation (22.0%).

Conclusion: These findings support the view that the incidence of maxillofacial fractures secondary to motor accidents is common in Saudi Arabia, particularly among males, perhaps as a result of the conservative nature of Saudi society, as the rules of Saudi Arabia do not allow the females to drive during research performing. Therefore, we recommend the high demand for the application of stricter traffic rules and to ensure strict compliance of these traffic regulations to reduce the rate of MVC.

KEY WORDS: maxillofacial trauma, Makkah City, Two-year retrospective study.

Volume 64, No 1, January 2018, Page 79-86

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CLINICAL EVALUATION OF THE EFFECT OF STANDARD AND MODIFIED STANDARD FLAPS DESIGN IN THE REMOVAL OF MESIO-ANGULAR IMPACTED LOWER 3RD MOLAR

Mahmoud Hasan Alawur – Reda Noval

Aim of the study: The propose of this study was designed to establish a successful comparison between removal of impacted lower third molar (wisdom tooth) using two different flap designs

(standard and modified standard flap) in post-operative pain, trismus and swelling, Methodology: The comparison was done after the removal of the impacted teeth using a specific criteria that was numbered and described in a this research, a total of ten systemically free patient with mesio-angular impacted lower third molar was choose as a candidate for conducting this research, the patients was divided into two groups (group 1 and group 2), a standard flap was used with the first group, in standard flap the vertical releasing incision was started at the level of buccal groove of the seven, while in group 2 a modified standard flap was used, in modified standard flap the vertical releasing incision was started just distally to the first molar .

Conclusion: finally, we concluded at the end of this study that the choice between these two flaps in removal of impacted lower third molar have no significant difference when compared to post-operative pain, swelling and trismus.

KEYWORDS: Impaction, Flaps, wisdom tooth, lower third molar

Volume 64, No 1, January 2018, Page 71-77

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A COMPARATIVE STUDY FOR THE EFFICIENCY OF THE PLATELET-RICH PLASMA AND HYALURONIC ACID IN TREATMENT OF TEMPOROMANDIBULAR JOINT OSTEOARTHRITIS

Hesham Fattouh

Objectives: The aim of this study is to compare the effect of Platelet-rich plasma (PRP) and Hyaluronic acid (HA) in management of Temporomandibular joint osteoarthritis (TMJ-OA)

Patients and methods: Among 46 patients who were diagnosed with TMJ-OA, 14 patients were treated with PRP, 17 patients were treated with HA and 15 patients were treated with arthrocentesis alone, evaluation of clinical improvement was done for each patient postoperatively at 6 and 12 months.

Results: After 6 months, there were no statistically significant differences in the mean changes between PRP and HA groups regarding the pain intensity value, joint sound and extent of maximum mouth opening, while at the end of the follow-up period, after 12 months, better clinical results were maintained in the group treated with PRP.

Conclusion: The application of PRP is more effective and remains for long term than HA injection TMJ-OA treatment.

KEYWORDS: TMJ – osteoarthritis – Platelet rich plasma – Hyaluronic acid

Volume 64, No 1, January 2018, Page 61-69

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OCULAR INJURIES IN MID-FACIAL FRACTURES: A RETROSPECTIVE STUDY

Hussein Hatem – Khaled Amr – Omnia I. Sultan

Purpose: Mid-face injuries are usually accompanied with loss of integrity of the orbital skeleton along with the subsequent affection of the visual apparatus. This study aimed to highlight the incidence of different eye injuries associated with mid-facial fractures and to accentuate the need of the maxillofacial surgeon to comprehend and approach the post-traumatic ophthalmic consequences.

Patients and methods: A total of twenty five patients suffering from mid-facial fractures and orbital involvement were included in this study from the departments of oral and maxillofacial surgery, faculties of Dentistry, Cairo University and MSA University. They were 22 males and 3 females with a mean age of 37 years. All the patients were subjected to immediate clinical and radiographic examination to evaluate the extent of the injury and its implications. An ophthalmologist was asked to further assess the eye apparatus to determine the exact ophthalmic complications. The collected clinical, radiographic and ophthalmic findings were recorded and analyzed.

Results: A dominating etiology of Road Traffic Accidents was found (64%) with a significant male predominance (88%). Mid-face trauma in the form of ZMC fracture was acquainted as the most common reason for ophthalmic problems (36%) followed by the direct orbital blow-out fractures (20%). A wide range of ophthalmic complications were recorded. Sub-conjunctival hemorrhage (92%) was the most common to occur followed by peri-orbital edema (84%) and lid ecchymosis and laceration (76%). A clinical complaint from sensory infra-orbital nerve paresthesia was documented (72%). Diplopia (48%) and Enophthalmus (24%) were encountered as the most severe types of complications with other non-significant occurrence of reduced vision (8%), retinal detachment (4%), corneal problems (8%) and traumatic hyphema (8%).

Conclusion: We concluded that it is a must to extend the maxillofacial surgeon’s knowledge to include post-traumatic ocular injuries and their ophthalmic complications to complement an optimal patients’ treatment outcome and to prevent disastrous ophthalmic repercussions following mid-face injuries.

KEYWORDS: Mid-face Fracture, ocular injuries, ophthalmic complications

Volume 64, No 1, January 2018, Page 55-60

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VIRTUAL SURGICAL PLANNING USING STEREOLITHOGRAPHIC MODELS FOR SEGMENTAL MANDIBULAR RESECTION WITH LIMITED EXTRAORAL SKIN INCISION VERSUS TRADITIONAL SURGICAL PROTOCOLS

Mohammad A. Elshall – Ibrahim M. Nowair – Abdelfattah A. Sadakah

Purpose: To evaluate, both clinically and radiographically the usage of stereolithographic model with limited extraoral skin incision versus the traditional method using dry mandibles in preoperative adaptation of locking reconstruction plate for lateral mandibular continuity defects in delayed type mandibular reconstruction.

Materials and methods: Sixteen patients were randomly classified into two equal groups; in which group I was the control (traditional method) and group II was the study group (new method). Group (I): 8 patients with mandibular lesions indicated for segmental mandibular resections via intraoral approach and a wide extraoral incision assisted with preoperative adaptation of the reconstruction plate on dry mandible and refined intraoperatively with the use of a plastic template. Group (II): 8 patients with mandibular lesions indicated for segmental mandibular resections via intraoral approach and with very limited extraoral incision assisted with preoperative adaptation of the reconstruction plate on the patient`s stereolithographic model.

Results: The operation time, plate bending and adaptation time, the intraoperative blood loss, scar visibility, TMJ dysfunction, facial asymmetry, accurate plate adaptation, proper plate angulation, and plate over-extension especially in the proximal segment beyond the sigmoid notch, all were with statistically significant differences between both groups with better results always found in group II patients. However, no cases of tumor recurrence, plate exposure, or abnormal condylar position were recorded at the last follow up visit (6 months) in both groups.

Conclusion: The use of the patient`s 3-D steriolithographic model for virtual surgical planning for segmental mandibular resection with limited skin incision has several advantages over the traditionally used method. It improves reconstruction of form and function, decreases operating room time and complications and enhances the capability to perform more accurate surgical procedures.

Volume 64, No 1, January 2018, Page 39-53

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LATERAL ARTHROPLASTY AS AN OPTIMAL TREATMENT FOR SURGICAL MANAGEMENT OF UNILATERAL TEMPOROMANDIBULAR JOINT ANKYLOSIS TYPE III IN CHILDREN

Abdelfattah A. Sadakah – Emad F. Essa – Mohammad A. Elshall

Management of temporomandibular joint (TMJ) ankylosis described in the literature showed many surgical techniques.

Purpose: The aim of this study was to evaluate the lateral TMJ arthroplasty as a surgical technique for treatment of type III Sawhney’s TMJ ankylosis in children both clinically and radiographically. In that surgical technique the need of a costochondral graft for reconstructive arthroplasty is avoided with its potential complications (as a donor site) and the unpredictable growth pattern.

Materials & Methods: Eight children with unilateral type III Sawheny ankylosis (ankylosis on the lateral aspect of the medially displaced condyle) were included in this research. They all underwent lateral TMJ arthroplasty with the aid of panoramic and coronal C.T views. Evaluation was done both clinically and radiographically regarding interincisal distance, lateral TMJ movement, protrusive movements, postoperative pain, patient’s satisfaction and hazards of facial nerve injury. All patients were seen weekly for 4 weeks, at three and six months then at one year.

Results: The used surgical technique of lateral arthroplasty had greatly achieved the desired goals of treating TMJ ankylosis during a follow up period of one year. Those achieved goals include restoration of full mandibular function and free movements of the joint with adequate mouth opening and a mean interincisal distance of 35 mm, maintaining acceptable occlusion and ramus height and obviates the need of any autogenous chondro-osseous graft (commonly costochondral) with potential complications of the donor sites.

Conclusion: The surgical procedure of lateral arthroplasty is an easy and safe technique. It is considered as an effective treatment modality in treatment of type III TMJ ankylosis especially in children.

KEY WORDS: Lateral arthroplasty, Preservation of medially displaced condyle, Temporomandibular joint ankylosis in children, Treatment modalities

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EVALUATION OF IMMUNOHISTOCHEMICAL ANALYSIS IN THE MANAGEMENT OF AMELOBLASTOMA

Mohamed Baha Khidr – Abdelmageed H Alfakhrany – Atef M Hassanen

Surgical management of ameloblastomas depends on radiographic extension of the lesion and the histological findings up till now. Meanwhile, there is controversy regarding the surgical techniques of different types of ameloblastomas. The aim of this study was to assess the degree of lesion aggressiveness, using p53, to determine the potential biologic behavior of those lesions. Patients and Methods, were conducted on 17 patients (10 males and 7 females), aged from 13 to 67 year. These patients divided initially as primary, recurrent, and of malignant ameloblastoma. Immunohistochemical analysis was used to classify ameloblastomas into aggressive and non-aggressive lesions.

Surgical technique was done according the immunohistochemical result. Postoperative results were accepted for patients and no recurrence was observed after surgical excision in all cases. The present study concluded that p53 is good approach to detect mutation and the biological behavior of the cells upon which surgery should be addressed. This study provided that treatment strategy of the ameloblastoma must be preceded by immunohistochemical evaluation to detect the natural behavior of the cells. Moreover, the conventional histological and radiographical assessment is not enough for the final management of such cases.

Volume 64, No 1, January 2018, Page 19-28

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